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Wiener L, Sannes TS, Randall J, Lahijana S, Applebaum AJ, Gray TF, McAndrew NS, Brewer BW, Amonoo HL. Psychosocial assessment practices for hematopoietic stem cell transplantation: a national survey study. Bone Marrow Transplant 2023; 58:1314-1321. [PMID: 37634015 PMCID: PMC10967240 DOI: 10.1038/s41409-023-02087-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
Psychosocial health predicts and contributes to medical outcomes for patients undergoing hematopoietic stem cell transplantation (HSCT). Yet, there are no standards for psychosocial assessments or support for both patients and caregivers across the care continuum. To examine the current state of psychosocial care, clinicians were sent a survey of their psychosocial assessment practices for patients and caregivers undergoing HSCT via the Listservs of professional organizations. Descriptive statistics and bivariate analyses were performed to summarize the findings. While 96% of participants reported routine pre-HSCT psychosocial assessment of patients, only 10.6% routinely used a validated transplant risk-assessment measure. Just 27% routinely performed follow-up psychosocial assessments. In contrast, only 47% of participants routinely assessed the psychosocial needs of family caregivers pre-HSCT, and 13% routinely performed follow-up assessments for caregivers. Most (90%) reported social workers were the primary providers of assessments. While patient-report measures were used for evaluation, the majority of assessments were clinical interviews. No significant differences were found between programs that treated adult and pediatric patients versus those only treating adult patients. Our findings highlight the lack of standard psychosocial practices for patients and family caregivers undergoing HSCT and we offer recommendations to fill this gap.
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Affiliation(s)
- Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA.
| | - Timothy S Sannes
- UMass Memorial Cancer Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jill Randall
- Center for Improving Patient and Population Health and Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Sheila Lahijana
- Department of Psychiatry and Behavioral Sciences; Division of Medical Psychiatry, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Natalie S McAndrew
- School of Nursing, College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
- Froedtert & the Medical College of Wisconsin, Froedtert Hospital, Patient Care Research, Milwaukee, WI, USA
| | - Benjamin W Brewer
- Department of Medicine, Division of Hematology, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
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2
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Lee YH, Lin CH, Wu WR, Chiu HY, Huang HC. Virtual reality exercise programs ameliorate frailty and fall risks in older adults: A meta-analysis. J Am Geriatr Soc 2023; 71:2946-2955. [PMID: 37165743 DOI: 10.1111/jgs.18398] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/23/2023] [Accepted: 04/08/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Virtual reality (VR) technology constitutes a promising rehabilitation strategy, but its effect on frailty in older adults remains inconclusive. This study examined the effects of interactive VR training programs on lower-limb muscle strength, walking speed, balance, and fall risks in older adults with frailty. METHODS Various electronic databases comprising PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, Embase, the Chinese Electronic Periodical Service, the Chinese National Knowledge Infrastructure, and gray literature were searched from their inception through December 31, 2022 for relevant studies. Randomized controlled trials that examined the effects of interactive VR training programs on lower-limb muscle strength, balance, walking speed, and fall risks as measured by validated scales or methods. in older adults aged 65 years and older with frailty were included. A random-effects model was employed to examine the overall effect size, and the trim-and-fill method was adopted to examine publication bias. RESULTS For those studies that defined frailty using fall risks, substantial evidence demonstrated that interactive VR training interventions increased lower-limb muscle strength (Hedges' g = 0.35, p = 0.015), walking speed (Hedges' g = 0.29, p = 0.003), balance (Hedges' g = 0.62, p = 0.011), and fall risks (Hedges' g = -0.61, p < 0.001). Studies that defined frailty in accordance with the Fried frailty phenotype criteria indicated that interactive VR training interventions only increased walking speed (Hedges' g = 0.28, p = 0.023) and balance (Hedges' g = 0.27, p = 0.049). CONCLUSIONS Interactive VR training programs may benefit older adults with frailty with respect to walking speed and balance. More studies with good study quality are required to validate the effects of interactive VR exercise training on these frailty-related parameters in older adults.
