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Razi T, Ramot N, Wolff Sagy Y, Arbel R, Shani M, Menashe I. Patient Satisfaction with Telehealth Services in Primary Care. Telemed J E Health 2024. [PMID: 38966964 DOI: 10.1089/tmj.2024.0363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
Objective: Patient satisfaction is an imperative factor in integrating telehealth services as a treatment modality in health care systems. Here, we compared patient satisfaction from telehealth versus in-person health care visits in a large heterogeneous population. Methods: We conducted a retrospective cohort study of patients making telehealth or in-person primary care visits between January 2021 and August 2022. Patient satisfaction with both service types was evaluated using a validated survey. Logistic regression models were employed to assess the association between type of visit (in-person/telehealth) and patient satisfaction (satisfied/unsatisfied) while accounting for sociodemographic and clinical characteristics. Results: Of the 247,087 surveys included in the study, 86,580 (35%) were answered following telehealth visits. Telehealth visitors were more satisfied than in-person visitors in aspects related to doctor-patient interactions, such as "courtesy and respect," "attentive listening," and "coherent explanations" (aOR = 1.17, 95% CI: 1.14-1.21; aOR = 1.16, 95% CI: 1.12-1.19; aOR = 1.15, 95% CI: 1.12-1.18, respectively), and less satisfied in aspects related to indirect services, such as adherence to appointment scheduling, effort required on the part of the patient, and staff cooperation (aOR = 0.95, 95% CI: 0.93-0.97; aOR = 0.89, 95% CI: 0.87-0.91; aOR = 0.85, 95% CI: 0.83-0.87, respectively). Importantly, considerably more telehealth visits were delayed (44%) than in-person visits (27%). Adjustment for this factor further strengthened the observed association between telehealth services and patient satisfaction. Conclusions: While telehealth was associated with high levels of satisfaction in doctor-patient interaction, improvements are still needed in indirect services. Addressing issues related to staff cooperation and streamlining processes to reduce delays could improve overall patient satisfaction with telehealth.
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Affiliation(s)
- Talish Razi
- Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Community Medical Services Division, Clalit Health Services, Tel Aviv, Israel
| | - Noga Ramot
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv, Israel
| | - Yael Wolff Sagy
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv, Israel
| | - Ronen Arbel
- Community Medical Services Division, Clalit Health Services, Tel Aviv, Israel
| | - Michal Shani
- Department of Family Medicine the Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Department of Family Medicine, Central District, Clalit Health Services, Rehovot, Israel
| | - Idan Menashe
- Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Chaiyachati KH, Shea JA, Ward M, Nelson MN, Ghosh M, Reilly J, Kelly S, Chisholm DL, Barbati Z, Hemmons JE, Abdel-Rahman D, Ebert JP, Xiong RA, Snider CK, Lee KC, Friedman AB, Meisel ZF, Kilaru AS, Asch DA, Delgado MK, Morgan AU. Patient and clinician perspectives of a remote monitoring program for COVID-19 and lessons for future programs. BMC Health Serv Res 2023; 23:698. [PMID: 37370059 PMCID: PMC10304230 DOI: 10.1186/s12913-023-09684-1] [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: 11/03/2022] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
COVID Watch is a remote patient monitoring program implemented during the pandemic to support home dwelling patients with COVID-19. The program conferred a large survival advantage. We conducted semi-structured interviews of 85 patients and clinicians using COVID Watch to understand how to design such programs even better. Patients and clinicians found COVID Watch to be comforting and beneficial, but both groups desired more clarity about the purpose and timing of enrollment and alternatives to text-messages to adapt to patients' preferences as these may have limited engagement and enrollment among marginalized patient populations. Because inclusiveness and equity are important elements of programmatic success, future programs will need flexible and multi-channel human-to-human communication pathways for complex clinical interactions or for patients who do not desire tech-first approaches.
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Affiliation(s)
- Krisda H Chaiyachati
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, PA, USA.
| | - Judy A Shea
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Michaela Ward
- Mixed Methods Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maria N Nelson
- Mixed Methods Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Medha Ghosh
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Julianne Reilly
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sheila Kelly
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Deena L Chisholm
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Zoe Barbati
- Mixed Methods Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica E Hemmons
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dina Abdel-Rahman
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey P Ebert
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruiying A Xiong
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- The Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher K Snider
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Kathleen C Lee
- Comcast NBCUniversal in Philadelphia, PA, Philadelphia, USA
| | - Ari B Friedman
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- The Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Zachary F Meisel
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Austin S Kilaru
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Asch
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, PA, USA
- The Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - M Kit Delgado
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, PA, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- The Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna U Morgan
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, PA, USA
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3
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Vomer RP, Carfagno D, Lewno A, Shah NP, Farford BA, Kieneker L, Pujalte GGA. Elbow Evaluation Via Telephone and Video Visit. Cureus 2023; 15:e39843. [PMID: 37397649 PMCID: PMC10314807 DOI: 10.7759/cureus.39843] [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] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
Background Elbow conditions and pathology are commonly seen in the outpatient clinic. Telephone and video visits can allow for expeditious assessment of elbow complaints, without the added challenges of commuting for a clinic-based evaluation. In the setting of a pandemic, the benefits of telemedicine are apparent, but the time and effort saved from being able to remotely evaluate musculoskeletal conditions are also useful in a non-pandemic situation. In this modern era of telemedicine, protocols need to be developed to provide guidance for a remote elbow evaluation. As with all musculoskeletal conditions, the history about the elbow complaint allows the clinician to develop a differential diagnosis, which is either supported or refuted based on physical examination and diagnostic studies. Appropriate questions asked over a telephone call can provide answers that lead the clinician to a specific diagnosis and treatment plan. Furthermore, responses to these same questions can be further supported by a video assessment of the affected elbow, which may provide additional evidence to support a diagnosis and plan of care. Aims To outline possible questions, responses, and video examination techniques to aid the clinician in elbow examinations conducted via telemedicine. Methods We have created a pathway for step-by-step evaluation to help physicians direct their patients through the typical elements of a thorough elbow examination via telehealth. Results We have created tables of questions, answers, and instructions to help guide the physician through different aspects of a telehealth elbow examination. We have also included a glossary of descriptive images that demonstrate each maneuver. Conclusion This article provides a structured guide to efficiently extracting clinically relevant information during telemedicine examinations of the elbow.
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Affiliation(s)
- Rock P Vomer
- Family Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, USA
- Family and Community Health, Orthopedics, Sports Medicine, Duke University, Durham, USA
| | - David Carfagno
- Sports Medicine, Scottsdale Sports Medicine Institute, Scottsdale, AFG
| | - Adam Lewno
- Sports Medicine, University of Michigan, Ann Arbor, USA
| | - Neil P Shah
- Family and Community Medicine, Mayo Clinic, Jacksonville, USA
| | | | | | - George G A Pujalte
- Family Medicine, Orthopedics, and Sports Medicine, Mayo Clinic, Jacksonville, USA
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Jericevic D, Brucker B. Telemedicine in Overactive Bladder Syndrome. CURRENT BLADDER DYSFUNCTION REPORTS 2023; 18:103-108. [PMID: 37193335 PMCID: PMC10015147 DOI: 10.1007/s11884-023-00689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 03/17/2023]
Abstract
Purpose of Review This review discusses the role and benefits of telemedicine as an integral component of the post-pandemic care paradigm in urological practice and, in particular, as part of the care of patients with overactive bladder (OAB). Recent Findings The COVID-19 pandemic accelerated the implementation of telemedicine across almost every medical specialty and (at least temporarily) swept away barriers including those regarding reimbursement and licensure. Telemedicine benefits patients and providers alike including savings on transportation costs, access to specialists or tertiary care from geographically remote locations, and minimized exposure to a contagious illness. Integration of telemedicine into clinical practice can reduce costs for office/exam space and staffing overhead, as well as facilitate greater scheduling efficiency. Many, if not most, aspects of care for the uncomplicated OAB patient can be as effectively managed remotely as with in-person encounters, across the treatment algorithm. Summary Telemedicine will almost certainly remain a key component in the care of OAB, general urology, and throughout all medical specialties.
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Affiliation(s)
- Dora Jericevic
- Departments of Urology and Obstetrics & Gynecology, New York University Langone Health, New York, NY USA
| | - Benjamin Brucker
- Departments of Urology and Obstetrics & Gynecology, New York University Langone Health, New York, NY USA
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Abdolkhani R, Gray K, Borda A, DeSouza R. Recommendations for the Quality Management of Patient-Generated Health Data in Remote Patient Monitoring: Mixed Methods Study. JMIR Mhealth Uhealth 2023; 11:e35917. [PMID: 36826986 PMCID: PMC10007009 DOI: 10.2196/35917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/01/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patient-generated health data (PGHD) collected from innovative wearables are enabling health care to shift to outside clinical settings through remote patient monitoring (RPM) initiatives. However, PGHD are collected continuously under the patient's responsibility in rapidly changing circumstances during the patient's daily life. This poses risks to the quality of PGHD and, in turn, reduces their trustworthiness and fitness for use in clinical practice. OBJECTIVE Using a sociotechnical health informatics lens, we developed a data quality management (DQM) guideline for PGHD captured from wearable devices used in RPM with the objective of investigating how DQM principles can be applied to ensure that PGHD can reliably inform clinical decision-making in RPM. METHODS First, clinicians, health information specialists, and MedTech industry representatives with experience in RPM were interviewed to identify DQM challenges. Second, these stakeholder groups were joined by patient representatives in a workshop to co-design potential solutions to meet the expectations of all the stakeholders. Third, the findings, along with the literature and policy review results, were interpreted to construct a guideline. Finally, we validated the guideline through a Delphi survey of international health informatics and health information management experts. RESULTS The guideline constructed in this study comprised 19 recommendations across 7 aspects of DQM. It explicitly addressed the needs of patients and clinicians but implied that there must be collaboration among all stakeholders to meet these needs. CONCLUSIONS The increasing proliferation of PGHD from wearables in RPM requires a systematic approach to DQM so that these data can be reliably used in clinical care. The developed guideline is an important next step toward safe RPM.
