Background: Telehealth is being adopted by health systems across the country and many barriers to the expansion of video visit programs have been identified. Our study focused on the usability of video visit technology by examining technical challenges faced by patients over the course of a video visit. Methods:We conducted a survey of patients who received care from the Michigan Medicine video visit program from January 31, 2019 to July 31, 2019. The video visit program includes more than 1,300 visits a year across more than 30 specialties. Following the completion of their video visit, all patients were invited to participate in our online survey through the patient portal. The survey included questions on patient satisfaction, motivation and technical challenges.Results: We received responses from 180 patients (response rate of 26%). Overall patient satisfaction was high; 90% of respondents agreed that their video visit experience was similar to that of in-person visits and 93.3% of respondents would recommend video visits. Despite this high satisfaction rate, 36 out of 180 (20.0%) respondents cited technical issues during their video visit: video issues (n=11), audio issues (n=5), video and audio issues (n=2), slow/dropped connection (n=7), initial set-up issues (n=4), long wait time (n=3), and other (n=4).Conclusions: While most patients report a high degree of satisfaction with their video visit, a meaningful subset of patients continue to experience technical challenges.
Objective:To explore challenges and opportunities for surgery departments’ academic missions as they become increasingly affiliated with expanding health systems.Summary Background Data:Academic medicine is in the midst of unprecedented change. In addition to facing intense competition, narrower margins, and decreased federal funding, medical schools are becoming increasingly involved with large, expanding health systems. The impact of these health system affiliations on surgical departments’ academic missions is unknown.Methods:Semistructured interviews with 30 surgical leaders at teaching hospitals affiliated with health systems from August - December 2019. Interviews were transcribed verbatim and coded in an iterative process using MaxQDA software. The topic of challenges and opportunities for the academic mission was an emergent theme, analyzed using thematic analysis.Results:Academic health systems typically expanded to support their business goals, rather than their academic mission. Changes in governance sometimes disempowered departmental leadership, shifted traditional compensation models, redirected research programs, and led to cultural conflict. However, at many institutions, health system growth cross-subsidized surgical departments’ research and training missions, expanded their clinical footprint, enabled them to improve standards of care, and enhanced opportunities for researchers and trainees.Conclusions:Although health system expansion generally intended to advance business goals, the accompanying academic and clinical opportunities were not always fully captured. Alignment between medical school and health system goals enabled some surgical department leaders to take advantage of their health systems’ reach and resources to support their academic missions.
BACKGROUND Though telemedicine is a promising approach for removing barriers to care and improving access for patients, telemedicine use for many medical specialties has decreased from its peak during the acute COVID-19 public health crisis. Understanding the barriers and facilitators to the maintenance of web-based visits—one key component of telemedicine—is critical for ensuring the continuous availability of this service for patients. OBJECTIVE The purpose of this study is to describe medical providers’ perceived barriers and facilitators to the continued use of web-based visits to inform quality improvement efforts and promote sustainability. METHODS We performed a qualitative content analysis of free-text responses from a survey of medical providers administered from February 5-14, 2021, at a large, midwestern academic institution, including all providers from medical professions that offered telemedicine (eg, physicians, residents or fellows, nurse practitioners, physicians assistants, or nurses) who completed at least 1 web-based visit from March 20, 2020, to February 14, 2021. The primary outcome was the experience of providing web-based visits, including barriers and facilitators to continued usage of web-based visits. Survey questions included 3 major domains: quality of care, technology, and satisfaction. Responses were coded using qualitative content analysis and further analyzed through a matrix analysis to understand the providers’ perspectives and elucidate key barriers and facilitators of web-based visit usage. RESULTS Of 2692 eligible providers, 1040 (38.6%) completed the survey, of whom 702 were providers from medical professions that offered telemedicine. These providers spanned 7 health care professions and 47 clinical departments. The most common professions represented were physicians (486/702, 46.7%), residents or fellows (85/702, 8.2%), and nurse practitioners (81/702, 7.8%), while the most common clinical departments were internal medicine (69/702, 6.6%), psychiatry (69/702, 6.6%), and physical medicine and rehabilitation (67/702, 6.4%). The following 4 overarching categories of provider experience with web-based visits emerged: quality of care, patient rapport, visit flow, and equity. Though many providers saw web-based visits as a tool for improving care access, quality, and equity, others shared how appropriate selection of web-based visits, support (eg, patient training, home devices, and broadband access), and institutional and nationwide optimization (eg, relaxation of licensing requirements across state borders and reimbursement for phone-only modalities) were needed to sustain web-based visits. CONCLUSIONS Our findings demonstrate key barriers to the maintenance of telemedicine services following the acute public health crisis. These findings can help prioritize the most impactful methods of sustaining and expanding telemedicine availability for patients who prefer this method of care delivery.
Sugar industry is one of the vital sectors in improving the economy of any country. But, sugar industries are striving hard to increase their profitability due to high cost of sugar production accompanied with low selling price. Without resorting to radical restructuring of sugar plant, but through proper planning, annual savings can be improved. One of the artifices to address this issue is through improving the quality of sugar so that selling price can be increased which in turn generates more revenue to the plant. The Juice Sulphitation process, as applied in the manufacturing of sugar, is a subject of such wide-spread interest. The mixed juice from the mills contains soluble and non-soluble suspended non-sugars. These impurities are to be precipitated by the judicious and controlled addition of Milk of Lime (CaO) and subsequent neutralization by Sulphur Dioxide (SO2) gas. This paper attempts to improve the quality of sugar by optimizing the quantity of lime (in the form of milk of lime) and sulphur (in the form of SO2 gas) added in the juice sulphitation process of a sugar plant. Two factor factorial experimentation was adopted to obtain an optimal combination of lime and sulphur quantities. Data of Transmittancy test on sugar juice was collected by varying the quantities of lime and sulphur. Analysis of Variance (ANOVA) table was plotted which explored the significant effects of individual treatments and interaction effects. Further to this, comparison of treatment means was carried out to find out the best treatment combination values for achieving the optimal quality of sugar from sugarcane.
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