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Affiliation(s)
- Yueh-Hua Lee
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Chueh-Ho Lin
- International Ph.D. Program in Gerontology and Long-Term Care, Taipei Medical University, Taipei City, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Wan-Ru Wu
- Department of Nursing, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
- Department of Nursing, Taipei Medical University Hospital, Taipei City, Taiwan
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Hui-Chuan Huang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
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Wiener L, Sannes T, Randall J, Lahijani S, Applebaum A, Gray T, McAndrew N, Brewer B, Amonoo H. Psychosocial Assessment Practices for Hematopoietic Stem Cell Transplantation: A National Survey Study. RESEARCH SQUARE 2023:rs.3.rs-3044597. [PMID: 37461551 PMCID: PMC10350176 DOI: 10.21203/rs.3.rs-3044597/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Psychosocial health predicts and contributes to medical outcomes for patients undergoing hematopoietic stem cell transplantation (HSCT). Yet, there are no standards for psychosocial assessments or support for both patients and caregivers across the care continuum. To examine the current state of psychosocial care, clinicians were sent a survey of their psychosocial assessment practices for patients and caregivers undergoing HSCT via the Listservs of professional organizations. Descriptive statistics and bivariate analyses were performed to summarize the findings. While 96% of participants reported routine pre-HSCT psychosocial assessment of patients, only 10.6% routinely used a validated transplant risk-assessment measure. Just 27% routinely performed follow-up psychosocial assessments. In contrast, only 47% of participants routinely assessed the psychosocial needs of family caregivers pre-HSCT, and 13% routinely performed follow-up assessments for caregivers. Most (90%) reported social workers were the primary providers of assessments. While patient-report measures were used for evaluation, the majority of assessments were clinical interviews. No significant differences were found between programs that treated adult and pediatric patients versus those only treating adult patients. Our findings highlight the lack of standard psychosocial practices for patients and family caregivers undergoing HSCT and we offer recommendations to fill this gap.
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Applebaum AJ, Sannes T, Mitchell HR, McAndrew NS, Wiener L, Knight JM, Nelson AJ, Gray TF, Fank PM, Lahijani SC, Pozo-Kaderman C, Rueda-Lara M, Miran DM, Landau H, Amonoo HL. Fit for Duty: Lessons Learned from Outpatient and Homebound Hematopoietic Cell Transplantation to Prepare Family Caregivers for Home-Based Care. Transplant Cell Ther 2023; 29:143-150. [PMID: 36572386 PMCID: PMC9780643 DOI: 10.1016/j.jtct.2022.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
In the past decade, the demand for home-based care has been amplified by the Coronavirus disease 2019 pandemic. Home-based care has significant benefits for patients, their families, and healthcare systems, but it relies on the often-invisible workforce of family and friend caregivers who shoulder essential health care responsibilities, frequently with inadequate training and support. Hematopoietic cell transplantation (HCT), a potentially curative but intensive treatment for many patients with blood disorders, is being increasingly offered in home-based care settings and necessitates the involvement of family caregivers for significant patient care responsibilities. However, guidelines for supporting and preparing HCT caregivers to effectively care for their loved ones at home have not yet been established. Here, informed by the literature and our collective experience as clinicians and researchers who care for diverse patients with hematologic malignancies undergoing HCT, we provide considerations and recommendations to better support and prepare family caregivers in home-based HCT and, by extension, family caregivers supporting patients with other serious illnesses at home. We suggest tangible ways to screen family caregivers for distress and care delivery challenges, educate and train them to prepare for their caregiving role, and create an infrastructure of support for family caregivers within this emerging care delivery model.
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Affiliation(s)
- A J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - T Sannes
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - H R Mitchell
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - N S McAndrew
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA; Froedtert & the Medical College of Wisconsin, Froedtert Hospital, Patient Care Research, Milwaukee, Wisconsin
| | - L Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD
| | - J M Knight
- Departments of Psychiatry, Medicine, and Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - A J Nelson
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts
| | - T F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - P M Fank
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - S C Lahijani
- Department of Psychiatry & Behavioral Sciences, Division of Medical Psychiatry, Stanford University School of Medicine, Palo Alto, California
| | - C Pozo-Kaderman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - M Rueda-Lara
- University of Miami/Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - D M Miran
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - H Landau
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - H L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Oseroff BH, Ankuda CK, Bollens-Lund E, Garrido MM, Ornstein KA. Patterns of Healthcare Utilization and Spending Among Homebound Older Adults in the USA: an Observational Study. J Gen Intern Med 2023; 38:1001-1007. [PMID: 35945471 PMCID: PMC9362988 DOI: 10.1007/s11606-022-07742-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/13/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Homebound older adults have complex social, medical, and financial needs, but little is known about their healthcare utilization and spending. OBJECTIVE To characterize healthcare utilization and spending among homebound older adults. DESIGN Cohort study using National Health and Aging Trends Study data linked to Medicare Fee-for-Service (FFS) claims data. PARTICIPANTS Adults aged 70 years and older with Medicare FFS coverage (n = 6468). MAIN MEASURES In a person-year analysis, survey-weighted rates and adjusted marginal differences in inpatient, outpatient, and emergency department utilization and spending 12 months post-interview were calculated by homebound status, defined as reporting never or rarely (no more than 1 day/week) leaving home in the last month. KEY RESULTS Compared to the non-homebound, homebound observations had lower annual unadjusted rates of accessing primary care (60.9% vs 71.9%, p < 0.001) and specialist care (61.0% vs 74.9%, p < 0.001) and higher annual rates of emergency department use (54.0% vs 32.6%, p < 0.001) and hospitalization (39.8% vs 19.8%, p < 0.001). Total annual Medicare spending was $11,346 higher among the homebound compared to the non-homebound (p < 0.001). In a single year analysis (2015), homebound older adults accounted for 11.0% of Medicare spending among those over 70 despite making up only 5.7% of this population. 13.6% of the homebound were in the 95th percentile or above of Medicare spending in 2015. In models adjusting for demographic, clinical, and geographic characteristics, homebound status was associated with a decreased likelihood of having an annual primary care or specialist visit and $2226 additional total annual Medicare spending. CONCLUSIONS Homebound older adults use more hospital-based care and less outpatient care than the non-homebound, contributing to higher levels of overall Medicare spending.