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Affiliation(s)
- Robab Abdolkhani
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Australia.,Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Australia
| | - Ann Borda
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Ruth DeSouza
- School of Art, Royal Melbourne Institue of Technology University, Melbourne, Australia
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Lim CS, Dodd CA, Rutledge LE, Sandridge SW, King KB, Jefferson DJ, Tucker T. Usability and Satisfaction Outcomes from a Pilot Open Trial Examining Remote Patient Monitoring to Treat Pediatric Obesity during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032373. [PMID: 36767739 PMCID: PMC9915194 DOI: 10.3390/ijerph20032373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Pediatric obesity is common and a significant burden. Supplementing pediatric obesity treatment with technology is needed. This manuscript examines the usability and satisfaction, as well as explores initial effectiveness, of a remote patient monitoring system (RPMS) designed for youth presenting for pediatric weight management treatment. METHODS 47 youth, 10 to 17 years old, with obesity and a caregiver participated. For three months, families received treatment via the RPMS. Usability and satisfaction outcomes were examined. Exploratory analyses were conducted to examine initial effectiveness from baseline and post-treatment (month 3) assessments. RESULTS More than 80% of patients used the RPMS, and overall, patients completed 27 out of 90 daily sessions (30%). Youth and caregivers reported high satisfaction. Non-parametric tests revealed no significant improvements for youth or caregiver weight status after the RPMS treatment. Significant improvements in other outcomes examined were limited. CONCLUSIONS Families were satisfied with the RPMS, but use of the system was limited. Initial effectiveness was not able to be determined due to the amount of missing data, which was impacted by the COVID-19 pandemic. Modifications of the RPMS and future evaluation of usability and effectiveness are warranted to determine utility in supplementing pediatric obesity clinical treatment.
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Affiliation(s)
- Crystal S. Lim
- Department of Health Psychology, University of Missouri, Columbia, MO 65203, USA
- Correspondence:
| | - Cameronne A. Dodd
- Cancer Center and Research Institute, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Laura E. Rutledge
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Shanda W. Sandridge
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Krista B. King
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Darryl J. Jefferson
- Center for Telehealth, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Tanya Tucker
- Center for Telehealth, University of Mississippi Medical Center, Jackson, MS 39216, USA
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7
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Pandit AA, Eswaran H, Bogulski CA, Rabbani M, Allison M‘K, Dawson L, Hayes CJ. Factors Associated with Remote Patient Monitoring Services Provision by Hospitals and Health Care Systems in the United States. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Ambrish A. Pandit
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hari Eswaran
- Rural Telehealth Evaluation Center, Institute of Digital Health and Innovation, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cari A. Bogulski
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Maysam Rabbani
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Rural Telehealth Evaluation Center, Institute of Digital Health and Innovation, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mary ‘Katy’ Allison
- Rural Telehealth Evaluation Center, Institute of Digital Health and Innovation, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Leah Dawson
- Rural Telehealth Evaluation Center, Institute of Digital Health and Innovation, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Corey J. Hayes
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
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Oswald LB, Fox RS, Murphy KM, Salsman JM, Sanford SD, McDade TW, Victorson DE. Preliminary Effects of Mindfulness Training on Inflammatory Markers and Blood Pressure in Young Adult Survivors of Cancer: Secondary Analysis of a Pilot Randomized Controlled Trial. Int J Behav Med 2022; 29:676-684. [PMID: 35048316 PMCID: PMC9296689 DOI: 10.1007/s12529-021-10050-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND This was a secondary analysis of a pilot randomized controlled trial (RCT) of mindfulness-based stress reduction (MBSR) among young adult (YA) survivors of cancer, which showed preliminary evidence for improving psychosocial outcomes. Secondary outcomes assessed were the feasibility of collecting biological data from YAs and preliminary effects of MBSR on markers of inflammation and cardiovascular function. METHOD Participants were randomized to 8-week MBSR or a waitlist control condition. Participants provided whole blood spot samples for analysis of C-reactive protein (CRP) and interleukin (IL)-6 as well as blood pressure data in-person at baseline and 16-week follow-up. Feasibility was assessed with rates of providing biological data. Linear mixed effects modeling was used to evaluate preliminary effects of MBSR on inflammatory markers and blood pressure over time. RESULTS Of 126 total participants enrolled, 77% provided biological data at baseline (n = 48/67 MBSR, n = 49/59 control). At 16 weeks, 97% of the 76 retained participants provided follow-up biological data (n = 34/35 MBSR, n = 40/41 control). Relative to the control group, MBSR was associated with decreased systolic blood pressure (p = 0.042, effect sizes (ES) = 0.45) and decreased diastolic blood pressure (p = 0.017, ES = 0.64). There were no changes in CRP or IL-6. CONCLUSION This was the first study to explore the feasibility of collecting biological data from YA survivors of cancer and assess preliminary effects of MBSR on inflammatory and cardiovascular markers in an RCT. Minimally invasive biological data collection methods were feasible. Results provide preliminary evidence for the role of MBSR in improving cardiovascular outcomes in this population, and results should be replicated.
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Affiliation(s)
- Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Rina S Fox
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 2205 Tech Drive, Suite 2-120, Evanston, Chicago, IL, USA
| | - Karly M Murphy
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 2205 Tech Drive, Suite 2-120, Evanston, Chicago, IL, USA
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stacy D Sanford
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 2205 Tech Drive, Suite 2-120, Evanston, Chicago, IL, USA
| | - Thomas W McDade
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 2205 Tech Drive, Suite 2-120, Evanston, Chicago, IL, USA
- Department of Anthropology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - David E Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 2205 Tech Drive, Suite 2-120, Evanston, Chicago, IL, USA.
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Chiang YC, Hsieh YC, Wu F. Implementation and Acceptance of Information and Communication Technology Incorporated into Long-Term Care. Healthcare (Basel) 2022; 10:healthcare10071253. [PMID: 35885780 PMCID: PMC9361131 DOI: 10.3390/healthcare10071253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
Every country in the world is facing serious demographic aging, since the average life expectancy is consistently increasing. Agencies involved in the implementation of caregiving through long-term care institutions can develop more convenient approaches using information and communication technology to enhance overall efficiency. Communication technology has enabled the strengthening of physiological instruments, improving the efficiency and quality of services, while integrating management systems for optimum efficiency. This work conducted empirical studies, collecting responses to questionnaires from residents and caregivers in five institutions located in the south of Taiwan. The PZB model, proposed by Parasuraman, Zeithaml, and Berry, was used to construct the questionnaire to analyze the service quality following the incorporation of information and communication technology. The results of the empirical study show that 34% and 63% of the relatives of the residents agreed and strongly agreed that the system was practical and convenient, respectively. As for the caregivers, 77% of them agreed or strongly agreed that the system was mobile, practical, and convenient, and they agreed that the system could significantly increase working efficiency, reduce waiting time, and improve administration for chronic diseases among care-home residents.
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Affiliation(s)
- Yi-Cheng Chiang
- Department of Information Management, National Chung-Cheng University, Chia-Yi 621301, Taiwan;
- Taichung Tzu-Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung 427213, Taiwan
| | - Yin-Chia Hsieh
- Department of Business Administration, National Chung-Cheng University, Chia-Yi 621301, Taiwan;
| | - Fan Wu
- Department of Information Management, National Chung-Cheng University, Chia-Yi 621301, Taiwan;
- Correspondence:
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10
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Padula WV, Miano MA, Kelley MA, Crawford SA, Choy BH, Hughes RM, Grosso R, Pronovost PJ. A Cost-Utility Analysis of Remote Pulse-Oximetry Monitoring of Patients With COVID-19. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:890-896. [PMID: 35667779 PMCID: PMC8536499 DOI: 10.1016/j.jval.2021.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Since 2020, COVID-19 has infected tens of millions and caused hundreds of thousands of fatalities in the United States. Infection waves lead to increased emergency department utilization and critical care admission for patients with respiratory distress. Although many individuals develop symptoms necessitating a ventilator, some patients with COVID-19 can remain at home to mitigate hospital overcrowding. Remote pulse-oximetry (pulse-ox) monitoring of moderately ill patients with COVID-19 can be used to monitor symptom escalation and trigger hospital visits, as needed. METHODS We analyzed the cost-utility of remote pulse-ox monitoring using a Markov model with a 3-week time horizon and daily cycles from a US health sector perspective. Costs (US dollar 2020) and outcomes were derived from the University Hospitals' real-world evidence and published literature. Costs and quality-adjusted life-years (QALYs) were used to determine the incremental cost-effectiveness ratio at a cost-effectiveness threshold of $100 000 per QALY. We assessed model uncertainty using univariate and probabilistic sensitivity analyses. RESULTS Model results demonstrated that remote monitoring dominates current standard care, by reducing costs ($11 472 saved) and improving outcomes (0.013 QALYs gained). There were 87% fewer hospitalizations and 77% fewer deaths among patients with access to remote pulse-ox monitoring. The incremental cost-effectiveness ratio was not sensitive to uncertainty ranges in the model. CONCLUSIONS Patient with COVID-19 remote pulse-ox monitoring increases the specificity of those requiring follow-up care for escalating symptoms. We recommend remote monitoring adoption across health systems to economically manage COVID-19 volume surges, maintain patients' comfort, reduce community infection spread, and carefully monitor needs of multiple individuals from one location by trained experts.
