Health Policy and Technology最新文献

{"title":"Professional perspectives towards implementing artificial intelligence in next generation sequencing–based newborn screening: A Q methodology study","authors":"Sara Soriano Longarón ,&nbsp;Lennart Johansson ,&nbsp;Imke Christiaans ,&nbsp;Erwin Birnie ,&nbsp;Marielle van Gijn ,&nbsp;Adelita V. Ranchor ,&nbsp;Mirjam Plantinga","doi":"10.1016/j.hlpt.2025.100982","DOIUrl":"10.1016/j.hlpt.2025.100982","url":null,"abstract":"<div><h3>Background</h3><div>The use of next generation sequencing (NGS) to expand current newborn screening (NBS) is being explored. NGS would enable early detection of more early onset diseases. However, to interpret a large amount of data within a short turn-around time, it is necessary to use artificial intelligence (AI). Use of AI in NGS-based NBS raises ethical and societal issues that require investigation of how healthcare professionals view the use of AI in this context and which requirements need to be met to realize responsible development and deployment of AI in NGS-based NBS.</div></div><div><h3>Objective</h3><div>To explore professionals’ perspectives on the requirements that are important for responsible development and deployment of AI in NGS-based NBS.</div></div><div><h3>Methods</h3><div>Q methodology was used to examine the perspectives of professionals, involving two steps: 1) an online focus group discussion to provide input for the development of 40 statements regarding requirements for responsible use of AI in NGS-based NBS and 2) an online sorting by the participants (<em>N</em> = 30) of the list of statements, according to their importance.</div></div><div><h3>Results</h3><div>The Q methodology approach identified two participant perspectives. The first emphasized the importance for professionals that they retain control over the task for which the AI is used. The second prioritized the importance of parental acceptance and of high uptake of the screening offer.</div></div><div><h3>Conclusions</h3><div>The findings indicate an overall optimistic attitude and suggest that for responsible development and implementation of AI in an NGS-based NBS, it is important to consider requirements covering ethical, legal and societal aspects.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 2","pages":"Article 100982"},"PeriodicalIF":3.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computerized clinical decision support systems for prescribing in primary care: Characteristics and implementation impact. Scoping review and evidence and gap maps","authors":"Héctor Acosta-García ,&nbsp;Juan Ruano-Ruiz ,&nbsp;Francisco José Gómez-García ,&nbsp;Susana Sánchez-Fidalgo ,&nbsp;Bernardo Santos-Ramos ,&nbsp;Teresa Molina-López","doi":"10.1016/j.hlpt.2025.100976","DOIUrl":"10.1016/j.hlpt.2025.100976","url":null,"abstract":"<div><div>This study aimed to conduct a scoping review and evidence and gap maps to characterize Clinical Decision Support Systems (CDSS) in primary care, evaluate their implementation and maintenance levels, and identify evidence gaps. Methods: A literature search covering January 2010 to May 2023 was conducted across various databases. Inclusion criteria encompassed studies involving real patients with detailed descriptions of CDSS, including both comparative and descriptive designs within primary care settings. Two independent reviewers screened the references, while four researchers independently extracted data, which included demographics, main findings, and system descriptions. The results were presented using interactive evidence and gap maps. Results: Among 1,447 initial citations, 75 studies met the selection criteria. The identified types of CDSS included adherence to guidelines/local protocols (45 %), antibiotic prescription (16 %), suitability (15 %), and others. Only one system was classified as \"intelligent,\" while 39 % received a complexity rating of 4 on a scale from 1 to 5. Assessment of various outcomes across the studies revealed health outcomes (20 %), economy/resource use (13 %), potentially inappropriate prescription (61 %), adherence to local guidelines/protocols (12 %), and acceptance/use (40 %). Two maps were created: The first one displayed the type of CDSS linked to the type of results measured. The second one showed the type of CDSS and their most relevant characteristics. Data were represented in a dynamic bubble diagram. Conclusion: Current evidence regarding CDSS in primary care is limited and heterogeneous. The identified systems exhibit relative complexity but are not classified as intelligent, primarily focusing on improving prescribing practices through clinical guidelines or prescription aid tools. The outcomes most frequently assessed included potentially inappropriate prescriptions and acceptance/use. The evidence and gap maps provide a user-friendly format for visualizing existing evidence and identifying research gaps in the implementation of CDSS within primary care.