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Affiliation(s)
- Benjamin H Oseroff
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Claire K Ankuda
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan Bollens-Lund
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa M Garrido
- Partnered Evidence-Based Policy Resource Center (PEPReC), VA Boston Healthcare System Research & Development, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Leff B, Ritchie C, Ciemins E, Dunning S. Prevalence of use and characteristics of users of home-based medical care in Medicare Advantage. J Am Geriatr Soc 2023; 71:455-462. [PMID: 36222194 DOI: 10.1111/jgs.18085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/07/2022] [Accepted: 09/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Home-based medical care (HBMC) is longitudinal medical care provided by physicians, advanced practice providers, and, often, inter-professional care teams to patients in their homes. Our objective is to determine the prevalence of HBMC among older adults (≥65) insured by a Medicare Advantage (MA) plan and compare characteristics of those who receive HBMC to those who do not. METHODS Study used de-identified medical claims and enrollment records for MA beneficiaries during calendar years 2017 and 2018 linked with socioeconomic status data in the OptumLabs Data Warehouse. We defined a cohort of MA beneficiaries age ≥65 receiving HBMC for at least 2 months during 2017-2018, described the cohort using demographic, utilization, and comorbidity data and compared it to a 5% random sample of a population of MA beneficiaries age ≥65 not receiving HBMC (No HBMC). RESULTS Overall, 1.45% of the study cohort age ≥65 received HBMC. Compared to No HBMC (n = 132,147), those receiving HBMC (n = 38,800) were more likely to be: older (46.6% vs. 11.9% age 85+); female (70.8% vs. 58.5%); Black (12.3% vs. 11.3%); urban (90.3% vs. 81.3%); experience hospitalization (38.0% vs. 13.3%), emergency department visit (58.3% vs. 26.9%), ambulance trip (44.1% vs. 9.6%), skilled nursing facility (37.6% vs. 6.4%), or hospice care admission (21.1% vs. 3.5%). They also were more likely to experience a wide range of chronic conditions including dementia (58.1% vs. 5.2%), morbidity burden (Charlson score 3.4 vs. 1.8), and serious illness (77.1% vs. 29.5%). All comparisons p < 0.0001. CONCLUSIONS MA beneficiaries who received HBMC are older, experience greater chronic and serious illness burden, and higher levels of facility-based care than those who did not receive HBMC. MA plans need strategies to identify patients that would benefit from HBMC and develop approaches to deliver such care to this impactful, often invisible population.
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Affiliation(s)
- Bruce Leff
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Center for Transformative Geriatrics Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Christine Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth Ciemins
- Analytics Department, AMGA (American Medical Group Association), Alexandria, Virginia, USA
| | - Stephan Dunning
- Outset Medical, Health Economics and Market Access, San Jose, California, USA
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Silva ÍDS, Silva CRDV, Lopes RH, de Araújo AJ, de Figueirêdo RC, Bay ODG, Lapão LV, Xavier PB, Uchôa SADC. Digital health interventions and quality of home-based primary care for older adults: A scoping review protocol. Front Public Health 2023; 10:1022587. [PMID: 36699882 PMCID: PMC9870288 DOI: 10.3389/fpubh.2022.1022587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction The use of digital health interventions has expanded, particularly in home-based primary care (HBPC), following the increase in the older adult population and the need to respond to the higher demand of chronic conditions, weakness and loss of autonomy of this population. There was an even greater demand with COVID-19 and subsequent isolation/social distancing measures for this risk group. The objective of this study is to map and identify the uses and types of digital health interventions and their reported impacts on the quality of HBPC for older adults worldwide. Methods and analysis This is a scoping review protocol which will enable a rigorous, transparent and reliable synthesis of knowledge. The review will be developed from the theoretical perspective of Arksey and O'malley, with updates by Levac and Peters and respective collaborators based on the Joanna Briggs Institute manual, and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Data from white literature will be extracted from multidisciplinary health databases such as: the Virtual Health Library, LILACS, MEDLINE/PubMed, Scopus, Web of Science, Cinahl and Embase; while Google Scholar will be used for gray literature. No date limit or language restrictions will be determined. The quantitative data will be analyzed through descriptive statistics and qualitative data through thematic analysis. The results will be submitted to stakeholder consultation for preliminary sharing of the study and will later be disseminated through publication in open access scientific journals, scientific events and academic and community journals. The full scoping review report will present the main impacts, challenges, opportunities and gaps found in publications related to the use of digital technologies in primary home care. Discussion The organization of this protocol will increase the methodological rigor, quality, transparency and accuracy of scoping reviews, reducing the risk of bias.
