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Alani Torres,1,* Melina Wenke,1,* Cristian Lieneck,1,* Zo Ramamonjiarivelo,1,* Arzu Ari2,* 1School of Health Administration; Texas State University, San Marcos, TX, USA; 2College of Health Professions; Texas State University, San Marcos, TX, USA*These authors contributed equally to this workCorrespondence: Cristian Lieneck, Email clieneck@txstate.eduAbstract: This systematic literature review evaluates the role of machine learning, artificial intelligence (AI), and social determinants of health (SDOH) in identifying loneliness during the COVID-19 pandemic. By examining various studies and articles through a comprehensive search of databases EBSCOhost, Medline Complete, Academic Search Complete, Directory of Open Access Journals, and Complementary Index, the research team sought to discern consistent themes and patterns. We identified four constructs central to understanding the impact of the pandemic on societal well-being: (1) the prediction of compliance with COVID-19 measures, (2) the prediction of loneliness and its effects, (3) the prediction of well-being and social inclusion, and (4) the prediction of drug use. Within these constructs, prevalent themes related to opioid overdose, stress levels, mental health, well-being, and cognitive decline emerged. The adherence to the PRISMA 2020 checklist has resulted in a PRISMA flow diagram that categorizes the selected literature. The findings of this review, including the proportion of studies predicting various attributes related to loneliness, demonstrate the critical intersections between machine learning, AI, SDOH, and the psychosocial phenomenon of loneliness amidst a global health crisis. The review results provide a summary of the occurrences and predictive percentages of each construct as determined by the literature, contributing to a nuanced understanding of the pandemic’s multifaceted impact on loneliness, social isolation, and drug use. Using AI to predict these constructs has remarkable capabilities in identifying individuals at risk and facilitating timely interventions to mitigate adverse outcomes and promote mental health resilience in the face of challenges such as the COVID-19 pandemic. Moving forward, future research is warranted to refine AI algorithms, validate predictive models and utilize AI-based interventions in healthcare and mental health services while ensuring data security, and individuals’ privacy.Keywords: loneliness, social isolation, drug use, COVID-19, pandemic, social déterminants of health, artificial intelligence and machine learning

Background and Objectives: The COVID-19 pandemic has led to significant changes in ambulatory care to meet new healthcare demands. Materials and Methods: A review of 21 articles focusing on patient co-creation initiatives during the pandemic shows that integrating patient feedback was crucial in transforming care delivery. Results: Joint efforts between healthcare professionals and patients led to new patient-focused telemedicine platforms, more efficient appointment systems, and improved safety measures. These adaptations overcame care barriers and maintained continuity of care. Key themes identified include monitoring community health standards, combining technology with patient-provider communication, and enhancing patient participation in health research. Conclusions : These co-creation efforts not only boosted patient satisfaction and outcomes but also demonstrated the potential for long-term healthcare innovations beyond the pandemic. The review further illuminates that co-creation in healthcare, particularly in tracking community health trends, is a practical strategy that involves diverse stakeholders in shaping healthcare delivery. The widespread adoption of co-creation in outpatient care during the pandemic highlights its role in driving patient-centered behavioral changes through innovative methods like crowdsourcing and dialogue conferencing. The review also recognizes that co-creation has been instrumental in responding to demographic changes, enhancing resources, creativity, and problem-solving in municipal-volunteer collaborations. Additionally, the evolution of technology in patient-provider communication, from initial resistance in the 1990s to its current critical role, particularly during the COVID-19 pandemic, underscores its importance in enhancing healthcare service delivery and patient data communication. The review also emphasizes the need for ethically and accessibly designed technology, especially for vulnerable groups, and highlights the significance of patient involvement in healthcare research, advocating for user-centered design and shared decision-making to create truly patient-centric interventions.

In this review, we examine the impact of the Inflation Reduction Act (IRA) of 2022 on pharmaceutical drugs in the United States, drawing on a diverse range of sources to understand the perceptions of multiple stakeholders and professionals. Findings suggest that the Act, while aiming to control price inflation, has had a multifaceted impact on the pharmaceutical sector. Stakeholders, including pharmaceutical companies, healthcare providers, patient advocacy groups, and policymakers, offered varied perspectives: while some laud the Act for its potential in controlling runaway drug prices and making healthcare more accessible, others raise concerns about possible reductions in drug innovation, disruptions to supply chains, and the sustainability of smaller pharmaceutical companies. The review identified four underlying constructs (themes) in the literature surrounding healthcare stakeholders' perceptions of the IRA's impact upon prescription drugs: pricing and/or dictation pricing issues, topics related to patent law and pharmaceuticals, processes surrounding the IRA's (2022) rules and regulations, and potential threats to the pharmaceutical industry concerning the research and development of future medications. The complex interplay of the Act's implications underscores the importance of ongoing assessment and potential iterative policy refinements as implementation endures.