</div><div><strong>Systematic Review registration</strong>: This study is registered in Open Science Framework. <span><span>https://bit.ly/2RqKrWp</span><svg><path></path></svg></span></div><div><strong>Results data: EGMs</strong>: The complete EGMs can be accessed at the following link: <span><span>https://proyectos.imibic.org/evidence-map/</span><svg><path></path></svg></span></div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 2","pages":"Article 100976"},"PeriodicalIF":3.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating ASEAN region Artificial Intelligence (AI) governance readiness in healthcare","authors":"Hein Minn Tun ,&nbsp;Lin Naing ,&nbsp;Owais Ahmed Malik ,&nbsp;Hanif Abdul Rahman","doi":"10.1016/j.hlpt.2025.100981","DOIUrl":"10.1016/j.hlpt.2025.100981","url":null,"abstract":"<div><h3>Background</h3><div>The International Monetary Fund (IMF) reported 40 % of jobs will be influenced by Artificial Intelligence (AI), globally. Integration of AI into healthcare holds immense promise to revolutionize patient care, diagnosis, and treatment strategies but significant concerns regarding ethical considerations of data privacy, security, and bias in AI algorithms. ASEAN member states are increasingly interested in AI implementation in healthcare, but a clear description of each country's landscape is lacking, hindering gap identification and development potential.</div></div><div><h3>Objective</h3><div>To explore the gaps in AI-related policies and guidance in the ASEAN region, with a specific focus on the healthcare sector.</div></div><div><h3>Method</h3><div>In this study, we assessed the \"Government AI Readiness Index from 2020 to 2023 by Oxford Insights to gauge ASEAN nations' readiness for AI utilization in healthcare. A comprehensive review of national and regional AI policies that focuses on the healthcare sector was conducted. Data collection involved gathering information from published official policies and guidelines, government health ministries' websites, and online sources. Additionally, guidance on digital health policies specific to the ASEAN region was explored.</div></div><div><h3>Results</h3><div>Descriptive analysis of government AI readiness reveals disparities with Singapore leading the region (ranked 2nd), followed by Malaysia (ranked 23), Thailand (ranked 37), Indonesia (ranked 42), Vietnam (ranked 59), Philippines (ranked 65), and Brunei Darussalam (ranked 74), highlighting progress in establishing AI governance frameworks. However, countries like Laos (ranked 136), Cambodia (ranked 145), Myanmar (ranked 149), and Timor-Leste (ranked 156) lag, with limited regulations and strategies in place. Singapore, Malaysia, Thailand, Indonesia, Vietnam, and the Philippines established a national-level policy with a focus on the health sector while others are still in progress. Regional AI guidance has been established recently with different approaches to the EU's AI Act. Despite witnessing progress in the digital health sector post-COVID-19, challenges persist in digital infrastructure and literacy across regional countries.</div></div><div><h3>Conclusion</h3><div>This study emphasizes the varied readiness for AI technology, particularly in healthcare, across the ASEAN region, highlighting the necessity for strengthening country-level policies, especially in governance, to facilitate the effective establishment of AI technologies in the healthcare sector. By implementing proper AI policies, training human capital, and enhancing digital infrastructure, ASEAN countries can markedly improve healthcare outcomes and make significant contributions to achieving SDG Goals 3 and 9b.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 2","pages":"Article 100981"},"PeriodicalIF":3.