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The purpose of this research paper is to explore the determinants of patients' service choices between telephone consultation and text consultation in online health communities (OHCs).

This study utilized an empirical model based on the elaboration likelihood model and examined the effect of information, regarding service quality (the central route) and service price (the peripheral route), using online health consultation data from one of the largest OHCs in China.

The logistic regression results indicated that both physician- and patient-generated information can influence the patients' service choices; service price signals will lead patients to cheaper options. However, individual motivations, disease risk and consulting experience change a patients' information processing regarding central and peripheral cues.

Previous researchers have investigated the mechanism of patient behavior in OHCs; however, the researchers have not focused on the patients' choices regarding the multiple health services provided in OHCs. The findings of this study have theoretical and practical implications for future researchers, OHC designers and physicians.

In the digital age, the spread of online behavior and real-world information leads to social contagion. This study aims to investigate the contagion phenomenon of online physician choice and then discuss its potential influence on the sub-specialization process in the healthcare service industry. In specific, this study aims to propose the basic mechanism of infection and immunity as follows – exposure to antigen may lead to an immune response, and the success of the immune response may depend on the provision of appropriate immune signaling.

Data collected from haodf.com including 4 disease types and 247 physicians from 2008 to 2015 were used to test the proposed hypotheses. Panel vector autoregression method was utilized to analyze the panel data.

The obtained result shows that social contagion of physician choice over disease type is salient on e-consultation platforms, indicating that physicians associated with/on haodf.com are concentrating on an even narrower type of disease. Disclosing more simple signals (physician history orders) results in more disease concentration for that physician in the future. In contrast, disclosing more detailed signals (physician-contributed knowledge or physician reviews) leads to less disease concentration.

This finding implies that physician-contributed knowledge and physician reviews may act as immune signal which will tend to trigger a success immune response. This study not only suggests managers should be careful about the double-edged sword effect of online physician choice contagion but also provides the useful approaches to promote or restrain such a contagion in a flexible way.

As healthcare continues to become more expensive and complex, considering the voice of the patient in the design and operation of healthcare practices is important. Wound care and rural healthcare scenarios pose additional complexities for providers and patients. This study sought to identify key determinants of patient service quality in wound care.

Patients at the wound care/ostomy clinic (WOC) in a rural hospital were surveyed using the Kano model. The Kano model enables the categorization of quality attributes based on the attributes' contribution to the subject's overall satisfaction (and dissatisfaction). Chi-square goodness-of-fit testing, multinomial analysis and power analysis were then used to determine the Kano categories for each satisfaction-related attribute.

The analyses resulted in 14 one-dimensional attributes and 3 indeterminable attributes. For the one-dimensional attributes, customer satisfaction is directly proportional to the level of performance for that attribute. The one-dimensional attributes included providing correct care on the first, provision of necessary supplies for care, appropriately qualified medical staff and confidence in care provided by medical staff, among others. Understanding the attributes important to the patient drive patient-centered care, which improves positive patient outcomes and recovery. These attributes can then be used by healthcare professionals to design patient-centric processes and services. This research provides a framework for incorporating the voice of the patient into healthcare services.

While the research methodology can be used in other healthcare settings, the findings are not generalizable to other wound care clinics. This research was conducted in one small, rural hospital. In addition, the sample size was small due to the size of the wound clinic; therefore, an analysis of the differences between demographics could not be performed.

Considering the perspectives of rural wound care patients is important, as the patients are an under-served population with unique challenges related to patient care. The research findings detail rural patients' expectations during wound care treatments, which enable the clinic to focus on improving patient satisfaction. This research contributes to understanding the factors that are important to patient satisfaction in wound care. Further, the methodology presented can be applied to other healthcare settings.

While studies exist using the Kano model in healthcare and the literature is sparse in rural healthcare, this is the first case study using the Kano model in wound care to understand patient preferences.

Given the popularity of online health communities (OHCs) and medical question-and-answer (Q&A) services, it is increasingly important to understand what constitutes useful answers and user-adopted standards in healthcare domain. However, few studies provide insights into how health information characteristics, provider characteristics and recipient characteristics jointly influence user information adoption decisions. To fill this research gap, this study examines the combined effects of physicians' certainty tone as information characteristics, seniority as provider characteristics and disease severity as recipient characteristics on patients' health information adoption.

Drawing on dual-process theory and information adoption model, an extended information adoption model is established in this study to examine the effect of attitude certainty on patients' health information adoption, and the moderating effects of online seniority and offline seniority, as well as patient motivation level—disease severity. Utilizing logit regression models, the authors empirically tested the hypotheses based on 4,224 Q&A records from a popular Chinese OHC.

