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204. Recommender Systems For Computer Tailored Health Communications

Author

Sadasivam, Rajani S., Marlin, Benjamin M., Allan, James, and Houston, Thomas K.

Subjects
GeneralLiterature_MISCELLANEOUS
Abstract

Presentation on the development of a recommender system for a computer-tailored health communications tool that assists with helping tobacco users to quit smoking. This presentation was part of the retreat mini-symposium entitled: Smartphones, Sensors, and Social Networks: The New Tools of Health Behavior Change.

Published
2013
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205. Collaborative Tagging of Phenotypic Data for Clinical and Translational Sciences

Author

Allan, James, Croft, W. Bruce, Houston, Thomas K., Sadasivam, Rajani S., Kamberi, Ariana, Kong, Weize, and Kim, Youngho

Abstract

To fully understand results derived from genetic research, a patient’s genotype data must be integrated with other information about the individual (vital signs, height/weight, lab values, disease history – the phenotype of the patient) that can be obtained through clinical records. Within the clinical and translational sciences awards (CTSA), significant effort has been supported to expand translational research through the creation and mining of a phenotypic data warehouse (i2b2) that can be further linked to genotype data. However, this is just a first step towards meaningful use of the available information. Much of the information in electronic clinical records is trapped in unstructured free text, and inaccessible. Transforming this information into usable data has great potential to improve personalized healthcare and enhance the scientific enterprise. We are using “collaborative tagging,” a newer web 2.0 phenomenon used to structure information for accessibility online in which groups of individuals can add any word or phrase as a tag to identify an object (a weblog entry, a picture, etc.). Because taggers create whatever they deem as the most important tags, and are not required to select from a complex tree of predetermined tags, folksonomies can be a more palatable form of data entry than selected from a complex, predetermined list of tags. We will present our results on tagging of clinical notes by UMMS and community-based providers. This presentation was part of the retreat mini-symposium entitled: Data-Driven Approaches for Health Informatics.

Published
2013
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206. Variations in tobacco control in National Dental PBRN practices: The role of patient and practice factors

Author

Ray, Midge N., Allison, Jeroan J., Coley, Heather L., Williams, Jessica H., Kohler, Connie, Gilbert, Gregg H., Richman, Joshua S., Kiefe, Catarina I., Sadasivam, Rajani S., and Houston, Thomas K.

Subjects
Patients, Tobacco, Humans, Smoking Cessation, Dental Health Services, Article, United States
Abstract

We engaged dental practices enrolled in The National Dental Practice-Based Research Network to quantify tobacco screening (ASK) and advising (ADVISE); and to identify patient and practice -characteristics associated with tobacco control. Dental practices (N = 190) distributed patient surveys that measured ASK and ADVISE. Twenty-nine percent of patients were ASKED about tobacco use during visit, 20% were identified as tobacco users, and 41% reported being ADVISED. Accounting for clustering of patients within practices, younger age and male gender were positively associated with ASK and ADVISE. Adjusting for patient age and gender, a higher proportion of non-whites in the practice, preventive services and proportion on public assistance were positively associated with ASK. Proportion of tobacco users in the practice and offering other preventive services were more strongly associated with ASK and ADVISE than other practice characteristics. Understanding variations in performance is an important step toward designing strategies for improving tobacco control in dentistry.

Published
2012

207. Clinical Research Informatics

Author

Houston, Thomas K. and English, Thomas M.

Subjects
ComputingMilieux_THECOMPUTINGPROFESSION, ComputingMilieux_COMPUTERSANDEDUCATION, ComputingMilieux_MISCELLANEOUS
Abstract

This seminar describes programs and resources available through the Biomedical Informatics component of the UMCCTS.

Published
2012
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208. USING ONLINE MARKETING TO INCREASE PARTICIPATION IN A WEB-BASED CONTINUING MEDICAL EDUCATION CULTURAL COMPETENCE CURRICULUM

Author

Estrada, Carlos A., Krishnamoorthy, Periyakaruppan, Smith, Ann, Staton, Lisa, Korf, Michele J., Allison, Jeroan J., and Houston, Thomas K.

