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Chart review is central to understanding adverse events (AEs) in medicine. In this article, we describe the process and results of educating chart reviewers assigned to evaluate dental AEs.We developed a Web-based training program, "Dental Patient Safety Training," which uses both independent and consensus-based curricula, for identifying AEs recorded in electronic health records in the dental setting. Training included (1) didactic education, (2) skills training using videos and guided walkthroughs, (3) quizzes with feedback, and (4) hands-on learning exercises. In addition, novice reviewers were coached weekly during consensus review discussions. TeamExpert was composed of 2 experienced reviewers, and TeamNovice included 2 chart reviewers in training. McNemar test, interrater reliability, sensitivity, specificity, positive predictive value, and negative predictive value were calculated to compare accuracy rates on the identification of charts containing AEs at the start of training and 7 months after consensus building discussions between the 2 teams.TeamNovice completed independent and consensus development training. Initial chart reviews were conducted on a shared set of charts (n = 51) followed by additional training including consensus building discussions. There was a marked improvement in overall percent agreement, prevalence and bias-adjusted κ correlation, and diagnostic measures (sensitivity, specificity, positive predictive value, and negative predictive value) of reviewed charts between both teams from the phase I training program to phase II consensus building.This study detailed the process of training new chart reviewers and evaluating their performance. Our results suggest that standardized training and continuous coaching improves calibration between experts and trained chart reviewers.

BACKGROUND Peripartum Depression (PPD) affects approximately 1 in 10 pregnant women and 1 in 8 new mothers in the U.S. every year, representing a significant population. Women of low socioeconomic status (low-SES) are more likely to develop PPD symptoms. Multilevel treatment barriers including, but not limited to, social stigma, misguided expectations on the role of motherhood, and not having appropriate PPD knowledge or access to mental health resources have played a major role in PPD-related disparities. Emerging advances in digital technologies and analytics provide us with opportunities to address access barriers, knowledge gaps, and engagement issues. However, the majority of digital market solutions currently available are produced in a generic manner and do not consider the information and technology needs of low-SES populations. OBJECTIVE In this research study, we describe our qualitative approach towards evaluating low-SES women and providers’ current experiences with digital management of perinatal mental health, and supplement this with information gathered from participants in PPD-related online forums. METHODS We have conducted (a) 2 focus groups (n= 9), (b) semi-structured interviews with care providers (n= 9) and low SES women (n= 10), as well as (c) secondary analysis of online forum messages (n= 1,424). Qualitative data were inductively analyzed using grounded theory, where we first perform line-by-line open coding of the data and then discover key PPD information and technology user needs through identifying patterns and relationships among core concepts. RESULTS Our qualitative analysis resulted in a total of 134 open codes from patient interviews, 185 from provider interviews, and 106 from focus groups. These revealed six core themes for PPD management: 1) “Use of Technology/Features”, 2) “Access to Care”, 3) “Pregnancy Education”, 4) “Social and Community Support”, 5) “Sources of information”, and 6) “Digital Data”. Two themes that were uniquely brought up by providers were “Managerial and Administrative Support for Providers” and “Peripartum Depression Clinical Decision Support”. Our social media analysis revealed the following six PPD topics of importance in online messages: “Physical and Mental Health” (50.9% of messages), “Social Support” (47.3%), “Medications” (42.9%), “Mother and Infant Dyad” (32.3%), “Family and Friends” (30.1%), and “Doctor and Patient Dyad” (29.7%). CONCLUSIONS Our triangulation of data allowed us to analyze PPD information and technology needs at different levels of granularity. Differences between patient and provider included a focus from providers on needing better support from administrative staff, as well as better PPD clinical decision support. Our social media analysis provided us with insights into PPD topics of interest being discussed by a broader sample of women participating in an online community. Our results can inform future research and development efforts to address PPD health disparities among low-SES perinatal women.

Postpartum Depression (PPD) is the most common childbirth complication, with approximately 15% of postpartum women experiencing depression symptoms. Mobile applications have potential to expand delivery of mental health interventions. However, our understanding of how these tools engage women with PPD and facilitate positive behavioral changes is limited. In our paper, we analyze 15 commercial PPD applications to understand their role as facilitators of change, engagement, and sustained use. Applications reviewed contained an average of four theory-based behavioral change techniques, and highest patient engagement level reached was to empower patients through patient-generated data. Heuristic violations were identified in areas including user control and freedom, aesthetic and minimalist design, and help and documentation. An inverse correlation was found between the number of theory-based behavior change features and patient engagement. Findings suggest underserved populations may suffer further limitations accessing relevant health resources in the current application market.

Postpartum Depression (PPD) is the most common childbirth complication, with approximately 15% of postpartum women experiencing depression symptoms. Mobile applications have potential to expand delivery of mental health interventions. However, our understanding of how these tools engage women with PPD and facilitate positive behavioral changes is limited. In our paper, we analyze 15 commercial PPD applications to understand their role as facilitators of change, engagement, and sustained use. Applications reviewed contained an average of four theory-based behavioral change techniques, and highest patient engagement level reached was to empower patients through patient-generated data. Heuristic violations were identified in areas including user control and freedom, aesthetic and minimalist design, and help and documentation. An inverse correlation was found between the number of theory-based behavior change features and patient engagement. Findings suggest underserved populations may suffer further limitations accessing relevant health resources in the current application market.