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a framework for managing conscientious objection in healthcare - Australia","authors":"Sami Isaac,&nbsp;Andrew McLachlan,&nbsp;Betty Chaar","doi":"10.1016/j.hlpt.2025.100978","DOIUrl":"10.1016/j.hlpt.2025.100978","url":null,"abstract":"<div><h3>Background</h3><div>Conscientious objection (CO) is a practitioner's refusal to engage or provide a service primarily because the action would violate their deeply held morals and/or ethical values. However, there is a lack of guidance around managing CO in healthcare. This study aims to develop and evaluate a proposed framework to assist in management of CO in Australian healthcare.</div></div><div><h3>Methods</h3><div>A three-round modified Delphi study of healthcare experts, was used to evaluate a proposed workplace framework to help guide management of CO in healthcare. Round 1: Assessment, <em>Round 2:</em> Feedback/discussion <em>Round 3:</em> Reassessment. The final proposed framework was collated once consensus was reached.</div></div><div><h3>Results</h3><div>10 expert panellists evaluated the first draft of the proposed framework. Four of eight steps required significant modifications, and others required slight rephrasing to minimise negative connotations. An additional ninth step was made based on panellists’ suggestions, to ensure greater application across various professions and scenarios. Thematic analysis generated the five key themes: 1.moral injury and workplace health and safety laws, 2.legislative rights and liability, 3.personal versus professional responsibilities, 4.stigma and communication, 5.context specific modifications.</div></div><div><h3>Conclusion</h3><div>A consensus framework on how to manage CO in the healthcare was developed and evaluated by healthcare experts. Implementation of the framework will require awareness, and uptake from professional organisation bodies, government policymakers and employers in healthcare to incorporate it in their workplace policies.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 2","pages":"Article 100978"},"PeriodicalIF":3.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Did COVID-19 reduce the digital divide? A systematic review","authors":"Georgina Connolly ,&nbsp;Joan Costa-Font ,&nbsp;Divya Srivastava","doi":"10.1016/j.hlpt.2025.100979","DOIUrl":"10.1016/j.hlpt.2025.100979","url":null,"abstract":"<div><h3>Aim</h3><div>This research paper aims synthesise literature evaluating how the increased use of digital health during the COVID-19 pandemic has impacted equitable access to healthcare in the United Kingdom (UK).</div></div><div><h3>Methods</h3><div>A systematic literature review was adopted to get a broad overview of the impact of digital exclusion in the UK. To enable a structured analytical approach a three-domain framework was adopted ((1) digital access, digital literacy, and digital assimilation), and two specific groups were selected to investigate (older people and people with a lower socioeconomic status (SES)).</div></div><div><h3>Results</h3><div>This review identified 17 relevant papers, of which 5 considered SES and 16 age, concerning equitable healthcare access via digital health in the UK. Three-domain framework analysis found that increased use of digital health during the COVID-19 pandemic had digitally excluded some groups, particularly people with a lower SES. 25 % of included studies identified negative outcomes associated with equitable access for older people, a figure which increased to 60 % in the lower SES analysis. Digital access and literacy were identified as key issues in the lower SES population, meanwhile behavioural factors, such as bounded learning and hassle costs, were identified as a key barrier in older adults. Notably, this review identified some studies where these barriers were effectively overcome, meaning that digital health was able to improve care access and experience for some older adults. This study also identified some cases where the use of digital health supported care to be effectively prioritised.</div></div><div><h3>Conclusion</h3><div>Digital inclusion must become a higher policy priority in the UK. In the meantime, health systems should be mindful of potentially digitally excluded groups and ensure alternate modes of care (e.g. in-person and telephone) are effectively prioritised for those that need it most.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 2","pages":"Article 100979"},"PeriodicalIF":3.4,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The European Health Data Space: Will it be emergency-ready?","authors":"Jane Arroyo,&nbsp;Hien Vu,&nbsp;Timothy Yu-Cheong Yeung","doi":"10.1016/j.hlpt.2025.100977","DOIUrl":"10.1016/j.hlpt.2025.100977","url":null,"abstract":"<div><h3>Objective</h3><div>The European Health Data Space (EHDS) aims to facilitate the sharing of health data for healthcare and research purposes. But how it would function to help the Union and the Member States to respond to a public health emergency is less researched. This paper aims to study the relevance of the EHDS for a public health emergency.