Subjects
Marketing of Health Services, Internet, Advertising, Information Dissemination, Community Participation, Humans, Education, Medical, Continuing, Pilot Projects, Curriculum, Cultural Competency, Article
Abstract

CME providers may be interested in identifying effective marketing strategies to direct users to specific content. Online advertisements for recruiting participants into activities such as clinical trials, public health programs, and continuing medical education (CME) have been effective in some but not all studies. The purpose of this study was to compare the impact of 2 marketing strategies in the context of an online CME cultural competence curriculum (www.c-comp.org).In an interrupted time-series quasi-experimental design, 2 marketing strategies were tested: (1) wide dissemination to relevant organizations over a period of approximately 4 months, and (2) Internet paid search using Google Ads (5 consecutive 8-week periods--control 1, cultural/CME advertisement, control 2, hypertension/ content advertisement, control 3). Outcome measures were CME credit requests, Web traffic (visits per day, page views, pages viewed per visit), and cost.Overall, the site was visited 19,156 times and 78,160 pages were viewed. During the wide dissemination phase, the proportion of visits requesting CME credit decreased between the first (5.3%) and second (3.3%) halves of this phase (p = .04). During the Internet paid search phase, the proportion of visits requesting CME credit was highest during the cultural/CME advertisement period (control 1, 1.4%; cultural/CME ad, 4.3%; control 2, 1.5%; hypertension/content ad, 0.6%; control 3, 0.8%; p.001). All measures of Web traffic changed during the Internet paid search phase (p.01); however, changes were independent of the advertisement periods. The incremental cost for the cultural advertisement per CME credit requested was US $0.64.Internet advertisement focusing on cultural competence and CME was associated with about a threefold increase in requests for CME credit at an incremental cost of under US $1; however, Web traffic changes were independent of the advertisement strategy.

Published
2011

212. LETTER TO THE EDITOR

Author

CLARK, JEANNE M, HOUSTON, THOMAS K, and KERN, DAVID E

Subjects
Letters to the Editor
Published
2004

213. PERSPeCT

Author

Adams, Roy J., primary, Sadasivam, Rajani S., additional, Balakrishnan, Kavitha, additional, Kinney, Rebecca L., additional, Houston, Thomas K., additional, and Marlin, Benjamin M., additional

Published
2014
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214. The National Cancer Institute’s Health Information National Trends Survey [HINTS]: a national cross-sectional analysis of talking to your doctor and other healthcare providers for health information

Author

Volkman, Julie E, primary, Luger, Tana M, additional, Harvey, Kimberly LL, additional, Hogan, Timothy P, additional, Shimada, Stephanie L, additional, Amante, Daniel, additional, McInnes, D Keith, additional, Feng, Hua, additional, and Houston, Thomas K, additional

Published
2014
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216. Smoking-Cessation e-Referrals

Author

Ray, Midge N., primary, Funkhouser, Ellen, additional, Williams, Jessica H., additional, Sadasivam, Rajani S., additional, Gilbert, Gregg H., additional, Coley, Heather L., additional, Rindal, D. Brad, additional, and Houston, Thomas K., additional

Published
2014
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217. Patient Perceptions of Physician Use of Handheld Computers

Author

Houston, Thomas K., Ray, Midge N., Crawford, Myra A., Giddens, Tonya, and Berner, Eta S.

Subjects
Adult, Male, Outpatient Clinics, Hospital, Medical Records Systems, Computerized, Attitude of Health Personnel, Attitude to Computers, Data Collection, Point-of-Care Systems, Internship and Residency, Middle Aged, Article, Statistics, Nonparametric, Hospitals, University, Cross-Sectional Studies, Socioeconomic Factors, Patient Satisfaction, Computers, Handheld, Physicians, Surveys and Questionnaires, Internal Medicine, Humans, Female, Minority Groups
Abstract

Handheld computers have advantages for healthcare providers including portability and integration into office workflow. However, negative patient perceptions of physician use of handheld computers in the examining room might limit integration.To survey patients' perceptions of handheld use, and compare those with their providers' perceptions.A survey of patient attitudes toward handhelds was conducted among patients at a low-income university clinic. Internal Medicine residents providing care were also surveyed.Patients (N=93) were mostly female (79%) and ethnic minorities (67%) with average age of 39. Only 10% of patients did not like the idea of a handheld computer in the exam room. Other negative attitudes were also seen in a minority of patients. Some physicians (23%) reported reservations about using the handheld computer with patients.Negative attitudes were rare among patients, but some providers were concerned about using the handheld in the exam room.