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Affiliation(s)
- Ísis de Siqueira Silva
- Postgraduate in Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil,*Correspondence: Ísis de Siqueira Silva ✉
| | | | - Rayssa Horácio Lopes
- Postgraduate in Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | - Osvaldo de Goes Bay
- Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | - Luís Velez Lapão
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Pedro Bezerra Xavier
- Postgraduate in Collective Health, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
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Ritchie C, Leff B. Home-Based Care Reimagined: A Full-Fledged Health Care Delivery Ecosystem Without Walls. Health Aff (Millwood) 2022; 41:689-695. [PMID: 35500180 DOI: 10.1377/hlthaff.2021.01011] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The COVID-19 pandemic exposed the dangers of tying health care delivery to brick-and-mortar health care facilities. Both before and, more intensely, during the pandemic, health systems have struggled to support high-need patients, especially those unable to engage with virtual technology or needing urgent care in the home. The pandemic has highlighted an ongoing need to create a distributed health care delivery ecosystem centered in patients' homes and the community. This age-friendly ecosystem would initially focus on high-need patients, expand access, improve equity, and be of high value. It would integrate episodic and longitudinal care and expand to serve broader populations as it matures. We briefly describe the evidence base for home-based care models that constitute this ecosystem, define the guiding principles underlying it, and discuss what will be required to build out and scale it.
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Affiliation(s)
- Christine Ritchie
- Christine Ritchie , Massachusetts General Hospital and Harvard University, Boston, Massachusetts
| | - Bruce Leff
- Bruce Leff, Johns Hopkins University, Baltimore, Maryland
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9
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De Vera K, Challa P, Liu RH, Fuller K, Feroz AS, Gamble A, Leung E, Seto E. Virtual Primary Care Implementation During COVID-19 in High-Income Countries: A Scoping Review. TELEMEDICINE JOURNAL AND E-HEALTH : THE OFFICIAL JOURNAL OF THE AMERICAN TELEMEDICINE ASSOCIATION 2021; 28:920-931. [PMID: 34847758 DOI: 10.1089/tmj.2021.0377] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The purpose of this scoping review was to map the challenges, strategies, and lessons learned from high-income countries that can be mobilized to inform decision-makers on how to best implement virtual primary care services during and after the COVID-19 pandemic. Findings of our scoping review identified the barriers and strategies within the Quadruple Aim components, which may prove to be an effective implementation strategy for virtual care adoption in primary care settings. Materials and Methods: The two concepts of virtual care and COVID-19 were searched in MEDLINE, EMBASE, and CINAHL on August 10, 2020, and Scopus was searched on August 15, 2020. The database searches returned 10,549 citations and an additional 766 citations were retrieved from searching the citations from the reference lists of articles that met all inclusion criteria. A total of 1,260 full-text articles were reviewed of which 38 articles met the eligibility criteria for inclusion in the review. Results: Seven key barriers and strategies were identified for the implementation of virtual primary care. Of the 38 articles included, the key barriers identified were equitable access to care (n = 20; 53%), lack of funding for virtual care (n = 14; 37%), negative patient and clinician perception (n = 11, 29%), lack of regulatory policies (n = 10, 26%), inadequate clinical workflows (n = 9, 21), lack of virtual care infrastructure (n = 8, 21%), and insufficient virtual care training and education (n = 5, 13%). Strategies included the following: increased funding (n = 15, 39%), improving clinical workflows (n = 13, 34%), appropriate education and training (n = 11, 29%), improving virtual care infrastructure and patient equity (n = 7, 18%), establishing regulatory policies (n = 5, 13%), and improving patient and clinician perceptions (n = 3, 7%). Conclusions: As many countries enter potential subsequent waves of the COVID-19 pandemic, applying early lessons learned to mitigate implementation barriers can help with the transition to equitable and appropriate virtual primary care services.