</div></div><div><h3>Method</h3><div>Drawing on insights from the literature and our study of the legal texts, we first explore potential benefits of EHDS during a public health emergency, and then assess its emergency-readiness.</div></div><div><h3>Results</h3><div>Despite many promising benefits generated by EHDS, its application in the area of public health emergency response is hardly straightforward. While the amended and adopted text is more aware of the possibility of a public health emergency, its emergency-readiness is suboptimal. If not properly addressed, the EHDS Regulation will fail to reach its potential in mitigating a public health emergency.</div></div><div><h3>Conclusions</h3><div>We recommend lawmakers at both Union and national levels consider defining an expedited procedure during an emergency and build a comprehensive emergency regime of the European Health Union that facilitates quicker data collection and sharing.</div></div><div><h3>Public Interest Summary</h3><div>The European Health Data Space (EHDS) aims to facilitate access to health data for healthcare delivery (primary use of data) and to provide a data sharing system for health research, policymaking, statistics and education activities (secondary use of data). This paper summarises some potential benefits of EHDS for better public health emergency response and discusses possible problems that might hinder EHDS from realising its full potential. Emergency-readiness is considered suboptimal in the adopted text of EHDS (April 2024), leaving it uncertain whether EHDS would speed up responses to emergencies while keeping health data sharing in a rule-based governance framework. We recommend lawmakers at both Union and national levels consider defining an expedited procedure during an emergency and build a comprehensive emergency regime of the European Health Union. Such a regime should link to the public health emergency recognition under Regulation (EU) 2022/2371, aiming to facilitate quicker data collection and sharing.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 2","pages":"Article 100977"},"PeriodicalIF":3.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Setting cost-effectiveness thresholds for health technologies in Vietnam: A WTP/QALY approach","authors":"Hien Thi Bich Tran ,&nbsp;Viet Nhu Nguyen ,&nbsp;Phuong Nhat Le ,&nbsp;Trung Quang Vo ,&nbsp;Hiep Thanh Nguyen ,&nbsp;Due The Ong ,&nbsp;Van Nu Hanh Pham ,&nbsp;Thao Ho Dieu Nguyen ,&nbsp;Nhi Pham Yen Le","doi":"10.1016/j.hlpt.2024.100972","DOIUrl":"10.1016/j.hlpt.2024.100972","url":null,"abstract":"<div><h3>Objectives</h3><div>Cost-effectiveness analysis is considered a foundational element for discussions of fair pricing by policymakers, comparing against a predetermined benchmark referred to as the cost-effectiveness threshold (CET), which determines if technology expenses are eligible for reimbursement. In Vietnam, the CET has not been established, creating a significant gap in the country's health policy decision-making process. This study aimed to establish a threshold for healthcare services by estimating the willingness to pay for a quality-adjusted life year (WTP/QALY).</div></div><div><h3>Methods</h3><div>A total of 2,261 Vietnamese individuals were enrolled in this study and randomly assigned to scenario-based questionnaires. WTP values were collected via a contingent valuation approach, which included dichotomous bidding and open-ended inquiry. Generalized linear models and logistic regression were used to evaluate the influence of variables on WTP/QALY.</div></div><div><h3>Results</h3><div>The mean WTP/QALY of the whole sample was USD 12,532 (VND 296.06 million), which is 3.01 times the country's gross domestic product (GDP) per capita. The mean WTP/QALY varied under different scenarios, with the highest in the life-saving scenario at USD 14,893 (VND 351.84 million), followed by the life-extension scenario at USD 14,547 (VND 343.64 million), and the life-improvement scenario at USD 10,146 (VND 239.69 million), ranging from 2.41 to 3.54 times the GDP per capita. Educational attainment, income level, proportion of certainty in treatment outcome, and scenario type substantially influenced WTP/QALY valuation.