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Mixed methods research (MMR) is versatile, pragmatic, and adaptable to constraints and opportunities during a research process. Although MMR has gain popularity in health services management research, little is known about how the research approach has been used and the quality of research. We conducted a systematic review of 198 MMR articles published in selected U.S.-based and international health services management journals from 2000 through 2018 to examine the extent of MMR application and scientific rigor. Results showed limited, yet increasing, use of MMR and a high degree of correspondence between MMR designs and study purposes. However, most articles did not clearly justify using MMR designs and the reporting of method details and research integration were inadequate in a significant portion of publications. We propose a checklist to assist the preparation and review of MMR manuscripts. Additional implications and recommendations to improve transparency, rigor, and quality in MMR are discussed.

ObjectiveTo explore diverse provider perspectives on: strategies for addressing patient medication cost barriers; patient medication cost information gaps; current medication cost-related informatics tools; and design features for future tool development.Materials and MethodsWe conducted 38 semistructured interviews with providers (physicians, nurses, pharmacists, social workers, and administrators) in a Midwestern health system in the United States. We used 3 rounds of qualitative coding to identify themes.ResultsProviders lacked access to information about: patients’ ability to pay for medications; true costs of full medication regimens; and cost impacts of patient insurance changes. Some providers said that while existing cost-related tools were helpful, they contained unclear insurance information and several questioned the information’s quality. Cost-related information was not available to everyone who needed it and was not always available when needed. Fragmentation of information across sources made cost-alleviation information difficult to access. Providers desired future tools to compare medication costs more directly; provide quick references on costs to facilitate clinical conversations; streamline medication resource referrals; and provide centrally accessible visual summaries of patient affordability challenges.DiscussionThese findings can inform the next generation of informatics tools for minimizing patients’ out-of-pocket costs. Future tools should support the work of a wider range of providers and situations and use cases than current tools do. Such tools would have the potential to improve prescribing decisions and better link patients to resources.ConclusionResults identified opportunities to fill multidisciplinary providers’ information gaps and ways in which new tools could better support medication affordability for patients.

ObjectiveInitiatives to reduce neighborhood-based health disparities require access to meaningful, timely, and local information regarding health behavior and its determinants. We examined the validity of Twitter as a source of information for neighborhood-level analysis of dietary choices and attitudes.Materials and MethodsWe analyzed the “healthiness” quotient and sentiment in food-related tweets at the census tract level, and associated them with neighborhood characteristics and health outcomes. We analyzed keywords driving the differences in food healthiness between the most and least-affluent tracts, and qualitatively analyzed contents of a random sample of tweets.ResultsSignificant, albeit weak, correlations existed between healthiness and sentiment in food-related tweets and tract-level measures of affluence, disadvantage, race, age, U.S. density, and mortality from conditions associated with obesity. Analyses of keywords driving the differences in food healthiness revealed foods high in saturated fat (eg, pizza, bacon, fries) were mentioned more frequently in less-affluent tracts. Food-related discussion referred to activities (eating, drinking, cooking), locations where food was consumed, and positive (affection, cravings, enjoyment) and negative attitudes (dislike, personal struggles, complaints).DiscussionTweet-based healthiness scores largely correlated with offline phenomena in the expected directions. Social media offer less resource-intensive data collection methods than traditional surveys do. Twitter may assist in informing local health programs that focus on drivers of food consumption and could inform interventions focused on attitudes and the food environment.ConclusionsTwitter provided weak but significant signals concerning food-related behavior and attitudes at the neighborhood level, suggesting its potential usefulness for informing local health disparity reduction efforts.

Objective The 2018 National NLP Clinical Challenge (2018 n2c2) focused on the task of cohort selection for clinical trials, where participating systems were tasked with analyzing longitudinal patient records to determine if the patients met or did not meet any of the 13 selection criteria. This article describes our participation in this shared task. Materials and Methods We followed a hybrid approach combining pattern-based, knowledge-intensive, and feature weighting techniques. After preprocessing the notes using publicly available natural language processing tools, we developed individual criterion-specific components that relied on collecting knowledge resources relevant for these criteria and pattern-based and weighting approaches to identify “met” and “not met” cases. Results As part of the 2018 n2c2 challenge, 3 runs were submitted. The overall micro-averaged F1 on the training set was 0.9444. On the test set, the micro-averaged F1 for the 3 submitted runs were 0.9075, 0.9065, and 0.9056. The best run was placed second in the overall challenge and all 3 runs were statistically similar to the top-ranked system. A reimplemented system achieved the best overall F1 of 0.9111 on the test set. Discussion We highlight the need for a focused resource-intensive effort to address the class imbalance in the cohort selection identification task. Conclusion Our hybrid approach was able to identify all selection criteria with high F1 performance on both training and test sets. Based on our participation in the 2018 n2c2 task, we conclude that there is merit in continuing a focused criterion-specific analysis and developing appropriate knowledge resources to build a quality cohort selection system.