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Affiliation(s)
- Kristina De Vera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Priyanka Challa
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Rebecca H Liu
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, Canada
| | - Kaitlin Fuller
- University of Toronto Libraries, University of Toronto, Toronto, Canada
| | - Anam Shahil Feroz
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Anissa Gamble
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Eunice Leung
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Center for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, Canada
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10
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Hansmann KJ, Chang T. Defining the "New Normal" in Primary Care. Ann Fam Med 2021; 19:457-459. [PMID: 34546953 PMCID: PMC8437564 DOI: 10.1370/afm.2711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/08/2020] [Accepted: 11/03/2020] [Indexed: 11/09/2022] Open
Abstract
Health care organizations in the United States have transformed at an unprecedented rate since March 2020 due to COVID-19, most notably with a shift to telemedicine. Despite rapidly adapting health care delivery in light of new safety considerations and a shifting insurance landscape, primary care offices across the country are facing drastic decreases in revenue and potential bankruptcy. To survive, primary care's adaptations will need to go beyond virtual versions of traditional office visits. Primary care is faced with a chance to redefine what it means to care for and support patients wherever they are. This opportunity to shape the "new normal" is a critical step for primary care to meet its full potential to lead a paradigm shift to patient-centered health care reform in America during this time when we need it most.
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Affiliation(s)
- Kellia J Hansmann
- School of Medicine and Public Health, Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin
| | - Tammy Chang
- University of Michigan, School of Medicine, Department of Family Medicine, Ann Arbor, Michigan
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11
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Ritchie CS, Gallopyn N, Sheehan OC, Sharieff SA, Franzosa E, Gorbenko K, Ornstein KA, Federman AD, Brody AA, Leff B. COVID Challenges and Adaptations Among Home-Based Primary Care Practices: Lessons for an Ongoing Pandemic from a National Survey. J Am Med Dir Assoc 2021; 22:1338-1344. [PMID: 34111388 PMCID: PMC8184288 DOI: 10.1016/j.jamda.2021.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 12/02/2022]
Abstract
Objectives Approximately 7.5 million US adults are homebound or have difficulty accessing office-based primary care. Home-based primary care (HBPC) provides such patients access to longitudinal medical care at home. The purpose of this study was to describe the challenges and adaptations by HBPC practices made during the first surge of the COVID-19 pandemic. Design Mixed-methods national survey. Setting and Participants HBPC practices identified as members of the American Academy of Homecare Medicine (AAHCM) or participants of Home-Centered Care Institute (HCCI) training programs. Methods Online survey regarding practice responses to COVID-19 surges, COVID-19 testing, the use of telemedicine, practice challenges due to COVID-19, and adaptations to address these challenges. Descriptive statistics and t tests described frequency distributions of nominal and categorical data; qualitative content analysis was used to summarize responses to the open-ended questions. Results Seventy-nine practices across 29 states were included in the final analyses. Eighty-five percent of practices continued to provide in-person care and nearly half cared for COVID-19 patients. Most practices pivoted to new use of video visits (76.3%). The most common challenges were as follows: patient lack of familiarity with telemedicine (81.9%), patient anxiety (77.8%), clinician anxiety (69.4%), technical difficulties reaching patients (66.7%), and supply shortages including masks, gown, and disinfecting materials (55.6%). Top adaptive strategies included using telemedicine (95.8%), reducing in-person visits (81.9%), providing resources for patients (52.8%), and staff training in PPE use and COVID testing (52.8%). Conclusions and Implications HBPC practices experienced a wide array of COVID-19–related challenges. Most continued to see patients in the home, augmented visits with telemedicine and creatively adapted to the challenges. An increased recognition of the need for in-home care by health systems who observed its critical role in caring for fragile older adults may serve as a silver lining to the otherwise dark sky of the COVID-19 pandemic.
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Affiliation(s)
- Christine S Ritchie
- Massachusetts General Hospital Department of Medicine, Division of Palliative Care and Geriatric Medicine, Boston, MA, USA; Massachusetts General Hospital Mongan Institute, Boston, MA, USA; Harvard Medical School Center for Palliative Care, Boston, MA, USA.
