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BACKGROUND: Racial minorities are disproportionately affected by stroke, with Black patients experiencing worse post-stroke outcomes than White patients. A modifiable aspect of acute stroke care delivery not yet examined is whether disparities in stroke outcomes are related to hospital nurse staffing levels. OBJECTIVES: To determine whether 7- and 30-day readmission disparities between Black and White patients were associated with nurse staffing levels. METHODS: We conducted a secondary analysis of 542 hospitals in four states. Risk-adjusted, logistic regression models were used to determine the association of nurse staffing with 7-day and 30-day all-cause readmissions for Black and White ischemic stroke patients. RESULTS: Our sample included 98,150 ischemic stroke patients (87% White, 13% Black). Thirty-day readmission rates were 10.4% (12.7% for Black, 10.0% for White patients). In models accounting for hospital and patient characteristics, the odds of 30-day readmissions were higher for Black than White patients. A significant interaction was found between race and nurse staffing, with Black patients experiencing higher odds of 30-day and 7-day readmissions for each additional patient cared for by a nurse. In the best-staffed hospitals (< 3 patients per nurse), Black and White stroke patients’ disparities were no longer significant. DISCUSSION: Disparities in readmissions between Black and White stroke patients may be linked to the level of nurse staffing in the hospitals where they receive care. Tailoring nurse staffing levels to meet the needs of Black ischemic stroke patients represents a promising intervention to address systemic inequities linked to readmission disparities among minority stroke patients.

The authors sought to determine whether providing summaries of patients' social media and other digital data to patients and their clinicians improves patients' health-related quality of life (HRQoL) measured by the RAND 36-Item Short Form Health Survey (SF-36).The authors randomly assigned 115 adults receiving outpatient mental health therapy to usual care or to periodic sharing of summaries of their digital data with their clinician providing psychosocial therapy. The study was conducted October 2020-December 2021.Patients' mean±SD age was 31.3±10.5 years, and 82% were women. At 60 days after enrollment, no statistically significant change was detected in SF-36 scores for patients randomly allocated to the intervention (mean difference=-0.39, 95% CI=-4.17, 3.39) or to usual care (mean difference=-1.98, 95% CI=-5.74, 1.77), and no significant between-arm difference was observed (between-arm difference=1.60, 95% CI=-3.67, 6.86).Collecting and summarizing digital data for use in mental health treatment was feasible for patients but did not significantly improve their HRQoL or other measures of mental health.

OBJECTIVES: Previous studies indicate that patient satisfaction with mental healthcare is correlated with both treatment outcomes and quality of life. This study aimed to 1) describe online reviews of mental health treatment facilities, including key themes in review content, and 2) evaluate the correlation between narrative review themes, facility characteristics, and review ratings. METHODS: United States National Mental Health Services Survey (N-MHSS) facilities were linked to their corresponding Yelp pages, created between March, 2007 and September, 2019. Correlations between review ratings and both machine-learning generated latent Dirichlet allocation topics and N-MHSS reported facility characteristics were measured using Spearman’s rank correlation coefficient, and significance was defined by a Bonferroni adjusted p

ImportanceThe COVID-19 pandemic has claimed nearly 6 million lives globally as of February 2022. While pandemic control efforts, including contact tracing, have traditionally been the purview of state and local health departments, the COVID-19 pandemic outpaced health department capacity, necessitating actions by private health systems to investigate and control outbreaks, mitigate transmission, and support patients and communities.ObjectiveTo investigate the process of designing and implementing a volunteer-staffed contact tracing program at a large academic health system from April 2020 to May 2021, including program structure, lessons learned through implementation, results of case investigation and contact tracing efforts, and reflections on how constrained resources may be best allocated in the current pandemic or future public health emergencies.Design, Setting, and ParticipantsThis case series study was conducted among patients at the University of Pennsylvania Health System and in partnership with the Philadelphia Department of Public Health. Patients who tested positive for COVID-19 were contacted to counsel them regarding safe isolation practices, identify and support quarantine of their close contacts, and provide resources, such as food and medicine, needed during isolation or quarantine.ResultsOf 5470 individuals who tested positive for COVID-19 and received calls from a volunteer, 2982 individuals (54.5%; median [range] age, 42 [18-97] years; 1628 [59.4%] women among 2741 cases with sex data) were interviewed; among 2683 cases with race data, there were 110 Asian individuals (3.9%), 1476 Black individuals (52.7%), and 817 White individuals (29.2%), and among 2667 cases with ethnicity data, there were 366 Hispanic individuals (13.1%) and 2301 individuals who were not Hispanic (82.6%). Most individuals lived in a household with 2 to 5 people (2125 of 2904 individuals with household data [71.6%]). Of 3222 unique contacts, 1780 close contacts (55.2%; median [range] age, 40 [18-97] years; 866 [55.3%] women among 1565 contacts with sex data) were interviewed; among 1523 contacts with race data, there were 69 Asian individuals (4.2%), 705 Black individuals (43.2%), and 573 White individuals (35.1%), and among 1514 contacts with ethnicity data, there were 202 Hispanic individuals (12.8%) and 1312 individuals (83.4%) who were not Hispanic. Most contacts lived in a household with 2 to 5 people (1123 of 1418 individuals with household data [79.2%]). Of 3324 cases and contacts who completed a questionnaire on unmet social needs, 907 (27.3%) experienced material hardships that would make it difficult for them to isolate or quarantine safely. Such hardship was significantly less common among White compared with Black participants (odds ratio, 0.20; 95% CI, 0.16-0.25).Conclusions and RelevanceThese findings demonstrate the feasibility and challenges of implementing a case investigation and contact tracing program at an academic health system. In addition to successfully engaging most assigned COVID-19 cases and close contacts, contact tracers shared health information and material resources to support isolation and quarantine, thus filling local public health system gaps and supporting local pandemic control.