Background and Objectives: Healthcare organizations have endured significant challenges and relied upon telehealth and related technological advances during the COVID-19 pandemic to allow for the sustainment of care. The purpose of this study was to systematically identify healthcare cybersecurity ethical concerns experienced during the pandemic to assist with the sustainability of the delivery of care going forward., Methods: This study was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocols for systematic reviews and focused on cybersecurity in healthcare organizations that published articles during the COVID-19 pandemic (March 2020 through October 2022). The articles were accessed using the EBSCOhost and Pub-Med (which queries MEDLINE) platforms, through which the Academic Search Complete, MEDLINE Complete, and Complementary Index databases were accessed. Follow-on supplementary topic modeling allowed for the additional application of ethical principles to the review findings., Results: Among the 22 articles that met the inclusion criteria, three ethical concerns were identified by the rapid review: smart and medical technology concerns (73% of occurrences), at-risk population cybersecurity (55% of occurrences), and legal challenges in data protection (73% of occurrences). The research team also conducted a latent Dirichlet allocation (LDA) analysis, identifying three topics from the review corpus: robotic and biomedical/clinical care outcomes, diagnostic applications, and public health data usage. These were then mapped to primary ethical healthcare principles., Conclusions: The sustainment of healthcare technology interoperability and related telehealth initiatives involves the ongoing assessment of cybersecurity threats and adequate knowledge of related ethical stakeholder concerns to promote ongoing care delivery.

This rapid review examined facilitators and barriers affecting oral healthcare access and utilization among women and children with a low socioeconomic status (SES) in the United States from 2019 to the present. A comprehensive search was conducted across multiple electronic databases, yielding a total of 30 relevant studies for inclusion. The findings highlight various facilitators that positively impact oral healthcare outcomes, including targeted educational programs, access to non-dental care healthcare services, community-based initiatives, and increased access to affordable oral health services. Conversely, barriers such as financial constraints, lack of access to food program social assistance, access to care difficulties, and limited oral health literacy were identified as major challenges faced by this population. Understanding these facilitators and barriers during the COVID-19 global pandemic can inform the development of tailored interventions and policies aimed at improving oral healthcare outcomes for women and children with a low SES in the United States.

The COVID-19 pandemic has significantly impacted the healthcare industry and its workforce, particularly nurses, who have been at the forefront of patient care. As the world begins to emerge from the pandemic, attention is turning to the long-term effects of the crisis on nurses' mental health and well-being, and specifically nursing burnout. Prevalent risk factors related to nursing burnout often historically involve high workload, insufficient support and/or resources, work-life imbalance, and even lack of autonomy and organization climate challenges. Understanding the factors that contribute to nursing burnout to help mitigate it is vital to ensuring the ongoing health and well-being of the nursing workforce, especially since the ongoing waning of coronavirus (COVID-19). This rapid review identifies 36 articles and explores the latest research on nursing burnout in outpatient (ambulatory care) healthcare facilities as the global pandemic continues to subside, and therefore identifies constructs that suggest areas for future research beyond previously identified contributing factors of nursing burnout while the pandemic virus levels were high.

Surprise medical bills received after care delivery in both emergency and non-emergency situations for out-of-network (OON) or other contractual health plan regulations adds additional stress upon the care guarantor, most often the patient. The passing and continued implementation of the federal No Surprises Act (NSA) and related state-level legislation continues to influence the processes of care delivery in the United States. This rapid review evaluated the literature specific to surprise medical billing in the United States since the passing of the No Surprise Act, guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol. A total of 33 articles were reviewed by the research team and the results demonstrate industry stakeholder perceptions related to two primary industry themes (constructs) surrounding surprise billing: healthcare stakeholder perspectives and medical claim dispute (arbitration) processes. Further investigation identified sub-constructs for each: the practice of balance-billing patients for OON care and healthcare provider, and facility equitable reimbursement challenges (primary theme 1), and arbitration observations and challenges surrounding (a) the NSA medical dispute process, (b) state-level arbitration processes and perceptions, and (c) use of the Medicare fee schedule as a benchmark for arbitration decisions (primary theme 2). The results indicate the need for formative policy improvement initiatives to address the generation of surprise billing.