</div></div><div><h3>Conclusions</h3><div>The results indicate that the established threshold is slightly greater than that proposed by the World Health Organization. This finding provides a foundational reference point for the development of health policy in Vietnam, ensuring fair pricing and effective allocation of healthcare resources.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 3","pages":"Article 100972"},"PeriodicalIF":3.4,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teleconsultation as a strategy to support primary health care professionals: A scoping review","authors":"Rodrigo da Silva Almeida ,&nbsp;Fábio Ferreira Amorim ,&nbsp;Jozinélio Severino Teixeira ,&nbsp;Claudilene Sousa Fortaleza ,&nbsp;Carlos Amilcar Salgado ,&nbsp;João Marcelo Barreto Silva ,&nbsp;Paulo Ricardo Giusti da Silva ,&nbsp;Maria Stella Peccin da Silva ,&nbsp;Leila Bernarda Donato Göttems ,&nbsp;Aline Mizusaki Imoto","doi":"10.1016/j.hlpt.2024.100971","DOIUrl":"10.1016/j.hlpt.2024.100971","url":null,"abstract":"<div><h3>Objectives</h3><div>Map the evidence available in the literature and identify the best experiences regarding teleconsultation (TC) as a strategy to support clinical decisions in primary health care (PHC).</div></div><div><h3>Methods</h3><div>This is a scoping review guided by the structure proposed by Arksey &amp; O'Malley and following the guidelines of the Joanna Briggs Institute (JBI) and The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). The databases consulted were MEDLINE via PubMed, EMBASE, Cochrane Library, and LILACS via BVSalud without the restriction of language or date of publication.</div></div><div><h3>Results</h3><div>The search resulted in a total of 4,272 articles. Of these studies, 211 were included in the review. Publications included 21 countries from various health specialties. The countries with the highest number of publications were the United States (USA), Canada, and Brazil. The experiences showed that TC benefits healthcare systems by reducing the time of access to specialized care by patients treated in PHC, preventing unnecessary referrals to specialized care. The main barriers were inadequate responses to TC requests, infrastructure problems, difficulty incorporating the program into the organizational culture, and lack of management support. Cost reduction for the system and user satisfaction with TC were highlighted as the main strengths.</div></div><div><h3>Conclusion</h3><div>Teleconsultation successfully implemented rapid and effective communication between PHC physicians and secondary care specialists, potentially improving access and quality of care.</div></div><div><h3>Public interest abstract</h3><div>We explored how teleconsultation, a method where healthcare providers consult specialists remotely, can support PHC teams in making better decisions. Our research was motivated by the growing need to improve access to specialized care, especially in remote or underserved areas with long waiting times for specialists. By reviewing studies from various countries, we found that teleconsultation can reduce the time patients wait for specialist care, lower healthcare costs, and increase patient satisfaction. For example, teleconsultation has helped bridge the gap between PHC providers and specialists in countries like the USA, Canada, and Brazil, ensuring quicker, more effective care. However, challenges like poor infrastructure and lack of support from institution management and health managers remain. This support may include implementing clear policies, appropriate allocation of resources, and training for the healthcare team. By addressing these issues, teleconsultation can be a powerful tool to improve healthcare systems globally, making specialized care more accessible to everyone, regardless of where they live.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 2","pages":"Article 100971"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual factors that affect laypeople's understanding of definitions of medical jargon","authors":"David A. Levy ,&nbsp;Harmon S. Jordan ,&nbsp;John P. Lalor ,&nbsp;Jenni Kim Smirnova ,&nbsp;Wen Hu ,&nbsp;Weisong Liu ,&nbsp;Hong Yu","doi":"10.1016/j.hlpt.2024.100932","DOIUrl":"10.1016/j.hlpt.2024.100932","url":null,"abstract":"<div><h3>Objective</h3><div>Patients have difficulty understanding medical jargon in electronic health record (EHR) notes. Lay definitions can improve patient comprehension, which is the goal of the NoteAid project. We assess whether the NoteAid definitions are understandable to laypeople and whether understandability differs with respect to layperson characteristics.