Background: Patients who are discharged from the emergency department (ED) after an encounter for acute heart failure are at high risk for return hospitalization. These patients may benefit from timely outpatient follow-up care to reassess volume status, adjust medications, and reinforce self-care strategies. This study examines the incidence of outpatient follow-up care after ED encounters for acute heart failure and describes patient characteristics associated with obtaining timely follow-up care. Methods: We conducted a retrospective cohort study using an administrative claims database for a large US commercial insurer, from January 1, 2012 to June 30, 2019. Participants included adult patients discharged from the ED with principal diagnosis of acute heart failure. The primary outcome was obtaining an in-person outpatient clinic visit for heart failure within 30 days. We also examined the competing risk of all-cause hospitalization within 30 days and without an intervening outpatient clinic visit. We estimated competing risk regression models to identify patient characteristics associated with obtaining outpatient follow-up and report cause-specific hazard ratios. Results: The cohort included 52 732 patients, with mean age of 73.9 years (95% CI, 73.8–74.0) and 27 395 (52.0% [95% CI, 51.5–52.4]) female patients. Within 30 days of the ED encounter, 12 279 (23.2%) patients attended an outpatient clinic visit for heart failure, with 8382 (15.9%) patients hospitalized before they could obtain an outpatient clinic visit. In the adjusted analysis, patients that were younger, women, reporting non-Hispanic Black race, and had fewer previous clinic visits were less likely to obtain outpatient follow-up care. Conclusions: Few patients obtain timely outpatient follow-up after ED visits for heart failure, although nearly 20% require hospitalization within 30 days. Improved transitions following discharge from the ED may represent an opportunity to improve outcomes for patients with acute heart failure.

BACKGROUND: Among adults with in-hospital cardiac arrest (IHCA), overall survival is lower in black patients compared to white patients. Data regarding racial differences in survival for pediatric IHCA are unknown. METHODS: Using 2000–2017 data from the American Heart Association Get With the Guidelines-Resuscitation® registry, we identified children >24 hours and < 18 years of age with IHCA due to an initial pulseless rhythm. We used generalized estimation equation to examine the association of black race with survival to hospital discharge, return of spontaneous circulation (ROSC), and favorable neurologic outcome at discharge. RESULTS: Overall, 2940 pediatric patients (898 black, 2042 white) at 224 hospitals with IHCA were included. The mean age was 3.0 years, 57% were male and 16% had an initial shockable rhythm. Age, sex, interventions in place at the time of arrest and cardiac arrest characteristics did not differ significantly by race. The overall survival to discharge was 36.9%, return of spontaneous circulation (ROSC) was 73%, and favorable neurologic survival was 20.8%. Although black race was associated with lower rates of ROSC compared to white patients (69.5% in blacks vs. 74.6% in whites; risk-adjusted OR 0.79, 95% CI 0.67 – 0.94, P= 0.016), black race was not associated with survival to discharge (34.7% in blacks vs. 37.8% in whites; risk-adjusted OR 0.96, 95% CI 0.80 – 1.15, P=0.68) or favorable neurologic outcome (18.7% in blacks vs. 21.8% in whites, risk-adjusted OR 0.98, 95% CI 0.80–1.20, p=0.85). CONCLUSIONS: In contrast to adults, we did not find evidence for racial differences in survival outcomes following IHCA among children.

BACKGROUND Burnout and the mental health burden of the COVID-19 pandemic have disproportionately impacted health care workers. The links between state policies, federal regulations, COVID-19 case counts, strains on health care systems, and the mental health of health care workers continue to evolve. The language used by state and federal legislators in public-facing venues such as social media is important, as it impacts public opinion and behavior, and it also reflects current policy-leader opinions and planned legislation. OBJECTIVE The objective of this study was to examine legislators’ social media content on Twitter and Facebook throughout the COVID-19 pandemic to thematically characterize policy makers’ attitudes and perspectives related to mental health and burnout in the health care workforce. METHODS Legislators’ social media posts about mental health and burnout in the health care workforce were collected from January 2020 to November 2021 using Quorum, a digital database of policy-related documents. The total number of relevant social media posts per state legislator per calendar month was calculated and compared with COVID-19 case volume. Differences between themes expressed in Democratic and Republican posts were estimated using the Pearson chi-square test. Words within social media posts most associated with each political party were determined. Machine-learning was used to evaluate naturally occurring themes in the burnout- and mental health–related social media posts. RESULTS A total of 4165 social media posts (1400 tweets and 2765 Facebook posts) were generated by 2047 unique state and federal legislators and 38 government entities. The majority of posts (n=2319, 55.68%) were generated by Democrats, followed by Republicans (n=1600, 40.34%). Among both parties, the volume of burnout-related posts was greatest during the initial COVID-19 surge. However, there was significant variation in the themes expressed by the 2 major political parties. Themes most correlated with Democratic posts were (1) frontline care and burnout, (2) vaccines, (3) COVID-19 outbreaks, and (4) mental health services. Themes most correlated with Republican social media posts were (1) legislation, (2) call for local action, (3) government support, and (4) health care worker testing and mental health. CONCLUSIONS State and federal legislators use social media to share opinions and thoughts on key topics, including burnout and mental health strain among health care workers. Variations in the volume of posts indicated that a focus on burnout and the mental health of the health care workforce existed early in the pandemic but has waned. Significant differences emerged in the content posted by the 2 major US political parties, underscoring how each prioritized different aspects of the crisis.