(1) Background: A biosimilar is a biologic medical product that has been approved by the United States Food and Federal Drug Administration (FDA) and is an almost identical copy of an original biologic product yet manufactured by a different company. Biosimilars are often assumed to be the same as generic medications, while often made from living organisms. Through clinical trials, biosimilars have been shown to be both as safe and as effective as their originator products. Biosimilars have also proven they can reduce the costs to both insurance companies and patients in many circumstances. However, despite their cost savings, biosimilar manufacturers continue to face barriers in having oncologists and cancer centers prescribe them for their patients. This review aims to identify barriers associated with medical provider prescriptive behaviors related to biosimilars for patients. (2) Methods: Reviewers analyzed 27 articles and identified common themes. (3) Results: After a thorough literature review, the researchers identified seven barriers to prescribing of biosimilars: physician comfort in originators instead of biosimilars, patient reluctance to switch from a current biologic to a biosimilar, provider profits associated with an originator biologic, lack of stakeholder education on biosimilars, lack of provider team knowledge of biosimilars, lack of knowledge surrounding the biosimilar FDA approval process, and hesitancy to stock multiple drugs for a specific indication. (4) Conclusions: This review's findings of identified barriers to use of biosimilars provides insight for healthcare providers and organizations surrounding prescribing practices and potential treatment benefits for cancer patients who may benefit from biosimilar treatment medications.

Background and Objectives: Information regarding the COVID-19 pandemic has spread internationally through a variety of platforms, including social media. While efforts have been made to help reduce the spread of misinformation on social media, many platforms are still largely unregulated. The influence of social media use on vaccination promotion is not fully understood. This systematic review aims to identify facilitators and barriers associated with vaccine promotion through social media use. Materials and Methods: Reviewers analyzed 25 articles and identified common themes. Facilitators of vaccine promotion included an increase in the efforts of social media companies to reduce misinformation, the use of social media to spread information on public health and vaccine promotion, and the positive influence towards vaccinations of family and friends. Results and Conclusions: Identified barriers to vaccine promotion included the spread of misinformation, decreased vaccine acceptance among users of social media for COVID-19 related information due to polarization, and a lack of regulation on social media platforms. The results of this review provide insight for improving public health campaign promotion on social media and can help inform policy on social media regulation and misinformation prevention.

Background and objectives: Health care organizations continue to respond to the COVID-19 global pandemic and an ongoing array of related mental health concerns. These pandemic-related challenges continue to be experienced by both the U.S. population and those abroad. Materials and methods: This systematic review queried three research databases to identify applicable studies related to protective and non-protective factors of mental health distress experienced during the pandemic within the United States. Results: Three primary factors were identified as protective factors, potentially helping to moderate the incidence of mental distress during the pandemic: demographics, personal support/self-care resources, and income/financial concerns. Researchers also identified these same three constructs of non-protective factors of mental health distress, as well as two additional variables: health/social status and general knowledge/government mistrust. Conclusions: This systematic review has identified protective and non-protective factors of mental health distress experienced in the United States during the COVID-19 pandemic (to date) that can further assist medical providers in the U.S. and beyond as the pandemic and related mental health concerns continue at a global level.

Background and Objectives: Ambulatory (outpatient) health care organizations continue to respond to the COVID-19 global pandemic using an array of initiatives to provide a continuity of care for both COVID-19 and non-COVID-19 patients. The purpose of this study is to systematically identify the facilitators and barriers experienced by outpatient health care organizations in an effort to maintain effective and efficient patient throughput during the pandemic., Materials and Methods: This study systematically reviewed articles focused on initiatives taken by ambulatory care organizations to maintain optimal outpatient throughput levels while balancing pandemic precautions, published during 2020., Results: Among the 30 articles that met the inclusion criteria, three initiatives healthcare organizations have taken to maintain throughput were identified: the use (and enhanced use) of telehealth, protocol development, and health care provider training. The research team also identified three barriers to patient throughput: lack of telehealth, lack of resources, and overall lack of knowledge., Conclusions: To maintain patient throughput during the COVID-19 pandemic, healthcare organizations need to develop strategies such as the use of virtual consultation and follow-up, new guidelines to move patients along the care delivery value-chain, and ongoing training of providers. Additionally, the availability of required technology for telehealth, availability of resources, and adequate knowledge are vital for continuous patient throughput to ensure continuity of care during a pandemic.