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Affiliation(s)
- William V Padula
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA; Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA; Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
| | - Marlea A Miano
- Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Marcella A Kelley
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA; Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - Samuel A Crawford
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA; Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - Bryson H Choy
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA; Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - Robert M Hughes
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Riley Grosso
- Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Peter J Pronovost
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA; School of Medicine, Case-Western Reserve University, Cleveland, OH, USA
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11
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Kim SH, Kang SY, Sunwoo S, Choi WS, Kim C, Park YK, Jung S, Kim YS. Experience With and Awareness of Telemedicine Among Korean Outpatients During the COVID-19 Pandemic. Telemed J E Health 2022; 28:1595-1603. [PMID: 35333644 DOI: 10.1089/tmj.2021.0492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Owing to the coronavirus disease 19 pandemic, the demand for telemedicine has increased. However, the awareness of and experience with telemedicine among the Korean population have not been investigated. Therefore, we examined Korean outpatients' experience with and awareness of telemedicine. Methods: From December 2020 to March 2021, we conducted a survey exploring the awareness of and experience with telemedicine of outpatients who were consecutively enrolled by family physicians from four hospitals. The participants completed questionnaires on sociodemographic characteristics and knowledge, experience, satisfaction, preference, and future considerations concerning telemedicine. We evaluated factors associated with satisfaction with telemedicine experiences using multivariate logistic regression analysis. Results: Among the 563 study participants, 364 participants had experience with telemedicine. More than 95% of the telemedicine visits were performed by telephone consultation, and the most common disease type for telemedicine visits was chronic diseases (67.5%). Overall, 82.4% of the participants were satisfied with telemedicine. More than 90% of the participants were satisfied with telemedicine in terms of saving time and money relative to hospital visits, no risk of infection, and convenience. According to the multivariate logistic regression analysis, adults aged ≥65 years (odds ratio [OR] 3.53, 95% confidence interval [CI] 1.44-8.68), residents of a metropolitan city (OR 6.8, 95% CI 1.41-32.55), and those with knowledge of telemedicine (OR 2.96, 95% CI 1.21-7.26) were more likely to be satisfied with their telemedicine experience, compared with their counterparts. For chronic diseases, participants with telemedicine experience were significantly more likely to prefer telemedicine for revisits, compared with those with no telemedicine experience. Nonetheless, most respondents recognized that telemedicine requires improvement. Conclusions: Most Korean outpatients showed high satisfaction with telemedicine. Telemedicine may be considered in various medical situations in the future. Therefore, building a practical system for telemedicine and changes in the medical environment are required.
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Affiliation(s)
- Seung Hee Kim
- Department of Family Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Republic of Korea
| | - Seo Young Kang
- International Healthcare Center, Asan Medical Center, Seoul, Republic of Korea
| | - Sung Sunwoo
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Whan-Seok Choi
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Churlmin Kim
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Kyu Park
- Department of Family Medicine, Bundang Jesaeng General Hospital, Seongnam, Republic of Korea
| | - Seungpil Jung
- Department of Family Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Young Sik Kim
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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12
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A System of Remote Patients’ Monitoring and Alerting Using the Machine Learning Technique. J FOOD QUALITY 2022. [DOI: 10.1155/2022/6274092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Machine learning has become an essential tool in daily life, or we can say it is a powerful tool in the majority of areas that we wish to optimize. Machine learning is being used to create techniques that can learn from labelled or unlabeled information, as well as learn from their surroundings. Machine learning is utilized in various areas, but mainly in the healthcare industry, where it provides significant advantages via appropriate decision and prediction methods. The proposed work introduces a remote system that can continuously monitor the patient and can produce an alert whenever necessary. The proposed methodology makes use of different machine learning algorithms along with cloud computing for continuous data storage. Over the years, these technologies have resulted in significant advancements in the healthcare industry. Medical professionals utilize machine learning tools and methods to analyse medical data in order to detect hazards and offer appropriate diagnosis and treatment. The scope of remote healthcare includes anything from tracking chronically sick patients, elderly people, preterm children, and accident victims. The current study explores the machine learning technologies’ capability of monitoring remote patients and alerts their current condition through the remote system. New advances in contactless observation demonstrate that it is only necessary for the patient to be present within a few meters of the sensors for them to work. Sensors connected to the body and environmental sensors connected to the surroundings are examples of the technology available.
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13
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Tabacof L, Baker TS, Durbin JR, Desai V, Zeng Q, Sahasrabudhe A, Herrera JE, Putrino D. Telehealth Treatment for Non-Specific Low Back Pain: A Review of the Current State in Mobile Health. PM R 2021; 14:1086-1098. [PMID: 34786870 DOI: 10.1002/pmrj.12738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Non-specific low back pain (LBP) is an idiopathic musculoskeletal condition that affects 4 out of 5 individuals in their lifetime and is the leading cause of job-related disability in the United States (US). The interest in interactive and dynamic telehealth treatments for LBP continues to grow, and it is important for the medical community to remain up-to-date on the state of the science. LITERATURE SURVEY Relevant studies published from March 2016 until March 2021 were identified through a systematic search of EMBASE, MedLine and Web of Science. The search strategy combined the concepts of back pain, telehealth and mobile applications. METHODOLOGY Titles and abstracts were screened to select full text randomized controlled trials or protocols and methodological quality and risk of bias was assessed using the Cochrane risk-of-bias tool. Data were synthesized narratively. SYNTHESIS We included seven concluded randomized controlled trials and two study protocols reporting mobile health (mHealth) solutions for LBP. Six of the seven concluded trials found a significant improvement in self-reported numerical pain rating scale compared to the control group. A single trial compared a mHealth solution to physical therapy, with the majority of studies comparing interventions to "usual care." Substantial heterogeneity in reporting of sample characteristics was found, indicating a lack of standardization through the field. CONCLUSIONS mHealth solutions may positively impact people with LBP. Larger trials should be encouraged and the field should coalesce around a set of baseline variables for collection and reporting. As many interventions involve patient engagement, future trials should aim to further quantify adherence levels and begin to define telehealth 'doses' associated with better outcomes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Laura Tabacof
- Abilities Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Rehabilitation & Human Performance Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Turner S Baker
- Sinai BioDesign, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Neoteric Consulting Group
| | - John R Durbin
- Sinai BioDesign, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Joseph E Herrera
- Rehabilitation & Human Performance Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Putrino
- Abilities Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Rehabilitation & Human Performance Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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14
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Lim C, Rutledge L, Sandridge S, King K, Jefferson D, Tucker T. Design, Implementation, and Examination of a Remote Patient Monitoring System for Pediatric Obesity: Protocol for an Open Trial Pilot Study. JMIR Res Protoc 2021; 10:e29858. [PMID: 34319245 PMCID: PMC8367111 DOI: 10.2196/29858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric obesity is a critical public health issue. Augmenting care in multidisciplinary pediatric obesity clinics with innovative evidence-based technology to improve weight status and health outcomes is needed. OBJECTIVE This study describes the design and methods of an open trial pilot study to examine a remote patient monitoring system (RPMS) for children aged 8-17 years who are receiving treatment in a multidisciplinary pediatric obesity clinic. METHODS Participants will include 45 youth with obesity and their parents. Families will receive standard care in the clinic and the RPMS for 3 months. The RPMS consists of a tablet, weight scale, and pedometer. The system provides daily educational content and involves the use of the pedometer and weekly weigh-ins. Children and parents will complete baseline, posttreatment (month 3), and follow-up assessments (month 6). The primary aim of the study is to examine feasibility and satisfaction with the RPMS and assess its initial effectiveness. RESULTS We hypothesize high feasibility and satisfaction, with rates over 75%. Furthermore, after RPMS treatment, children will exhibit improved weight status, health outcomes, dietary intake, physical activity, health-related quality of life, self-efficacy, and home-food environment compared to before treatment. These gains are expected to persist at follow-up. CONCLUSIONS This study is novel in that it is the first to design, implement, and examine an RPMS in a pediatric obesity clinic. If the RPMS is feasible, effective, and easily accessible, it may prove to be a practical, acceptable, and cost-effective weight management treatment for youth seeking treatment for severe obesity. TRIAL REGISTRATION ClinicalTrials.gov NCT04029597; https://clinicaltrials.gov/ct2/show/NCT04029597. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/29858.
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Affiliation(s)
- Crystal Lim
- Department of Psychiatry & Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
| | - Laura Rutledge
- Department of Psychiatry & Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
| | - Shanda Sandridge
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Krista King
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Darryl Jefferson
- Center for Telehealth, University of Mississippi Medical Center, Jackson, MS, United States
| | - Tanya Tucker
- Center for Telehealth, University of Mississippi Medical Center, Jackson, MS, United States
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15
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The emerging clinical role of wearables: factors for successful implementation in healthcare. NPJ Digit Med 2021; 4:45. [PMID: 33692479 PMCID: PMC7946921 DOI: 10.1038/s41746-021-00418-3] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/16/2021] [Indexed: 01/06/2023] Open
Abstract
Wearable technologies promise to redefine assessment of health behaviors, yet their clinical implementation remains a challenge. To address this gap, two of the NIH’s Big Data to Knowledge Centers of Excellence organized a workshop on potential clinical applications of wearables. A workgroup comprised of 14 stakeholders from diverse backgrounds (hospital administration, clinical medicine, academia, insurance, and the commercial device industry) discussed two successful digital health interventions that involve wearables to identify common features responsible for their success. Seven features were identified including: a clearly defined problem, integration into a system of healthcare delivery, technology support, personalized experience, focus on end-user experience, alignment with reimbursement models, and inclusion of clinician champions. Health providers and systems keen to establish new models of care inclusive of wearables may consider these features during program design. A better understanding of these features is necessary to guide future clinical applications of wearable technology.
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16
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Stasolla F, Matamala-Gomez M, Bernini S, Caffò AO, Bottiroli S. Virtual Reality as a Technological-Aided Solution to Support Communication in Persons With Neurodegenerative Diseases and Acquired Brain Injury During COVID-19 Pandemic. Front Public Health 2021; 8:635426. [PMID: 33665181 PMCID: PMC7921156 DOI: 10.3389/fpubh.2020.635426] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/24/2020] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 poses an ongoing threat to lives around the world and challenges the existing public health and medical service delivery. The lockdown or quarantine measures adopted to prevent the spread of COVID-19 has caused the interruption in ongoing care and access to medical care including to patients with existing neurological conditions. Besides the passivity, isolation, and withdrawal, patients with neurodegenerative diseases experience difficulties in communication due to a limited access to leisure opportunities and interaction with friends and relatives. The communication difficulties may exacerbate the burden on the caregivers. Therefore, assistive-technologies may be a useful strategy in mitigating challenges associated with remote communication. The current paper presents an overview of the use of assistive technologies using virtual reality and virtual body ownership in providing communication opportunities to isolated patients, during COVID-19, with neurological diseases and moderate-to-severe communication difficulties. We postulate that the assistive technologies-based intervention may improve social interactions in patients with neurodegenerative diseases and acquired brain injury-thereby reducing isolation and improving their quality of life and mental well-being.
