Janel Hanmer

Background . Nonpharmaceutical interventions (NPIs) were critical for mitigating COVID-19 transmission, yet their social and economic costs generated substantial public resistance. We aimed to quantify US adults’ acceptance of key NPIs. Methods . We conducted a national discrete-choice experiment between May and December 2024 among a quota-based panel of US adults, considering 6 NPIs: mask mandates, reduced public transit capacity, school closures with/without remote learning, closure of crowded indoor venues, and closure of nonessential businesses (e.g., restaurants). Scenarios varied by COVID-19 infection risk and health care restrictions. Results . A total of 5,047 adults participated, with age, gender, race, and income distributions reflecting those of the US population. Participants considered mask mandates, reduced transit capacity, and school closures with remote learning acceptable even if they do not reduce cases. School closures without remote learning and closure of nonessential businesses were acceptable only if they reduced cases by at least 75 per 100 persons within 1 mo. Restricted access to primary and optional care was strongly objected to. Male participants, Republicans, Independents, adults ≥65 y, and those without chronic conditions showed the lowest acceptance of NPIs regardless of projected benefit. Female participants, younger adults, those living with children, and those with chronic conditions were more receptive. Still, they required a reduction of >50 cases per 100 persons to accept school closures without remote learning and closure of nonessential businesses. Limitations . Temporal distancing may have affected participants’ recollection of their experiences with NPIs. Conclusions . US adults displayed heterogeneous but generally high thresholds for accepting school closures without remote learning, closure of nonessential businesses, and health care restrictions. These findings can guide pandemic preparedness plans that balance public acceptance with disease-control goals. Highlights: What levels of COVID-19 risk reduction were required for US adults to accept nonpharmaceutical interventions (NPIs) such as school or business closures? In a discrete-choice experiment of 5,047 US adults, mask mandates and other moderate NPIs were broadly acceptable even if they do not reduce cases. School closures without remote learning and closure of nonessential businesses were acceptable only if they reduced infections by ≥75 per 100 persons per month. Our survey participants did not find pandemic response plans that rely on disruptive NPIs acceptable but found indoor mask mandates and school closures with remote learning acceptable, independent of their impact on infection risk.

Background: Reliable internet connectivity is crucial for family participation in pediatric digital health care, including telehealth. Lack of internet connectivity is a barrier to pediatric telehealth access. While surveys commonly inquire about metrics, such as internet plan or device ownership, fewer measures exist for the reliability of internet connectivity when needed. There is limited knowledge of the national prevalence of reliable internet connectivity among households with children and how reports of reliable internet connectivity are associated with use of internet plans and devices. Objective: We examined the prevalence of reliable internet connectivity among households with children and its association with digital technology access and sociodemographic factors. Methods: We performed a secondary data analysis of a US national cross-sectional survey examining parents’ health-seeking decisions for children younger than 18 years old. The respondent panel was hosted by the National Opinion Research Center (NORC) AmeriSpeak. This analysis focused on survey items on reliable internet connectivity, digital technology access (internet plan type and device ownership type), and sociodemographic characteristics (education, employment, geographic region, race and ethnicity, and disability) of parent respondents and their children. The dependent variable was a binary indicator of household reliable internet connectivity. Respondents were categorized as having unreliable internet connectivity if they self-reported internet worry or unreliable internet experience. Unadjusted Rao-Scott chi-square tests and adjusted multivariable logistic regressions with sampling weights were applied. Results: The final survey sample (N=1158) comprised 753 (55%) females, 614 (57%) non-Hispanic White, and 948 (81%) metropolitan respondents. There were 125 (12%) parents who reported internet worry, 152 (13%) parents who reported unreliable internet experience, and 76 (7%) parents who reported both. Combining these measures, we identified 201 (19%) parents with unreliable internet connectivity, defined as reporting either internet worry or unreliable internet experience. In contrast, 957 (81%) parents reported reliable internet connectivity in the household. In adjusted analysis, reliable internet connectivity was significantly associated with owning both nonmobile and mobile internet plans combined (86% reliable internet connectivity) versus nonmobile internet plan-only (67%; P =.001); postgraduate (94%) versus high school education (75%; P <.001); employment (84%) versus unemployment (76%; P =<.01); racial and ethnic marginalized status (77%) versus nonmarginalized (85%; P =<.01); and disability (70%) versus without disability (85%; P <.001), but not with device ownership, geographic region, race and ethnicity as separate groups, or parent sex. Conclusions: One-fifth of families with children experienced unreliable internet connectivity, highlighting an important dimension of the digital health divide that appears distinct from internet plan use or device ownership alone. Future research is needed to derive consensus on measuring reliable internet connectivity as a separate metric, including specifying the definition, survey questions, response options, and time frame of unreliability experience. Since reliable internet connectivity is needed for the growing field of digital health care, it is a critical issue for equitable pediatric health care access and delivery.