| | - Naomi Gallopyn
- Massachusetts General Hospital Department of Medicine, Division of Palliative Care and Geriatric Medicine, Boston, MA, USA; Massachusetts General Hospital Mongan Institute, Boston, MA, USA
| | - Orla C Sheehan
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shanaz Ahmed Sharieff
- Massachusetts General Hospital Department of Medicine, Division of Palliative Care and Geriatric Medicine, Boston, MA, USA; Massachusetts General Hospital Mongan Institute, Boston, MA, USA
| | - Emily Franzosa
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - Bruce Leff
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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Nikolova-Simons M, Golas SB, den Buijs JO, Palacholla RS, Garberg G, Orenstein A, Kvedar J. A randomized trial examining the effect of predictive analytics and tailored interventions on the cost of care. NPJ Digit Med 2021; 4:92. [PMID: 34083743 PMCID: PMC8175712 DOI: 10.1038/s41746-021-00449-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/16/2021] [Indexed: 12/13/2022] Open
Abstract
This two-arm randomized controlled trial evaluated the impact of a Stepped-Care intervention (predictive analytics combined with tailored interventions) on the healthcare costs of older adults using a Personal Emergency Response System (PERS). A total of 370 patients aged 65 and over with healthcare costs in the middle segment of the cost pyramid for the fiscal year prior to their enrollment were enrolled for the study. During a 180-day intervention period, control group (CG) received standard care, while intervention group (IG) received the Stepped-Care intervention. The IG had 31% lower annualized inpatient cost per patient compared with the CG (3.7 K, $8.1 K vs. $11.8 K, p = 0.02). Both groups had similar annualized outpatient costs per patient ($6.1 K vs. $5.8 K, p = 0.10). The annualized total cost reduction per patient in the IG vs. CG was 20% (3.5 K, $17.7 K vs. $14.2 K, p = 0.04). Predictive analytics coupled with tailored interventions has great potential to reduce healthcare costs in older adults, thereby supporting population health management in home or community settings.
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Affiliation(s)
| | - Sara Bersche Golas
- Partners Connected Health Innovation, Partners HealthCare, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Ramya S Palacholla
- Partners Connected Health Innovation, Partners HealthCare, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | | | | | - Joseph Kvedar
- Partners Connected Health Innovation, Partners HealthCare, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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13
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Baker MC, Weng Y, Fairchild R, Ahuja N, Rohatgi N. Comparison of Adverse Events Among Home- vs Facility-Administered Biologic Infusions, 2007-2017. JAMA Netw Open 2021; 4:e2110268. [PMID: 34081140 PMCID: PMC8176330 DOI: 10.1001/jamanetworkopen.2021.10268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Infusion reactions occur in 7% to 20% of patients receiving biologics. Home infusions are convenient and incur lower costs but may be associated with more adverse events; the safety of receiving biologic infusions for immune-mediated diseases at home remains unclear. OBJECTIVE To assess whether patients receiving home biologic infusions have increased adverse events requiring emergency department (ED) or hospital admission compared with patients receiving facility infusions. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used administrative claims data from a large national insurer for adult patients who received biologic infusions for immune-mediated disease between January 2007 and December 2017. Patients with hematologic malignant neoplasms or bone marrow transplantation were excluded. Data were analyzed from August 2019 to October 2020. MAIN OUTCOMES AND MEASURES ED or hospital admission on the same or next day after administration of a biologic infusion at home vs at a facility; secondary outcomes included discontinuation of the biologic after an ED or hospital admission and postinfusion mortality. RESULTS Of a total of 57 220 patients (mean [SD] age, 50.1 [14.8] years; 512 314 [68.1%] women) who received 752 150 biologic infusions (34 078 home infusions [4.5%] to 3954 patients and 718 072 facility infusions [95.5%] to 54 770 patients), patients who received home infusions were younger (mean [SD] age, 43.2 [13.2] vs 51.3 [14.8] years), more likely to be men (14 031 [41.2%] vs 225 668 [31.4%]), and had a lower Charlson comorbidity score compared with patients who received facility infusions (mean [SD] score, 0.5 [1.0] vs 1.1 [1.3]). Home infusions were associated with 25% increased odds of ED or hospital admission on the same or next day after the infusion (odds ratio [OR], 1.25; 95% CI, 1.09-1.44; P = .002) and 28% increased odds of discontinuation of the biologic after the ED or hospital admission (OR, 1.28; 95% CI, 1.08-1.51; P = .005). There was no difference in postinfusion mortality between home or facility infusions. The rates of adverse events were highest with home infusions of tocilizumab (48 of 481 infusions [10.0%]), vedolizumab (150 of 2681 infusions [5.6%]), and infliximab (1085 of 20 653 infusions [5.3%]), although the number of tocilizumab and vedolizumab infusions was low. CONCLUSIONS AND RELEVANCE In this study, biologic infusions administered at home, compared with those administered at a facility, were associated with increased adverse events requiring escalation of care. Because the number of home infusions has increased and is expected to continue to rise, the safety implications of administering biologic infusions at home needs to be further assessed.