To improve care coordination, forestall emergencies, and save costs, there is a growing movement to have patients at home habitually collect and provide data about their health status and related experiences to health care providers. One aspect of this movement involves the recurring use of reliable and valid questionnaires to collect and share patient reported outcomes (PRO) data. However, studies indicate that health care providers have a host of legitimate concerns about the systematic and routine collection, sharing, and use of PRO data. To explore these provider-specific concerns further, we developed a configurable prototype software application for use by providers and their patients called the PRO Data Dashboard (PDD). Using the PDD along with several written clinical case scenarios, we conducted focus groups with a diverse group of oncology care providers to generate findings relevant to the design, configuration, and use of PRO-based tools. We organized our findings into three categories: scope of use of PRO tools, configuration of PRO tools, and clinician user experience. We conclude that providers require fine-grained control over the configuration of PRO data collection and sharing features in e-Health applications.

BACKGROUND Health system decisions to put new technologies into clinical practice require a rapid and trustworthy decision-making process informed by best evidence. OBJECTIVE This study aimed to present a rapid evidence review process that can be used to inform health system leaders and clinicians seeking to implement new technology tools to improve patient-clinician decision making and patient-oriented outcomes. METHODS The rapid evidence review process we pioneered involved 5 sequential subprocesses: (1) environmental scan, (2) expert panel recruitment, (3) host evidence review panel, (4) analysis, and (5) local validation panel. We conducted an environmental scan of health information technology (IT) literature to identify relevant digital tools in oncology care. We synthesized the recent literature using current evidence review methods, creating visual summaries for use by a national panel of experts. Panelists were taken through a 6-hour modified Delphi process to prioritize tools for implementation. Findings from the rapid evidence review panel were taken to a local validation panel for further rapid review during a 3-hour session. RESULTS Our rapid evidence review process shows promise for informing decision making by reducing the amount of time and resources needed to identify and prioritize adoption of IT tools. Despite evidence of improved patient outcomes, panelists had substantial concerns about implementing patient-reported outcome tracking tools, voicing concerns about liability, lack of familiarity with new technology, and additional time and workflow changes such tools would require. Instead, clinicians favored technologies that did not require clinician involvement. CONCLUSIONS Health system leaders can use the rapid evidence review process presented here to usefully inform local technology adoption, implementation, and use in practice.

HIV/AIDS-related research requires recruitment of representative samples of MSM; yet, we know little about the comparative yield, diversity and cost–benefit tradeoffs between different recruitment venues. We compared 11 recruitment venues used for nine HIV prevention-related focus groups with MSM in Metropolitan Detroit. Of the 64 participants, 24 were clients recruited via an HIV/AIDS-focused nonprofit, 20 from Grindr advertisements, 6 from university-student email lists, and 5 from flyers/palmcards. Significantly more African–American, low-income and HIV-positive participants were recruited via the nonprofit. The best cost–benefit tradeoffs were for organizational Facebook posts, email groups, personal networking, and nonprofit recruitment. Grindr increased the size of the sample, though at greater expense. Facebook and Scruff advertisements and gay bar outreach represented greater costs than benefits. Only 11.6% of Grindr respondents attended the focus groups. A mix of online and offline recruitment venues can generate a large and diverse sample of MSM, but venue performance is uneven.

