Emergency Nurses' Reasons for Not Recommending Their Hospital to Clinicians as a Good Place to Work.

Importance: Half of emergency nurses report high burnout and intend to leave their job in the next year. Whether emergency nurses would recommend their workplace to other clinicians may be an important indicator of a hospital's ability to recruit clinicians. Objective: To examine why emergency nurses do not recommend their hospital to other clinicians as a good place to work. Design, Setting, and Participants: This qualitative study used directed content analysis of open-text responses (n = 142) from the RN4CAST-NY/IL survey of registered nurses licensed in New York and Illinois between April 13 and June 22, 2021. Inductive and deductive analytic approaches guided study theme development informed by the Social Ecological Model. The collected data were analyzed from April to June 2023. Main Outcomes and Measures: Nurses who answered "probably not" or "definitely not" to the survey question, "Would you recommend your place of employment as a good place to work?" were prompted to provide a rationale in an open-text response. Results: In this qualitative study of 142 emergency nurses (mean [SD] age, 43.5 [12.5] years; 113 [79.6%] female; mean [SD] experience, 14.0 [12.2] years), 94 (66.2%) were licensed to work in New York and the other 48 (33.8%) in Illinois. Five themes and associated subthemes emerged from the data. Themes conveyed understaffing of nurses and ancillary support (theme 1: unlimited patients with limited support); inadequate responsiveness from unit management to work environment safety concerns (theme 2: unanswered calls for help); perceptions that nurses' licenses were in jeopardy given unsafe working conditions and compromised care quality (theme 3: license always on the line); workplace violence on a patient-to-nurse, clinician-to-nurse, and systems level (theme 4: multidimensional workplace violence); and nurse reports of being undervalued by hospital management and unfulfilled at work in delivering suboptimal care to patients in unsafe working conditions (theme 5: undervalued and unfulfilled). Conclusions and Relevance: This study found that emergency department nurses did not recommend their workplace to other clinicians as a good place to work because of poor nurse and ancillary staffing, nonresponsive hospital leadership, unsafe working conditions, workplace violence, and a lack of feeling valued. These findings inform aspects of the work environment that employers can address to improve nurse recruitment and retention.

Perspectives of Black Patients on Racism Within Emergency Care.

Importance: Numerous Black individuals experience racism persistently throughout their lives, with repercussions extending into health care settings. The perspectives of Black individuals regarding emergency department (ED) care, racism, and patient-centered approaches for dismantling structural racism remain less explored. Objective: To qualitatively explore the perspectives and experiences of Black patients related to race, racism, and health care following a recent ED visit. Design, Setting, and Participants: In this qualitative study, the audio from semistructured interviews of Black patients discharged from an academic urban ED between August 2021 to April 2022 were recorded, transcribed, and analyzed using thematic analysis. Main Outcomes and Measures: The main outcomes encompassed the main themes from the analysis of the interviews with Black patients regarding their perspectives on race, racism, and clinical care. Results: A total of 25 Black patients (20 [80%] female; mean [SD] age, 44.6 [12.9] years) discharged from the ED were interviewed. Three broad domains were identified: (1) racism in health care; (2) ED clinical care; and (3) recommendations for improvement. Within these domains, the first 2 were grouped into specific themes. Within the first domain, racism in health care, 7 themes were identified using thematic analysis: (1) a history of medical racism; (2) dismissiveness; (3) patient expectations on encountering racism; (4) medical mistrust; (5) health literacy; (6) postencounter outcomes, and (7) discrimination beyond but associated with race. Within the second theme, ED clinical care, 5 themes were identified using the same thematic analysis method: (1) discharge plan; (2) patient experience; (3) waiting room perceptions; (4) medication treatment; and (5) pain management. The third domain, recommendations for improvement, incorporated patient-generated suggestions for enhancing the Black patient experience. Conclusions and Relevance: In this qualitative study, the fabric of clinical care delivery in the ED was intricately woven with Black patients' experiences of racism. Patients expressed a pervasive sense of mistrust, skepticism, and dismissiveness at the system level. Instances of racism were consistently highlighted by patients from their entry to the ED to discharge. These perspectives illuminate the pervasive nature of racism in clinical care, providing valuable insights for exploring patient-centered approaches to foster antiracist cultures in the ED and throughout the broader medical landscape.