Background Racial disparities in survival among patients who had an in-hospital cardiac arrest (IHCA) have been linked to hospital-level factors. Objectives To determine whether nurse staffing is associated with survival disparities after IHCA. Research design Cross-sectional data from (1) the American Heart Association's Get With the Guidelines-Resuscitation database; (2) the University of Pennsylvania Multi-State Nursing Care and Patient Safety Survey; and (3) The American Hospital Association annual survey. Risk-adjusted logistic regression models, which took account of the hospital and patient characteristics, were used to determine the association of nurse staffing and survival to discharge for black and white patients. Subjects A total of 14,132 adult patients aged 18 and older between 2004 and 2010 in 75 hospitals in 4 states. Results In models that accounted for hospital and patient characteristics, the odds of survival to discharge was lower for black patients than white patients [odds ratio (OR)=0.70; 95% confidence interval (CI), 0.61-0.82]. A significant interaction was found between race and medical-surgical nurse staffing for survival to discharge, such that each additional patient per nurse lowered the odds of survival for black patients (OR=0.92; 95% CI, 0.87-0.97) more than white patients (OR=0.97; 95% CI, 0.93-1.00). Conclusions Our findings suggest that disparities in IHCA survival between black and white patients may be linked to the level of medical-surgical nurse staffing in the hospitals in which they receive care and that the benefit of being admitted to hospitals with better staffing may be especially pronounced for black patients.

Highlights • COVID-19 pandemic has changed the risk-benefit balance for cardiopulmonary resuscitation [CPR]. • Amongst many aerosol producing procedures performed on patients, CPR is a highly aerosol-generating procedure. • Available literature is inadequate to direct clinicians towards keeping low or high threshold for performing CPR in COVID-19 patient.

Aim of the study Since over 80% of sudden cardiac arrests occur in the home, cardiopulmonary resuscitation (CPR) training for family members of high-risk cardiac patients represents a promising intervention. The use of mobile application-based (mApp) CPR training may facilitate this approach, but evidence regarding its efficacy is lacking. Methods We conducted a multicenter, pragmatic, cluster-randomized trial assessing CPR training for family members of cardiac patients. The interventions were mApp (video, no manikin) and VSI (video + manikin). CPR skills were evaluated 6-months post-training. We hypothesized that chest compression (CC) rate from training with an mApp would be no worse than 5 compressions per minute (CPM) lower compared to VSI. Results From 01/2016 to 01/2018, we enrolled 1325 eligible participants (mean age 51.6 years, 68.2% female and 59.4% white). CPR skills were evaluated 6-months post-training in 541 participants (275 VSI, 266 mApp). Mean rate was 84.6 CPM (95% CI: 80.4, 88.6) in VSI, compared to 82.7 CPM (95% CI: 76.2, 89.1) in the mApp, and mean depth was 42.1 mm (95% CI: 40.3, 43.8) in VSI, compared to 38.9 mm (95% CI: 36.2, 41.6) in the mApp. After adjustment, the mean difference in CC rate was −2.3 CPM (95% CI −9.4, 4.8, p = 0.25, non-inferiority) and CC depth was −3.2 mm (95% CI −5.9, 0.1, p = 0.056). Conclusion In this large prospective trial of CPR skill retention for family members of cardiac patients, mApp training was associated with lower CC quality. Future work is required to understand additional approaches to improve CPR skill retention. Clinical Trial Registration URL: ClinicalTrials.gov, Identifier: NCT02548793 .

OBJECTIVES: To describe the content of reviews submitted on Yelp that pertain to nursing home physicians. DESIGN: Retrospective qualitative study. SETTING AND PARTICIPANTS: US nursing homes reviewed on Yelp in 2009 - 2018 with reviews that discussed nursing home physicians (N=375 nursing homes in 31 states). MEASUREMENTS: Content analysis was performed to detect recurrent themes and divergent ideas about nursing home physicians perceived by reviewers. RESULTS: Average rating among nursing homes with physician reviews was 2.0 (standard deviation 1.5, range 1-5). The major themes from content analysis of reviews that discussed physicians were perceived attitudes of clinicians toward patients and caregivers, physician communication with patients or caregivers, and perceived clinical expertise of the physicians. CONCLUSION: Unsolicited online reviews of nursing homes that comment on patient and caregiver perceptions of physician care represent a small but growing number of online comments about nursing home. These reviews contain important information about aspects of physician care valued by nursing home patients and caregivers. However, the sample of comments about physicians represents a small proportion of online reviews and is not representative of all nursing homes. As online reviews grow in number and become more representative, these data could be used by physicians to improve perceptions of their care by the NH patients and their families, and by NHs to inform expectations of their medical director and attending physicians.