Importance: Care is commonly sought for pediatric acute respiratory tract infections (ARTIs). The site where families seek ARTI care affects continuity, quality, and costs, but how parents of young children balance tradeoffs between care sites is unknown.Objectives: To evaluate preferences for attributes of ARTI care sites among parents of young children using a discrete choice experiment (DCE).Design, Setting, and Participants: This survey study using a DCE was conducted among a nationally representative panel of US parents of children aged 6 months to 5 years between July 31 and August 18, 2023. Participants completed a DCE survey with 7 care attributes (visit modality, visit timeliness, noncare time, out-of-pocket costs, clinician continuity, pediatric expertise, and follow-up availability), with 2 to 5 levels each. The DCE used standard choice-based conjoint procedures. Sawtooth software was used to create a random, balanced overlap experimental design. Data were analyzed between October 2023 and October 2024.Main Outcomes and Measures: The main outcomes were preferences for attributes and their levels, examined using hierarchical bayesian and latent class analyses and market simulation of care choices under different scenarios.Results: Of 944 respondents, 63 (6.7%) self-identified as Asian or Pacific Islander, 228 (24.2%) as Hispanic, 120 (12.8%) as Black non-Hispanic, 501 (53.1%) as White non-Hispanic, and 30 (3.3%) as other non-Hispanic; 53% were women; 285 spoke a language other than English at home; and 338 had children who received Medicaid. Respondents’ mean (SD) age was 36.5 (7.4). Overall, respondents gave most weight to visit modality (in person vs telemedicine; importance, 22.7%) and out-of-pocket costs (importance, 23.7%) and least weight to noncare time (importance, 5.8%) and availability of follow-up within 2 days (importance, 6.8%). Latent class analysis identified 4 subgroups: urgency focused (47.4% of respondents), continuity focused (22.7%), cost focused (20.6%), and in-person visit focused (9.3%). The addition of a telehealth visit option with the child’s usual primary care practice available within 30 minutes to options of in-person primary care, urgent care, and emergency department care shifted reduced anticipated care seeking outside of primary care in urgency-focused (−13.3%) and cost-focused (−5.6%) subgroups and reduced forgone care in the cost-focused subgroup (−8.1%).Conclusions and Relevance: In this survey study using a DCE, a subset of parents prioritized in-person care for pediatric ARTI care, and most parents had other profiles focused on different care attributes. Results of this research suggest that access to low-cost, quickly available telehealth services with a clinician in a child’s usual practice could shift some urgent care and emergency department visits for ARTI to the child’s primary care practice.