The Science of Precision Prevention: Research Opportunities and Clinical Applications to Reduce Cardiovascular Health Disparities.

Precision prevention embraces personalized prevention but includes broader factors such as social determinants of health to improve cardiovascular health. The quality, quantity, precision, and diversity of data relatable to individuals and communities continue to expand. New analytical methods can be applied to these data to create tools to attribute risk, which may allow a better understanding of cardiovascular health disparities. Interventions using these analytic tools should be evaluated to establish feasibility and efficacy for addressing cardiovascular disease disparities in diverse individuals and communities. Training in these approaches is important to create the next generation of scientists and practitioners in precision prevention. This state-of-the-art review is based on a workshop convened to identify current gaps in knowledge and methods used in precision prevention intervention research, discuss opportunities to expand trials of implementation science to close the health equity gaps, and expand the education and training of a diverse precision prevention workforce.

The American Heart Association Emergency Cardiovascular Care 2030 Impact Goals and Call to Action to Improve Cardiac Arrest Outcomes: A Scientific Statement From the American Heart Association.

Every 10 years, the American Heart Association (AHA) Emergency Cardiovascular Care Committee establishes goals to improve survival from cardiac arrest. These goals align with broader AHA Impact Goals and support the AHA's advocacy efforts and strategic investments in research, education, clinical care, and quality improvement programs. This scientific statement focuses on 2030 AHA emergency cardiovascular care priorities, with a specific focus on bystander cardiopulmonary resuscitation, early defibrillation, and neurologically intact survival. This scientific statement also includes aspirational goals, such as establishing cardiac arrest as a reportable disease and mandating reporting of standardized outcomes from different sources; advancing recognition of and knowledge about cardiac arrest; improving dispatch system response, availability, and access to resuscitation training in multiple settings and at multiple time points; improving availability, access, and affordability of defibrillators; providing a focus on early defibrillation, in-hospital programs, and establishing champions for debriefing and review of cardiac arrest events; and expanding measures to track outcomes beyond survival. The ability to track and report data from these broader aspirational targets will potentially require expansion of existing data sets, development of new data sets, and enhanced integration of technology to collect process and outcome data, as well as partnerships of the AHA with national, state, and local organizations. The COVID-19 (coronavirus disease 2019) pandemic, disparities in COVID-19 outcomes for historically excluded racial and ethnic groups, and the longstanding disparities in cardiac arrest treatment and outcomes for Black and Hispanic or Latino populations also contributed to an explicit focus and target on equity for the AHA Emergency Cardiovascular Care 2030 Impact Goals.

Left Without Being Seen: Nurse Work Environment and Timely Outcomes in New York and Illinois Emergency Departments.

INTRODUCTION: This study determined the relationship between the emergency nurse work environment and emergency department patient left without being seen rates and lengths of stay. METHODS: Cross-sectional analysis of 215 New York and Illinois emergency departments. The work environment (abbreviated Practice Environment Scale of the Nursing Work Index) was measured by emergency nurses in the 2021 RN4CAST-NY/IL survey and linked with outcomes from Hospital Compare. Regression models estimated the relationship between the nurse work environment and emergency department patient left without being seen rates, median length of stay (in minutes), and median behavioral health patient length of stay. Model coefficients were used to estimate expected additional care minutes gained if emergency department work environments improved. RESULTS: "Mixed" work environments had the longest median overall length of stay (3.4 hours) and the highest median left without being seen rates (2.2%), while "poor" work environments had the longest median length of stay for behavioral health patients (6 hours). Improving the emergency department work environment from poor to mixed (and mixed to better) was associated with a 13-minute reduction in overall length of stay (P ≤ .05), a 33-minute reduction in behavioral health length of stay (P ≤ .01), and a 19% reduction in left without being seen rates (P ≤ .01). We estimated 11,824 to 41,071 additional patients could be seen in emergency departments associated with work environment improvements from "poor" to "better," depending on annual patient volumes. DISCUSSION: Hospital administrators should consider investing in nurse work environments as a foundation to improve timely outcomes.

Leveraging Digital Health to Improve the Cardiovascular Health of Women.