Little is known about how discrimination in health care relates to inequities in hospital-based care because of limitations in the ability to measure discrimination. Consumer reviews offer a novel source of data to capture experiences of discrimination in health care settings.To examine how health care consumers perceive and report discrimination through public consumer reviews.This qualitative study assessed Yelp online reviews from January 1, 2011, to December 31, 2020, of 100 randomly selected acute care hospitals in the US. Word filtering was used to identify reviews potentially related to discrimination by using keywords abstracted from the Everyday Discrimination Scale, a commonly used questionnaire to measure discrimination. A codebook was developed through a modified grounded theory and qualitative content analysis approach to categorize recurrent themes of discrimination, which was then applied to the hospital reviews.Reported experiences of discrimination within a health care setting.Perceptions of how discrimination in health care is experienced and reported by consumers.A total of 10 535 reviews were collected. Reviews were filtered by words commonly associated with discriminatory experiences, which identified 2986 reviews potentially related to discrimination. Using the codebook, the team manually identified 182 reviews that described at least 1 instance of discrimination. Acts of discrimination were categorized by actors of discrimination (individual vs institution), setting (clinical vs nonclinical), and directionality (whether consumers expressed discriminatory beliefs toward health care staff). A total of 53 reviews (29.1%) were coded as examples of institutional racism; 89 reviews (48.9%) mentioned acts of discrimination that occurred in clinical spaces as consumers were waiting for or actively receiving care; 25 reviews (13.7%) mentioned acts of discrimination that occurred in nonclinical spaces, such as lobbies; and 66 reviews (36.3%) documented discrimination by the consumer directed at the health care workforce. Acts of discrimination are described through 6 recurrent themes, including acts of commission, omission, unprofessionalism, disrespect, stereotyping, and dehumanizing.In this qualitative study, consumer reviews were found to highlight recurrent patterns of discrimination within health care settings. Applying quality improvement tools, such as the Plan-Do-Study-Act cycle, to this source of data and this study's findings may help inform assessments and initiatives directed at reducing discrimination within the health care setting.

ImportanceDigital health information has many potential health applications, but privacy is a growing concern among consumers and policy makers. Consent alone is increasingly seen as inadequate to safeguard privacy.ObjectiveTo determine whether different privacy protections are associated with consumers’ willingness to share their digital health information for research, marketing, or clinical uses.Design, Setting, and ParticipantsThis 2020 national survey with an embedded conjoint experiment recruited US adults from a nationally representative sample with oversampling of Black and Hispanic individuals. Willingness to share digital information across 192 different scenarios reflecting the product of 4 possible privacy protections, 3 uses of information, 2 users of information, and 2 sources of digital information was evaluated. Each participant was randomly assigned 9 scenarios. The survey was administrated between July 10 and July 31, 2020, in Spanish and English. Analysis for this study was conducted between May 2021 and July 2022.Main Outcomes and MeasuresParticipants rated each conjoint profile on a 5-point Likert scale measuring their willingness to share their personal digital information (with 5 indicating the most willingness to share). Results are reported as adjusted mean differences.ResultsOf the 6284 potential participants, 3539 (56%) responded to the conjoint scenarios. A total of 1858 participants (53%) were female, 758 (21%) identified as Black, 833 (24%) identified as Hispanic, 1149 (33%) had an annual income less than $50 000, and 1274 (36%) were 60 years or older. Participants were more willing to share health information with the presence of each individual privacy protection, including consent (difference, 0.32; 95% CI, 0.29-0.35; P P P P Conclusions and RelevanceIn this survey study of a nationally representative sample of US adults, consumers’ willingness to share personal digital health information for health purposes was associated with the presence of specific privacy protections beyond consent alone. Additional protections, including data transparency, oversight, and data deletion may strengthen consumer confidence in sharing their personal digital health information.