</div></div><div><h3>Methods</h3><div>Definitions for jargon terms were written for laypersons with a 4th-to-7th-grade reading level. 300 definitions were randomly sampled from a corpus of approximately 30,000 definitions. 280 laypeople (crowdsource workers) were recruited; each layperson rated the understandability of 20 definitions. Understandability was rated on a 5-point scale. Using a generalized estimating equation model (GEE) we analyzed the relationship between understandability and age, sex, race/ethnicity, education level, native language, health literacy, and definition writer.</div></div><div><h3>Results</h3><div>Overall, 81.1 % (95 % CI: 76.5–85.7 %) of the laypeople reported that the definitions were understandable. Males were less likely to report understanding the definitions than females (OR: 0.73, 95 % CI: 0.63–0.84). Asians, Hispanics, and those who marked their race/ethnicity as “other” were more likely to report understanding the definitions than whites (Asians: OR: 1.43, 95 % CI: 1.17–1.73; Hispanics: OR: 1.86, 95 % CI: 1.33–2.59; Other: OR: 2.48, 95 % CI: 1.65–3.74). Laypeople whose native language was not English were less likely to report understanding the definitions (OR: 0.51, 95 % CI: 0.36–0.74). Laypeople with lower health literacy were less likely to report understanding definitions (health literacy score 3: OR: 0.51, 95 % CI: 0.43–0.62; health literacy score 4: OR: 0.40, 95 % CI: 0.29–0.55).</div></div><div><h3>Conclusion</h3><div>Understandability of definitions among laypeople was high. There were statistically significant race/ethnic differences in self-reported understandability, even after controlling for multiple demographics.</div></div><div><h3>Public interest summary</h3><div>We conducted a study to ensure that definitions written for the NoteAid EHR jargon identification tool are understandable. We recruited a diverse group of crowdsource workers and found that overall, the definitions were understandable, but understanding levels varied based on several demographic characteristics.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 6","pages":"Article 100932"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges of shared decision-making in virtual care: Whom should we care for, and how?","authors":"Lujia Sun ,&nbsp;Martin Buijsen","doi":"10.1016/j.hlpt.2024.100931","DOIUrl":"10.1016/j.hlpt.2024.100931","url":null,"abstract":"<div><h3>Objective</h3><div>This article examines challenges in implementing shared decision-making within virtual care. Virtual care platforms emphasise quick delivery, patient choice and empowerment, offering convenient access to remote medical consultations at patients’ homes. However, shared decision-making is a collaborative and deliberative process that does not prioritise efficiency and individual decisions over the principles of sound medical practice. Recognised as the gold standard in healthcare, extending shared decision-making to virtual care platforms is indispensable, but it would encounter difficulties in implementation.</div></div><div><h3>Methods</h3><div>Combining an empirical methodology with ethical reasoning, an integrated approach facilitates critical discourse on shared decision-making within virtual care settings. This involves an ethical premise concerning shared decision-making norms, followed by an ethical analysis drawing upon empirical findings from literature via keyword searches. Adopting an interdisciplinary perspective, the study merges ethical and social viewpoints to elucidate shared decision-making’s significance and policy implications in virtual care.</div></div><div><h3>Results</h3><div>The investigation identifies four significant factors that may challenge implementing shared decision-making within virtual care contexts. These include consumer-like behaviours, the absence of pre-existing relationships, information expansion, and physicians’ evolving roles.</div></div><div><h3>Conclusions</h3><div>It is concluded that a collaborative approach to a caring relationship that focuses on patients’ needs and values, continuity of care, and medical professionalism is essential to this new integration of virtual care and shared decision-making.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 6","pages":"Article 100931"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}