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Yu J, Civelek Y, Casalino LP, Jung HY, Pierre R, Zhang M, Khullar D. Telehealth Delivery Differs Significantly By Physician And Practice Characteristics. Health Aff (Millwood) 2024; 43:1311-1318. [PMID: 39226507 DOI: 10.1377/hlthaff.2024.00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
In this study of 2022 Medicare fee-for-service claims, we found that female physicians, primary care physicians, psychiatrists, and physicians in nonrural practices delivered relatively higher proportions of visits via telehealth.
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Affiliation(s)
- Jiani Yu
- Jiani Yu , Cornell University, New York, New York
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2
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Leopold SM, Brown DH, Zhang X, Nguyen XT, Al-Subu AM, Olson KR. Early Impressions and Adoption of the AtriAmp for Managing Arrhythmias Following Congenital Heart Surgery. Pediatr Cardiol 2024:10.1007/s00246-024-03573-y. [PMID: 38970655 DOI: 10.1007/s00246-024-03573-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/30/2024] [Indexed: 07/08/2024]
Abstract
AtriAmp is a new medical device that displays a continuous real-time atrial electrogram on telemetry using temporary atrial pacing leads. Our objective was to evaluate early adoption of this device into patient care within our pediatric intensive care unit (PICU). This is a qualitative study using inductive analysis of semi-structured interviews to identify dominant themes. The study was conducted in a single-center, tertiary, academic 21-bed mixed PICU. The subjects were PICU multidisciplinary team members (Pediatric Cardiac Intensivists, PICU Nurse Practitioners, PICU nurses and Pediatric Cardiologists) who were early adopters of the AtriAmp (n = 14). Three prominent themes emerged: (1) Accelerated time from arrhythmia event to diagnosis and treatment; (2) Increased confidence in the accuracy of providers' arrhythmia diagnosis; and (3) Improvement in the ability to educate providers about post-operative arrhythmias. Providers also noted some learning curves, but none compromised medical care or clinical workflow. Insights from early adopters of AtriAmp signal the need for simplicity and fidelity in new PICU technologies. Our research suggests that such technologies can be pivotal to the support and growth of multi-disciplinary teams, even among those who do not participate in early implementation. Further research is needed to understand when and why novel technology adoption becomes widespread in high-stakes settings.
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Affiliation(s)
- Scott M Leopold
- Division of Critical Care, Department of Pediatrics, American Family Children's Hospital, 600 Highland Ave, Mailcode 4108, Madison, WI, 53742, USA.
| | - Diane H Brown
- Division of Critical Care, Department of Pediatrics, Presbyterian Hospital, Albuquerque, NM, USA
| | - Xiao Zhang
- Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Xuan T Nguyen
- Department of Sociology, University of Wisconsin-Madison, Madison, WI, USA
| | - Awni M Al-Subu
- Division of Critical Care, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Krisjon R Olson
- Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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3
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Gul ZG, Sharbaugh DR, Ellimoottil C, Rak KJ, Yabes JG, Davies BJ, Jacobs BL. Telemedicine in urologic oncology care: Will telemedicine exacerbate disparities? Urol Oncol 2024; 42:28.e1-28.e7. [PMID: 38220521 DOI: 10.1016/j.urolonc.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/15/2023] [Accepted: 10/16/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Disparities in prostate, bladder, and kidney cancer outcomes are associated with access to care. Telemedicine can improve access but may be underutilized by certain patient populations. Our objective was to determine if the patient populations who suffer worse oncologic outcomes are the same as those who are less likely to use telemedicine. METHODS Using an institutional database, we identified all prostate, bladder and kidney cancer encounters from March 14, 2020 to October 31, 2021 (n = 15,623; n = 4, 14; n = 3,830). Telemedicine was used in 13%, 8%, and 12% of these encounters, respectively. We performed random effects modeling analysis to examine patient and provider characteristics associated with telemedicine use. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were reported as measures of association. RESULTS Among prostate, bladder, and kidney cancer patients, Black patients had lower odds of a telemedicine encounter (OR 0.51, 95% CI 0.37-0.69; OR 0.22, 95% CI 0.07-0.70; OR 0.46, 95% CI 0.24-0.86), and patients residing in small and isolated small rural towns areas had higher odds of a telemedicine encounter (OR 1.44, 95% CI 1.09-1.91; OR 2.12, 95% CI 1.14-3.94; OR 1.89, 95% CI 1.12-3.19). Compared to providers in practice ≤5 years, providers in practice for 6 to 15 years had significantly higher odds of a telemedicine encounter for prostate and bladder cancer patients (OR 4.10, 95% CI 1.4511.58; OR 3.42, 95% CI 1.09-10.77). CONCLUSION The lower rates of telemedicine use among Black patients could exacerbate pre-existing disparities in prostate, bladder, and kidney cancer outcomes.
