Methodological Challenges in Online Trials

Health care and health care services are increasingly being delivered over the Internet. There is a strong argument that interventions delivered online should also be evaluated online to maximize the trial’s external validity. Conducting a trial online can help reduce research costs and improve some aspects of internal validity. To date, there are relatively few trials of health interventions that have been conducted entirely online. In this paper we describe the major methodological issues that arise in trials (recruitment, randomization, fidelity of the intervention, retention, and data quality), consider how the online context affects these issues, and use our experience of one online trial evaluating an intervention to help hazardous drinkers drink less (DownYourDrink) to illustrate potential solutions. Further work is needed to develop online trial methodology.     

新媒体环境下医学图书馆服务水平的提升

介绍新媒体的内涵和特征,阐述新媒体在信息传播中的表现形式丰富、获取信息便捷等优势,论述新媒体环境下医学资源的采集与揭示,提出完善新媒体服务形式、理念的途径和方法。     

Internet activity as a proxy for vaccination compliance

Tracking the progress of vaccination campaigns is a challenging and important public health need. Examining a recent Polio outbreak in the Middle East, we show that novel methods utilizing online search trends have great potential to provide a real-time, reliable proxy for vaccination rates over space and time.     

A roadmap for comparing readmission policies with application to Denmark,England, Germany and the United States

Hospital readmissions receive increasing interest from policy makers because reducing unnecessary readmissions has the potential to simultaneously improve quality and save costs. This paper reviews readmission policies in Denmark, England, Germany and the United States (Medicare system). The suggested roadmap enables researchers and policy makers to systematically compare and analyse readmission policies. We find considerable differences across countries. In Germany, the readmission policy aims to avoid unintended consequences of the introduction of DRG-based payment; it focuses on readmissions of individual patients and hospitals receive only one DRG-based payment for both the initial and the re-admission. In Denmark, England and the US readmission policies aim at quality improvement and focus on readmission rates. In Denmark, readmission rates are publicly reported but payments are not adjusted in relation to readmissions. In England and the US, financial incentives penalise hospitals with readmission rates above a certain benchmark. In England, this benchmark is defined through local clinical review, while it is based on the risk-adjusted national average in the US. At present, not enough evidence exists to give recommendations on the optimal design of readmission policies. The roadmap can be a tool for systematically assessing how elements of other countries’ readmission policies can potentially be adopted to improve national policies.     

On pins and needles: How vaccines are portrayed on Pinterest

Vaccination is an effective public health tool for reducing morbidity and mortality caused by infectious diseases. However, increasing numbers of parents question the safety of vaccines or refuse to vaccinate their children outright. The Internet is playing a significant role in the growing voice of the anti-vaccination movement as a growing number of people use the Internet to obtain health information, including information about vaccines. Given the role the Internet plays in providing vaccination-related communication, coupled with limited research in this area, this study focused on the social media platform Pinterest, analyzing 800 vaccine-related pins through a quantitative content analysis. The majority of the pins were anti-vaccine, and most were original posts as opposed to repins. Concerns about vaccine safety and side effects were oft-repeated themes, as was the concept of conspiracy theory. Pro-vaccine pins elicited consistently more engagement than anti-vaccine pins. Health educators and public health organizations should be aware of these dynamics, since a successful health communication campaign should start with an understanding of what and how publics communicate about the topic at hand.     

云计算环境下网络医学信息资源服务模型的构建

阐述了云计算的原理及优点,并针对网络医学信息资源及其利用存在的问题,提出了构建云计算环境下网络医学信息资源服务模型。该模型可有效整合异构环境的资源、实现资源优化配置、优化网络医学信息资源服务、避免重复建设医学信息资源、减少人力财力的浪费、提高资源共享与利用。     

Strategic Provider Behavior Under Global Budget Payment with Price Adjustment in Taiwan

Global budget payment is one of the most effective strategies for cost containment, but its impacts on provider behavior have not been explored in detail. This study examines the theoretical and empirical role of global budget payment on provider behavior. The study proposes that global budget payment with price adjustment is a form of common‐pool resources. A two‐product game theoretic model is derived, and simulations demonstrate that hospitals are expected to expand service volumes, with an emphasis on products with higher price–marginal cost ratios. Next, the study examines the early effects of Taiwan's global budget payment system using a difference‐in‐difference strategy and finds that Taiwanese hospitals exhibited such behavior, where the pursuit of individual interests led to an increase in treatment intensities. Furthermore, hospitals significantly increased inpatient service volume for regional hospitals and medical centers. In contrast, local hospitals, particularly for those without teaching status designation, faced a negative impact on service volume, as larger hospitals were better positioned to induce demand and pulled volume away from their smaller counterparts through more profitable services and products such as radiology and pharmaceuticals. Copyright © 2014 John Wiley & Sons, Ltd.     

Do Diagnosis‐Related Group‐Based Payments Incentivise Hospitals to Adjust Output Mix?

This study investigates whether the diagnosis‐related group (DRG)‐based payment method motivates hospitals to adjust output mix in order to maximise profits. The hypothesis is that when there is an increase in profitability of a DRG, hospitals will increase the proportion of that DRG (own‐price effects) and decrease those of other DRGs (cross‐price effects), except in cases where there are scope economies in producing two different DRGs. This conjecture is tested in the context of the case payment scheme (CPS) under Taiwan's National Health Insurance programme over the period of July 1999 to December 2004. To tackle endogeneity of DRG profitability and treatment policy, a fixed‐effects three‐stage least squares method is applied. The results support the hypothesised own‐price and cross‐price effects, showing that DRGs which share similar resources appear to be complements rather substitutes. For‐profit hospitals do not appear to be more responsive to DRG profitability, possibly because of their institutional characteristics and bonds with local communities. The key conclusion is that DRG‐based payments will encourage a type of ‘product‐range’ specialisation, which may improve hospital efficiency in the long run. However, further research is needed on how changes in output mix impact patient access and pay‐outs of health insurance. Copyright © 2014 John Wiley & Sons, Ltd.