Background and objectives: Ambulatory (outpatient) healthcare organizations continue to respond to the COVID-19 global pandemic using an array of initiatives to sustain a continuity of palliative care. Continuance of palliative care during major crises has been previously accomplished; however, the global pandemic presents new challenges to the US healthcare industry. Materials and methods: This systematic review queried four research databases to identify applicable studies related to the provision of palliative care during the pandemic in outpatient organizations within the United States. Results: There are two primary facilitators for the ongoing provision of palliative care for the outpatient segment of the United States healthcare industry: technology and advanced care planning. Researchers also identified two primary barriers in the outpatient setting impacting the continuance of palliative care: lack of resources and accessibility to care. Conclusions: This systematic review identified facilitators and barriers for palliative care initiatives in the United States that can further assist future outpatient (ambulatory care) providers at a global level as the pandemic and associated public health initiatives continue.

This study estimated the effects of Medicaid Expansion, demographics, socioeconomic status (SES), and health status on disease management of diabetes over time. The hypothesis was that the introduction of the ACA and particularly Medicaid Expansion would increase the following dependent variables (all proportions): (1) provider checks of HbA1c, (2) provider checks of feet, (3) provider checks of eyes, (4) patient education, (5) annual physician checks for diabetes, (6) patient self-checks of blood sugar. Data were available from the Behavioral Risk Factor Surveillance System for 2011 to 2019. We filtered the data to include only patients with diagnosed non-gestational diabetes of age 45 or older ( n = 510,991 cases prior to weighting). Linear splines modeled Medicaid Expansion based on state of residence as well as implementation status. Descriptive time series plots showed no major changes in proportions of the dependent variables over time. Quasibinomial analysis showed that implementation of Medicaid Expansion had a statistically negative effect on patient self-checks of blood sugar (odds ratio = 0.971, p < 0.001), a statistically positive effect on physician checks of HbA1c (odds ratio = 1.048, p < 0.001), a statistically positive effect on feet checks (odds ratio = 1.021, p < 0.001), and no other significant effects. Evidence of demographic, SES, and health status disparities existed for most of the dependent variables. This finding was especially significant for HbA1c checks by providers. Barriers to achieving better diabetic care remain and require innovative policy interventions.

The relationship between healthcare organizational accreditation and their leaders' professional certification in healthcare management is of specific interest to institutions of higher education and individuals in the healthcare management field. Since academic program accreditation is one piece of evidence of high-quality education, and since professional certification is an attestation to the knowledge, skills, and abilities of those who are certified, we expect alumni who graduated from accredited programs and obtained professional certification to have a positive impact on the organizations that they lead, compared with alumni who did not graduate from accredited programs and who did not obtain professional certification. The authors' analysis examined the impact of hiring graduates from higher education programs that held external accreditation from the Commission on Accreditation of Healthcare Management Education (CAHME). Graduates' affiliation with the American College of Healthcare Executives (ACHE) professional healthcare leadership organization was also assessed as an independent variable. Study outcomes focused on these graduates' respective healthcare organization's performance measures (cost, quality, and access) to assess the researchers' inquiry into the perceived value of a CAHME-accredited graduate degree in healthcare administration and a professional ACHE affiliation. The results from this study found no effect of CAHME accreditation or ACHE affiliation on healthcare organization performance outcomes. The study findings support the need for future research surrounding healthcare administration professional graduate degree program characteristics and leader development affiliations, as perceived by various industry stakeholders.

Background and objectives: Ambulatory (outpatient) health care organizations continue to respond to the COVID-19 global pandemic using an array of initiatives to provide a continuity of care and related patient outcomes. Telehealth has quickly become an advantageous tool in assisting outpatient providers in this challenge, which has also come with an adaptation of U.S. government policy, procedures, and, as a result, organizational protocols surrounding the delivery of telehealth care. Materials and methods: This systematic review identified three primary facilitators to the implementation and establishment of telehealth services for the outpatient segment of the United States health care industry: patient engagement, operational workflow and organizational readiness, and regulatory changes surrounding reimbursement parity for telehealth care. Results: Researchers identified three barriers impacting the implementation and use of telehealth resources: patient telehealth limitations, lack of clinical care telehealth guidelines, and training, technology, and financial considerations. Conclusions: This systematic review's identified facilitators and barriers for telehealth implementation initiatives in the United States can assist future outpatient providers as the global pandemic and associated public health initiatives such as physical distancing continue.