Background Burnout and the mental health burden of the COVID-19 pandemic have disproportionately impacted health care workers. The links between state policies, federal regulations, COVID-19 case counts, strains on health care systems, and the mental health of health care workers continue to evolve. The language used by state and federal legislators in public-facing venues such as social media is important, as it impacts public opinion and behavior, and it also reflects current policy-leader opinions and planned legislation. Objective The objective of this study was to examine legislators’ social media content on Twitter and Facebook throughout the COVID-19 pandemic to thematically characterize policy makers’ attitudes and perspectives related to mental health and burnout in the health care workforce. Methods Legislators’ social media posts about mental health and burnout in the health care workforce were collected from January 2020 to November 2021 using Quorum, a digital database of policy-related documents. The total number of relevant social media posts per state legislator per calendar month was calculated and compared with COVID-19 case volume. Differences between themes expressed in Democratic and Republican posts were estimated using the Pearson chi-square test. Words within social media posts most associated with each political party were determined. Machine-learning was used to evaluate naturally occurring themes in the burnout- and mental health–related social media posts. Results A total of 4165 social media posts (1400 tweets and 2765 Facebook posts) were generated by 2047 unique state and federal legislators and 38 government entities. The majority of posts (n=2319, 55.68%) were generated by Democrats, followed by Republicans (n=1600, 40.34%). Among both parties, the volume of burnout-related posts was greatest during the initial COVID-19 surge. However, there was significant variation in the themes expressed by the 2 major political parties. Themes most correlated with Democratic posts were (1) frontline care and burnout, (2) vaccines, (3) COVID-19 outbreaks, and (4) mental health services. Themes most correlated with Republican social media posts were (1) legislation, (2) call for local action, (3) government support, and (4) health care worker testing and mental health. Conclusions State and federal legislators use social media to share opinions and thoughts on key topics, including burnout and mental health strain among health care workers. Variations in the volume of posts indicated that a focus on burnout and the mental health of the health care workforce existed early in the pandemic but has waned. Significant differences emerged in the content posted by the 2 major US political parties, underscoring how each prioritized different aspects of the crisis.

ImportanceAlthough objective data are used routinely in prescription drug recommendations, it is unclear how referring physicians apply evidence when making surgeon or hospital recommendations for surgery.ObjectiveTo compare the factors associated with the hospital or surgeon referral decision-making process with that used for prescription medication recommendations.Design, Setting, and ParticipantsThis qualitative study comprised interviews conducted between April 26 and May 18, 2021, of a purposive sample of 21 primary care physicians from a large primary care network in the Northeast US.Main Outcomes and MeasuresMain outcomes were the factors considered when making prescription medication recommendations vs referral recommendations to specific surgeons or hospitals for surgery.ResultsAll 21 participant primary care physicians (14 women [66.7%]) reported use of evidence-based decision support tools and patient attributes for prescription medication recommendations. In contrast, for surgeon and hospital referral recommendations, primary care physicians relied on professional experience and training, personal beliefs about surgical quality, and perceived convenience. Primary care physicians cited perceived limitations of existing data on surgical quality as a barrier to the use of such data in the process of making surgical referrals.Conclusions and RelevanceAs opposed to the widespread use of objective decision support tools for guidance on medication recommendations, primary care physicians relied on subjective factors when making referrals to specific surgeons and hospitals. The findings of this study highlight the potential to improve surgical outcomes by introducing accessible, reliable data as an imperative step in the surgical referral process.

Background Online platforms are used to manage aspects of our lives including health outside clinical settings. Little is known about the effectiveness of using online platforms to manage hypertension. We assessed effects of tweeting/retweeting cardiovascular health content by individuals with poorly controlled hypertension on systolic blood pressure (SBP) and patient activation. Methods and Results We conducted this 2‐arm randomized controlled trial. Eligibility included diagnosis of hypertension; SBP >140 mm Hg; and an existing Twitter account or willingness to create one to follow study Twitter account. Intervention arm was asked to tweet/retweet health content 2×/week using a specific hashtag for study duration (6 months). The main measures include primary outcome change in SBP; secondary outcome point change in Patient Activation Measure (PAM). We remotely recruited and enrolled 611 participants, mean age 52 (SD, 11.7). Mean baseline SBP for the intervention group was 155.8 and for control was 155.6. At 6 months, mean SBP for intervention group was 137.6 and for control was 135.7. Mean change in SBP from baseline to 6 months for the intervention group was −18.5 and for control was −19.8 (P =0.48). Mean PAM at baseline for the intervention group was 70.3 for control was 72.7. At 6 months, mean PAM scores were 71.1 (intervention) and 75.6 (control). Mean change in PAM score for the intervention group was 0.0 and for control was 3.3 ( P =0.12). Conclusions Recruiting and engaging patients and collecting outcome measures remotely are feasible using Twitter. Encouraging patients with poorly controlled hypertension to tweet or retweet health content on Twitter did not improve SBP or PAM score at 6 months. Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02622256.

Background Incorporating insights from social media into the patient-provider encounter is increasingly being explored in health care settings. Less is known about the utility of these data in mental health therapy. Objective This study aims to prospectively investigate and characterize how social media and digital data are used in mental health therapy from both the patient and mental health therapist perspective. Methods Patients enrolled in mental health therapy and mental health therapists were interviewed using a semistructured interview guide. All interviews were transcribed and coded using a deductive framework analysis. Themes and subthemes were identified. Participants completed a sociodemographic survey, while mental health therapists also completed a behavioral norms and elicitation survey. Results Seventeen participants, that is, 8 (48%) mental health therapists and 9 (52%) patients were interviewed. Overall, participants identified 4 themes and 9 subthemes. Themes were current data collection practices, social media and digital data in therapy, advantages of social media and digital data in therapy, and disadvantages of social media and digital data in therapy. Most subthemes were related to the advantages and disadvantages of incorporating digital data in mental health therapy. Advantage subthemes included convenience, objective, builds rapport, and user-friendliness while disadvantage subthemes were nonreflective, ethically ambiguous, and nongeneralizable. The mental health therapists' behavioral norms and elicitation survey found that injunctive and descriptive normative beliefs mapped onto 2 advantage subthemes: convenience and objectivity. Conclusions This qualitative pilot study established the advantages and disadvantages of social media and digital data use in mental health therapy. Patients and therapists highlighted similar concerns and uses. This study indicated that overall, both patients and therapists are interested in and are comfortable to use and discuss social media and digital data in mental health therapy.