Purpose of Review: In this review, we present a comprehensive discussion on the population-level implications of digital health interventions (DHIs) to improve cardiovascular health (CVH) through sex- and gender-specific prevention strategies among women. Recent Findings: Over the past 30 years, there have been significant advancements in the diagnosis and treatment of cardiovascular diseases, a leading cause of morbidity and mortality among men and women worldwide. However, women are often underdiagnosed, undertreated, and underrepresented in cardiovascular clinical trials, which all contribute to disparities within this population. One approach to address this is through DHIs, particularly among racial and ethnic minoritized groups. Implementation of telemedicine has shown promise in increasing adherence to healthcare visits, improving BP monitoring, weight control, physical activity, and the adoption of healthy behaviors. Furthermore, the use of mobile health applications facilitated by smart devices, wearables, and other eHealth (defined as electronically delivered health services) modalities has also promoted CVH among women in general, as well as during pregnancy and the postpartum period. Overall, utilizing a digital health approach for healthcare delivery, decentralized clinical trials, and incorporation into daily lifestyle activities has the potential to improve CVH among women by mitigating geographical, structural, and financial barriers to care. Summary: Leveraging digital technologies and strategies introduces novel methods to address sex- and gender-specific health and healthcare disparities and improve the quality of care provided to women. However, it is imperative to be mindful of the digital divide in specific populations, which may hinder accessibility to these novel technologies and inadvertently widen preexisting inequities.

Widespread Third-Party Tracking On Hospital Websites Poses Privacy Risks For Patients And Legal Liability For Hospitals.

Computer code that transfers data to third parties (third-party tracking) is common across the web and is subject to few federal privacy regulations. We determined the presence of potentially privacy-compromising data transfers to third parties on a census of US nonfederal acute care hospital websites, and we used descriptive statistics and regression analyses to determine the hospital characteristics associated with a greater number of third-party data transfers. We found that third-party tracking is present on 98.6 percent of hospital websites, including transfers to large technology companies, social media companies, advertising firms, and data brokers. Hospitals in health systems, hospitals with a medical school affiliation, and hospitals serving more urban patient populations all exposed visitors to higher levels of tracking in adjusted analyses. By including third-party tracking code on their websites, hospitals are facilitating the profiling of their patients by third parties. These practices can lead to dignitary harms, which occur when third parties gain access to sensitive health information that a person would not wish to share. These practices may also lead to increased health-related advertising that targets patients, as well as to legal liability for hospitals.

State and Federal Legislators' Responses on Social Media to the Mental Health and Burnout of Health Care Workers Throughout the COVID-19 Pandemic: Natural Language Processing and Sentiment Analysis.

Background: Burnout and the mental health burden of the COVID-19 pandemic have disproportionately impacted health care workers. The links between state policies, federal regulations, COVID-19 case counts, strains on health care systems, and the mental health of health care workers continue to evolve. The language used by state and federal legislators in public-facing venues such as social media is important, as it impacts public opinion and behavior, and it also reflects current policy-leader opinions and planned legislation. Objective: The objective of this study was to examine legislators' social media content on Twitter and Facebook throughout the COVID-19 pandemic to thematically characterize policy makers' attitudes and perspectives related to mental health and burnout in the health care workforce. Methods: Legislators' social media posts about mental health and burnout in the health care workforce were collected from January 2020 to November 2021 using Quorum, a digital database of policy-related documents. The total number of relevant social media posts per state legislator per calendar month was calculated and compared with COVID-19 case volume. Differences between themes expressed in Democratic and Republican posts were estimated using the Pearson chi-square test. Words within social media posts most associated with each political party were determined. Machine-learning was used to evaluate naturally occurring themes in the burnout- and mental health-related social media posts. Results: A total of 4165 social media posts (1400 tweets and 2765 Facebook posts) were generated by 2047 unique state and federal legislators and 38 government entities. The majority of posts (n=2319, 55.68%) were generated by Democrats, followed by Republicans (n=1600, 40.34%). Among both parties, the volume of burnout-related posts was greatest during the initial COVID-19 surge. However, there was significant variation in the themes expressed by the 2 major political parties. Themes most correlated with Democratic posts were (1) frontline care and burnout, (2) vaccines, (3) COVID-19 outbreaks, and (4) mental health services. Themes most correlated with Republican social media posts were (1) legislation, (2) call for local action, (3) government support, and (4) health care worker testing and mental health. Conclusions: State and federal legislators use social media to share opinions and thoughts on key topics, including burnout and mental health strain among health care workers. Variations in the volume of posts indicated that a focus on burnout and the mental health of the health care workforce existed early in the pandemic but has waned. Significant differences emerged in the content posted by the 2 major US political parties, underscoring how each prioritized different aspects of the crisis.