Published
2003

218. Exploring Online Asynchronous Counseling With Tobacco Treatment Specialists in the QUIT-PRIMO and National Dental PBRN HI-QUIT Studies: Who Uses It and What Do They Say?

Author

Williams, Jessica H., DeLaughter, Kathryn, Volkman, Julie E., Sadasivam, Rajani S., Ray, Midge N., Gilbert, Gregg H., and Houston, Thomas K.

Abstract

Purpose: To describe the content of messages sent by smokers through asynchronous counseling within a Web-based smoking cessation intervention.Design: Qualitative.Setting: National community-based setting of patients who had been engaged by the medical or dental practices at which they attended or via Google advertisements.Participants: Adults older than 19 years who were current smokers and interested in quitting. Participants throughout the United States referred to a Web-based cessation intervention by their medical or dental provider or by clicking on a Google advertisement.Methods: We conducted a qualitative review of 742 asynchronous counseling messages sent by 270 Web site users. Messages were reviewed, analyzed, and organized into qualitative themes by the investigative team.Results: The asynchronous counseling feature of the intervention was used most frequently by smokers who were white (87%), female (67%), aged 45 to 54 (32%), and who had at least some college-level education (70%). Qualitative analysis yielded 7 basic themes—Talk about the Process of Quitting, Barriers to Quitting, Reasons to Quit, Quit History, Support and Strategies for Quitting, Quitting with Medication, and Quit Progress. The most common theme was Support and Strategies for Quitting with 255 references among all messages.Conclusion: We found rich communication across the spectrum of the quit process, from persons preparing to quit to those who had successfully quit. Asynchronous smoking cessation counseling provides a promising means of social support for smokers during the quit process.

Published
2018
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220. Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery

Author

Bradley, Katharine A, Rubinsky, Anna D, Sun, Haili, Bryson, Chris L, Bishop, Michael J, Blough, David K, Henderson, William G, Maynard, Charles, Hawn, Mary T, Tønnesen, Hanne, Hughes, Grant, Beste, Lauren A, Harris, Alex H S, Hawkins, Eric J, Houston, Thomas K, Kivlahan, Daniel R, Bradley, Katharine A, Rubinsky, Anna D, Sun, Haili, Bryson, Chris L, Bishop, Michael J, Blough, David K, Henderson, William G, Maynard, Charles, Hawn, Mary T, Tønnesen, Hanne, Hughes, Grant, Beste, Lauren A, Harris, Alex H S, Hawkins, Eric J, Houston, Thomas K, and Kivlahan, Daniel R

Abstract

Patients who misuse alcohol are at increased risk for surgical complications. Four weeks of preoperative abstinence decreases the risk of complications, but practical approaches for early preoperative identification of alcohol misuse are needed.

Published
2011

221. Multiple uncontrolled conditions and blood pressure medication intensification: an observational study

Author

Salanitro, Amanda H., Funkhouser, Ellen M., Agee, Bonita S., Allison, Jeroan J., Halanych, Jewell H., Houston, Thomas K., Litaker, Mark S., Levine, Deborah A., Safford, Monika M., Salanitro, Amanda H., Funkhouser, Ellen M., Agee, Bonita S., Allison, Jeroan J., Halanych, Jewell H., Houston, Thomas K., Litaker, Mark S., Levine, Deborah A., and Safford, Monika M.