BACKGROUND Incorporating insights from social media into the patient-provider encounter is increasingly being explored in health care settings. Less is known about the utility of these data in mental health therapy. OBJECTIVE This study aims to prospectively investigate and characterize how social media and digital data are used in mental health therapy from both the patient and mental health therapist perspective. METHODS Patients enrolled in mental health therapy and mental health therapists were interviewed using a semistructured interview guide. All interviews were transcribed and coded using a deductive framework analysis. Themes and subthemes were identified. Participants completed a sociodemographic survey, while mental health therapists also completed a behavioral norms and elicitation survey. RESULTS Seventeen participants, that is, 8 (48%) mental health therapists and 9 (52%) patients were interviewed. Overall, participants identified 4 themes and 9 subthemes. Themes were current data collection practices, social media and digital data in therapy, advantages of social media and digital data in therapy, and disadvantages of social media and digital data in therapy. Most subthemes were related to the advantages and disadvantages of incorporating digital data in mental health therapy. Advantage subthemes included convenience, objective, builds rapport, and user-friendliness while disadvantage subthemes were nonreflective, ethically ambiguous, and nongeneralizable. The mental health therapists' behavioral norms and elicitation survey found that injunctive and descriptive normative beliefs mapped onto 2 advantage subthemes: convenience and objectivity. CONCLUSIONS This qualitative pilot study established the advantages and disadvantages of social media and digital data use in mental health therapy. Patients and therapists highlighted similar concerns and uses. This study indicated that overall, both patients and therapists are interested in and are comfortable to use and discuss social media and digital data in mental health therapy.

BACKGROUND The COVID-19 pandemic has placed strains on communities. During this public health crisis, health systems have created remote methods of monitoring symptom progression and delivering care virtually. OBJECTIVE Using an SMS text message-based system, we sought to build and test a remote model to explore community needs, connect individuals to curated resources, and facilitate community health worker intervention when needed during the pandemic. The primary aims of this pilot study were to establish the feasibility (ie, engagement with the text line) and acceptability (ie, participant ratings of resources and service) of delivering automated well-being resources via smartphone technology. METHODS Eligible patients (aged 18 years or older, having a cell phone with SMS text messaging capability, and recently visited the emergency department) were identified using the electronic health record. The patients were consented to enroll and begin receiving COVID-19–related information and links to community resources. We collected open-ended and close-ended resource and mood ratings. We calculated the frequencies and conducted a thematic review of the open-ended responses. RESULTS In 7 weeks, 356 participants were enrolled; 13,917 messages were exchanged including 333 resource ratings (mean 4) and 673 well-being scores (mean 6.8). We received and coded 386 open-ended responses, most of which elaborated upon their self-reported mood score (29%). Overall, 77% (n=274) of our participants rated the platform as a service they would highly recommend to a family member or friend. CONCLUSIONS This approach is designed to broaden the reach of health systems, tailor to community needs in real time, and connect at-risk individuals with robust community health support.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Systemic amyloidosis – which causes organ dysfunction by extracellular deposition of misfolded protein fibrils into various organs – is substantially underdiagnosed. Recent breakthroughs in highly ...

Despite the importance of high-quality and patient-centered substance use disorder treatment, there are no standardized ratings of specialized drug treatment facilities and their services. Online platforms offer insights into potential drivers of high and low patient experience. We sought to analyze publicly available online review content of specialized drug treatment facilities and identify themes within high and low ratings. This was a retrospective analysis of online ratings and reviews of specialized drug treatment facilities in Pennsylvania listed within the 2016 National Directory of Drug and Alcohol Abuse Treatment Facilities. Latent Dirichlet Allocation, a machine learning approach to narrative text, was used to identify themes within reviews. Differential Language Analysis was then used to measure correlations between themes and star ratings. Online reviews of Pennsylvania’s specialized drug treatment facilities posted to Google and Yelp (July 2010–August 2018). A total of 7823 online ratings were posted over 8 years. The distribution was bimodal (43% 5-star and 34% 1-star). The average weighted rating of a facility was 3.3 stars. Online themes correlated with 5-star ratings were the following: focus on recovery (r = 0.53), helpfulness of staff (r = 0.43), compassionate care (r = 0.37), experienced a life-changing moment (r = 0.32), and staff professionalism (r = 0.29). Themes correlated with a 1-star rating were waiting time (r = 0.41), poor accommodations (0.26), poor phone communication (r = 0.24), medications given (0.24), and appointment availability (r = 0.23). Themes derived from review content were similar to 9 of the 14 facility-level services highlighted by the Substance Abuse and Mental Health Services Administration’s National Survey of Substance Abuse Treatment Services. Individuals are sharing their ratings and reviews of specialized drug treatment facilities on online platforms. Organically derived reviews of the patient experience, captured by online platforms, reveal potential drivers of high and low ratings. These represent additional areas of focus which can inform patient-centered quality metrics for specialized drug treatment facilities.