Objective Long-acting reversible contraception (LARC) is safe, effective and cost-saving when provided immediately postpartum but currently underutilized due to nonreimbursement by Medicaid and other insurers. The objectives of this study were to (a) determine which state Medicaid agencies provide specific reimbursement for immediate postpartum LARC and (b) identify modifiable policy-level barriers and facilitators of immediate postpartum LARC access. Study Design We conducted semistructured telephone interviews with representatives of 40 Medicaid agencies to characterize payment methodology for immediate postpartum LARC. We coded transcripts using grounded theory and content analysis principles. Results Three categories of immediate postpartum LARC payment methodology emerged: state Medicaid agency (a) provides separate or increased bundled payment ( n =15), (b) is considering providing enhanced payment ( n =9) or (c) is not considering enhanced payment ( n =16). Two major themes emerged related to Medicaid decision-making about immediate postpartum LARC coverage: (a) Health effects: States with payment for immediate postpartum LARC frequently cited improved maternal/child health outcomes as motivating their reimbursements. Conversely, states without payment expressed misinformation about LARC's clinical effects and lack of advocacy from local providers about clinical need for this service. (b) Financial implications: States providing payment emphasized overall cost savings. Conversely, states without reimbursement expressed concern about immediate budget constraints and potential adverse impact on existing global payment methodology for inpatient care. Conclusions Many states have recently provided Medicaid coverage of immediate postpartum LARC, and several other states are considering such coverage. Addressing misinformation about clinical effects and concerns about cost-effectiveness of immediate postpartum LARC may promote adoption of immediate postpartum LARC reimbursement in Medicaid agencies currently without it. Implications Medicaid policy for reimbursement of immediate postpartum LARC is evolving rapidly across the US. Our findings suggest several concrete strategies to remove policy-level barriers and promote facilitators of immediate postpartum LARC.

