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Little attention has been paid to health inequities designed into the physical spaces themselves. Clearly design is an important part of patient care. Design is simultaneously a complex system itself while existing as part of a larger complex (healthcare) system. For example, it is not enough to say that a patient experiences more stress because she/he is being treated in a hospital in a lower income area. The key, here, is that evidence demonstrates design as an important component, systemically, in healthcare. We know this to be true and base re-design efforts on this fact, but only in certain places. The central addition of this study is to point out that hospitals in higher income areas utilize the waiting room’s ecology and its influence on patient stress and care. Efforts to intervene, through design, in waiting room ecology have consequences to equitable access to healthcare. Therefore, this study examines the implications of health inequities designed-into physical space. Additionally, this study seeks to forefront the influence communication ecologies have in addressing health inequities. Innovations in addressing mental health needs in humanitarian settings: A complexity informed Action Research Case Study. Frontiers in Communication: Health Communication. 10.3389/fcomm.2020.601792 para 19, 2020). Thus, the purpose of this paper is to investigate, but also articulate, the ways design decisions impact people unequally and perpetuate health inequalities. To do so, this study investigates the communication ecologies of waiting rooms and their influence on patient stress and health equity and elucidates under-examined systemic components patient stress and well-being.

Rationale & Objective: Electronic health record portals are increasingly emphasized in chronic kidney disease (CKD). However, associations of portal use with clinical and patient-centered outcomes remain unknown. Study Design: Cross-sectional survey (April 2015 to March 2018). Setting & Participants: Nondialysis patients with CKD from nephrology clinics within 1 academic medical center. Exposures: Patient demographics (age, sex, race, ethnicity, education, and income), kidney function. Outcomes: Association between portal use as an outcome and exposures. Additionally, associations of portal use and patient demographics with 4 patient–centered outcomes (CKD-specific knowledge, stress, and 2 self-ratings of health). Analytic Approach: Logistic regression to examine associations between patient portal use, demographics, and kidney function. Linear regression to examine associations between portal use and patient-centered outcomes. Results: Of 245 participants, mean age was 60 ± 17 (SD) years, 182 (77%) were White, 121 (49%) were women, 230 (96%) had a high school education or higher, and 96 (45%) had

Patient experience is a widely used indicator for assessing the quality-of-care process during a patient's journey in hospital. However, the literature rarely discusses three components: patient stress, anxiety, and frustration. Furthermore, little is known about what drives each component during hospital visits. In order to explore this, we utilized data from a patient experience survey, including patient- and provider-related determinants, that was administered at a local hospital in Abu Dhabi, UAE. A machine-learning-based random forest (RF) algorithm, along with its embedded importance analysis function feature, was used to explore and rank the drivers of patient stress, anxiety, and frustration throughout two stages of the patient journey: registration and consultation. The attribute 'age' was identified as the primary patient-related determinant driving patient stress, anxiety, and frustration throughout the registration and consultation stages. In the registration stage, 'total time taken for registration' was the key driver of patient stress, whereas 'courtesy demonstrated by the registration staff in meeting your needs' was the key driver of anxiety and frustration. In the consultation step, 'waiting time to see the doctor/physician' was the key driver of both patient stress and frustration, whereas 'the doctor/physician was able to explain your symptoms using language that was easy to understand' was the main driver of anxiety. The RF algorithm provided valuable insights, showing the relative importance of factors affecting patient stress, anxiety, and frustration throughout the registration and consultation stages. Healthcare managers can utilize and allocate resources to improve the overall patient experience during hospital visits based on the importance of patient- and provider-related determinants.

Rationale & Objective: Electronic health record portals are increasingly emphasized in chronic kidney disease (CKD). However, associations of portal use with clinical and patient-centered outcomes remain unknown., Study Design: Cross-sectional survey (April 2015 to March 2018)., Setting & Participants: Nondialysis patients with CKD from nephrology clinics within 1 academic medical center., Exposures: Patient demographics (age, sex, race, ethnicity, education, and income), kidney function., Outcomes: Association between portal use as an outcome and exposures. Additionally, associations of portal use and patient demographics with 4 patient-centered outcomes (CKD-specific knowledge, stress, and 2 self-ratings of health)., Analytic Approach: Logistic regression to examine associations between patient portal use, demographics, and kidney function. Linear regression to examine associations between portal use and patient-centered outcomes., Results: Of 245 participants, mean age was 60 ± 17 (SD) years, 182 (77%) were White, 121 (49%) were women, 230 (96%) had a high school education or higher, and 96 (45%) had <$50,000 annual income. Examining portal use, 159 (65%) used the portal as follows: checking laboratory test results, 157 (99%); managing appointments, 133 (84%); messaging providers, 131 (82%); viewing medical history, 127 (80%); reviewing educational resources, 113 (71%); and renewing prescriptions, 98 (62%). African Americans (OR, 0.34; 95% CI, 0.16-0.72 vs White patients), patients with less formal education (OR, 0.06; 95% CI, 0.01-0.36), and those with lower income (OR, 0.28; 95% CI, 0.13-0.60; and OR, 0.26; 95% CI, 0.12-0.54 comparing income < $25,000 and $25,000-$50,000, respectively, with ≥$50,000) had lower odds of using the portal. In adjusted analysis, only lower income predicted lower portal use. Examining patient-centered outcomes in univariable analysis, portal users had higher knowledge (β = 4.89; P  = 0.02), higher ratings of current health (β = 0.28; P  = 0.03), and lower CKD-related stress (β = -0.18; P  = 0.05). In adjusted analysis, only patient demographics and/or kidney function remained independent predictors of patient-centered outcomes., Limitations: Cross-sectional study design, cannot determine causality., Conclusions: Interventions are needed to ensure that all patients have access to portals to mitigate disparities in care., (© 2021 The Authors.)