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Affiliation(s)
| | - Marta Matamala-Gomez
- Department of Human Sciences for Education "Riccardo Massa", Center for Studies in Communication Sciences "Luigi Anolli" (CESCOM), University of Milano-Bicocca, Milan, Italy
| | - Sara Bernini
- Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS), Mondino Foundation, Pavia, Italy
| | - Alessandro O Caffò
- Department of Educational Sciences, Psychology and Communication, University of Bari, Bari, Italy
| | - Sara Bottiroli
- "Giustino Fortunato" University of Benevento, Benevento, Italy.,Scientific Institute for Research, Hospitalization, and Healthcare (IRCCS), Mondino Foundation, Pavia, Italy
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17
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Biswas U, Goh CH, Ooi SY, Lim E, Redmond SJ, Lovell NH. Telemedicine systems to manage chronic disease. Digit Health 2021. [DOI: 10.1016/b978-0-12-818914-6.00020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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18
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Singh R, Baird A, Mathiassen L. Ambidextrous governance of IT-enabled services: A pragmatic approach. INFORMATION AND ORGANIZATION 2020. [DOI: 10.1016/j.infoandorg.2020.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Hatch MN, Martinez RN, Etingen B, Cotner B, Hogan TP, Wickremasinghe IM, Sippel J, Smith BM. Characterization of Telehealth Use in Veterans With Spinal Cord Injuries and Disorders. PM R 2020; 13:1094-1103. [PMID: 33098620 DOI: 10.1002/pmrj.12515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 09/24/2020] [Accepted: 10/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Individuals with spinal cord injuries and disorders (SCI/D) require frequent interdisciplinary health care to address impairments in mobility, autonomic function, and secondary complications. Telehealth has the capacity to substantially transform health care delivery and improve care by increasing access and communication. However, relatively little is known about telehealth use in this specific population. Here we attempt to fill part of this gap. OBJECTIVE To investigate the frequency and characteristics associated with telehealth use in Veterans with SCI/D. DESIGN Cross-sectional, descriptive project. SETTING Veterans Health Administration (VHA) facilities. PARTICIPANTS A total of 15 028 Veterans living with SCI/D who received services from the VHA SCI/D System of Care. INTERVENTION Not applicable. OUTCOME MEASURES Frequency and characteristics associated with VHA telehealth utilization. RESULTS Of the 15 028 Veterans with SCI/D included in the evaluation, 17% used some form of telehealth in VHA Fiscal Year (FY)2017. Veterans older than 65 years of age had lower odds (odds ratio [OR] = 0.88, P < .05, confidence interval [CI] 0.80-0.98) of using telehealth. Being Caucasian (OR = 1.29, P < .01, CI 1.09-1.52), living in rural areas (OR = 1.16, P < .01, CI 1.05-1.28), living greater distances away from the VHA (P < .01 for all distances), and being in priority group 8, meaning that Veterans have higher copayment requirements (OR = 1.46, P < .001, CI 1.19-1.81), were all significantly associated with greater odds of telehealth use. The most frequent types of telehealth used were real-time clinical video and store-and-forward between a provider and patient within the same hub network. CONCLUSION There are opportunities to increase telehealth adoption in the SCI/D arena. The findings from this project highlight which Veterans are currently using telehealth services, as well as gaps regarding telehealth adoption in this population.
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Affiliation(s)
- Maya N Hatch
- Spinal Cord Injury/Disorder Center, Long Beach Veterans Affairs (VA) Medical Center, Long Beach, CA, USA
- Physical Medicine & Rehabilitation Department, UC Irvine School of Medicine, Irvine, CA, USA
| | - Rachael N Martinez
- Edward Hines Jr. Department of VA Hospital, Center of Innovation for Complex Chronic Healthcare, Chicago, IL, USA
| | - Bella Etingen
- Edward Hines Jr. Department of VA Hospital, Center of Innovation for Complex Chronic Healthcare, Chicago, IL, USA
| | - Bridget Cotner
- Rehabilitation Outcomes Research Section, Research Service, James A. Haley VA Medical Center, Tampa, FL, USA
- Department of Anthropology, University of South Florida, Tampa, FL, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Edith Norse Rogers Memorial VA Hospital, Bedford, MA, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Itala M Wickremasinghe
- U.S. Department of Veterans Affairs, Spinal Cord Injuries and Disorders System of Care Program Office, Seattle, WA, USA
| | - Jennifer Sippel
- U.S. Department of Veterans Affairs, Spinal Cord Injuries and Disorders System of Care Program Office, Seattle, WA, USA
| | - Bridget M Smith
- Edward Hines Jr. Department of VA Hospital, Center of Innovation for Complex Chronic Healthcare, Chicago, IL, USA
- Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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20
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Nguyen M, Fujioka J, Wentlandt K, Onabajo N, Wong I, Bhatia RS, Bhattacharyya O, Stamenova V. Using the technology acceptance model to explore health provider and administrator perceptions of the usefulness and ease of using technology in palliative care. BMC Palliat Care 2020; 19:138. [PMID: 32895060 PMCID: PMC7476427 DOI: 10.1186/s12904-020-00644-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/30/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Studies have shown that telehealth applications in palliative care are feasible, can improve quality of care, and reduce costs but few studies have focused on user acceptance of current technology applications in palliative care. Furthermore, the perspectives of health administrators have not been explored in palliative care and yet they are often heavily involved, alongside providers, in the coordination and use of health technologies. The study aim was to explore both health care provider and administrator perceptions regarding the usefulness and ease of using technology in palliative care. METHODS The Technology Acceptance Model (TAM) was used as the guiding theoretical framework to provide insight into two key determinants that influence user acceptance of technology (perceived usefulness and ease of use). Semi-structured interviews (n = 18) with health providers and administrators with experience coordinating or using technology in palliative care explored the usefulness of technologies in palliative care and recommendations to support adoption. Interview data were analyzed using inductive thematic analysis to identify common, meaningful themes. RESULTS Four themes were identified; themes related to perceived usefulness were: enabling remote connection and information-sharing platform. Themes surrounding ease of use included: integration with existing IT systems and user-friendly with ready access to technical support. Telehealth can enable remote connection between patients and providers to help address insufficiencies in the current palliative care environment. Telehealth, as an information sharing platform, could support the coordination and collaboration of interdisciplinary providers caring for patients with palliative needs. However, health technologies need to passively integrate with existing IT systems to enhance providers' workflow and productivity. User-friendliness with ready access to technical support was considered especially important in palliative care as patients often experience diminished function. CONCLUSION Participants' perspectives of technology acceptance in palliative care were largely dependent on their potential to help address major challenges in the field without imposing significant burden on providers and patients.
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Affiliation(s)
- M Nguyen
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada.
| | - J Fujioka
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - K Wentlandt
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - N Onabajo
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - I Wong
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - R S Bhatia
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - O Bhattacharyya
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - V Stamenova
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
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21
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22
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Liu N, Huang R, Baldacchino T, Sud A, Sud K, Khadra M, Kim J. Telehealth for Noncritical Patients With Chronic Diseases During the COVID-19 Pandemic. J Med Internet Res 2020; 22:e19493. [PMID: 32721925 PMCID: PMC7419134 DOI: 10.2196/19493] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/16/2020] [Accepted: 07/26/2020] [Indexed: 02/06/2023] Open
Abstract
During the recent coronavirus disease (COVID-19) pandemic, telehealth has received greater attention due to its role in reducing hospital visits from patients with COVID-19 or other conditions, while supporting home isolation in patients with mild symptoms. The needs of patients with chronic diseases tend to be overlooked during the pandemic. With reduced opportunities for routine clinic visits, these patients are adopting various telehealth services such as video consultation and remote monitoring. We advocate for more innovative designs to be considered to enhance patients' feelings of "copresence"-a sense of connection with another interactant via digital technology-with their health care providers during this time. The copresence-enhanced design has been shown to reduce patients' anxiety and increase their confidence in managing their chronic disease condition. It has the potential to reduce the patient's need to reach out to their health care provider during a time when health care resources are being stretched.
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Affiliation(s)
- Na Liu
- The University of Sydney Business School, Sydney, Australia
| | - Robin Huang
- School of Computer Science, The University of Sydney, NSW, Australia
| | - Tanya Baldacchino
- Telehealth and Technology Centre, Nepean Blue Mountains Local Health District, NSW, Australia
| | - Archana Sud
- Department of Infectious Diseases, Nepean Hospital, NSW, Australia.,Department of Medicine (Infectious Diseases and Immunology), Nepean Clinical School, University of Sydney, NSW, Australia
| | - Kamal Sud
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,Department of Renal Medicine, Nepean Hospital, Kingswood, NSW, Australia
| | - Mohamed Khadra
- Strategy and Innovation, Nepean Blue Mountains Local Health District, NSW, Australia
| | - Jinman Kim
- School of Computer Science, The University of Sydney, NSW, Australia.,Telehealth and Technology Centre, Nepean Blue Mountains Local Health District, NSW, Australia
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23
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Biswas S, Adhikari SD, Bhatnagar S. Integration of Telemedicine for Home-Based End-of-Life Care in Advanced Cancer Patients during Nationwide Lockdown: A Case Series. Indian J Palliat Care 2020; 26:S176-S178. [PMID: 33088116 PMCID: PMC7535007 DOI: 10.4103/ijpc.ijpc_174_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 11/19/2022] Open
Abstract
Dignified death is a basic human right that has been widely overlooked in countries like India. During nationwide lockdown, it is extremely challenging to provide quality end-of-life care (EOLC) to all patients with a poor system for dignified death. Telemedicine, whose feasibility for community-based EOLC in rural settings has already been established, was a useful tool for us to overcome these barriers. Adding a widely used smartphone-based application for video calls along with voice calls and text messages made the process more dynamic and convenient. Here, we share our experience with three patients with advanced malignancy in providing EOLC during COVID-19 lockdown. A well-planned study for the utility of this service for a larger cancer patient population from different sociocultural and demographic backgrounds is warranted in the future.