To examine the feasibility and effectiveness of community-based maternal mortality surveillance in rural Ghana, where most information on maternal deaths usually comes from retrospective surveys and hospital records.In 2013, community-based surveillance volunteers used a modified reproductive age mortality survey (RAMOS 4+2) to interview family members of women of reproductive age (13-49 years) who died in Bosomtwe district in the previous five years. The survey comprised four yes-no questions and two supplementary questions. Verbal autopsies were done if there was a positive answer to at least one yes-no question. A mortality review committee established the cause of death.Survey results were available for 357 women of reproductive age who died in the district. A positive response to at least one yes-no question was recorded for respondents reporting on the deaths of 132 women. These women had either a maternal death or died within one year of termination of pregnancy. Review of 108 available verbal autopsies found that 64 women had a maternal or late maternal death and 36 died of causes unrelated to childbearing. The most common causes of death were haemorrhage (15) and abortion (14). The resulting maternal mortality ratio was 357 per 100 000 live births, compared with 128 per 100 000 live births derived from hospital records.The community-based mortality survey was effective for ascertaining maternal deaths and identified many deaths not included in hospital records. National surveys could provide the information needed to end preventable maternal mortality by 2030.Étudier la faisabilité et l'efficacité d'un système de surveillance communautaire de la mortalité maternelle en milieu rural au Ghana, où la plupart des données sur les morts maternelles proviennent souvent d'enquêtes rétrospectives et des registres hospitaliers.En 2013, des volontaires au sein des communautés rurales du district de Bosomtwe ont employé une version modifiée de l'enquête sur la mortalité des femmes en âge de procréer (RAMOS 4+2) pour interviewer les membres des familles de femmes en âge de procréer (13–49 ans) décédées dans le district au cours des cinq dernières années. Cette enquête comprenait quatre questions fermées de type Oui/Non et deux questions complémentaires. En cas de réponse positive à au moins une des questions fermées, des autopsies verbales ont été réalisées. Les causes des décès ont été déterminées par un comité d'examen de la mortalité.Cette enquête a permis d'obtenir des résultats pour 357 femmes en âge de procréer décédées dans le district. Une réponse positive à au moins une des questions fermées a été renseignée pour le décès de 132 femmes. Ces femmes sont décédées à la suite de complications pendant leur grossesse, lors de l’accouchement ou dans l'année suivant le terme de la grossesse. L'examen des 108 autopsies verbales disponibles a révélé que 64 cas correspondaient à des cas de mort maternelle ou de mort maternelle tardive et 36 cas à des décès non liées à la grossesse. Les causes de décès les plus fréquentes ont été les hémorragies (15) et les avortements (14). Le taux de mortalité maternelle correspondant a été établi à 357 pour 100 000 naissances vivantes, contre 128 pour 100 000 naissances vivantes selon les registres hospitaliers.Cette enquête sur la mortalité directement menée au sein des communautés a été efficace pour évaluer la mortalité maternelle et identifier de nombreux décès non enregistrés dans les dossiers hospitaliers. Des enquêtes de ce type réalisées à l'échelle nationale pourraient fournir les informations requises pour mettre un terme aux décès maternels évitables d'ici à 2030.Examinar la viabilidad y efectividad del seguimiento de ámbito comunitario de la mortalidad materna en la Ghana rural, donde la mayor parte de la información acerca de la mortalidad materna suele provenir de encuestas retrospectivas y registros hospitalarios.En 2013, los voluntarios del seguimiento de ámbito comunitario utilizaron una encuesta sobre mortalidad en edad reproductiva (RAMOS 4+2) para entrevistar a miembros de familias de mujeres en edad reproductiva (13-49 años) que fallecieron en el distrito de Bosomtwe durante los cinco años anteriores. La encuesta estaba formada por preguntas de sí y no y dos preguntas adicionales. Se realizaron autopsias verbales en caso de que se respondiera de forma afirmativa al menos a una pregunta de sí y no. Un comité de revisión de mortalidad estableció la causa de la muerte.Se disponía de los resultados de la encuesta para 357 mujeres en edad reproductiva que fallecieron en el distrito. Se registró una respuesta afirmativa a al menos una pregunta de sí y no para los encuestados que informaron sobre el fallecimiento de 132 mujeres. Estas mujeres sufrieron de mortalidad materna o fallecieron durante el año posterior al fin de su embarazo. Una revisión de 108 autopsias verbales constató que 64 mujeres sufrieron de muerte materna o muerte materna tardía y que 36 fallecieron por causas no relacionadas con la procreación. Las causas más comunes de fallecimiento fueron la hemorragia (15) y el aborto (14). El índice de mortalidad materna resultante fue de 357 por 100 000 nacidos vivos, frente a 128 por 100 000 nacimientos vivos según los registros hospitalarios.La encuesta sobre mortalidad de ámbito comunitario resultó eficaz al determinar las muertes maternas e identificar muchas otras no incluidas en los registros hospitalarios. Las encuestas nacionales podrían proporcionar la información necesaria para acabar con la mortalidad materna evitable en 2030.دراسة مدى جدوى وفعالية المراقبة المجتمعية لوفيات الأمهات في المناطق الريفية بغانا، حيث تأتي معظم المعلومات المتعلقة بوفيات الأمهات عادةً من مسوح أجريت بأثر رجعي ومن سجلات المستشفى.في عام 2013، استخدم المتطوعون القائمون على المراقبة المجتمعية مسوحًا معدلة لمعدل الوفاة في سن الإنجاب (‎RAMOS 4+2) لمقابلة أفراد أسرة النساء في سن الإنجاب (من 13 إلى 49 عامًا) اللاتي توفين في مقاطعة ”بوسومتوي“ في الأعوام الخمسة الماضية. وكان المسح يتألف من أربعة أسئلة تكون إجابتها بنعم أو لا وسؤالين تكميليين. وكان يتم إجراء عمليات التشريح السردي إذا كانت هناك إجابة إيجابية واحدة بنعم أو لا على الأقل لأحد الأسئلة. وقامت لجنة مراجعة الوفيات بإثبات سبب الوفاة.كانت نتائج المسح متوفرة لـ 357 سيدة في سن الإنجاب واللاتي توفين في المقاطعة. وتم تسجيل إجابة إيجابية بنعم أو لا لأحد الأسئلة على الأقل من المشاركين الذين يبلغون عن وفاة 132 سيدة. ولقد توفيت هؤلاء السيدات إما نتيجة لوفيات الأمومة أو في غضون عام واحد من إنهاء الحمل. إن المراجعة الخاصة بحالات التشريح السردي المتوفرة لـ 108 سيدة وجدت أن 64 سيدة تعرضن لحالة وفيات أمهات أو وفيات أمهات متأخرة و36 سيدة توفين لأسباب لا علاقة لها بالإنجاب. وكانت الأسباب الأكثر شيوعًا للوفاة هي النزف (15) والإجهاض (14). كان معدل وفيات الأمهات الناتج 357 في كل 100 000 من المواليد على قيد الحياة، بالمقارنة مع 128 في كل 100 000من المواليد على قيد الحياة الصادر من سجلات المستشفى.كان المسح المجتمعي للوفيات فعالاً لتحديد وفيات الأمومة وقام بتحديد العديد من حالات الوفاة التي لا تتضمنها سجلات المستشفى. يمكن للمسوح الوطنية توفير المعلومات اللازمة لوضع حد لمشكلة وفيات الأمومة بحلول عام 2030.旨在检测加纳农村地区以社区为基础开展的孕产妇死亡率监查的可行性和有效性，该监查的大多数孕产妇死亡信息通常来自回顾式调查和医院记录。.2013 年，以社区为基础的监查志愿者使用经过改进的育龄女性死亡率调查 (RAMOS 4+2) 访问五年前死于博苏姆推地区的育龄（13 至 49 岁）女性家庭成员。该调查由四个一般疑问句和两个追加问题组成。如果至少有一个一般疑问句是肯定答案，则开展口头探查。由死亡审查委员会确定死亡原因。.调查结果来自死于该地区的 357 名育龄女性。其中至少有一个一般疑问句的肯定答案（ 132 名女性死者）被记录于受访者报告中。这些女性或死于孕产期，或死于产后一年内。在相关的 108 次口头探查中发现，64 名女性死于孕产期或孕产后期；36 名女性死于与分娩无关的其他原因。最常见的死亡原因是大出血 (15) 和流产 (14)。所得出的孕产期死亡率为每 100000 个活胎占 357 例，而医院得出的结果为每 100000 个活胎占 128 例。.以社区为基础的孕产妇调查在查明孕产妇死亡和确定很多未被医院记录在册的死亡方面非常有效，全国性调查可提供 2030 年前消除可预防孕产妇死亡所需信息。.Проанализировать осуществимость и эффективность отслеживания случаев материнской смертности на уровне общин в сельской местности Ганы, где основная информация по материнской смертности поступает из ретроспективных исследований и больничной документации.В 2013 году добровольцы, проводящие отслеживание на уровне общин, в ходе модифицированного исследования причин смертности женщин репродуктивного возраста (RAMOS 4+2) опросили в районе Босумтви членов семей, в которых женщины репродуктивного возраста (13–49 лет) умерли в течение предыдущих 5 лет. Опрос состоял из четырех вопросов, требующих ответов «да-нет», и двух дополнительных вопросов. Если хотя бы на один из вопросов, требующих ответов «да-нет», был получен утвердительный ответ, проводилась вербальная аутопсия. Причину смерти определял комитет по анализу смертности.Результаты исследования были получены для 357 женщин репродуктивного возраста, умерших в этом районе. Утвердительный ответ по меньшей мере на один вопрос, требующий ответа «да-нет», был получен от респондентов, сообщивщих о смерти 132 женщин. Смерть этих женщин либо относилась к случаям материнской смертности, либо наступила в течение года после прерывания беременности. Анализ 108 доступных вербальных аутопсий показал, что в 64 случаях имела место материнская смертность или поздняя материнская смертность, а 36 смертей наступили по причине, не связанной с деторождением. Наиболее распространенными причинами смертности были кровотечение (15) и аборт (14). Полученный в результате данного анализа коэффициент смертности составил 357 на 100 000 живорожденных. Для сравнения: на основании исследования больничной документации был получен результат 128 на 100 000 живорожденных.Исследование смертности на уровне общин было эффективным в плане определения материнской смертности и позволило выявить множество случаев смертности, не зафиксированных в больничной документации. Исследования на национальном уровне позволили бы получить информацию, необходимую для искоренения предотвратимой материнской смертности к 2030 году.