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Affiliation(s)
- Zeynep G Gul
- Department of Surgery, Division of Urology, University of Washington in St. Louis, St. Louis, MO.
| | - Danielle R Sharbaugh
- Department of Urology, Division of Health Services Research, University of Pittsburgh, Pittsburgh, PA
| | - Chad Ellimoottil
- Department of Urology, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - Kimberly J Rak
- Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jonathan G Yabes
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Benjamin J Davies
- Department of Urology, Division of Health Services Research, University of Pittsburgh, Pittsburgh, PA
| | - Bruce L Jacobs
- Department of Urology, Division of Health Services Research, University of Pittsburgh, Pittsburgh, PA
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Rodler S, Kidess MA, Westhofen T, Kowalewski KF, Belenchon IR, Taratkin M, Puliatti S, Gómez Rivas J, Veccia A, Piazza P, Checcucci E, Stief CG, Cacciamani GE. A Systematic Review of New Imaging Technologies for Robotic Prostatectomy: From Molecular Imaging to Augmented Reality. J Clin Med 2023; 12:5425. [PMID: 37629467 PMCID: PMC10455161 DOI: 10.3390/jcm12165425] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
New imaging technologies play a pivotal role in the current management of patients with prostate cancer. Robotic assisted radical prostatectomy (RARP) is a standard of care for localized disease and through the already imaging-based console subject of research towards combinations of imaging technologies and RARP as well as their impact on surgical outcomes. Therefore, we aimed to provide a comprehensive analysis of the currently available literature for new imaging technologies for RARP. On 24 January 2023, we performed a systematic review of the current literature on Pubmed, Scopus and Web of Science according to the PRISMA guidelines and Oxford levels of evidence. A total of 46 studies were identified of which 19 studies focus on imaging of the primary tumor, 12 studies on the intraoperative tumor detection of lymph nodes and 15 studies on the training of surgeons. While the feasibility of combined approaches using new imaging technologies including MRI, PSMA-PET CT or intraoperatively applied radioactive and fluorescent dyes has been demonstrated, the prospective confirmation of improvements in surgical outcomes is currently ongoing.
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Affiliation(s)
- Severin Rodler
- Department of Urology, University Hospital of Munich, 81377 Munich, Germany (T.W.); (C.G.S.)
| | - Marc Anwar Kidess
- Department of Urology, University Hospital of Munich, 81377 Munich, Germany (T.W.); (C.G.S.)
| | - Thilo Westhofen
- Department of Urology, University Hospital of Munich, 81377 Munich, Germany (T.W.); (C.G.S.)
| | | | - Ines Rivero Belenchon
- Urology and Nephrology Department, Virgen del Rocío University Hospital, Manuel Siurot s/n, 41013 Seville, Spain;
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, 117418 Moscow, Russia;
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, 42122 Modena, Italy;
| | - Juan Gómez Rivas
- Department of Urology, Hospital Clinico San Carlos, 28040 Madrid, Spain;
| | - Alessandro Veccia
- Urology Unit, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy;
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy;
| | - Christian Georg Stief
- Department of Urology, University Hospital of Munich, 81377 Munich, Germany (T.W.); (C.G.S.)