The results show that (1) attitude certainty has a significant positive impact on patients' health information adoption, (2) the relationship between attitude certainty and information adoption is negatively moderated by physicians' online seniority, but is positively moderated by offline seniority; (3) there is a negative three-way interaction effect of attitude certainty, online seniority and disease severity on patients' health information adoption.

This study extends the information adoption model to examine the two-way interaction between argument quality and source reliability, as well as the three-way interaction with user motivation level, especially for health information adoption in the healthcare field. These findings also provide direct practical applications for knowledge contributors and OHCs.

Waiting time, as an important predictor of queue abandonment and patient satisfaction, is important for resource utilization and patient experience management. Medical institutions have given top priority to reforming the appointment system for many years; however, whether the increased information transparency brought about by the appointment scheduling mechanism could improve patient waiting time is not well understood. In this study, the authors examine the effects of information transparency in reducing patient waiting time from an uncertainty perspective.

Leveraging a quasi-natural experiment in a tertiary academic hospital, the authors analyze over one million observational patient visit records and design the propensity score matching plus the difference in difference (PSM-DID) model and hierarchical linear modeling (HLM) to address this issue.

The authors confirm that, on average, improved information transparency significantly reduces the waiting time for patients by approximately 6.43 min, a 4.90% reduction. The authors identify three types of uncertainties (resource, process and outcome uncertainty) in the patient visit process that affect patients' waiting time. Moreover, information transparency moderates the relationship between three sources of uncertainties and waiting time.

The authors’ work not only provides important theoretical explanations for the patient-level factors of in-clinic waiting time and the reasons for information technology (IT)-enabled appointment scheduling by time slot (ITASS) to shorten patient waiting time and improve patient experience but also provides potential solutions for further exploration of measures to reduce patient waiting time.

This paper aims to explore the antecedents and consequences of service chain flexibility (SCF) in healthcare service delivery.

A structural model was developed based on a literature review. A 29-indicator questionnaire was circulated among service providers in the healthcare system across India, and 253 valid responses were received, corresponding to a response rate of 46%. The research model was assessed using a cross-sectional research design, and the data were analyzed by structural equation modeling using analysis of moment structures (AMOS) software.

Service orientation (SO), technology integration (TI), knowledge sharing (KS) and supply chain integration (SCI) were identified as antecedents of SCF, the consequence of which is responsiveness in service delivery (RSD). Furthermore, patient-centered care moderates the relationship between SCF and RSD.

This paper highlights the impact of SCF on RSD in healthcare organizations. Consideration of the four constructs of SO, TI, KS and SCI as antecedents of SCF and, in turn, RSD may be one of the limitations. Future work may identify other theoretical constructs with potential impacts on SCF and RSD. Furthermore, eight months for data collection could have resulted in early-late response bias. This study was operationalized in India and may reflect political, economic, social, technological, environmental and legal factors unique to India.

The study provides suggestions to practitioners for building RSD by leveraging SO, TI, KS and SCI in flexibility-driven service chain processes. Recognizing the relationships among these constructs can aid in the timely formulation of corrective actions and patient-centric policies.

This paper highlights how focusing on a SCF can promote RSD. This understanding may aid the design of processes that develop patient-centricity and deliver health as a social good in an effective manner.

The empirical evidence from this study can help hospitals integrate and build flexibility in their functions, thus enabling them to deliver responsiveness in care.

The study aims to address a critical gap in existing healthcare payment schemes and care service pricing by recognizing the influential role of patients' decisions on self-management efforts. These decisions not only impact health outcomes but also shape the demand for care, subsequently influencing care costs. Despite the significance of this interplay, current payment schemes often overlook these dynamics. The research focuses on investigating the implications of a novel behavior-based payment scheme, designed to align incentives and establish a direct connection between patients' decisions and care costs. The primary objective is to comprehensively understand whether and how this innovative payment scheme structure influences key stakeholders, including patients, care providers, insurers and overall social welfare.

In this paper, we propose a game-theoretical model to incorporate the performance of self-management with the demand for healthcare service, compare the patient's effort decision for self-management and provider's price decision for healthcare service under a behavior-based scheme with that under two implemented widely payment schemes, that is, co-payment scheme and co-insurance scheme.

