The study used semi-structured interviews, a structured vignette and a pile-sorting exercise. In all, 10 British Indians were interviewed at a General Practice in North West London. Findings Those interviewed were informed about their diabetes but had difficulties in adapting their diet. Themes identified included causal beliefs of diabetes, use of alternative therapies, moderation of food, adaption of exercise regimes and sources of information. All were aware of avoiding certain foods yet some still continued to consume these items. Participants expressed the need for culturally sensitive forums to help manage their diabetes.

BackgroundTo reduce the cost of health care while increasing efficiency and quality, health systems are seeking innovative means to engage and empower patients. Improved use of information technology and electronic health record (EHR) infrastructure is essential, and required for “meaningful use” as mandated by the federal government. Providing personalized health information using tablets at the point of care could enhance the clinical experience and enable efficient collection of patient reported outcome measures to guide clinical decision making.ObjectiveThe aim of this study is to explore patient and provider attitudes and interest in a proposed clinic-based tablet system for personal health information exchange. To provide a context to understand patients’ use of tablets during their clinic visit, we also examine patients’ current activities and time spent in the waiting room, and their use of health information resources.MethodsSurveys were administered to 84 patients in the waiting room of a community health center affiliated with Massachusetts General Hospital (MGH) in Boston, MA. This survey included a vignette and illustration describing a proposed tablet-based system in which the patient, upon sign in at the clinic, receives a tablet loaded with personalized information tailored to their specific medical conditions and preferences. Patients were queried about their interest in such a system in comparison to traditional forms of patient education as well as their current health information seeking behaviors and activities and time spent in the waiting room. Interviews with five MGH-affiliated health care providers were conducted to assess their opinions regarding the proposed tablet system.ResultsThe majority (>60%) of patients were “very” or “extremely” interested in the proposed tablet system and thought it would improve their knowledge about their medical condition (60%), assist them in making healthy choices (57%), and help them to feel more comfortable talking with their provider (55%). Patients thought the system would be more motivating, informative, and engaging than traditional printed health education materials. The tablet system was not considered more effective than face-to-face interaction with providers, though 44% thought it would improve their relationship with their physician. Overall, 91% of respondents were willing to learn how to use a tablet and 75% reported being “very” or “extremely” confident they could use one. Four of the five providers believed that the proposed tablet system would improve clinical workflow and patient education. Patients and providers were concerned about privacy and security of data collected using the tablets.ConclusionsBoth patients and providers were highly amenable to integrating tablets into the clinical experience, and tablets may be useful in improving patients’ health knowledge, the collection of patient reported outcome measures, and improved patient-provider communication. Further research into operationalizing such systems and their validation is ...

Background Electronic health record (EHR) data, collected primarily for individual patient care and billing purposes, compiled in health information exchanges (HIEs) may have a secondary use for population health surveillance of noncommunicable diseases. However, data compilation across fragmented data sources into HIEs presents potential barriers and quality of data is unknown. Methods We compared 2015 patient data from a mid-size health system (Database A) to data from System A patients in the Utah HIE (Database B). We calculated concordance of structured data (sex and age) and unstructured data (blood pressure reading and A1C). We estimated adjusted hypertension and diabetes prevalence in each database and compared these across age groups. Results Matching resulted in 72,356 unique patients. Concordance between Database A and Database B exceeded 99% for sex and age, but was 89% for A1C results and 54% for blood pressure readings. Sensitivity, using Database A as the standard, was 57% for hypertension and 55% for diabetes. Age and sex adjusted prevalence of diabetes (8.4% vs 5.8%, Database A and B, respectively) and hypertension (14.5% vs 11.6%, respectively) differed, but this difference was consistent with parallel slopes in prevalence over age groups in both databases. Conclusions We identified several gaps in the use of HIE data for surveillance of diabetes and hypertension. High concordance of structured data demonstrate some promise in HIEs capacity to capture patient data. Improving HIE data quality through increased use of structured variables may help make HIE data useful for population health surveillance in places with fragmented EHR systems. Electronic supplementary material The online version of this article (10.1186/s12889-019-7367-z) contains supplementary material, which is available to authorized users.

We study the causal effect of winning an Oscar Award on an actor or actress's survival. Does the increase in social rank from a performer winning an Oscar increase the performer's life expectancy? Previous studies of this issue have suffered from healthy performer survivor bias, that is, candidates who are healthier will be able to act in more films and have more chance to win Oscar Awards. To correct this bias, we adapt Robins' rank preserving structural accelerated failure time model and g-estimation method. We show in simulation studies that this approach corrects the bias contained in previous studies. We estimate that the effect of winning an Oscar Award on survival is 4.2 years, with a 95% confidence interval of [−0.4, 8.4] years. There is not strong evidence that winning an Oscar increases life expectancy.