Introduction The coronavirus disease 2019 (COVID-19) pandemic resulted in an unprecedented expansion in telehealth, but little is known about differential use of telehealth according to demographics, rurality, or insurance status. Methods We performed a cross-sectional analysis of 7742 family medicine encounters at a single USA institution in the initial month of the COVID-19 public health emergency (PHE). We compared the demographics of those using telehealth during the PHE to those with face-to-face visits during the same time period; we also compared the demographics of those using full audio-video to those using audio-only. Results The likelihood of any telehealth visit in the first 30 days of telehealth expansion was higher for women, those age 65 years and older, self-pay patients, and those with Medicaid and Medicare as primary payers. The likelihood of a telehealth visit was reduced for rural residence and Black or other races. Among all telehealth visits, the likelihood of a full audio-video telehealth visit was reduced for patients who were older, Black, from urban areas, or who were self-pay, Medicaid, or Medicare payer status. Discussion Significant disparities exist in telehealth use during the COVID-19 PHE by age, race, residence and payer.
Objectives Improving the usability of electronic health records (EHR) continues to be a focus of clinicians, vendors, researchers, and regulatory bodies. To understand the impact of usability redesign of an existing, site-configurable feature, we evaluated the user interface (UI) used to screen for depression, alcohol and drug misuse, fall risk, and the existence of advance directive information in ambulatory settings.
Methods As part of a quality improvement project, based on heuristic analysis, the existing UI was redesigned. Using an iterative, user-centered design process, several usability defects were corrected. Summative usability testing was performed as part of the product development and implementation cycle. Clinical quality measures reflecting rolling 12-month rates of screening were examined over 8 months prior to the implementation of the redesigned UI and 9 months after implementation.
Results Summative usability testing demonstrated improvements in task time, error rates, and System Usability Scale scores. Interrupted time series analysis demonstrated significant improvements in all screening rates after implementation of the redesigned UI compared with the original implementation.
Conclusion User-centered redesign of an existing site-specific UI may lead to significant improvements in measures of usability and quality of patient care.
Prompt access to medical services is considered critical in managing acute myocardial infarction (AMI). Several socioeconomic and geographic factors affect access to such care in rural areas. This study measured the effect of geographic distance from care on utilization of cardiovascular technology and death after AMI. The records of 1,658 rural Missouri residents age 65 or older with a discharge diagnosis of AMI in 1991 were obtained from Medicare data. The rate of use of cardiovascular technology and rate of post‐AMI mortality for rural Missouri residents who live far from emergency departments and cardiac referral centers (CRC) were compared with those who live nearest such services. Those living 60 miles or more from a CRC were less likely to have cardiac catheterization (odds ratio [OR]=0.55; 95% confidence interval [CI]=0.40 to 0.75) or angioplasty (OR=0.68; 95% CI=0.47 to 0.98), compared with those living fewer than 30 miles from a CRC. There were no differences in 30‐day, 90‐day, or one‐year mortality rates. After adjusting for distance to a CRC, those living 20 miles or more from emergency services were more likely to have coronary artery bypass grafting (OR=1.92; 95% CI=1.18 to 3.15) than those living fewer than 10 miles from such services, but there was no difference in mortality. Distance from services strongly predicts utilization of cardiovascular resources, but it does not predict mortality among rural Missouri Medicare beneficiaries hospitalized with AMI.
Acute salicylate poisoning with enteric-coated aspirin may result from accidental ingestion, a suicide attempt, or a complication of long-term therapy. Because absorption of enteric-coated aspirin is delayed, use of the Done nomogram to determine toxicity may lead to underestimating the severity of the poisoning. Treatment options include induction of emesis or diuresis, gastric lavage, administration of activated charcoal, and surgery.
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