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Affiliation(s)
- Swagata Biswas
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. Bhimrao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Shreya Das Adhikari
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. Bhimrao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. Bhimrao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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24
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Behmanesh A, Sadoughi F, Mazhar FN, Joghataei MT, Yazdani S. Tele-orthopaedics: A systematic mapping study. J Telemed Telecare 2020; 28:3-23. [PMID: 32393139 DOI: 10.1177/1357633x20919308] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The use of telemedicine in orthopaedics can provide high-quality orthopaedic services to patients in remote areas. Tele-orthopaedics is widely acknowledged for decreasing travel, time and cost, increasing accessibility and quality of care. In the absence of a comprehensive review on tele-orthopaedics applications and services, here, we systematically identify and classify the tele-orthopaedic applications and services and provide an overview of the trends in the field. METHODS In this study, a systematic mapping was conducted to answer six research questions, we searched the databases Scopus, PubMed, IEEE Digital Library and Web of Science up to 2019. Consequently, 77 papers were screened and selected on the basis of specific inclusion and exclusion criteria. RESULTS We found that mobile-based teleconsultation was mostly asynchronous, while non-mobile teleconsultation was synchronous. The results showed that the physician-patient relationship was more common than other interactions, such as physician-physician and physician-robot interactions. In addition, more than half of the services provided by tele-orthopaedics have been used for orthopaedic diseases/traumas in which joint replacement and fracture reduction have been the most important orthopaedic procedures. It has been noted that more attention has been paid to tele-orthopaedics in developed countries such as the USA, Australia, Canada and Finland. DISCUSSION Telemonitoring (teleconsultation and telemetry) and telesurgery (telerobotics and telementoring) were found to be the two major forms of tele-orthopaedics. Mobile phones were used asynchronously in most of the teleconsultations. The development of different applications may result in the use of multiple smartphones applications in real-time teleconsultation. The use of smartphones is expected to increase in the near future.
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Affiliation(s)
- Ali Behmanesh
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farahnaz Sadoughi
- Health Management and Economics Research Centre, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farid Najd Mazhar
- Bone and Joint Reconstruction Research Centre, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Shahram Yazdani
- School of Management and Medical Education Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Huang R, Liu N, Nicdao MA, Mikaheal M, Baldacchino T, Albeos A, Petoumenos K, Sud K, Kim J. Emotion sharing in remote patient monitoring of patients with chronic kidney disease. J Am Med Inform Assoc 2020; 27:185-193. [PMID: 31633755 PMCID: PMC7647270 DOI: 10.1093/jamia/ocz183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/15/2019] [Accepted: 09/30/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate the relationship between emotion sharing and technically troubled dialysis (TTD) in a remote patient monitoring (RPM) setting. MATERIALS AND METHODS A custom software system was developed for home hemodialysis patients to use in an RPM setting, with focus on emoticon sharing and sentiment analysis of patients' text data. We analyzed the outcome of emoticon and sentiment against TTD. Logistic regression was used to assess the relationship between patients' emotions (emoticon and sentiment) and TTD. RESULTS Usage data were collected from January 1, 2015 to June 1, 2018 from 156 patients that actively used the app system, with a total of 31 159 dialysis sessions recorded. Overall, 122 patients (78%) made use of the emoticon feature while 146 patients (94%) wrote at least 1 or more session notes for sentiment analysis. In total, 4087 (13%) sessions were classified as TTD. In the multivariate model, when compared to sessions with self-reported very happy emoticons, those with sad emoticons showed significantly higher associations to TTD (aOR 4.97; 95% CI 4.13-5.99; P = < .001). Similarly, negative sentiments also revealed significant associations to TTD (aOR 1.56; 95% CI 1.22-2; P = .003) when compared to positive sentiments. DISCUSSION The distribution of emoticons varied greatly when compared to sentiment analysis outcomes due to the differences in the design features. The emoticon feature was generally easier to understand and quicker to input while the sentiment analysis required patients to manually input their personal thoughts. CONCLUSION Patients on home hemodialysis actively expressed their emotions during RPM. Negative emotions were found to have significant associations with TTD. The use of emoticons and sentimental analysis may be used as a predictive indicator for prolonged TTD.
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Affiliation(s)
- Robin Huang
- School of Computer Science, The University of Sydney, Camperdown, Australia
| | - Na Liu
- School of Computer Science, The University of Sydney, Camperdown, Australia
| | - Mary Ann Nicdao
- Home Hemodialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Sydney, Australia
| | - Mary Mikaheal
- Home Hemodialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Sydney, Australia
| | - Tanya Baldacchino
- Home Hemodialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Sydney, Australia
| | - Annabelle Albeos
- Home Hemodialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Sydney, Australia
| | | | - Kamal Sud
- Home Hemodialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Sydney, Australia
- Department of Renal Medicine, Nepean Hospital, Sydney, Australia
- The University of Sydney Medical School, Sydney, Australia
| | - Jinman Kim
- School of Computer Science, The University of Sydney, Camperdown, Australia
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Ruhatiya RS, Adukia SA, Manjunath RB, Maheshwarappa HM. Current Status and Recommendations in Multimodal Neuromonitoring. Indian J Crit Care Med 2020; 24:353-360. [PMID: 32728329 PMCID: PMC7358870 DOI: 10.5005/jp-journals-10071-23431] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Every patient in neurocritical care evolves through two phases. Acute pathologies are addressed first. These include trauma, hemorrhagic or ischemic stroke, or neuroinfection. Soon after, the concentration shifts to identifying secondary pathologies like fever, seizures, and ischemia, which may exacerbate the brain injury. Frequent bedside examinations are not sufficient for timely detection and prevention of secondary brain injury (SBI) as per the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care. Multimodality monitoring (MMM) can help in tailoring treatment decisions to prevent such a brain injury. Multimodal neuromonitoring involves data-guided therapeutic interventions by employing various tools and data integration to understand brain physiology. Monitors provide real-time information on cerebral hemodynamics, oxygenation, metabolism, and electrophysiology. The monitors may be invasive/noninvasive and global/regional. We have reviewed such technologies in this write-up. Novel themes like bioinformatics, clinical research, and device development will also be discussed.
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Affiliation(s)
- Radhika S Ruhatiya
- Department of Critical Care Medicine, Narayana Hrudayalaya, NH Health City, Bengaluru, Karnataka, India
| | - Sachin A Adukia
- Department of Neurology, Narayana Hrudayalaya, NH Health City, Bengaluru, Karnataka, India
| | - Ramya B Manjunath
- Department of Anesthesia, Narayana Hrudayalaya, NH Health City, Bengaluru, Karnataka, India
| | - Harish M Maheshwarappa
- Department of Critical Care Medicine, Narayana Hrudayalaya, NH Health City, Bengaluru, Karnataka, India
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Safavi KC, Driscoll W, Wiener-Kronish JP. Remote Surveillance Technologies: Realizing the Aim of Right Patient, Right Data, Right Time. Anesth Analg 2019; 129:726-734. [PMID: 31425213 PMCID: PMC6693927 DOI: 10.1213/ane.0000000000003948] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 01/11/2023]
Abstract
The convergence of multiple recent developments in health care information technology and monitoring devices has made possible the creation of remote patient surveillance systems that increase the timeliness and quality of patient care. More convenient, less invasive monitoring devices, including patches, wearables, and biosensors, now allow for continuous physiological data to be gleaned from patients in a variety of care settings across the perioperative experience. These data can be bound into a single data repository, creating so-called data lakes. The high volume and diversity of data in these repositories must be processed into standard formats that can be queried in real time. These data can then be used by sophisticated prediction algorithms currently under development, enabling the early recognition of patterns of clinical deterioration otherwise undetectable to humans. Improved predictions can reduce alarm fatigue. In addition, data are now automatically queriable on a real-time basis such that they can be fed back to clinicians in a time frame that allows for meaningful intervention. These advancements are key components of successful remote surveillance systems. Anesthesiologists have the opportunity to be at the forefront of remote surveillance in the care they provide in the operating room, postanesthesia care unit, and intensive care unit, while also expanding their scope to include high-risk preoperative and postoperative patients on the general care wards. These systems hold the promise of enabling anesthesiologists to detect and intervene upon changes in the clinical status of the patient before adverse events have occurred. Importantly, however, significant barriers still exist to the effective deployment of these technologies and their study in impacting patient outcomes. Studies demonstrating the impact of remote surveillance on patient outcomes are limited. Critical to the impact of the technology are strategies of implementation, including who should receive and respond to alerts and how they should respond. Moreover, the lack of cost-effectiveness data and the uncertainty of whether clinical activities surrounding these technologies will be financially reimbursed remain significant challenges to future scale and sustainability. This narrative review will discuss the evolving technical components of remote surveillance systems, the clinical use cases relevant to the anesthesiologist's practice, the existing evidence for their impact on patients, the barriers that exist to their effective implementation and study, and important considerations regarding sustainability and cost-effectiveness.