Consumer Views on Privacy Protections and Sharing of Personal Digital Health Information.

Importance: Digital health information has many potential health applications, but privacy is a growing concern among consumers and policy makers. Consent alone is increasingly seen as inadequate to safeguard privacy. Objective: To determine whether different privacy protections are associated with consumers' willingness to share their digital health information for research, marketing, or clinical uses. Design, Setting, and Participants: This 2020 national survey with an embedded conjoint experiment recruited US adults from a nationally representative sample with oversampling of Black and Hispanic individuals. Willingness to share digital information across 192 different scenarios reflecting the product of 4 possible privacy protections, 3 uses of information, 2 users of information, and 2 sources of digital information was evaluated. Each participant was randomly assigned 9 scenarios. The survey was administrated between July 10 and July 31, 2020, in Spanish and English. Analysis for this study was conducted between May 2021 and July 2022. Main Outcomes and Measures: Participants rated each conjoint profile on a 5-point Likert scale measuring their willingness to share their personal digital information (with 5 indicating the most willingness to share). Results are reported as adjusted mean differences. Results: Of the 6284 potential participants, 3539 (56%) responded to the conjoint scenarios. A total of 1858 participants (53%) were female, 758 (21%) identified as Black, 833 (24%) identified as Hispanic, 1149 (33%) had an annual income less than $50 000, and 1274 (36%) were 60 years or older. Participants were more willing to share health information with the presence of each individual privacy protection, including consent (difference, 0.32; 95% CI, 0.29-0.35; P < .001), followed by data deletion (difference, 0.16; 95% CI, 0.13-0.18; P < .001), oversight (difference, 0.13; 95% CI, 0.10-0.15; P < .001), and transparency of data collected (difference, 0.08; 95% CI, 0.05-0.10; P < .001). The relative importance (importance weight on a 0%-100% scale) was greatest for the purpose of use (29.9%) but when considered collectively, the 4 privacy protections together were the most important (51.5%) factor in the conjoint experiment. When the 4 privacy protections were considered separately, consent was the most important (23.9%). Conclusions and Relevance: In this survey study of a nationally representative sample of US adults, consumers' willingness to share personal digital health information for health purposes was associated with the presence of specific privacy protections beyond consent alone. Additional protections, including data transparency, oversight, and data deletion may strengthen consumer confidence in sharing their personal digital health information.

Factors Associated With Primary Care Physician Decision-making When Making Medication Recommendations vs Surgical Referrals.

Importance: Although objective data are used routinely in prescription drug recommendations, it is unclear how referring physicians apply evidence when making surgeon or hospital recommendations for surgery. Objective: To compare the factors associated with the hospital or surgeon referral decision-making process with that used for prescription medication recommendations. Design, Setting, and Participants: This qualitative study comprised interviews conducted between April 26 and May 18, 2021, of a purposive sample of 21 primary care physicians from a large primary care network in the Northeast US. Main Outcomes and Measures: Main outcomes were the factors considered when making prescription medication recommendations vs referral recommendations to specific surgeons or hospitals for surgery. Results: All 21 participant primary care physicians (14 women [66.7%]) reported use of evidence-based decision support tools and patient attributes for prescription medication recommendations. In contrast, for surgeon and hospital referral recommendations, primary care physicians relied on professional experience and training, personal beliefs about surgical quality, and perceived convenience. Primary care physicians cited perceived limitations of existing data on surgical quality as a barrier to the use of such data in the process of making surgical referrals. Conclusions and Relevance: As opposed to the widespread use of objective decision support tools for guidance on medication recommendations, primary care physicians relied on subjective factors when making referrals to specific surgeons and hospitals. The findings of this study highlight the potential to improve surgical outcomes by introducing accessible, reliable data as an imperative step in the surgical referral process.