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Affiliation(s)
- Matthew C. Baker
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California
| | - Yingjie Weng
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, California
| | - Robert Fairchild
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California
| | - Neera Ahuja
- Division of Hospital Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Nidhi Rohatgi
- Division of Hospital Medicine, Department of Medicine, Stanford University, Stanford, California
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14
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Hardy RY, Liu GC, Conkol KJ, Gleeson SP, Kelleher KJ. Left behind again: Rural home health services in a Medicaid pediatric accountable care organization. J Rural Health 2021; 38:420-426. [PMID: 33978993 PMCID: PMC9291131 DOI: 10.1111/jrh.12587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose To contrast trends in rural and urban pediatric home health care use among Medicaid enrollees. Methods Medicaid administrative claims data were used to assess differences in home health care use for child members in a large pediatric accountable care organization (ACO) in Ohio. Descriptive statistics assessed rural and urban differences in health care use over a 10‐year period between 2010 and 2019. Findings Pediatric home health care use increased markedly in the low‐income (CFC) and disabled (ABD) Medicaid categories. Over the past 10 years, CFC‐enrolled children from urban communities have seen more home health visits, fewer emergency department (ED) visits, and more well child visits compared to rural CFC‐enrolled children. Children enrolled due to disabilities in urban communities have also seen more home health visit use but fewer preventive care visits than their rural counterparts. Conclusions Within a pediatric ACO, rural home health care use has remained relatively stagnant over a 10‐year period, a stark contrast to increases in home health care use among comparable urban populations. There are likely multiple explanations for these differences, including overuse in urban communities, lack of access in rural communities, and changes to home health reimbursement. More can be done to improve rural home health access. Such improvement will likely necessitate large‐scale changes to home health care delivery, workforce, and financing. Improvements should be evaluated for return‐on‐investment not only in terms of direct costs, that is, reduced inpatient or ED costs, but also in terms of patient and family quality‐of‐life or key indicators of child well‐being such as educational attainment.
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Affiliation(s)
- Rose Y Hardy
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Innovation in Pediatric Practice, Columbus, Ohio, USA
| | - Gilbert C Liu
- Partners For Kids, Columbus, Ohio, USA.,Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Sean P Gleeson
- Partners For Kids, Columbus, Ohio, USA.,Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kelly J Kelleher
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Innovation in Pediatric Practice, Columbus, Ohio, USA.,Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
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15
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Josephsen SR, Fritz RL. Smart moves for an aging population. J Am Geriatr Soc 2021; 69:1695-1697. [PMID: 33713420 DOI: 10.1111/jgs.17100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Samuel R Josephsen
- Elson S. Floyd College of Medicine, Washington State University Spokane, Washington, USA
| | - Roschelle L Fritz
- College of Nursing, Washington State University Vancouver, Washington, USA
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16
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Ankuda CK, Husain M, Bollens-Lund E, Leff B, Ritchie CS, Liu SH, Ornstein KA. The dynamics of being homebound over time: A prospective study of Medicare beneficiaries, 2012-2018. J Am Geriatr Soc 2021; 69:1609-1616. [PMID: 33683707 PMCID: PMC8192419 DOI: 10.1111/jgs.17086] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Approximately 2 million people, or 6% of older adults in the United States, are homebound. In cross-sectional studies, homebound older adults have high levels of morbidity and mortality, but there is little evidence of longitudinal outcomes after becoming homebound. The aim of this research is to prospectively assess over 6 years the dynamics of homebound status, ongoing community residence, and death in a population of community-dwelling older adults who are newly homebound. DESIGN/SETTING Prospective cohort study using 2011-2018 data from the National Health and Aging Trends Study (NHATS), an annual, nationally-representative longitudinal study of aging in the United States. PARTICIPANTS Two hundred and sixty seven newly homebound older adults in 2012. MEASUREMENTS Homebound status was defined via self-report as living in the community but rarely/never leaving home in the prior month. Semi-homebound was defined as leaving the house only with difficulty or help. RESULTS One year after becoming newly homebound, 33.1% remained homebound, 22.8% were completely independent, 23.8% were semi-homebound, 2.2% were in a nursing home, and 18.0% died. Homebound status is highly dynamic; 6 years after becoming homebound, 13.5% remained homebound and 65.0% had died. Recovering from being homebound at 1 year was associated with younger age and lower baseline rates of receiving help with activities of daily living, in particular, with bathing. CONCLUSION Homebound status is a dynamic state. Even if transient, becoming homebound is strongly associated with functional decline and death. Identifying newly homebound older adults and developing interventions to mitigate associated negative consequences needs to be prioritized.