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Affiliation(s)
- Kyan C. Safavi
- From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - William Driscoll
- From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeanine P. Wiener-Kronish
- From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Goslinga-van der Gaag SME, Delhaas EM, Frankema SPG, Huygen FJPM. Efficiency and Safety of Aftercare With Intrathecal Baclofen on Location. Neuromodulation 2019; 22:828-833. [PMID: 31423696 PMCID: PMC6851888 DOI: 10.1111/ner.13038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/28/2019] [Accepted: 07/11/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Patients with intractable spasticity treated with intrathecal baclofen (ITB) need regular evaluation and aftercare in an outpatient clinic or pain clinic setting. Logistically, this can be challenging. A solution could be to perform treatment at the patient's home setting. In the Netherlands, a project of the Dutch Healthcare Authority was initiated to deliver ambulatory ITB-related services via a home-based Ambulant Care Clinic. This aftercare is performed by nurse practitioners (NP) with support from a medical specialist. The scope of the study was to investigate the efficiency and safety of ITB-care for patients with severe disabling spasticity in their home setting. MATERIALS AND METHODS A retrospective analysis of prospectively collected data. Patients with congenital or acquired spasticity were treated with ITB (1st April 2011 to January 1st 2016) using an implanted programmable pump system were referred to the home-based Ambulant Care Clinic by various neuromodulation centers in the Netherlands. All study parameters were a part of the standard intake and follow-up documentation. RESULTS Of the 900 patients treated with ITB in the Netherlands, 239 were referred to the home-based Ambulant Care Clinic and included in this study. Mean age was 45.5 (range 7-82) years; 52% lived at home; the average satisfaction score was 9 (scale 0-10); and 0.29% had (serious) adverse events (60% of clinical manifestations were prevented by remote double-check control). Certifications for patient safety and quality standards were obtained. CONCLUSIONS The concept of ITB aftercare on location demonstrated efficacy and safety in the described setting. For troubleshooting, close collaboration with a neuromodulation center is necessary and can be arranged in chain-based care.
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Affiliation(s)
- Simone M E Goslinga-van der Gaag
- Ambulatory Care Clinic, Care4homecare, 's Hertogenbosch, The Netherlands.,Center for Pain Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Elmar M Delhaas
- Ambulatory Care Clinic, Care4homecare, 's Hertogenbosch, The Netherlands.,Center for Pain Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sander P G Frankema
- Center for Pain Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frank J P M Huygen
- Center for Pain Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
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Berryhill MB, Culmer N, Williams N, Halli-Tierney A, Betancourt A, Roberts H, King M. Videoconferencing Psychotherapy and Depression: A Systematic Review. Telemed J E Health 2019; 25:435-446. [DOI: 10.1089/tmj.2018.0058] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Micha Blake Berryhill
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, Alabama
| | - Nathan Culmer
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama
| | - Nelle Williams
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama
| | - Anne Halli-Tierney
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama
| | - Alex Betancourt
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, Alabama
| | - Hannah Roberts
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, Alabama
| | - Michael King
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, Alabama
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31
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Development of a Smart Mobile Data Module for Fetal Monitoring in E-Healthcare. J Med Syst 2018; 42:83. [DOI: 10.1007/s10916-018-0938-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
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32
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Rodríguez I, Herskovic V, Gerea C, Fuentes C, Rossel PO, Marques M, Campos M. Understanding Monitoring Technologies for Adults With Pain: Systematic Literature Review. J Med Internet Res 2017; 19:e364. [PMID: 29079550 PMCID: PMC5681725 DOI: 10.2196/jmir.7279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 08/24/2017] [Accepted: 09/10/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Monitoring of patients may decrease treatment costs and improve quality of care. Pain is the most common health problem that people seek help for in hospitals. Therefore, monitoring patients with pain may have significant impact in improving treatment. Several studies have studied factors affecting pain; however, no previous study has reviewed the contextual information that a monitoring system may capture to characterize a patient's situation. OBJECTIVE The objective of this study was to conduct a systematic review to (1) determine what types of technologies have been used to monitor adults with pain, and (2) construct a model of the context information that may be used to implement apps and devices aimed at monitoring adults with pain. METHODS A literature search (2005-2015) was conducted in electronic databases pertaining to medical and computer science literature (PubMed, Science Direct, ACM Digital Library, and IEEE Xplore) using a defined search string. Article selection was done through a process of removing duplicates, analyzing title and abstract, and then reviewing the full text of the article. RESULTS In the final analysis, 87 articles were included and 53 of them (61%) used technologies to collect contextual information. A total of 49 types of context information were found and a five-dimension (activity, identity, wellness, environment, physiological) model of context information to monitor adults with pain was proposed, expanding on a previous model. Most technological interfaces for pain monitoring were wearable, possibly because they can be used in more realistic contexts. Few studies focused on older adults, creating a relevant avenue of research on how to create devices for users that may have impaired cognitive skills or low digital literacy. CONCLUSIONS The design of monitoring devices and interfaces for adults with pain must deal with the challenge of selecting relevant contextual information to understand the user's situation, and not overburdening or inconveniencing users with information requests. A model of contextual information may be used by researchers to choose possible contextual information that may be monitored during studies on adults with pain.
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Affiliation(s)
- Iyubanit Rodríguez
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Valeria Herskovic
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carmen Gerea
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Fuentes
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
- School of Computer Science, University of Nottingham, Nottingham, United Kingdom
| | - Pedro O Rossel
- Department of Computer Science, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Maíra Marques
- Department of Computer Science, Universidad de Chile, Santiago, Chile
| | - Mauricio Campos
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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BARROS L, GREFFIN K. Supporting health-related parenting: A scoping review of programs assisted by the Internet and related technologies. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2017. [DOI: 10.1590/1982-02752017000300002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract eHealth interventions have been proposed as a possible solution to overcome major obstacles associated with low adherence rates, low accessibility, and high costs of parenting programs. Due to the number and variety of interventions found in the literature, this study aimed to conduct a scoping review of parenting interventions directed at supporting parents in promoting their child’s health and carrying out disease-related tasks. The scoping review identified 119 technology-based programs directed both at universal, preventive objectives and at the management and adaptation to chronic or severe acute health conditions. Several different web-based applications have been creatively used in healthrelated parenting interventions. Most programs use evidence-based psychological methodologies to promote parental self-management, build specific parenting skills, and provide customized feedback and social support. Further studies are needed to assess the contribution of the Internet and mobile applications to enhance the effectiveness of health-related parenting interventions and the dissemination of empirically validated programs.
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[Tele-cooperation for innovative care using the example of the University Hospital Aachen. Telematics in intensive care medicine, emergency medicine, and telemedical intersectoral rehabilitation planning in geriatric trauma]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 58:1056-61. [PMID: 26281718 DOI: 10.1007/s00103-015-2224-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The demographic challenge of the ageing society is associated with increasing comorbidity. On the other hand, there will be an ageing workforce in medicine, resulting in an imbalance between the demand and supply of medical care in the near future. In rural areas in particular, this imbalance is already present today. Based on three best practice projects carried out by our telemedical center in Aachen, including emergency medicine, intensive care medicine, and the rehabilitation planning of geriatric trauma care, some experience and the potential of the intersectoral provision of care, supported by telemedicine, are demonstrated. Telemedicine is the provision of medical services over a geographical distance by using tele-communication and data transfer. It has been proven to ensure a constant quality of health care. Telemedical support enables shared expertise independent of time and space, and allows efficient allocation of resources. A review of international experience supports this notion.
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Abstract
Between 1996 and 2003, a network of 85 telehealth videoconference sites was implemented in Western Australia (WA), together with 19 teleradiology facilities. Telehealth services have been growing steadily, and in 2002 there were over 30,000 teleradiology transmissions and 1250 clinical occasions of service via videoconference. The funding bodies, and in particular the WA Department of Health, need to know whether the aims of the project have been achieved. They must also decide whether investment should continue. A process of progressive evaluation has been implemented to identify progress to date, the benefits achieved and the potential for further development. However, it is difficult to evaluate a broad range of programmes in rural and remote locations for such an embryonic service. These difficulties are compounded by the lack of a strategy at national level to ensure consistency and compatibility not only of infrastructure, equipment and standards but also of data capture and evaluation methodologies for telehealth. This would allow comparisons across regions and states, which in turn would provide opportunities to learn from others and thus improve health-care nationally.
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Affiliation(s)
- Eric Dillon
- Telehealth Unit, Department of Health, Perth, Western Australia, Australia.
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36
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Riaz MS, Atreja A. Personalized Technologies in Chronic Gastrointestinal Disorders: Self-monitoring and Remote Sensor Technologies. Clin Gastroenterol Hepatol 2016; 14:1697-1705. [PMID: 27189911 PMCID: PMC5108695 DOI: 10.1016/j.cgh.2016.05.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 02/07/2023]
Abstract
With increased access to high-speed Internet and smartphone devices, patients have started to use mobile applications (apps) for various health needs. These mobile apps are now increasingly used in integration with telemedicine and wearables to support fitness, health education, symptom tracking, and collaborative disease management and care coordination. More recently, evidence (especially around remote patient monitoring) has started to build in some chronic diseases, and some of the digital health technologies have received approval from the Food and Drug Administration. With the changing healthcare landscape and push for value-based care, adoption of these digital health initiatives among providers is bound to increase. Although so far there is a dearth of published evidence about effectiveness of these apps in gastroenterology care, there are ongoing trials to determine whether remote patient monitoring can lead to improvement in process metrics or outcome metrics for patients with chronic gastrointestinal diseases.
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Affiliation(s)
| | - Ashish Atreja
- Icahn School of Medicine at Mount Sinai, New York, New York.
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Chorin E, Padegimas A, Havakuk O, Birati EY, Shacham Y, Milman A, Topaz G, Flint N, Keren G, Rogowski O. Assessment of Respiratory Distress by the Roth Score. Clin Cardiol 2016; 39:636-639. [PMID: 27701750 DOI: 10.1002/clc.22586] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/19/2016] [Accepted: 08/01/2016] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Health care demand is increasing due to greater longevity of patients with chronic comorbidities. This increasing demand is occurring in a setting of resource scarcity. To address these changes, high-value care initiatives, such as telemedicine, are valuable resource-preservation strategies. This study introduces the Roth score as a telemedicine tool that uses patient counting times to accurately risk-stratify dyspnea severity in terms of hypoxia. HYPOTHESIS The Roth score has correlation with dyspnea severity. METHODS This is a prospective, controlled-cohort study. Roth score index is measured by having the patient count from 1 to 30 in their native language, in a single breath, as rapidly as possible. The primary result of the Roth score is the duration of time and the highest number reached. RESULTS There was a strongly positive correlation between pulse oximetry and both maximal count achieved in 1 breath (r = 0.67; P < 0.001) and counting time (r = 0.59; P < 0.001). For oxygen saturation <95%, the maximal count number area under the curve is 0.828 and counting time area under the curve is 0.764. Counting time >8 seconds had a sensitivity of 78% and specificity of 73% for pulse oximetry <95%. CONCLUSIONS The Roth score has strong correlation with dyspnea severity as determined by hypoxia. This tool is reproducible, low resource-utilization, and amenable to telemedicine. It is not intended to replace full clinical workup and diagnosis of respiratory distress, but it is useful in risk-stratifying severity of dyspnea that warrants further clinical evaluation.