Our findings confirm that the behavior-based scheme incentives patient self-management more than current schemes while reducing their possibility of seeking healthcare service, which indirectly induces the provider to lower the price of the service. The stakeholders' utility under various payment schemes is sensitive to the cost of treatment and the perceived health utility of patients. Especially, patient health awareness is not always benefited provider profit, as it motivates patient self-management while diminishing the demand for care.

We provide a novel framework for characterizing behavior-based payment schemes. Our results confirm the need for modification of the current payment scheme to incentivize patient self-management.

In the state of Hawaii, it has been shown that certain ethnic minority groups, such as Filipinos and Pacific Islanders, suffer disproportionally high rates of cardiovascular disease, evidence that local health-care systems and governing bodies fail to equally extend the human right to health to all. This study aims to examine whether these ethnic health disparities in cardiovascular disease persist even within an already globally disadvantaged group, the houseless population of Hawaii.

A retrospective chart review of records from Hawaii Houseless Outreach and Medical Education Project clinic sites from 2016 to 2020 was performed to gather patient demographics and reported histories of type II diabetes, obesity, hyperlipidemia, hypertension and other cardiovascular disease diagnoses. Reported disease prevalence rates were compared between larger ethnic categories as well as ethnic subgroups.

Unexpectedly, the data revealed lower reported prevalence rates of most cardiometabolic diseases among the houseless compared to the general population. However, multiple ethnic health disparities were identified, including higher rates of diabetes and obesity among Native Hawaiians and other Pacific Islanders and higher rates of hypertension among Filipinos and Asians overall. The findings suggest that even within a generally disadvantaged houseless population, disparities in health outcomes persist between ethnic groups and that ethnocultural considerations are just as important in caring for this vulnerable population.

To the best of the authors’ knowledge, this is the first comprehensive study focusing on ethnic health disparities in cardiovascular disease and the structural processes that contribute to them, among a houseless population in the ethnically diverse state of Hawaii.

Continuous knowledge contribution behaviors (CKCB) are critical for the healthy development of online medical communities (OMCs). However, it is unclear that if and how contributors' prior actions and the responses they received from the community influence the nature of their future contributions. Drawing upon the Information Systems Continuance theory and Service Feedback theory, the purpose of the study is to examine the impact of knowledge contribution performance (KCP) on doctors' CKCB. Evaluation of social motivation, financial incentive and the moderating influence of expertise level (EL) provided further insight into the pathways that motivate various forms of CKCB.

In order to better understand the CKCB of physicians in OMCs, the authors divided it into two categories: A_CKCB (active CKCB) and P_CKCB (passive CKCB). Information Systems Continuance theory and Service Feedback theory are adapted and integrated with empirical findings from previous research on OMCs to develop a model of CKCB. This study used ordinary least squares (OLS) regression to test hypotheses in the preexisting research model based on data collected from a Chinese OMC platform.

The results show that KCP helps develop several facets of CKCB. According to the findings, doctors' CKCB improved dramatically after receiving feedback from A_CKCB and P_CKCB, but feedback from peers did not promote CKCB. This study found that financial rewards only have a significant positive effect on P_CKCB, and that the level of expertise has a negative effect on the effect. The findings also demonstrated that doctors' level of expertise moderates the relationship between fA_CKCB (a comprehensive evaluation of doctors' A_CKCB) and A_CKCB.

Future studies should look at the role of self-efficacy as a mediator and attitudes as a moderator in the link between KCP and various forms of CKCB. This will help authors figure out how important KCP is for physicians' CKCB. And future research should use more than one way to gather data to prove the above roles.

This study makes a significant contribution to understanding the association between CKCB and KCP by highlighting the significance of distinguishing between the various forms of CKCB and their underlying causes.

This research has advanced both the theory and practice of OMCs' user management by illuminating the central role of KCP in this context.

The purpose of this paper is to provide an example of patient-led co-production.

The New Economics Foundation’s six principles of co-production (nef, 2013) have been used to frame the activities undertaken during the author’s relationship with a community mental health nurse.

This paper describes a co-produced project between a patient and a community mental health nurse to create a range of resources and to deliver training, resulting in mutual benefit for both parties.

This paper invites policy makers to consider the unique role that community mental health nurses can play in supporting patients with long-term challenges that have developed because of an imbalance and an abuse of power within earlier relationships; by adopting a co-production approach, centred on the patient’s interests and skills, a working partnership can be achieved wherein both parties feel that they matter.

Co-production is usually used with groups of stakeholders working together in an equitable way to design or deliver a new service; this paper, however, seeks to demonstrate how the process can be effectively used when the project is patient-led within the context of a therapeutic relationship.