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Affiliation(s)
- Claire K Ankuda
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Mohammed Husain
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Evan Bollens-Lund
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Bruce Leff
- The Center for Transformative Geriatric Research, Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Christine S Ritchie
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shelley H Liu
- Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine, New York, New York, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
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17
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Wade DT. The future of rehabilitation in the United Kingdom National Health Service: Using the COVID-19 crisis to promote change, increasing efficiency and effectiveness. Clin Rehabil 2020; 35:471-480. [PMID: 33167682 DOI: 10.1177/0269215520971145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
THE PROBLEM Rehabilitation services in the UK are inadequate, with insufficient capacity or flexibility to meet the needs of patients after Covid-19. HISTORY Rehabilitation developed in a piecemeal way, focused on specific problems: spinal cord injury, burns, polio, stroke, back pain, equipment and adaptations etc. Rehabilitation is also provided using other names (e.g. intermediate care). Patients with complex needs do not fit easily within this system. SYSTEM FAILURE After Covid-19, patients have problems that cross existing condition-specific and/or treatment-specific services. Covid-19 has exposed the lack of any coherent organisational principle underlying development or commissioning of rehabilitation services. Consequently, in order to have their needs met, patients either have to engage with two or more separate services or they receive good management for some problems and sub-optimal management for other problems. THE GOALS The multitude of small specific services need to coalesce into an integrated service able to meet all the needs of any patient referred. Second, rehabilitation needs to be fully integrated into all healthcare services. A SOLUTION The purpose of healthcare is to 'improve our health and well-being . . . to stay as well as we can to the end of our lives'. (NHS constitution) All healthcare services need to consider patients holistically, giving equal attention to disease, disability, and distress. Rehabilitation, acute care, mental health and palliative care services need to work in parallel to achieve this purpose. Healthcare providers, supported by commissioners and rehabilitation experts, could achieve structural and organisational change, meeting the needs of patients.
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Affiliation(s)
- Derick T Wade
- Professor of Neurological Rehabilitation, OxINMAHR, and Movement Science Group, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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18
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Sinha S, Kern LM, Gingras LF, Reshetnyak E, Tung J, Pelzman F, McGrath TA, Sterling MR. Implementation of Video Visits During COVID-19: Lessons Learned From a Primary Care Practice in New York City. Front Public Health 2020; 8:514. [PMID: 33042950 PMCID: PMC7527590 DOI: 10.3389/fpubh.2020.00514] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022] Open
Abstract
Background: During the height of the coronavirus (COVID-19) pandemic, there was an unprecedented demand for “virtual visits,” or ambulatory visits conducted via video interface, in order to decrease the risk of transmission. Objective: To describe the implementation and evaluation of a video visit program at a large, academic primary care practice in New York, NY, the epicenter of the COVID-19 pandemic. Design and participants: We included consecutive adults (age > 18) scheduled for video visits from March 16, 2020 to April 17, 2020 for COVID-19 and non-COVID-19 related complaints. Intervention: New processes were established to prepare the practice and patients for video visits. Video visits were conducted by attendings, residents, and nurse practitioners. Main measures: Guided by the RE-AIM Framework, we evaluated the Reach, Effectiveness, Adoption, and Implementation of video visits. Key results: In the 4 weeks prior to the study period, 12 video visits were completed. During the 5-weeks study period, we completed a total of 1,030 video visits for 817 unique patients. Of the video visits completed, 42% were for COVID-19 related symptoms, and the remainder were for other acute or chronic conditions. Video visits were completed more often among younger adults, women, and those with commercial insurance, compared to those who completed in-person visits pre-COVID (all p < 0.0001). Patients who completed video visits reported high satisfaction (mean 4.6 on a 5-point scale [SD: 0.97]); 13.3% reported technical challenges during video visits. Conclusions: Video visits are feasible for the delivery of primary care for patients during the COVID-19 pandemic.
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Affiliation(s)
- Sanjai Sinha
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Lisa M Kern
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Laura F Gingras
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Evgeniya Reshetnyak
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Judy Tung
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Fred Pelzman
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Thomas A McGrath
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Madeline R Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
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19
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Jones CD, Bowles KH. Emerging Challenges and Opportunities for Home Health Care in the Time of COVID-19. J Am Med Dir Assoc 2020; 21:1517-1518. [PMID: 33138933 PMCID: PMC7498200 DOI: 10.1016/j.jamda.2020.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA; Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, CO, USA.
| | - Kathryn H Bowles
- New Courtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA; Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
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20
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Mosnaim GS, Stempel H, Van Sickle D, Stempel DA. The Adoption and Implementation of Digital Health Care in the Post-COVID-19 Era. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:2484-2486. [PMID: 32585407 PMCID: PMC7308018 DOI: 10.1016/j.jaip.2020.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/22/2020] [Accepted: 06/05/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Giselle S Mosnaim
- Research Institute, NorthShore University HealthSystem, Evanston, Ill
| | - Hilary Stempel
- Department of Pediatrics, University of Colorado School of Medicine, Denver, Colo
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