Reddit language indicates changes associated with diet, physical activity, substance use, and smoking during COVID-19.

COVID-19 has adversely impacted the health behaviors of billions of people across the globe, modifying their former trends in health and lifestyle. In this paper, we compare the psychosocial language markers associated with diet, physical activity, substance use, and smoking before and after the onset of COVID-19 pandemic. We leverage the popular social media platform Reddit to analyze 1 million posts between January 6, 2019, to January 5, 2021, from 22 different communities (i.e., subreddits) that belong to four broader groups-diet, physical activity, substance use, and smoking. We identified that before the COVID-19 pandemic, posts involved sharing information about vacation, international travel, work, family, consumption of illicit substances, vaping, and alcohol, whereas during the pandemic, posts contained emotional content associated with quarantine, withdrawal symptoms, anxiety, attempts to quit smoking, cravings, weight loss, and physical fitness. Prevalent topic analysis showed that the pandemic was associated with discussions about nutrition, physical fitness, and outdoor activities such as backpacking and biking, suggesting users' focus shifted toward their physical health during the pandemic. Starting from the week of March 23, 2020, when several stay-at-home policies were enacted, users wrote more about coping with stress and anxiety, alcohol misuse and abuse, and harm-reduction strategies like switching from hard liquor to beer/wine after people were socially isolated. In addition, posts related to use of substances such as benzodiazepines (valium, xanax, clonazepam), nootropics (kratom, phenibut), and opioids peaked around March 23, 2020, followed by a decline. Of note, unlike the general decline observed, the volume of posts related to alternatives to heroin (e.g., fentanyl) increased during the COVID-19 pandemic. Posts about quitting smoking gained momentum after late March 2020, and there was a sharp decline in posts about craving to smoke. This study highlights the significance of studying social media discussions on platforms like Reddit which are a rich ecological source of human experiences and provide insights to inform targeted messaging and mitigation strategies, and further complement ongoing traditional primary data collection methods.

Effect of Integrating Patient-Generated Digital Data Into Mental Health Therapy: A Randomized Controlled Trial.

OBJECTIVE: The authors sought to determine whether providing summaries of patients' social media and other digital data to patients and their clinicians improves patients' health-related quality of life (HRQoL) measured by the RAND 36-Item Short Form Health Survey (SF-36). METHODS: The authors randomly assigned 115 adults receiving outpatient mental health therapy to usual care or to periodic sharing of summaries of their digital data with their clinician providing psychosocial therapy. The study was conducted October 2020-December 2021. RESULTS: Patients' mean±SD age was 31.3±10.5 years, and 82% were women. At 60 days after enrollment, no statistically significant change was detected in SF-36 scores for patients randomly allocated to the intervention (mean difference=-0.39, 95% CI=-4.17, 3.39) or to usual care (mean difference=-1.98, 95% CI=-5.74, 1.77), and no significant between-arm difference was observed (between-arm difference=1.60, 95% CI=-3.67, 6.86). CONCLUSIONS: Collecting and summarizing digital data for use in mental health treatment was feasible for patients but did not significantly improve their HRQoL or other measures of mental health.

Assessing experiences of racism among Black and White patients in the emergency department.

Objective: The objective of this study was to investigate the differences in patient-reported experiences related to emergency department (ED) care using a post-discharge text messaging survey. Methods: This was a prospective cohort study of patients discharged from the ED using an automated text messaging platform to assess patient experience and impact of race on ED care. The study was conducted for 7 weeks between August 6 and September 24, 2021. Participants included adults (aged ≥18 years) discharged from 2 urban, academic EDs with an active mobile phone number in the electronic health record. The primary outcome of interest was patient-reported impact of race on overall rating of ED care. Secondary outcomes included overall satisfaction with care and perceived impact of race on components of care, including respect, communication, and quality of care. A 6-point Likert scale was used, and chi-square and Wilcoxon rank sum tests were used to analyze responses. Results: A total of 590 (14%) discharged patients consented, and 462 patients completed the entire survey; the mean age was 43 years (SD 17.3); 67% were women, and 60.0% were Black. Black patients reported a higher overall rating of ED care (median 5 [3, 5]; P = 0.013). Proportionately, when compared with White patients, more Black patients reported that race negatively impacted the rating of care (10.8% vs 1.4%; P = 0.002). More than a quarter of Black patients (27.4%) reported race highly impacting being treated with respect (P = 0.024), and 22.4% reported a high impact on quality of service (P = 0.003) when compared with White patients. Conclusion: Health systems lack methods that specifically identify patient experiences of racism. We demonstrate the feasibility of using text messaging to collect patient-reported experiences of racism. For a significant number of Black patients, race negatively impacted their care, including communication, quality, and respect.