Objective To assess the availability and price of naloxone as well as pharmacy staff knowledge of the standing order for naloxone in Pennsylvania pharmacies. Methods We conducted a telephone audit study from December 2016 to April 2017 in which staff from Pennsylvania pharmacies were surveyed to evaluate naloxone availability, staff understanding of the naloxone standing order, and out-of-pocket cost of naloxone. Results Responses were obtained from 682 of 758 contacted pharmacies (90% response rate). Naloxone was stocked (ie, available for dispensing) in 306 (45%) pharmacies surveyed. Of the 376 (55%) pharmacies that did not stock naloxone, 118 (31%) stated that they could place an order for naloxone for pickup within 1 business day. Responses by pharmacy staff to questions about key components of the standing order for naloxone were collected from 581 of the 682 pharmacies who participated in the survey (85%). Of the 581 pharmacy staff members who stated that they either stocked or could order naloxone, 64% correctly answered all questions pertaining to understanding of the naloxone standing order. The respective median out-of-pocket prices stated in the audit varied by formulation and ranged from $50 to $4000. Staff from national pharmacies were significantly more likely than staff from regional/local chain and non-chain pharmacies to correctly answer that a prescription was not required to obtain naloxone (68.5%, 57.7%, and 52.4% respectively, (P = 0.0045). Conclusions Multiple barriers to naloxone access exist in pharmacies across a large, diverse state, despite the presence of a standing order to facilitate such access. Limited availability of naloxone in pharmacies, lack of knowledge or understanding by pharmacy staff of the standing order, and variability in out-of-pocket cost for this drug are among these potential barriers. Regulatory or legal incentives for pharmacies or drug manufacturers, education efforts directed toward pharmacy staff members, or other interventions may be needed to increase naloxone availability in pharmacies.

IMPORTANCE: Pulse oximetry guides triage and therapy decisions for COVID-19. Whether reported racial inaccuracies in oxygen saturation measured by pulse oximetry are present in patients with COVID-19 and associated with treatment decisions is unknown. OBJECTIVE: To determine whether there is differential inaccuracy of pulse oximetry by race or ethnicity among patients with COVID-19 and estimate the association of such inaccuracies with time to recognition of eligibility for oxygen threshold–specific COVID-19 therapies. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study of clinical data from 5 referral centers and community hospitals in the Johns Hopkins Health System included patients with COVID-19 who self-identified as Asian, Black, Hispanic, or White. EXPOSURES: Concurrent measurements (within 10 minutes) of oxygen saturation levels in arterial blood (SaO(2)) and by pulse oximetry (SpO(2)). MAIN OUTCOMES AND MEASURES: For patients with concurrent SpO(2) and SaO(2) measurements, the proportion with occult hypoxemia (SaO(2)

Background In 2020, the number of internet users surpassed 4.6 billion. Individuals who create and share digital data can leave a trail of information about their habits and preferences that collectively generate a digital footprint. Studies have shown that digital footprints can reveal important information regarding an individual’s health status, ranging from diet and exercise to depression. Uses of digital applications have accelerated during the COVID-19 pandemic where public health organizations have utilized technology to reduce the burden of transmission, ultimately leading to policy discussions about digital health privacy. Though US consumers report feeling concerned about the way their personal data is used, they continue to use digital technologies. Objective This study aimed to understand the extent to which consumers recognize possible health applications of their digital data and identify their most salient concerns around digital health privacy. Methods We conducted semistructured interviews with a diverse national sample of US adults from November 2018 to January 2019. Participants were recruited from the Ipsos KnowledgePanel, a nationally representative panel. Participants were asked to reflect on their own use of digital technology, rate various sources of digital information, and consider several hypothetical scenarios with varying sources and health-related applications of personal digital information. Results The final cohort included a diverse national sample of 45 US consumers. Participants were generally unaware what consumer digital data might reveal about their health. They also revealed limited knowledge of current data collection and aggregation practices. When responding to specific scenarios with health-related applications of data, they had difficulty weighing the benefits and harms but expressed a desire for privacy protection. They saw benefits in using digital data to improve health, but wanted limits to health programs’ use of consumer digital data. Conclusions Current privacy restrictions on health-related data are premised on the notion that these data are derived only from medical encounters. Given that an increasing amount of health-related data is derived from digital footprints in consumer settings, our findings suggest the need for greater transparency of data collection and uses, and broader health privacy protections.