BACKGROUND: Supratentorial intracerebral hemorrhage (ICH) is common and often devastating. In a randomized controlled trial, ICH evacuation with minimally invasive trans-sulcal parafascicular surgery (MIPS) improved functional outcomes at 180 days compared with medical management (MM), primarily in patients with lobar hemorrhages. The cost-effectiveness of MIPS compared with MM is explored. METHODS: A Markov model compared costs and outcomes using ENRICH trial (Early Minimally Invasive Removal of Intracerebral Hemorrhage) data for MIPS versus MM over the 6-month trial duration. Costs were 2020 US$ and effectiveness was quality-adjusted life years. Monthly model transitions between modified Rankin Scale score health states were estimated from trial data. Costs were obtained from US databases and literature. MIPS device costs were $5705/patient. Primary outcomes were total hospital costs from the hospital perspective and the incremental cost-effectiveness ratio between MIPS and MM (ie, the 6-month cost difference between strategies divided by quality-adjusted life year difference) from the healthcare perspective for patients with lobar ICH. Sensitivity analyses were performed. RESULTS: From the hospital perspective, MIPS costs were $2782 less per patient than MM ($74 252 versus $77 034), with MIPS having decreased the intensive care unit hospital length of stay, non-MIPS neurosurgery, mortality, and rehospitalization. From the healthcare perspective, including hospital and nonhospital costs, MIPS in lobar ICH cost $8850 less and gained 0.068 quality-adjusted life year per patient compared with MM; thus MIPS was dominant (less costly and more effective). Results were robust to individual parameter variation over plausible ranges and, with all parameters varied simultaneously in a probabilistic sensitivity analysis, MIPS was dominant in >93% of 10 000 model iterations and favored in >99% at $100 000/quality-adjusted life year gained (a common US benchmark). CONCLUSIONS: In the ENRICH randomized controlled trial, MIPS cost less and was more effective compared with MM from both hospital and healthcare perspectives for patients with lobar ICH. REGISTRATION: URL: https://clinicaltrials.gov/ ; Unique identifier: NCT02880878.

Objectives: The EQ-5D-5L and Patient-Reported Outcomes Measurement Information System (PROMIS®) preference score (PROPr) are preference-based measures. This study compares mapping and linking approaches to align the PROPr and the PROMIS domains included in PROPr plus Anxiety with EQ-5D-5L item responses and preference scores. Methods: A general population sample of 983 adults completed the online survey. Regression-based mapping methods and item response theory (IRT) linking methods were used to align scores. Mapping was used to predict EQ-5D-5L item responses or preference scores using PROMIS domain scores. Equating strategies were applied to address regression to the mean. The linking approach estimated item parameters of EQ-5D-5L based on the PROMIS score metric and generated bidirectional crosswalks between EQ-5D-5L item responses and relevant PROMIS domain scores. Results: EQ-5D-5L item responses were significantly accounted for by PROMIS domains of Anxiety, Depression, Fatigue, Pain Interference, Physical Function, Social Roles, and Sleep Disturbance. EQ-5D-5L preference scores were accounted for by the same PROMIS domains, excluding Anxiety and Fatigue, and by the PROPr preference scores. IRT-linking crosswalks were generated between EQ-5D-5L item responses and PROMIS domains of Physical Function, Pain, and Depression. Small differences were found between observed and predicted scores for all 3 methods. The direct mapping approach (directly predicting EQ-5D-5L scores) with the equipercentile equating strategy proved superior to the linking method due to improved prediction accuracy and comparable score range coverage. Conclusions: The PROPr and the PROMIS domains included in the PROMIS-29+2 predict EQ-5D-5L preference scores or item responses. Both methods can generate acceptably precise EQ-5D-5L preference scores, with the direct mapping approach using the equating strategy offering better precision. We summarized recommended score conversion tables based on available and desired scores. Highlights: This study compares mapping (score prediction) and IRT-based linking approaches to align the PROPr and the PROMIS domains with EQ-5D-5L item responses and preference scores. Researchers, clinicians, and stakeholders can use this study’s regression formulas and score crosswalks to convert scores between PROMIS and EQ-5D-5L. Mapping can generate more precise scores, while linking offers greater flexibility in score estimation when fewer PROMIS domain scores are collected.