Abstract

BACKGROUND: Multiple uncontrolled medical conditions may act as competing demands for clinical decision making. We hypothesized that multiple uncontrolled cardiovascular risk factors would decrease blood pressure (BP) medication intensification among uncontrolled hypertensive patients. METHODS: We observed 946 encounters at two VA primary care clinics from May through August 2006. After each encounter, clinicians recorded BP medication intensification (BP medication was added or titrated). Demographic, clinical, and laboratory information were collected from the medical record. We examined BP medication intensification by presence and control of diabetes and/or hyperlipidemia. 'Uncontrolled' was defined as hemoglobin A1c >/= for diabetes, BP >/= 140/90 mmHg (>/= 130/80 mmHg if diabetes present) for hypertension, and low density lipoprotein cholesterol (LDL-c) >/= 130 mg/dl (>/= 100 mg/dl if diabetes present) for hyperlipidemia. Hierarchical regression models accounted for patient clustering and adjusted medication intensification for age, systolic BP, and number of medications. RESULTS: Among 387 patients with uncontrolled hypertension, 51.4% had diabetes (25.3% were uncontrolled) and 73.4% had hyperlipidemia (22.7% were uncontrolled). The BP medication intensification rate was 34.9% overall, but higher in individuals with uncontrolled diabetes and uncontrolled hyperlipidemia: 52.8% overall and 70.6% if systolic BP >/= 10 mmHg above goal. Intensification rates were lowest if diabetes or hyperlipidemia were controlled, lower than if diabetes or hyperlipidemia were not present. Multivariable adjustment yielded similar results. CONCLUSIONS: The presence of uncontrolled diabetes and hyperlipidemia was associated with more guideline-concordant hypertension care, particularly if BP was far from goal. Efforts to understand and improve BP medication intensification in patients with controlled diabetes and/or hyperlipidemia are warranted.

Published
2010

224. Abstract 5: Management Of Intravenous tPA In Non-ICU Environments: Safety, Clinical Outcome, And Cost Savings

Author

Coleman, Kisha C, primary, Palazzo, Paola, additional, Shahripour, Reza B, additional, Brooks, Amy L, additional, Cronin, Mary A, additional, Sands, Kara A, additional, Lyerly, Michael J, additional, Sisson, April, additional, Houston, Thomas, additional, Rawal, Pawan, additional, Alvi, Muhammad, additional, Kapoor, Niren, additional, Albright, Karen C, additional, Boehme, Amelia K, additional, Alexandrov, Andrei V, additional, and Alexandrov, Anne W, additional

Published
2013
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227. Visit satisfaction and the use of tailored health behavior communications in primary care

Author

Sciamanna, Chris N, Novak, Scott P, Houston, Thomas K, Gramling, Robert, Marcus, Bess H, Sciamanna, Chris N, Novak, Scott P, Houston, Thomas K, Gramling, Robert, and Marcus, Bess H

Abstract

BACKGROUND: Though studies suggest that computer-tailored health communications can help patients improve health behaviors, their effect on patient satisfaction, when used in health care settings, has yet to be examined. METHODS: A computer application was developed to provide tailored, printed feedback for patients and physicians about two of the most common adverse health behaviors seen in primary care, smoking and physical inactivity. Ten primary care providers and 150 of their patients were recruited to use the program in the office before their visit. After the visit, patients completed a self-report survey that addressed demographics, computer use history, satisfaction with the visit and the extent to which the physician addressed the reports during the visit. RESULTS: Most patients were female (67.6%), approximately half (46.0%) were seen for a routine exam, most (63.3%) had at least one chronic illness and fewer than a third (31.3%) had ever used the Internet or email. Most (81.1%) patients reported that the program was easy to use, but fewer than half of the doctors looked at the report in front of the patient (49.2%) or discussed the report with the patient (44.3%). Multivariate modeling showed that visit satisfaction was significantly greater among those whose doctor examined the report. This effect of the doctor examining the report on satisfaction was even greater for those who reported a chronic illness. CONCLUSIONS: Physicians who incorporate computer tailored messaging programs into the primary care setting, but who do not address the feedback reports that they create may contribute to patients being less satisfied with their care.

Published
2005

231. Prevalence of alcohol misuse among men and women undergoing major noncardiac surgery in the Veterans Affairs health care system

Author

Bradley, Katharine A., primary, Rubinsky, Anna D., additional, Sun, Haili, additional, Blough, David K., additional, Tønnesen, Hanne, additional, Hughes, Grant, additional, Beste, Lauren A., additional, Bishop, Michael J., additional, Hawn, Mary T., additional, Maynard, Charles, additional, Harris, Alex S.H., additional, Hawkins, Eric J., additional, Bryson, Chris L., additional, Houston, Thomas K., additional, Henderson, William G., additional, and Kivlahan, Daniel R., additional

Published
2012
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234. African American Veterans Storytelling

Author

Houston, Thomas K., Fix, Gemmae M., Shimada, Stephanie L., Long, Judith A., Gordon, Howard S., Pope, Charlene, Volkman, Julie, Allison, Jeroan J., DeLaughter, Kathryn, Orner, Michelle, and Bokhour, Barbara G.