The delivery of routine health care during the COVID-19 global pandemic continues to be challenged as public health guidelines and other local/regional/state and other policies are enforced to help prevent the spread of the virus. The objective of this systematic review is to identify the facilitators and barriers affecting the delivery of routine health care services during the pandemic to provide a framework for future research. In total, 32 articles were identified for common themes surrounding facilitators of routine care during COVID-19. Identified constructed in the literature include enhanced education initiatives for parents/patients regarding routine vaccinations, an importance of routine vaccinations as compared to the risk of COVID-19 infection, an enhanced use of telehealth resources (including diagnostic imagery) and identified patient throughput/PPE initiatives. Reviewers identified the following barriers to the delivery of routine care: conservation of medical providers and PPE for non-routine (acute) care delivery needs, specific routine care services incongruent the telehealth care delivery methods, and job-loss/food insecurity. Review results can assist healthcare organizations with process-related challenges related to current and/or future delivery of routine care and support future research initiatives as the global pandemic continues.

Ambulatory health care provider organizations participating in Accountable Care Organizations (ACOs) organizations assume costs beyond typical practice operations that are directly associated with value-based care initiatives. Identifying these variables that influence such costs are essential to an organization's financial viability. To enable the U.S. healthcare system to respond to the COVID-19 pandemic CMS issued blanket waivers that permit enhanced flexibility, extension, and other emergency declaration changes to ACO reporting requirements through the unforeseen future. This relaxation and even pausing of reporting requirements encouraged the researchers to conduct a systematic review and identify variables that have influenced costs incurred by ambulatory care organizations participating in ACOs prior to the emergency declaration. The research findings identified ACO-ambulatory care variables (enhanced patient care management, health information technology improvements, and organizational ownership/reimbursement models) that helped to reduce costs to the ambulatory care organization. Additional variables (social determinants of health/environmental conditions, lack of integration/standardization, and misalignment of financial incentives) were also identified in the literature as having influenced costs for ambulatory care organizations while participating in an ACO initiative with CMS. Findings can assist ambulatory care organizations to focus on new and optimized strategies as they begin to prepare for the post-pandemic resumption of ACO quality reporting requirements once the emergency declaration is eventually lifted.

Background: Assessing competencies or program learning outcomes in educational programs is often a leadership challenge. This case study reports medical education program's efforts to document undergraduate competency attainment using a pre-post, third-party, objective testing service that allows for inter-university comparison, a testing service that is being adopted by some certification and accrediting bodies., Methods: Students completed a pre-test after program acceptance and a post-test at the end of the last didactic semester (1.5 years later) just prior to their required internships. Scores and subscores were evaluated using t-tests (Holm-adjusted p-values). MANOVA models of sub-competency difference scores were also evaluated., Results: Results indicate competency improvement for each of the 12 areas based on the n = 55 student sample, (p < .001 for all scores). These improvements were independent of ethnicity, age, gender, and grades. The average student improved by 12.85 points (95% CI of 10.52 to 15.18) with the largest improvements in strategic planning and leadership competency areas (21.30 and 18.33 percentage points, respectively)., Conclusions: The third-party pre-post has some face validity given that student performance improved after completing a related curriculum as would be expected. Congruent with earlier studies, we find that repeated testing helps document competency attainment and that a single method for assessment is insufficient. We further document limitations of this 3d-party exam.

The implementation and continued expansion of telehealth services assists a variety of health care organizations in the delivery of care during the current COVID-19 global pandemic. However, limited research has been conducted on recent, rapid telehealth implementation and expansion initiatives regarding facilitators and barriers surrounding the provision of quality patient care. Our rapid review evaluated the literature specific to rapid telehealth implementation during the current COVID-19 pandemic from three research databases between January 2020 and May 2020 and reported using preferred reporting items for systematic reviews and meta-analyses (PRISMA). The results indicate the rapid implementation and enhanced use of telehealth during the COVID-19 pandemic in the United States surrounding the facilitators and barriers to the provision of patient care, which are categorized into three identified themes: (1) descriptive process-oriented implementations, (2) the interpretation and infusion of the CARES Act of 2020 telehealth exemptions related to the relaxation of patient privacy and security (HIPAA) protocols, and (3) the standard of care protocols and experiences addressing organizational liability and the standard of care. While the study limitation of sample size exists ( n = 21), an identification of rapid telehealth implementation advancements and challenges during the current pandemic may assist health care organizations in the delivery of ongoing quality care during the COVID-19 pandemic.