Incidence of Timely Outpatient Follow-Up Care After Emergency Department Encounters for Acute Heart Failure.

BACKGROUND: Patients who are discharged from the emergency department (ED) after an encounter for acute heart failure are at high risk for return hospitalization. These patients may benefit from timely outpatient follow-up care to reassess volume status, adjust medications, and reinforce self-care strategies. This study examines the incidence of outpatient follow-up care after ED encounters for acute heart failure and describes patient characteristics associated with obtaining timely follow-up care. METHODS: We conducted a retrospective cohort study using an administrative claims database for a large US commercial insurer, from January 1, 2012 to June 30, 2019. Participants included adult patients discharged from the ED with principal diagnosis of acute heart failure. The primary outcome was obtaining an in-person outpatient clinic visit for heart failure within 30 days. We also examined the competing risk of all-cause hospitalization within 30 days and without an intervening outpatient clinic visit. We estimated competing risk regression models to identify patient characteristics associated with obtaining outpatient follow-up and report cause-specific hazard ratios. RESULTS: The cohort included 52 732 patients, with mean age of 73.9 years (95% CI, 73.8-74.0) and 27 395 (52.0% [95% CI, 51.5-52.4]) female patients. Within 30 days of the ED encounter, 12 279 (23.2%) patients attended an outpatient clinic visit for heart failure, with 8382 (15.9%) patients hospitalized before they could obtain an outpatient clinic visit. In the adjusted analysis, patients that were younger, women, reporting non-Hispanic Black race, and had fewer previous clinic visits were less likely to obtain outpatient follow-up care. CONCLUSIONS: Few patients obtain timely outpatient follow-up after ED visits for heart failure, although nearly 20% require hospitalization within 30 days. Improved transitions following discharge from the ED may represent an opportunity to improve outcomes for patients with acute heart failure.

Design, Implementation, and Outcomes of a Volunteer-Staffed Case Investigation and Contact Tracing Initiative at an Urban Academic Medical Center.

Importance: The COVID-19 pandemic has claimed nearly 6 million lives globally as of February 2022. While pandemic control efforts, including contact tracing, have traditionally been the purview of state and local health departments, the COVID-19 pandemic outpaced health department capacity, necessitating actions by private health systems to investigate and control outbreaks, mitigate transmission, and support patients and communities. Objective: To investigate the process of designing and implementing a volunteer-staffed contact tracing program at a large academic health system from April 2020 to May 2021, including program structure, lessons learned through implementation, results of case investigation and contact tracing efforts, and reflections on how constrained resources may be best allocated in the current pandemic or future public health emergencies. Design, Setting, and Participants: This case series study was conducted among patients at the University of Pennsylvania Health System and in partnership with the Philadelphia Department of Public Health. Patients who tested positive for COVID-19 were contacted to counsel them regarding safe isolation practices, identify and support quarantine of their close contacts, and provide resources, such as food and medicine, needed during isolation or quarantine. Results: Of 5470 individuals who tested positive for COVID-19 and received calls from a volunteer, 2982 individuals (54.5%; median [range] age, 42 [18-97] years; 1628 [59.4%] women among 2741 cases with sex data) were interviewed; among 2683 cases with race data, there were 110 Asian individuals (3.9%), 1476 Black individuals (52.7%), and 817 White individuals (29.2%), and among 2667 cases with ethnicity data, there were 366 Hispanic individuals (13.1%) and 2301 individuals who were not Hispanic (82.6%). Most individuals lived in a household with 2 to 5 people (2125 of 2904 individuals with household data [71.6%]). Of 3222 unique contacts, 1780 close contacts (55.2%; median [range] age, 40 [18-97] years; 866 [55.3%] women among 1565 contacts with sex data) were interviewed; among 1523 contacts with race data, there were 69 Asian individuals (4.2%), 705 Black individuals (43.2%), and 573 White individuals (35.1%), and among 1514 contacts with ethnicity data, there were 202 Hispanic individuals (12.8%) and 1312 individuals (83.4%) who were not Hispanic. Most contacts lived in a household with 2 to 5 people (1123 of 1418 individuals with household data [79.2%]). Of 3324 cases and contacts who completed a questionnaire on unmet social needs, 907 (27.3%) experienced material hardships that would make it difficult for them to isolate or quarantine safely. Such hardship was significantly less common among White compared with Black participants (odds ratio, 0.20; 95% CI, 0.16-0.25). Conclusions and Relevance: These findings demonstrate the feasibility and challenges of implementing a case investigation and contact tracing program at an academic health system. In addition to successfully engaging most assigned COVID-19 cases and close contacts, contact tracers shared health information and material resources to support isolation and quarantine, thus filling local public health system gaps and supporting local pandemic control.