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Affiliation(s)
- Ehud Chorin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Allison Padegimas
- Department of Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ofer Havakuk
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edo Y Birati
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yacov Shacham
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Milman
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Topaz
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Flint
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Rogowski
- Department of Internal Medicine "C", Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Thanos A, Yonekawa Y, Todorich B, Moshfeghi DM, Trese MT. Screening and treatments using telemedicine in retinopathy of prematurity. Eye Brain 2016; 8:147-151. [PMID: 28539810 PMCID: PMC5398746 DOI: 10.2147/eb.s94440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Several studies have validated the role of telemedicine as a new powerful screening and diagnostic tool for retinal disorders, such as diabetic retinopathy and retinopathy of prematurity. With regard to retinopathy of prematurity, bedside examination with binocular indirect ophthalmoscopy has been the gold standard technique for screening, yet with several limitations. Herein, we review the current evidence that supports the role of telemedicine for the screening of infants with retinopathy of prematurity.
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Affiliation(s)
- Aristomenis Thanos
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI
| | - Yoshihiro Yonekawa
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI.,Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Bozho Todorich
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI
| | - Darius M Moshfeghi
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Michael T Trese
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI
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Penn DL, Simpson L, Edie G, Leggett S, Wood L, Hawgood J, Krysinska K, Yellowlees P, De Leo D. Development of ACROSSnet: an online support system for rural and remote community suicide prevention workers in Queensland, Australia. Health Informatics J 2016. [DOI: 10.1177/1460458205058755] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Communication and information technologies can reduce the barriers of distance and space that disadvantage communities in Australia's underserved rural areas, where the health status of residents is often worse than that of their urban counterparts. ACROSSnet (Australians Creating Rural Online Support Systems) is a 3 year collaborative action research project that aims to design and develop an online support system that will assist rural communities in accessing information, education and support regarding suicide and its prevention, whilst considering the challenges of Internet speed, cost and availability that can impede the delivery of online services. The site provides three distinct levels of access: one level for community members, and two further levels for appropriately credentialled mental health workers. In creating this environment, the ACROSSnet team hopes that online communities of practice will develop, engaging participants of different ages, income and education levels, location, and socioeconomic backgrounds.
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Affiliation(s)
- Danielle L. Penn
- Service Leadership Innovation and Research Program, Queensland University of Technology, GPO Box 2434, Brisbane QLD 4001, Australia,
| | - Lyn Simpson
- Service Leadership Innovation and Research Program, Queensland University of Technology, GPO Box 2434, Brisbane QLD 4001, Australia,
| | - Gavin Edie
- Service Leadership Innovation and Research Program, Queensland University of Technology, GPO Box 2434, Brisbane QLD 4001, Australia,
| | - Susan Leggett
- Service Leadership Innovation and Research Program, Queensland University of Technology, GPO Box 2434, Brisbane QLD 4001, Australia,
| | - Leanne Wood
- Service Leadership Innovation and Research Program, Queensland University of Technology, GPO Box 2434, Brisbane QLD 4001, Australia,
| | - Jacinta Hawgood
- Australian Institute for Suicide Research and Prevention (AISRAP), Griffith University, Mt Gravatt Campus, Brisbane QLD 4111, Australia,
| | - Karolina Krysinska
- Australian Institute for Suicide Research and Prevention (AISRAP), Griffith University, Mt Gravatt Campus, Brisbane QLD 4111, Australia,
| | - Peter Yellowlees
- UC Davis, Suite 2631, Administrative Support Building 2450, 48th Street, Sacramento, CA 95817, USA,
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention (AISRAP), Griffith University, Mt Gravatt Campus, Brisbane QLD 4111, Australia,
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McManus SG. A Telehealth Program to Reduce Readmission Rates Among Heart Failure Patients: One Agency’s Experience. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2016. [DOI: 10.1177/1084822303262542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Posthospital management of congestive heart failure (CHF), a chronic disease with frequent hospital readmissions, continues to challenge the already financially burdened health care system and growing nursing shortage. A promising approach to the multidisciplinary management of this and other chronic diseases is Telehealth, defined as the delivery of health care and sharing of medical knowledge over a distance using telecommunication systems. One home health agencycompared CHF patients’ hospital readmissions with patients who received routine home care skilled nursing visits and those who also received remote video telehealth contacts.
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Affiliation(s)
- Susan G. McManus
- Home Health Services and Hospice visiting staff at the Visiting Nurse Association of Somerset Hills in Bernardsville, New Jersey
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Vegesna A, Tran M, Angelaccio M, Arcona S. Remote Patient Monitoring via Non-Invasive Digital Technologies: A Systematic Review. Telemed J E Health 2016; 23:3-17. [PMID: 27116181 PMCID: PMC5240011 DOI: 10.1089/tmj.2016.0051] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND We conducted a systematic literature review to identify key trends associated with remote patient monitoring (RPM) via noninvasive digital technologies over the last decade. MATERIALS AND METHODS A search was conducted in EMBASE and Ovid MEDLINE. Citations were screened for relevance against predefined selection criteria based on the PICOTS (Population, Intervention, Comparator, Outcomes, Timeframe, and Study Design) format. We included studies published between January 1, 2005 and September 15, 2015 that used RPM via noninvasive digital technology (smartphones/personal digital assistants [PDAs], wearables, biosensors, computerized systems, or multiple components of the formerly mentioned) in evaluating health outcomes compared to standard of care or another technology. Studies were quality appraised according to Critical Appraisal Skills Programme. RESULTS Of 347 articles identified, 62 met the selection criteria. Most studies were randomized control trials with older adult populations, small sample sizes, and limited follow-up. There was a trend toward multicomponent interventions (n = 26), followed by smartphones/PDAs (n = 12), wearables (n = 11), biosensor devices (n = 7), and computerized systems (n = 6). Another key trend was the monitoring of chronic conditions, including respiratory (23%), weight management (17%), metabolic (18%), and cardiovascular diseases (16%). Although substantial diversity in health-related outcomes was noted, studies predominantly reported positive findings. CONCLUSIONS This review will help decision makers develop a better understanding of the current landscape of peer-reviewed literature, demonstrating the utility of noninvasive RPM in various patient populations. Future research is needed to determine the effectiveness of RPM via noninvasive digital technologies in delivering patient healthcare benefits and the feasibility of large-scale implementation.
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Affiliation(s)
- Ashok Vegesna
- 1 Jefferson College of Population Health , Philadelphia, Pennsylvania.,2 Novartis Pharmaceuticals Corporation , East Hanover, New Jersey
| | - Melody Tran
- 2 Novartis Pharmaceuticals Corporation , East Hanover, New Jersey.,3 Scott & White Health Plan , Temple, Texas
| | | | - Steve Arcona
- 2 Novartis Pharmaceuticals Corporation , East Hanover, New Jersey
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Abstract
eHealth is an umbrella term incorporating any area that combines healthcare and technology to improve efficiencies and reduce costs. The ultimate goal of eHealth is to rationalize treatment selection to improve patient safety and outcomes. Telemedicine, first used in the 1920s, is the oldest form of eHealth. The introduction of broadband Internet, followed by wireless technologies, has allowed an explosion of mHealth applications within this field. Wearable technologies, such as smartwatches, are now being used for diagnostics and patient monitoring. Challenges remain to develop reusable Clinical Decision Support systems that will streamline the flow of data from clinical laboratories to point of care. This review explores the history of eHealth, and describes some of the remaining integration and implementation challenges.
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Affiliation(s)
- Tibor van Rooij
- Department of Computer Science, University of Victoria, Victoria, British Columbia, Canada
| | - Sharon Marsh
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
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Yang YT, Iqbal U, Ching JHY, Ting JBS, Chiu HT, Tamashiro H, Hsu YHE. Trends in the growth of literature of telemedicine: A bibliometric analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2015; 122:471-479. [PMID: 26415760 DOI: 10.1016/j.cmpb.2015.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 09/03/2015] [Accepted: 09/08/2015] [Indexed: 06/05/2023]
Abstract
Over the past two decades, the use of telemedicine as a way to provide medical services has grown as communication technologies advance and patients seek more convenient ways to receive care. Because developments within this field are still rapidly evolving, identifying trends within telemedicine literature is an important task to help delineate future directions of telemedicine research. In this study, we analyzed 7960 telemedicine-related publication records found in the Science Citations Index - Expanded database between 1993 and 2012. Bibliometric analyses revealed that while the total growth in telemedicine literature has been significant in the last twenty years, the publication activity per country and over time has been variable. While the United States led the world in the cumulative number of telemedicine publications, Norway ranked highest when we ordered countries by publications per capita. We also saw that the growth in the number of publications per year has been inconsistent over the past two decades. Our results identified that neuroscience neurology and nursing as two fields of research in telemedicine that have seen considerable growth in interest in this field, and are poised to be the focus of research activity in the near future.
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Affiliation(s)
- Ya-Ting Yang
- School of Health Care Administration, Taipei Medical University, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taiwan; Golden Dream Think Tank and Research Center, Taiwan
| | - Usman Iqbal
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Jack Horn-Yu Ching
- School of Health Care Administration, Taipei Medical University, Taiwan; Golden Dream Think Tank and Research Center, Taiwan
| | - Jonathan Bee-Shen Ting
- Golden Dream Think Tank and Research Center, Taiwan; College of Health Sciences, Purdue University, West Lafayette, IN, USA
| | - Hsien-Tsai Chiu
- Golden Dream Think Tank and Research Center, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan
| | - Hiko Tamashiro
- Hokkaido University Office of International Affairs, Sapporo, Japan
| | - Yi-Hsin Elsa Hsu
- School of Health Care Administration, Taipei Medical University, Taiwan; Golden Dream Think Tank and Research Center, Taiwan.