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Saylor KW, Klein WM, Calancie L, Lewis KL, Biesecker LG, Turbitt E, Roberts MC. Genetic Testing and Other Healthcare Use by Black and White Individuals in a Genomic Sequencing Study. Public Health Genomics 2023; 26:90-102. [PMID: 37544304 PMCID: PMC10614486 DOI: 10.1159/000533356] [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: 05/02/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION Early adopters play a critical role in the diffusion of medical innovations by spreading awareness, increasing acceptability, and driving demand. Understanding the role of race in the context of other characteristics of potential early adopters can shed light on disparities seen in the early implementation of genomic medicine. We aimed to understand the association between self-identified race and individual experience with genetic testing outside of the research context. METHODS We assessed factors associated with the odds of having ever received genetic testing prior to enrollment in a genomic sequencing study among 674 self-identified white and 407 self-identified African, African American, or Afro-Caribbean ("Black") individuals. RESULTS Controlling for individual determinants of healthcare use (demographics, personality traits, knowledge and attitudes, and health status), identifying as Black was associated with lower odds of prior genetic testing (OR = 0.43, 95% CI [0.27-0.68], p < 0.001). In contrast, self-identified race was not associated with the use of non-genetic clinical screening tests (e.g., echocardiogram, colonoscopy). Black and white individuals were similar on self-reported personality traits tied to early adoption but differed by sociodemographic and resource facilitators of early adoption. CONCLUSION Persistent racial disparities among early adopters may represent especially-entrenched disparities in access to and knowledge of genomic technologies in clinical settings.
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Affiliation(s)
- Katherine W. Saylor
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - William M.P. Klein
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Larissa Calancie
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Katie L. Lewis
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Leslie G. Biesecker
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Erin Turbitt
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Megan C. Roberts
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
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Deng W, Yang T, Deng J, Liu R, Sun X, Li G, Wen X. Investigating Factors Influencing Medical Practitioners' Resistance to and Adoption of Internet Hospitals in China: Mixed Methods Study. J Med Internet Res 2023; 25:e46621. [PMID: 37523226 PMCID: PMC10425818 DOI: 10.2196/46621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND The swift shift toward internet hospitals has relied on the willingness of medical practitioners to embrace new systems and workflows. Low engagement or acceptance by medical practitioners leads to difficulties in patient access. However, few investigations have focused on barriers and facilitators of adoption of internet hospitals from the perspective of medical practitioners. OBJECTIVE This study aims to identify both enabling and inhibiting predictors associated with resistance and behavioral intentions of medical practitioners to use internet hospitals by combining the conservation of resources theory with the Unified Theory of Acceptance and Use of Technology and technostress framework. METHODS A mixed methods research design was conducted to qualitatively identify the factors that enable and inhibit resistance and behavioral intention to use internet hospitals, followed by a quantitative survey-based study that empirically tested the effects of the identified factors. The qualitative phase involved conducting in-depth interviews with 16 experts in China from June to August 2022. Thematic analysis was performed using the qualitative data analysis software NVivo version 10 (QSR International). On the basis of the findings and conceptual framework gained from the qualitative interviews, a cross-sectional, anonymous, web-based survey of 593 medical practitioners in 28 provincial administrative regions of China was conducted. The data collected were analyzed using the partial least squares method, with the assistance of SPSS 27.0 (IBM Corp) and Mplus 7.0 (Muthen and Muthen), to measure and validate the proposed model. RESULTS On the basis of qualitative results, this study identified 4 facilitators and inhibitors, namely performance expectancy, social influence, work overload, and role ambiguity. Of the 593 medical practitioners surveyed in the quantitative research, most were female (n=364, 61.4%), had a middle title (n=211, 35.6%) or primary title (n=212, 35.8%), and had an average use experience of 6 months every year. By conducting structural equation modeling, we found that performance expectancy (β=-.55; P<.001) and work overload (β=.16; P=.005) had the most significant impact on resistance to change. Resistance to change fully mediated the influence of performance expectancy and partially mediated the influences of social influence (variance accounted for [VAF]=43.3%; P=.002), work overload (VAF=37.2%; P=.03), and role ambiguity (VAF=12.2%; P<.001) on behavioral intentions to use internet hospitals. In addition, this study found that the sex, age, professional title, and use experience of medical practitioners significantly moderated the aforementioned influencing mechanisms. CONCLUSIONS This study investigated the factors that facilitate or hinder medical practitioners' resistance to change and their behavioral intentions to use internet hospitals. The findings suggest that policy makers avoid the resistance and further promote the adoption of internet hospitals by ensuring performance expectancy and social influence and eliminating work overload and role ambiguity.
