Adam C. Powell

In Search of a Few Good Apps

mHealth apps are mobile device applications intended to improve health outcomes, deliver health care services, or enable health research.1 The number of apps has increased substantially, and more than 40 000 health, fitness, and medical apps currently are available on the market.2 Because apps can be used to inexpensively promote wellness and manage chronic diseases, their appeal has increased with health reform and the increasing focus on value. The bewildering diversity of apps available has made it difficult for clinicians and the public to discern which apps are the safest or most effective.

Physician Workload and Hospital Reimbursement: Overworked Physicians Generate Less Revenue per Patient

We study the impact of physician workload on hospital reimbursement utilizing a detailed data set from the trauma department of a major urban hospital. We find that the proportion of patients assigned a “high-severity” status for reimbursement purposes, which maps, on average, to a 47.8% higher payment for the hospital, is substantially reduced as the workload of the discharging physician increases. This effect persists after we control for a number of systematic differences in patient characteristics, condition, and time of discharge. Furthermore, we show that it is unlikely to be caused by selection bias or endogeneity in either discharge timing or allocation of discharges to physicians. We attribute this phenomenon to a workload-induced reduction in diligence of paperwork execution. We estimate the associated monetary loss to be approximately 1.1% (95% confidence interval, 0.4%--1.9%) of the departments annual revenue.

Interrater Reliability of mHealth App Rating Measures: Analysis of Top Depression and Smoking Cessation Apps

Background There are over 165,000 mHealth apps currently available to patients, but few have undergone an external quality review. Furthermore, no standardized review method exists, and little has been done to examine the consistency of the evaluation systems themselves. Objective We sought to determine which measures for evaluating the quality of mHealth apps have the greatest interrater reliability. Methods We identified 22 measures for evaluating the quality of apps from the literature. A panel of 6 reviewers reviewed the top 10 depression apps and 10 smoking cessation apps from the Apple iTunes App Store on these measures. Krippendorff’s alpha was calculated for each of the measures and reported by app category and in aggregate. Results The measure for interactiveness and feedback was found to have the greatest overall interrater reliability (alpha=.69). Presence of password protection (alpha=.65), whether the app was uploaded by a health care agency (alpha=.63), the number of consumer ratings (alpha=.59), and several other measures had moderate interrater reliability (alphas>.5). There was the least agreement over whether apps had errors or performance issues (alpha=.15), stated advertising policies (alpha=.16), and were easy to use (alpha=.18). There were substantial differences in the interrater reliabilities of a number of measures when they were applied to depression versus smoking apps. Conclusions We found wide variation in the interrater reliability of measures used to evaluate apps, and some measures are more robust across categories of apps than others. The measures with the highest degree of interrater reliability tended to be those that involved the least rater discretion. Clinical quality measures such as effectiveness, ease of use, and performance had relatively poor interrater reliability. Subsequent research is needed to determine consistent means for evaluating the performance of apps. Patients and clinicians should consider conducting their own assessments of apps, in conjunction with evaluating information from reviews.

The increased financial burden of further proposed orthopaedic resident work-hour reductions.

BACKGROUNDnIncreased funding for graduate medical education was not provided during implementation of the eighty-hour work week. Many teaching hospitals responded to decreased work hours by hiring physician extenders to maintain continuity of care. Recent proposals have included a further decrease in work hours to a total of fifty-six hours. The goal of this study was to determine the direct cost related to a further reduction in orthopaedic-resident work hours.nnnMETHODSnA survey was delivered to 152 residency programs to determine the number of full-time equivalent (FTE) physician extenders hired after implementation of the eighty-hour work-week restriction. Thirty-six programs responded (twenty-nine university-based programs and seven community-based programs), encompassing 1021 residents. Previous published data were used to determine the change in resident work hours with implementation of the eighty-hour regulation. A ratio between change in full-time equivalent staff per resident and number of reduced hours was used to determine the cost of the proposed further decrease.nnnRESULTSnAfter implementation of the eighty-hour work week, the average reduction among orthopaedic residents was approximately five work hours per week. One hundred and forty-three physician extenders (equal to 142 full-time equivalent units) were hired to meet compliance at a frequency-weighted average cost of

Certification of Mobile Apps for Health Care—Reply

96,000 per full-time equivalent unit. A further reduction to fifty-six hours would increase the cost by

The Economic Benefits of Mobile Apps for Mental Health and Telepsychiatry Services When Used by Adolescents

64,000 per resident. With approximately 3200 orthopaedic residents nationwide, sensitivity analyses (based on models of eighty and seventy-three-hour work weeks) demonstrate that the increased cost would be between

Electronic health record use in an affluent region in India: Findings from a survey of Chandigarh hospitals

147 million and

The New Digital Divide For Digital Biomarkers

208 million per fiscal year. For each hourly decrease in weekly work hours, the cost is

The Complexity of Mental Health App Privacy Policies: A Potential Barrier to Privacy

8 million to

The power of capturing and using information at the point of care.

12 million over the course of a fiscal year.nnnCONCLUSIONSnMandated reductions in resident work hours are a costly proposition, without a clear decrease in adverse events. The federal government should consider these data prior to initiating unfunded work-hour mandates, as further reductions in resident work hours may make resident education financially unsustainable.