Opioid overdose is the leading cause of death for Americans 25 to 64 years of age, and opioid use disorder affects >2 million Americans. The epidemiology of opioid-associated out-of-hospital cardiac arrest in the United States is changing rapidly, with exponential increases in death resulting from synthetic opioids and linear increases in heroin deaths more than offsetting modest reductions in deaths from prescription opioids. The pathophysiology of polysubstance toxidromes involving opioids, asphyxial death, and prolonged hypoxemia leading to global ischemia (cardiac arrest) differs from that of sudden cardiac arrest. People who use opioids may also develop bacteremia, central nervous system vasculitis and leukoencephalopathy, torsades de pointes, pulmonary vasculopathy, and pulmonary edema. Emergency management of opioid poisoning requires recognition by the lay public or emergency dispatchers, prompt emergency response, and effective ventilation coupled to compressions in the setting of opioid-associated out-of-hospital cardiac arrest. Effective ventilation is challenging to teach, whereas naloxone, an opioid antagonist, can be administered by emergency medical personnel, trained laypeople, and the general public with dispatcher instruction to prevent cardiac arrest. Opioid education and naloxone distributions programs have been developed to teach people who are likely to encounter a person with opioid poisoning how to administer naloxone, deliver high-quality compressions, and perform rescue breathing. Current American Heart Association recommendations call for laypeople and others who cannot reliably establish the presence of a pulse to initiate cardiopulmonary resuscitation in any individual who is unconscious and not breathing normally; if opioid overdose is suspected, naloxone should also be administered. Secondary prevention, including counseling, opioid overdose education with take-home naloxone, and medication for opioid use disorder, is important to prevent recurrent opioid overdose.

Digital health and technologies are essential to curbing the novel coronavirus 2019 (COVID-19) pandemic especially with shelter-in-place and social distancing orders. Epidemiologists and public health officials are tapping into frequently used technologies like wearables, digital devices, digital and social media data to detect and validate COVID-19 symptoms throughout the pandemic, especially during early stages when symptoms were evolving. In this article, we review how digital technologies and social media platforms can identify and inform our understanding of COVID-19 pandemic surveillance and recovery efforts. We analyze Reddit narrative posts and comments on r/covidlonghaulers to demonstrate how social media can be used to better understand COVID-19 pandemic. Using Reddit data, we highlight long haulers' patient journeys and shed light on potential consequences of their condition. We identified 21 themes, of which the following were significantly associated with valence: COVID-19 Symptoms (r = -0.037), medical advice (r = -0.030), medical system (r = -0.029), bodily processes (r = -0.020), questions (r = 0.024), physical activity (r = 0.033), self-differentials and negations (r = 0.040) and supplements (r = 0.025). Our brief literature review and analysis of r/covidlonghaulers narrative posts demonstrate the value of digital technologies and social media platforms as they act as modern avenues for public health, safety, and well-being.

The speed at which social media is propagating COVID-19 misinformation and its potential reach and impact is growing, yet little work has focused on the potential applications of these data for informing public health communication about COVID-19 vaccines. We used Twitter to access a random sample of over 78 million vaccine-related tweets posted between December 1, 2020 and February 28, 2021 to describe the geographical and temporal variation in COVID-19 vaccine discourse. Urban suburbs posted about equitable distribution in communities, college towns talked about in-clinic vaccinations near universities, evangelical hubs posted about operation warp speed and thanking God, exurbs posted about the 2020 election, Hispanic centers posted about concerns around food and water, and counties in the ACP African American South posted about issues of trust, hesitancy, and history. The graying America ACP community posted about the federal government's failures; rural middle American counties posted about news press conferences. Topics related to allergic and adverse reactions, misinformation around Bill Gates and China, and issues of trust among Black Americans in the healthcare system were more prevalent in December, topics related to questions about mask wearing, reaching herd immunity and natural infection, and concerns about nursing home residents and workers increased in January, and themes around access to black communities, waiting for appointments, keeping family safe by vaccinating and fighting online misinformation campaigns were more prevalent in February. Twitter discourse around COVID-19 vaccines in the United States varied significantly across different communities and changed over time; these insights could inform targeted messaging and mitigation strategies.

BACKGROUND In 2020, the number of internet users surpassed 4.6 billion. Individuals who create and share digital data can leave a trail of information about their habits and preferences that collectively generate a digital footprint. Studies have shown that digital footprints can reveal important information regarding an individual’s health status, ranging from diet and exercise to depression. Uses of digital applications have accelerated during the COVID-19 pandemic where public health organizations have utilized technology to reduce the burden of transmission, ultimately leading to policy discussions about digital health privacy. Though US consumers report feeling concerned about the way their personal data is used, they continue to use digital technologies. OBJECTIVE This study aimed to understand the extent to which consumers recognize possible health applications of their digital data and identify their most salient concerns around digital health privacy. METHODS We conducted semistructured interviews with a diverse national sample of US adults from November 2018 to January 2019. Participants were recruited from the Ipsos KnowledgePanel, a nationally representative panel. Participants were asked to reflect on their own use of digital technology, rate various sources of digital information, and consider several hypothetical scenarios with varying sources and health-related applications of personal digital information. RESULTS The final cohort included a diverse national sample of 45 US consumers. Participants were generally unaware what consumer digital data might reveal about their health. They also revealed limited knowledge of current data collection and aggregation practices. When responding to specific scenarios with health-related applications of data, they had difficulty weighing the benefits and harms but expressed a desire for privacy protection. They saw benefits in using digital data to improve health, but wanted limits to health programs’ use of consumer digital data. CONCLUSIONS Current privacy restrictions on health-related data are premised on the notion that these data are derived only from medical encounters. Given that an increasing amount of health-related data is derived from digital footprints in consumer settings, our findings suggest the need for greater transparency of data collection and uses, and broader health privacy protections.