Background Review of Systems (ROS) forms are a common tool for clinical assessment and billing. However, terms on ROS forms vary widely. Understanding the variations in ROS terms and perceived definitions (or misperceptions) has implications for patient care and effective implementation of electronic health record (EHR) documentation practices. Objective(s) To define a representative list of ROS terms and to assess the range of perceived definitions (and misperceptions) of ROS terms among clinicians and lay volunteers. Design Qualitative review of ROS forms and qualitative interviews with clinicians and lay volunteers. Participations/Patients/Subjects Eleven clinicians in general internal medicine and internal medicine sub-specialties; 30 lay volunteers. Approach We employed a mental models framework approach to understand patient perceptions, accurate and inaccurate, of commonly used ROS terms. To do this, we first abstracted common ROS terminology used in medicine practices. Then, we developed consensus definitions of ROS terms with a sample of expert clinicians. Lastly, we conducted qualitative interviews with lay volunteers to assess their interpretations of these terms. Key Results By consensus, clinicians generally agreed on general principles of operational definitions. Yet, misinterpretations among clinicians were common, particularly with respect to timeframe, duration, and nuances of symptoms. Laypersons had varied interpretations which often differed from the clinicians. Conclusions ROS forms are inconsistently operationalized and defined, with misunderstandings across both clinicians and the public. Simultaneously, the forms create additional burden across individuals involved in care delivery, including patients and families. Broad terms and discussion of concerns with patients may provide an efficient alternative to meeting both billing requirements and patient needs.

Introduction Deficits in decision-making (DM) can lead to adverse outcomes across multiple domains such as financial management and medical care. By hindering such DM abilities, cognitive impairment (CI) often affects quality of life. Routine screening for CI, however, does not include systematic and comprehensive assessment of DM ability. While there are many DM measures, there is considerable heterogeneity in what constructs are measured and the populations in which they have been validated. This scoping review protocol details the proposed comprehensive examination of published literature on DM measures used in adults aged 45 years and older. Methods and analysis Arksey and O’Malley’s (2005) scoping review methodology framework will guide the current scoping review. We will systematically search Embase (Elsevier), MEDLINE (Ovid), PsycINFO (Ebsco), Cochrane Library (Wiley), Web of Science (Clarivate) and Scopus (Elsevier) to identify the studies meeting our eligibility criteria. We will review literature published between January 2018 and November 2023. Following best practice recommendations, a two-stage study selection process will be applied. First, titles and abstracts will be independently reviewed by two reviewers based on our eligibility criteria. Second, full texts will be screened and data will be extracted only from the articles included after the full review. The results of the current scoping review will be reported in adherence to PRISMA-Scr guidelines. Ethics and dissemination This study does not require ethics approval as the scoping review methodology involves reviewing results from publicly available published materials. Results of the scoping review will be submitted for publication in a peer-reviewed journal. Trial registration number NIA grant number 1U24AG082022-01.

Purpose: Preference-based summary scores are used to quantify values, differences, and changes in health-related quality of life (HRQoL) that can be used for cost-effectiveness analyses. The PROMIS-Preference (PROPr) measure is a preference-based summary score comprised of 7 PROMIS domains. The PROMIS-16 is a new PROMIS profile instrument. We evaluated the measurement properties of PROPr generated from the widely used PROMIS-29 + 2 compared with the PROMIS-16. Methods: We performed a secondary analysis of data from an online survey of the general US population, with a longitudinal subsample who reported back pain. The survey included both the PROMIS-16 and the PROMIS-29 + 2 profiles. PROPr scores were calculated from each profile and compared by the distribution of scores, overall mean scores, product-moment correlations with pain measure scores (Oswestry Disability Index, Roland-Morris Disability Questionnaire, Pain Intensity, Interference with Enjoyment of Life, Interference with General Activity Scale, and Graded Chronic Pain Scale), and difference in mean scores in subgroups with 13 chronic health conditions (Cohen’s d). Results: Of the 4,115 participants in the baseline survey, 1,533 with any reported back pain were invited for the 6-month follow-up survey and 1,256 completed it. At baseline, the overall mean (SD) PROPr score was 0.532 (0.240) from PROMIS-16 and 0.535 (0.250) from PROMIS 29 + 2. At both time points, the correlations of PROPr scores with physical and mental health summary scores from the PROMIS-29 and 4 pain scales were within 0.01 between profiles. Using subgroups with chronic health conditions and comparing between profiles, Cohen’s d estimates of the difference in effect size were small (< 0.2). Conclusion: PROPr scores from the 16-item PROMIS profile measure are similar to PROPr scores from the longer PROMIS-29 + 2.