COVID-19 contact tracing app reviews reveal concerns and motivations around adoption.

BACKGROUND: Google and Apple's Exposure Notifications System (ENS) was developed early in the COVID-19 pandemic to complement existing contact tracing efforts while protecting user privacy. An analysis by the Associated Press released in December 2020 estimated approximately 1 in 14 people had downloaded apps in states one was available. In this study, we assessed the motivation and experience of individuals who downloaded ENS apps from the Google Play and Apple App Stores. METHODS: We collected review text, star rating, and date of rating for all the reviews on ENS apps in the Google Play and Apple App stores. We extracted the relative frequency of single words and phrases from reviews and created an open vocabulary language, with themes categorized by the research team, to study the salient themes around reviews with high (3-5 stars), neutral (3 stars), and negative (1-2 stars) ratings using logistic regression. RESULTS: Of 7622 reviews obtained from 26 states between 04/07/2020 to 03/31/2021, 6364 were from Google Play Store, and 1258 were from Apple App Store. We obtained reviews for a total of 38 apps, with 25 apps from the Google Play Store and 13 apps from the Apple Play Store. 78% of the reviews are either 1 star or 5 stars. Positive reviews were driven by ease of use, support for the state government in creating the app, and encouragement for others to download, as well as engage in other COVID-19 precautions. Negative and neutral reviews focused on issues with app functionality (i.e., installation and tracking errors). CONCLUSIONS: Uptake was the largest barrier to success for ENS apps, but states can use insight from app store reviews to better position themselves if they choose to develop further public health apps.

Perspectives of Patients and Therapists on Social Media and Digital Data Use in Mental Health Therapy: Thematic Analysis.

BACKGROUND: Incorporating insights from social media into the patient-provider encounter is increasingly being explored in health care settings. Less is known about the utility of these data in mental health therapy. OBJECTIVE: This study aims to prospectively investigate and characterize how social media and digital data are used in mental health therapy from both the patient and mental health therapist perspective. METHODS: Patients enrolled in mental health therapy and mental health therapists were interviewed using a semistructured interview guide. All interviews were transcribed and coded using a deductive framework analysis. Themes and subthemes were identified. Participants completed a sociodemographic survey, while mental health therapists also completed a behavioral norms and elicitation survey. RESULTS: Seventeen participants, that is, 8 (48%) mental health therapists and 9 (52%) patients were interviewed. Overall, participants identified 4 themes and 9 subthemes. Themes were current data collection practices, social media and digital data in therapy, advantages of social media and digital data in therapy, and disadvantages of social media and digital data in therapy. Most subthemes were related to the advantages and disadvantages of incorporating digital data in mental health therapy. Advantage subthemes included convenience, objective, builds rapport, and user-friendliness while disadvantage subthemes were nonreflective, ethically ambiguous, and nongeneralizable. The mental health therapists' behavioral norms and elicitation survey found that injunctive and descriptive normative beliefs mapped onto 2 advantage subthemes: convenience and objectivity. CONCLUSIONS: This qualitative pilot study established the advantages and disadvantages of social media and digital data use in mental health therapy. Patients and therapists highlighted similar concerns and uses. This study indicated that overall, both patients and therapists are interested in and are comfortable to use and discuss social media and digital data in mental health therapy.