Doug Easterling

Access to Radiologic Reports via a Patient Portal: Clinical Simulations to Investigate Patient Preferences

PURPOSE The aim of this study was to determine (1) the patient-preferred timing characteristics of a system for online patient access to radiologic reports and (2) patient resource needs and preferences after exposure to reports. METHODS Adult outpatients from a single imaging center completed researcher-administered electronic questionnaires. Participants were exposed to 3 simulated clinical scenarios and asked to answer questions on the basis of what they thought they would do in each. Scenarios included symptomatology and written radiology reports that were nearly normal, seriously abnormal, and indeterminate, with reports containing typical medical terminology. Participants were asked about preferred timing for online access to reports, communication methods, educational resources, and alternative formats. McNemars test correlated proportions and generalized estimating equations were used to evaluate responses. RESULTS Participants (n = 53) most often preferred immediate access to reports: 32 (60.2%) for the nearly normal scenario, 25 (47.2%) for the seriously abnormal scenario, and 24 (45.3%) for the indeterminate scenario. Three-day delayed access was next most commonly preferred: 15 (28.3%), 19 (35.8%), and 19 (35.8%), respectively. Forty-two participants (79.2%) preferred the portal method of notification over ways they have historically gotten results, with an increased proportion being satisfied with it overall (P < .04). Most would use a variety of educational resources and found alternative lay language conclusions and hyperlinks helpful. CONCLUSIONS Some outpatients want immediate online access to complete, written radiologic reports and would use multiple resources to understand report contents. Effects of immediate access on provider workflow and on anxiety and autonomy among a diverse population of patients still need to be studied.

Associations Between Mild Cognitive Impairment and Hospitalization and Readmission.

To determine whether older adults with mild cognitive impairment (MCI), a condition not previously explored as a risk factor, have more hospitalizations and 30‐day readmissions than those with normal cognition.

The Colorado Trust’s Healthy Communities Initiative: Results and Lessons for Comprehensive Community Initiatives

24 THE FoundationReview Over the past 20 years, a small but influential cohort of foundations (e.g., Annie E. Casey, Ford, Kellogg) has experimented with comprehensive community initiatives (CCIs) as a means of generating sustainable, community-wide improvements in health and quality of life (Kubisch et al., 2002). Rather than funding individual organizations to achieve a particular set of programmatic outcomes, CCIs seek to transform “communities” (neighborhoods, towns, cities, or larger regions) through a locally driven approach to system reform or community development. According to Brown and Garg (1997), these initiatives are characterized by (a) the devolution of authority

The role of home smoking bans in limiting exposure to secondhand tobacco smoke in Hungary

Our objective was to assess how exposure to secondhand tobacco smoke occurs in Hungarian homes, particularly among non-smokers, and to examine the effectiveness of home smoking bans in eliminating exposure to secondhand smoke at home. In 2009, 2286 non-smokers and smokers aged 16-70 years, who were selected randomly from a nationally representative sample of 48 Hungarian settlements, completed paper-and-pencil self-administered questionnaires addressing tobacco-related attitudes, opinions and behaviors. Chi-square tests, one-way analysis of variance and multivariate logistic regression models were used to assess the effect of demographics, socio-economic characteristics and home smoking policies on the risk of exposure to secondhand tobacco smoke at home. Significantly higher risk of exposure was found among younger, lower educated and poorer people and among those having no or partial home smoking restrictions. There was a significant interaction between education level and home smoking policies: the effect of a smoking ban on exposure to secondhand tobacco smoke was stronger for the lower educated group than the higher educated group. The results suggest that Hungarians are making good progress in implementing home smoking bans, and that in the majority of population these bans are working. More can be done to promote the uptake of home smoking bans among poorer and less educated subpopulations.

Values‐Based Measures of Impacts to Indigenous Health

Values-based indicators of risks to Indigenous health have the potential to improve the accuracy and quality of a wide range of decisions affecting Native lands and cultures. Current health impact assessment approaches often omit important health priorities rooted in the history, social structures, and cultural context of Indigenous communities. Insights and methods from the decision sciences can be used to develop more culturally appropriate and context-relevant health indicators that can articulate and track changes to important dimensions of Indigenous health. Identifying and addressing priority cultural, social, economic, and environmental contributors to the health of Indigenous communities will help to generate better project alternatives and foster more responsive choices.

Evaluation of Free to Grow: Head Start partnerships to promote substance-free communities:

Free to Grow: Head Start Partnerships to Promote Substance-free Communities (FTG) was a national initiative in which local Head Start (HS) agencies, in partnership with other community organizations, implemented a mix of evidence-based family-strengthening and community-strengthening strategies. The evaluation of FTG used a quasi-experimental design to compare 14 communities that participated in the FTG intervention with 14 matched comparison communities. Telephone surveys were conducted with two cohorts of the primary caregivers of children in HS at baseline and then annually for 2 years. The survey was also administered to repeated cross-sectional samples of primary caregivers of young children who were not enrolled in HS. No consistent evidence was found in changes in family functioning or neighborhood conditions when the 14 FTG sites were compared to 14 matched sites. However, caregivers of young children who were not in HS in three high-implementing FTG sites showed evidence of improvements in neighborhood organization, neighborhood norms against substance abuse, and child disciplinary practices. Results provide highly limited support for the concept that family and neighborhood conditions that are likely to affect child development and well-being can be changed through organized efforts implemented by local HS programs.