Abstract

Supplemental Digital Content is available in the text.

Published
2017
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235. Online tobacco websites and online communities-who uses them and do users quit smoking? The quit-primo and national dental practice-based research network Hi-Quit studies.

Author

Cutrona, Sarah L, Sadasivam, Rajani S, DeLaughter, Kathryn, Kamberi, Ariana, Volkman, Julie E, Cobb, Nathan, Gilbert, Gregg H, Ray, Midge N, and Houston, Thomas K

Abstract

Online tobacco cessation communities are beneficial but underused. Our study examined whether, among smokers participating in a web-assisted tobacco intervention (Decide2quit.org), specific characteristics were associated with navigating to BecomeAnEx.org, an online cessation community, and with subsequent quit rates. Among smokers (N = 759) registered with Decide2quit.org, we identified visitors to BecomeAnEx.org, examining associations between smoker characteristics and likelihood of visiting. We then tested for associations between visits and 6-month cessation (point prevalence). We also tested for an interaction between use of other online support-seeking (Decide2quit.org tobacco cessation coaches), visiting, and 6-month cessation. One quarter (26.0 %; n = 197) of the smokers visited BecomeAnEx.org; less than one tenth (7.5 %; n = 57) registered to participate in the online forum. Visitors were more likely to be female (73.0 vs. 62.6 % of non-visitors, P < 0.01) to have visited a cessation website before (33.0 vs. 17.4 %, P < 0.01) and to report quit attempts in the previous year (62.0 vs. 53.0 %, P = 0.03). In analyses of all participants, BecomeAnEx.org visiting was not associated with 6-month quit completion. Among participants who communicated with a coach, BecomeAnEx.org visiting also lacked a significant association with 6 month quit completion, although a non-significant trend toward quit completion in visitors was noted (OR 2.21, 95 % CI 0.81-3.1). Online cessation communities attract smokers with previous cessation website experience and recent quit attempts. Community visiting was not associated with quit rates in our study, but low use may have limited our power to detect differences. Further research should explore whether an additive effect can be achieved by offering community visitors support via online coaches.

Published
2016
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240. Defining Core Issues in Utilizing Information Technology to Improve Access: Evaluation and Research Agenda

Author

Jackson, George L., primary, Krein, Sarah L., additional, Alverson, Dale C., additional, Darkins, Adam W., additional, Gunnar, William, additional, Harada, Nancy D., additional, Helfrich, Christian D., additional, Houston, Thomas K., additional, Klobucar, Thomas F., additional, Nazi, Kim M., additional, Poropatich, Ronald K., additional, Ralston, James D., additional, and Bosworth, Hayden B., additional

Published
2011
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244. The Art and Science of Patient Storytelling—Harnessing Narrative Communication for Behavioral Interventions: The ACCE Project

Author

Houston, Thomas K., primary, Cherrington, Andrea, additional, Coley, Heather L., additional, Robinson, Kimberly M., additional, Trobaugh, John A., additional, Williams, Jessica H., additional, Foster, Pamela H., additional, Ford, Daniel E., additional, Gerber, Ben S., additional, Shewchuk, Richard M., additional, and Allison, Jeroan J., additional

Published
2011
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249. Culturally Appropriate Storytelling to Improve Blood Pressure

Author

Houston, Thomas K., primary, Allison, Jeroan J., additional, Sussman, Marc, additional, Horn, Wendy, additional, Holt, Cheryl L., additional, Trobaugh, John, additional, Salas, Maribel, additional, Pisu, Maria, additional, Cuffee, Yendelela L., additional, Larkin, Damien, additional, Person, Sharina D., additional, Barton, Bruce, additional, Kiefe, Catarina I., additional, and Hullett, Sandral, additional

Published
2011
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