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Affiliation(s)
- Wenhao Deng
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
- Sustainable Development Research Institute for Economy and Society of Beijing, Beijing, China
| | - Tianan Yang
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
- Sustainable Development Research Institute for Economy and Society of Beijing, Beijing, China
| | - Jianwei Deng
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
- Sustainable Development Research Institute for Economy and Society of Beijing, Beijing, China
| | - Ran Liu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Xueqin Sun
- Department of Medical Insurance Management, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Gang Li
- TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinmei Wen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Lan YT, Chen YW, Niu R, Chang DC, Hollenbeck BL, Mattingly DA, Smith EL, Talmo CT. The trend and future projection of technology-assisted total knee arthroplasty in the United States. Int J Med Robot 2023; 19:e2478. [PMID: 36321582 DOI: 10.1002/rcs.2478] [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: 07/07/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND As technology-assisted surgery has boosted in the last decades, we aimed to investigate the factors affecting adoption and to predict the future utilization of technology among patients who underwent total knee arthroplasty (TKA). METHODS Patients underwent TKA in 2017-2019 in the MarketScan Database were included. Percentage of technology-assisted surgery was calculated. Multivariable logistic regression models were performed to analyse the factors and make the prediction. RESULTS Of 112,161 TKA procedures, 7.2% were technology-assisted. The proportion of technology-assisted TKA is expected to reach 50% by 2032. The West showed the highest proportion of technology-assisted TKA (12.3%), while the South had the lowest (5.7%). Over time, the Midwest showed the greatest increase in technology adoption (OR = 1.26 compared to the Northeast, 95% CI [1.15, 1.38]). CONCLUSIONS Technology adoption rate of TKA will continue to increase for the next 20 years in the United States with a slight geographical variation.
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Affiliation(s)
- Yu-Tung Lan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ya-Wen Chen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ruijia Niu
- Department of Orthopedics, New England Baptist Hospital, Boston, MA, USA
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian L Hollenbeck
- Department of Orthopedics, New England Baptist Hospital, Boston, MA, USA
| | - David A Mattingly
- Department of Orthopedics, New England Baptist Hospital, Boston, MA, USA
| | - Eric L Smith
- Department of Orthopedics, New England Baptist Hospital, Boston, MA, USA
| | - Carl T Talmo
- Department of Orthopedics, New England Baptist Hospital, Boston, MA, USA
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Sharrief A, Guzik AK, Jones E, Okpala M, Love M, Ranasinghe TIJ, Bushnell C. Telehealth Trials to Address Health Equity in Stroke Survivors. Stroke 2023; 54:396-406. [PMID: 36689591 PMCID: PMC11061884 DOI: 10.1161/strokeaha.122.039566] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Telehealth has seen rapid expansion into chronic care management in the past 3 years because of the COVID-19 pandemic. Telehealth for acute care management has expanded access to equitable stroke care to many patients over the past two decades, but there is limited evidence for its benefit for addressing disparities in the chronic care of patients living with stroke. In this review, we discuss advantages and disadvantages of telehealth use for the outpatient management of stroke survivors. Further, we explore opportunities and potential barriers for telehealth in addressing disparities in stroke outcomes related to various social determinants of health. We discuss two ongoing large randomized trials that are utilizing telehealth and telemonitoring for management of blood pressure in diverse patient populations. Finally, we discuss strategies to address barriers to telehealth use in patients with stroke and in populations with adverse social determinants of health.