Background: Health system decisions to put new technologies into clinical practice require a rapid and trustworthy decision-making process informed by best evidence. Objective: This study aimed to present a rapid evidence review process that can be used to inform health system leaders and clinicians seeking to implement new technology tools to improve patient-clinician decision making and patient-oriented outcomes. Methods: The rapid evidence review process we pioneered involved 5 sequential subprocesses: (1) environmental scan, (2) expert panel recruitment, (3) host evidence review panel, (4) analysis, and (5) local validation panel. We conducted an environmental scan of health information technology (IT) literature to identify relevant digital tools in oncology care. We synthesized the recent literature using current evidence review methods, creating visual summaries for use by a national panel of experts. Panelists were taken through a 6-hour modified Delphi process to prioritize tools for implementation. Findings from the rapid evidence review panel were taken to a local validation panel for further rapid review during a 3-hour session. Results: Our rapid evidence review process shows promise for informing decision making by reducing the amount of time and resources needed to identify and prioritize adoption of IT tools. Despite evidence of improved patient outcomes, panelists had substantial concerns about implementing patient-reported outcome tracking tools, voicing concerns about liability, lack of familiarity with new technology, and additional time and workflow changes such tools would require. Instead, clinicians favored technologies that did not require clinician involvement. Conclusions: Health system leaders can use the rapid evidence review process presented here to usefully inform local technology adoption, implementation, and use in practice.