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Schmidt JM, De Georgia M. Multimodality monitoring: informatics, integration data display and analysis. Neurocrit Care 2015; 21 Suppl 2:S229-38. [PMID: 25208675 DOI: 10.1007/s12028-014-0037-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The goal of multimodality neuromonitoring is to provide continuous, real-time assessment of brain physiology to prevent, detect, and attenuate secondary brain injury. Clinical informatics deals with biomedical data, information, and knowledge including their acquisition, storage, retrieval, and optimal use for clinical decision-making. An electronic literature search was conducted for English language articles describing the use of informatics in the intensive care unit setting from January 1990 to August 2013. A total of 64 studies were included in this review. Clinical informatics infrastructure should be adopted that enables a wide range of linear and nonlinear analytical methods be applied to patient data. Specific time epochs of clinical interest should be reviewable. Analysis strategies of monitor alarms may help address alarm fatigue. Ergonomic data display that present results from analyses with clinical information in a sensible uncomplicated manner improve clinical decision-making. Collecting and archiving the highest resolution physiologic and phenotypic data in a comprehensive open format data warehouse is a crucial first step toward information management and two-way translational research for multimodality monitoring. The infrastructure required is largely the same as that needed for telemedicine intensive care applications, which under the right circumstances improves care quality while reducing cost.
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Affiliation(s)
- J Michael Schmidt
- Division of Critical Care Neurology, Neurological Institute, Columbia University College of Physicians and Surgeons, 177 Fort Washington Avenue, MHB Suite 8-300, New York, NY, 10032, USA,
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Rationale and Considerations for the Internet-Based Delivery of Parent-Child Interaction Therapy. COGNITIVE AND BEHAVIORAL PRACTICE 2015; 22:302-316. [PMID: 26120268 DOI: 10.1016/j.cbpra.2014.07.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Given the enormous individual, familial, and societal costs associated with early disruptive behavior disorders, transformative efforts are needed to develop innovative options for overcoming traditional barriers to effective care and for broadening the availability of supported interventions. This paper presents the rationale and key considerations for a promising innovation in the treatment of early-onset disruptive behavior disorders-that is, the development of an Internet-based format for the delivery of Parent-Child Interaction Therapy (PCIT) directly to families in their own homes. Specifically, we consider traditional barriers to effective care, and discuss how technological innovations can overcome problems of treatment availability, accessibility, and acceptability. We then detail our current Internet-delivered PCIT treatment program (I-PCIT), which is currently being evaluated across multiple randomized clinical trials relative to waitlist comparison, and to traditional in-office PCIT. Embedded video clips of children treated with I-PCIT are used to illustrate novel aspects of the treatment.
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Remote patient monitoring acceptance trends among older adults residing in a frontier state. COMPUTERS IN HUMAN BEHAVIOR 2015. [DOI: 10.1016/j.chb.2014.11.044] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Henderson K, Carlisle Davis T, Smith M, King M. Nurse Practitioners in Telehealth: Bridging the Gaps in Healthcare Delivery. J Nurse Pract 2014. [DOI: 10.1016/j.nurpra.2014.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Shane-McWhorter L, Lenert L, Petersen M, Woolsey S, McAdam-Marx C, Coursey JM, Whittaker TC, Hyer C, LaMarche D, Carroll P, Chuy L. The Utah Remote Monitoring Project: improving health care one patient at a time. Diabetes Technol Ther 2014; 16:653-60. [PMID: 24991923 PMCID: PMC4183896 DOI: 10.1089/dia.2014.0045] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The expanding role of technology to augment diabetes care and management highlights the need for clinicians to learn about these new tools. As these tools continue to evolve and enhance improved outcomes, it is imperative that clinicians consider the role of telemonitoring, or remote monitoring, in patient care. This article describes a successful telemonitoring project in Utah. SUBJECTS AND METHODS This was a nonrandomized prospective observational preintervention-postintervention study, using a convenience sample. Patients with uncontrolled diabetes and/or hypertension from four rural and two urban primary care clinics and one urban stroke center participated in a telemonitoring program. The primary clinical outcome measures were changes in hemoglobin A1C (A1C) and blood pressure. Other outcomes included fasting lipids, weight, patient engagement, diabetes knowledge, hypertension knowledge, medication adherence, and patient perceptions of the usefulness of the telemonitoring program. RESULTS Mean A1C decreased from 9.73% at baseline to 7.81% at the end of the program (P<0.0001). Systolic blood pressure also declined significantly, from 130.7 mm Hg at baseline to 122.9 mm Hg at the end (P=0.0001). Low-density lipoprotein content decreased significantly, from 103.9 mg/dL at baseline to 93.7 mg/dL at the end (P=0.0263). Other clinical parameters improved nonsignificantly. Knowledge of diabetes and hypertension increased significantly (P<0.001 for both). Patient engagement and medication adherence also improved, but not significantly. Per questionnaires at study end, patients felt the telemonitoring program was useful. CONCLUSIONS Telemonitoring improved clinical outcomes and may be a useful tool to help enhance disease management and care of patients with diabetes and/or hypertension.
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Affiliation(s)
- Laura Shane-McWhorter
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah
| | - Leslie Lenert
- Medical University of South Carolina, Charleston, South Carolina
| | - Marta Petersen
- University of Utah Health Care, Salt Lake City, Utah
- Utah Telehealth Network, Salt Lake City, Utah
| | - Sarah Woolsey
- Community Health Centers, Inc., Midvale, Utah
- Health Insight, Salt Lake City, Utah
| | - Carrie McAdam-Marx
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah
| | - Jeffrey M. Coursey
- University of Utah Health Care, Salt Lake City, Utah
- Community Health Centers, Inc., Midvale, Utah
| | | | | | - Deb LaMarche
- University of Utah Health Care, Salt Lake City, Utah
- Utah Telehealth Network, Salt Lake City, Utah
| | - Patricia Carroll
- University of Utah Health Care, Salt Lake City, Utah
- Utah Telehealth Network, Salt Lake City, Utah
| | - Libbey Chuy
- Association for Utah Community Health, Salt Lake City, Utah
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Fatehi F, Martin-Khan M, Gray LC, Russell AW. Design of a randomized, non-inferiority trial to evaluate the reliability of videoconferencing for remote consultation of diabetes. BMC Med Inform Decis Mak 2014; 14:11. [PMID: 24528569 PMCID: PMC3925960 DOI: 10.1186/1472-6947-14-11] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 02/07/2014] [Indexed: 11/26/2022] Open
Abstract
Background An estimated 366 million people are living with diabetes worldwide and it is predicted that its prevalence will increase to 552 million by 2030. Management of this disease and its complications is a challenge for many countries. Optimal glycaemic control is necessary to minimize complications, but less than 70% of diabetic patients achieve target levels of blood glucose, partly due to poor access to qualified health care providers. Telemedicine has the potential to improve access to health care, especially for rural and remote residents. Video teleconsultation, a real-time (or synchronous) mode of telemedicine, is gaining more popularity around the world through recent improvements in digital telecommunications. If video consultation is to be offered as an alternative to face-to-face consultation in diabetes assessment and management, then it is important to demonstrate that this can be achieved without loss of clinical fidelity. This paper describes the protocol of a randomised controlled trail for assessing the reliability of remote video consultation for people with diabetes. Methods/Design A total of 160 people with diabetes will be randomised into either a Telemedicine or a Reference group. Participants in the Reference group will receive two sequential face-to-face consultations whereas in the Telemedicine group one consultation will be conducted face-to-face and the other via videoconference. The primary outcome measure will be a change in the patient’s medication. Secondary outcome measures will be findings in physical examination, detecting complications, and patient satisfaction. A difference of less than 20% in the aggregated level of agreement between the two study groups will be used to identify if videoconference is non-inferior to traditional mode of clinical care (face-to-face). Discussion Despite rapid growth in application of telemedicine in a variety of medical specialities, little is known about the reliability of videoconferencing for remote consultation of people with diabetes. Results of this proposed study will provide evidence of the reliability of specialist consultation offered by videoconference for people with diabetes. Trial registration number Australian New Zealand Clinical Trials Registry ACTRN12612000315819.
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Affiliation(s)
- Farhad Fatehi
- Centre for Online Health, The University of Queensland, Brisbane, Australia.
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Comer JS, Barlow DH. The occasional case against broad dissemination and implementation: retaining a role for specialty care in the delivery of psychological treatments. AMERICAN PSYCHOLOGIST 2014; 69:1-18. [PMID: 23915401 PMCID: PMC4260460 DOI: 10.1037/a0033582] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Mental illness imposes a staggering public health burden in the United States. Although the past 40 years have witnessed tremendous advances in the identification of evidence-based practices (EBPs) in psychological treatments, gaps persist between treatment in experimental settings and services available in the community. In response, considerable attention and large financial commitments have focused in recent years on broad dissemination and implementation efforts designed to improve the quality of psychological services delivered by a variety of generalist practitioners across practice settings. Increasingly, under the influence of the Patient Protection and Affordable Care Act, it is envisioned that these generalists will practice in integrated primary care settings. These advances hold enormous potential, and yet, given the tremendous diversity of mental health problems and human suffering, broad dissemination and implementation efforts to generalists alone may not be sufficient to adequately address the burden of mental illness. Some EBPs may prove too complex for universal dissemination, and the time and expense required for quality dissemination and implementation preclude large-scale training in the treatment of low base rate disorders. As dissemination and implementation efforts work to ensure a quality generalist mental health care workforce, herein we highlight the vital need for available specialty care in the delivery of psychological treatments. Given traditional barriers that interfere with the accessibility of specialty care, we propose the transformative potential of a specialty behavioral telehealth care workforce, transacting with the generalist practitioner workforce to collectively ensure the highest quality and timely delivery of needed treatments to affected individuals.
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