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Affiliation(s)
- Anjail Sharrief
- University of Texas Health Sciences Center at Houston, McGovern Medical School, Department of Neurology
- University of Texas Health Sciences Center, McGovern Medical School, Stroke Institute
| | - Amy K Guzik
- Wake Forest Baptist Health, Wake Forest University School of Medicine, Department of Neurology
| | - Erica Jones
- University of Texas Southwestern Medical Center, Department of Neurology
| | - Munachi Okpala
- University of Texas Health Sciences Center at Houston, McGovern Medical School, Department of Neurology
| | - Mary Love
- University of Houston College of Nursing
| | | | - Cheryl Bushnell
- Wake Forest Baptist Health, Wake Forest University School of Medicine, Department of Neurology
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Onitilo AA, Shour AR, Puthoff DS, Tanimu Y, Joseph A, Sheehan MT. Evaluating the adoption of voice recognition technology for real-time dictation in a rural healthcare system: A retrospective analysis of dragon medical one. PLoS One 2023; 18:e0272545. [PMID: 36952436 PMCID: PMC10035815 DOI: 10.1371/journal.pone.0272545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 03/02/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND In 2013, Marshfield Clinic Health System (MCHS) implemented the Dragon Medical One (DMO) system provided by Nuance Management Center (NMC) for Real-Time Dictation (RTD), embracing the idea of streamlined clinic workflow, reduced dictation hours, and improved documentation legibility. Since then, MCHS has observed a trend of reduced time in documentation, however, the target goal of 100% adoption of voice recognition (VR)-based RTD has not been met. OBJECTIVE To evaluate the uptake/adoption of VR technology for RTD in MCHS, between 2018-2020. METHODS DMO data for 1,373 MCHS providers from 2018-2020 were analyzed. The study outcome was VR uptake, defined as the median number of hours each provider used VR technology to dictate patient information, and classified as no/yes. Covariates included sex, age, US-trained/international medical graduates, trend, specialty, and facility. Descriptive statistics and unadjusted and adjusted logistic regression analyses were performed. Stata/SE.version.17 was used for analyses. P-values less than/equal to 0.05 were considered statistically significant. RESULTS Of the 1,373 MCHS providers, the mean (SD) age was 48.3 (12.4) years. VR uptake was higher than no uptake (72.0% vs. 28.0%). In both unadjusted and adjusted analyses, VR uptake was 4.3 times and 7.7 times higher in 2019-2020 compared to 2018, respectively (OR:4.30,95%CI:2.44-7.46 and AOR:7.74,95%CI:2.51-23.86). VR uptake was 0.5 and 0.6 times lower among US-trained physicians compared to internationally-trained physicians (OR:0.53,95%CI:0.37-0.76 and AOR:0.58,95%CI:0.35-0.97). Uptake was 0.2 times lower among physicians aged 60/above than physicians aged 29/less (OR:0.20,95%CI:0.10-0.59, and AOR:0.17,95%CI:0.27-1.06). CONCLUSION Since 2018, VR adoption has increased significantly across MCHS. However, it was lower among US-trained physicians than among internationally-trained physicians (although internationally physicians were in minority) and lower among more senior physicians than among younger physicians. These findings provide critical information about VR trends, physician factors, and which providers could benefit from additional training to increase VR adoption in healthcare systems.
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Affiliation(s)
- Adedayo A Onitilo
- Cancer Care and Research Center, Department of Oncology, Marshfield Clinic Health System, Marshfield, Wisconsin, United States of America
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin, United States of America
| | - Abdul R Shour
- Cancer Care and Research Center, Department of Oncology, Marshfield Clinic Health System, Marshfield, Wisconsin, United States of America
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin, United States of America
| | - David S Puthoff
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin, United States of America
| | - Yusuf Tanimu
- Cancer Care and Research Center, Department of Oncology, Marshfield Clinic Health System, Marshfield, Wisconsin, United States of America
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin, United States of America
| | - Adedayo Joseph
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Michael T Sheehan
- Department of Endocrinology, Marshfield Clinic, Weston, WI, United States of America
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Demaerschalk BM, Hollander JE, Krupinski E, Scott J, Albert D, Bobokalonova Z, Bolster M, Chan A, Christopherson L, Coffey JD, Edgman-Levitan S, Goldwater J, Hayden E, Peoples C, Rising KL, Schwamm LH. Quality Frameworks for Virtual Care: Expert Panel Recommendations. MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES 2022; 7:31-44. [PMID: 36619179 PMCID: PMC9811201 DOI: 10.1016/j.mayocpiqo.2022.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Given the significant advance of virtual care in the past year and half, it seems timely to focus on quality frameworks and how they have evolved collaboratively across health care organizations. Massachusetts General Hospital's (MGH) Center for TeleHealth and Mass General Brigham's (MGB) Virtual Care Program are committed to hosting annual symposia on key topics related to virtual care. Subject matter experts across the country, health care organizations, and academic medical centers are invited to participate. The inaugural MGH/MGB Virtual Care Symposium, which focused on rethinking curriculum, competency, and culture in the virtual care era, was held on September 2, 2020. The second MGH/MGB Virtual Care Symposium was held on November 2, 2021, and focused on virtual care quality frameworks. Resultant topics were (1) guiding principles necessary for the future of virtual care measurement; (2) best practices deployed to measure quality of virtual care and how they compare and align with in-person frameworks; (3) evolution of quality frameworks over time; (4) how increased adoption of virtual care has impacted patient access and experience and how it has been measured; (5) the pitfalls and barriers which have been encountered by organizations in developing virtual care quality frameworks; and (6) examples of how quality frameworks have been applied in various use cases. Common elements of a quality framework for virtual care programs among symposium participants included improving the patient and provider experience, a focus on achieving health equity, monitoring success rates and uptime of the technical elements of virtual care, financial stewardship, and clinical outcomes. Virtual care represents an evolution in the access to care paradigm that helps keep health care aligned with other modern industries in digital technology and systems adoption. With advances in health care delivery models, it is vitally important that the quality measurement systems be adapted to include virtual care encounters. New methods may be necessary for asynchronous transactions, but synchronous virtual visits and consults can likely be accommodated in traditional quality frameworks with minimal adjustments. Ultimately, quality frameworks for health care will adapt to hybrid in-person and virtual care practices.
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Affiliation(s)
- Bart M. Demaerschalk
- Department of Neurology, Mayo Clinic College of Medicine and Science and Center for Digital Health, Mayo Clinic, Phoenix, AZ,Correspondence: Address to Bart M. Demaerschalk, MD, M.Sc., Mayo Clinic College of Medicine and Science and Center for Digital Health Mayo Clinic, Phoenix, 13400 East Shea Boulevard, Scottsdale, AZ 85259.
| | - Judd E. Hollander
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Elizabeth Krupinski
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta GA
| | | | - Daniel Albert
- Geisel School of Medicine and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Marcy Bolster
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | - Albert Chan
- Department of Medicine, Division of Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA
| | - Laura Christopherson
- Mayo Clinic Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jordan D. Coffey
- Mayo Clinic Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Susan Edgman-Levitan
- The John D. Stoekle Center for Primary Care Innovation, Massachusetts General Hospital, Boston, MA
| | | | - Emily Hayden
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | | | - Kristin L. Rising
- Jefferson Center for Connected Care, Thomas Jefferson University, Philadelphia, PA
| | - Lee H. Schwamm
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
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Takahashi EA, Schwamm LH, Adeoye OM, Alabi O, Jahangir E, Misra S, Still CH. An Overview of Telehealth in the Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e558-e568. [PMID: 36373541 DOI: 10.1161/cir.0000000000001107] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Telehealth enables the remote delivery of health care through telecommunication technologies and has substantially affected the evolving medical landscape. The COVID-19 pandemic accelerated the utilization of telehealth as health care professionals were forced to limit face-to-face in-person visits. It has been shown that information delivery, diagnosis, disease monitoring, and follow-up care can be conducted remotely, resulting in considerable changes specific to cardiovascular disease management. Despite increasing telehealth utilization, several factors such as technological infrastructure, reimbursement, and limited patient digital literacy can hinder the adoption of remote care. This scientific statement reviews definitions pertinent to telehealth discussions, summarizes the effect of telehealth utilization on cardiovascular and peripheral vascular disease care, and identifies obstacles to the adoption of telehealth that need to be addressed to improve health care accessibility and equity.
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Schönenberger KA, Reber E, Vu DT, Krieger-Grübel C, Gerber PA, Muri R, Huwiler VV, Mühlebach S, Leuenberger M, Stanga Z. Attitudes and expectations of patients on home parenteral nutrition towards eHealth: A multicenter survey. Clin Nutr ESPEN 2022; 52:445-449. [PMID: 36513485 DOI: 10.1016/j.clnesp.2022.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/08/2022] [Accepted: 09/25/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND & AIMS Advances in technology enable patients on home parenteral nutrition (HPN) to manage their treatment more independently and safely. eHealth is a promising application of electronic means in healthcare, aimed at improving and simplifying processes and connecting the different parties involved. A thorough understanding of the attitudes and expectations of patients on HPN towards eHealth is a prerequisite for a successful implementation. However, to the best of our knowledge, such a survey preceding the implementation of HPN specific eHealth care has never been conducted. The objective of this preliminary survey is the acquisition of insights on the attitudes and expectations of patients on HPN towards eHealth. Resulting findings then serve as the basis for the design of an eHealth platform to facilitate communication among those involved in HPN care, improve the HPN management, and safeguard and monitor the treatment. METHODS We conducted a survey on the attitudes and expectations of patients towards an envisioned eHealth platform for HPN. Patients were recruited from large Swiss hospitals by their treating physician or directly by the research team. The surveys were conducted between September 2020 and October 2021 by structured personal interviews based on a questionnaire. RESULTS We included 35 patients on HPN (21 [60%] females) treated in ambulant care of 4 hospitals. They had a median (interquartile range) age of 55 (18) years and a median (interquartile range) duration of parenteral nutrition of 1.3 (3.1) years. Most patients (n = 30, 86%) were equipped with a smartphone, tablet, or computer and 22 (63%) used apps and rated themselves as proficient with the corresponding digital device. A majority of patients rated the following aspects and features of the platform as important: Data collection and storage (n = 29, 83%), checklists for PN, catheter, and infusion pump handling (n = 28, 80%), video instructions (n = 27, 77%), and videoconferencing with physicians (n = 25, 71%). Most patients (n = 26, 74%) were willing to enter data into the platform themselves. The type of data to be entered should be defined on an individual basis. CONCLUSIONS Patients on HPN are open to videoconference consultations and using an eHealth platform. Two-thirds have the necessary technical skills including suitable digital devices for an eHealth care. We identified key features of an eHealth platform to improve HPN management.
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Affiliation(s)
- Katja A Schönenberger
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
| | - Emilie Reber
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Duy-Tan Vu
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Claudia Krieger-Grübel
- Department of Gastroenterology and Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Philipp A Gerber
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland
| | - Raphaela Muri
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Valentina V Huwiler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Stefan Mühlebach
- Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Michèle Leuenberger
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Zeno Stanga
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Tindale A, Panoulas V. Real-world intravascular ultrasound (IVUS) use in percutaneous intervention-naïve patients is determined predominantly by operator, patient, and lesion characteristics. Front Cardiovasc Med 2022; 9:974161. [PMID: 36426219 PMCID: PMC9678943 DOI: 10.3389/fcvm.2022.974161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/26/2022] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Intravascular Ultrasound (IVUS) has been shown to improve clinical outcomes in patients undergoing percutaneous intervention (PCI) in numerous trials. However, it is still underutilized outside of trial settings, and most trials include a significant proportion of patients with prior PCI. The aim of this study is to look at real-world use and outcomes in PCI-naïve patients who undergo IVUS-guided intervention. METHODS AND RESULTS Prospectively collected data from 10,574 consecutive patients undergoing their index PCI was retrospectively analyzed. 455 (4.3%) patients underwent IVUS, with a median follow-up of 4.6 years. Patients undergoing IVUS had higher levels of comorbidities including diabetes (27.5% vs. 19.7%, p < 0.001), hypertension (58.0% vs. 47.9%, p < 0.001), hypercholesterolemia (51.6% vs. 39.2%, p < 0.001) and were generally older (65.9 ± 14.5 vs. 64.5 ± 13.4 years, p = 0.031) with higher mean baseline creatinine levels (95.4 ± 63.3 vs. 87.8 ± 46.1 μmol/L). The strongest predictor of IVUS use was the operating consultant graduating from medical school after the year 2000 [OR 14.5 (3.5-59.8), p < 0.001] and the presence of calcific lesions [OR 5.2 (3.4-8.0) p < 0.001]. There was no significant difference in MACE nor 1-year mortality between patients undergoing IVUS-guided or angiography-only PCI on unadjusted analysis [OR 1.04 (0.73-1.5), p = 0.81, OR 1.055 (0.65-1.71) p = 0.828] nor mortality throughout the study period (HR 0.93 (0.69-1.26), p = 0.638). This held true for stents longer than 28 mm. Propensity matched analysis of patients similarly showed no mortality difference between arms for all patients and those with longer stents (p = 0.564 and p = 0.919). CONCLUSION The strongest predictors of IVUS use in PCI-naïve patients are the operator's year of graduation from medical school and proxy measures of calcific lesions. On both matched and adjusted analysis there was no evidence of improved mortality nor reduced MACE in this specific retrospective cohort, although this may well be explained by significant selection bias.
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Affiliation(s)
- Alexander Tindale
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Vasileios Panoulas
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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