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Tian X, Zhang Y, Chen S, Xia X, Xu Q, Wang Y, Wu S, Wang A. Systolic blood pressure time in target range within 24 hours and incident heart failure: insights from the real-world setting. Hypertens Res 2024:10.1038/s41440-024-01840-2. [PMID: 39138364 DOI: 10.1038/s41440-024-01840-2] [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: 03/30/2024] [Revised: 06/29/2024] [Accepted: 07/23/2024] [Indexed: 08/15/2024]
Abstract
Systolic blood pressure (SBP) time in target (TTR) over months were associated with lower risk of adverse clinical outcomes in hypertensive patients, whether short-term of 24-h SBP TTR was effective in predicting heart failure (HF) risk in the general population remained unclear. This prospective study aimed to investigate the association of 24-h SBP TTR with HF in the real-world settings. Based on Kailuan study, 24-h SBP target range defined as 110-140 mmHg was calculated with linear interpolation. Among 5152 participants included in the analysis, 186 (3.61%) cases of incident HF occurred during a median follow-up of 6.96 years. Compared with participants with SBP TTR of 0 to <25%, those with TTR of 75% to 100% had 47% lower risk of HF (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.32-0.89). The restricted spline curve depicted an inverse relationship between SBP TTR and incident HF. Additionally, the addition of SBP TTR, rather than mean SBP and SBP variation, to a conventional risk model had an incremental effect on the predictive value for HF, with integrated discrimination improvement value of 0.31% (P = 0.0003) and category-free net reclassification improvement value of 19.79% (P = 0.0081). Higher SBP TTR was associated with a lower risk of incident HF. Efforts to attain SBP within 110 to 140 mmHg may be an effective strategy to prevent HF.
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Affiliation(s)
- Xue Tian
- Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yijun Zhang
- Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Xue Xia
- Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China
| | - Qin Xu
- Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China
| | - Yi Wang
- Department of Internal Medicine, Majiagou Hospital of Kailuan, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China.
| | - Anxin Wang
- Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China.
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Mills KT, O'Connell SS, Pan M, Obst KM, He H, He J. Role of Health Care Professionals in the Success of Blood Pressure Control Interventions in Patients With Hypertension: A Meta-Analysis. Circ Cardiovasc Qual Outcomes 2024; 17:e010396. [PMID: 39027934 PMCID: PMC11338746 DOI: 10.1161/circoutcomes.123.010396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/29/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Globally, only 13.8% of patients with hypertension have their blood pressure (BP) controlled. Trials testing interventions to overcome barriers to BP control have produced mixed results. Type of health care professional delivering the intervention may play an important role in intervention success. The goal of this meta-analysis is to determine which health care professionals are most effective at delivering BP reduction interventions. METHODS We searched Medline and Embase (until December 2023) for randomized controlled trials of interventions targeting barriers to hypertension control reporting who led intervention delivery. One hundred articles worldwide with 116 comparisons and 90 474 participants with hypertension were included. Trials were grouped by health care professional, and the effects of the intervention on systolic and diastolic BP were combined using random effects models and generalized estimating equations. RESULTS Pharmacist-led interventions , community health worker-led interventions, and health educator-led interventions resulted in the greatest systolic BP reductions of -7.3 (95% CI, -9.1 to -5.6), -7.1 (95% CI, -10.8 to -3.4), and -5.2 (95% CI, -7.8 to -2.6) mm Hg, respectively. Interventions led by multiple health care professionals, nurses, and physicians also resulted in significant systolic BP reductions of -4.2 (95% CI, -6.1 to -2.4), -3.0 (95% CI, -4.2 to -1.9), and -2.4 (95% CI, -3.4 to -1.5) mm Hg, respectively. Similarly, the greatest diastolic BP reductions were -3.9 (95% CI, -5.2 to -2.5) mm Hg for pharmacist-led and -3.7 (95% CI, -6.6 to -0.8) mm Hg for community health worker-led interventions. In pairwise comparisons, pharmacist were significantly more effective than multiple health care professionals, nurses, and physicians at delivering interventions. CONCLUSIONS Pharmacists and community health workers are most effective at leading BP intervention implementation and should be prioritized in future hypertension control efforts.
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Affiliation(s)
- Katherine T Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., S.S.O., M.P., K.M.O., H.H., J.H.)
- Tulane University Translational Science Institute, New Orleans, LA (K.T.M., K.M.O., H.H., J.H.)
| | - Samantha S O'Connell
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., S.S.O., M.P., K.M.O., H.H., J.H.)
| | - Meng Pan
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., S.S.O., M.P., K.M.O., H.H., J.H.)
| | - Katherine M Obst
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., S.S.O., M.P., K.M.O., H.H., J.H.)
- Tulane University Translational Science Institute, New Orleans, LA (K.T.M., K.M.O., H.H., J.H.)
| | - Hua He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., S.S.O., M.P., K.M.O., H.H., J.H.)
- Tulane University Translational Science Institute, New Orleans, LA (K.T.M., K.M.O., H.H., J.H.)
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (K.T.M., S.S.O., M.P., K.M.O., H.H., J.H.)
- Tulane University Translational Science Institute, New Orleans, LA (K.T.M., K.M.O., H.H., J.H.)
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Paz E, Pargaonkar VS, Roach BJ, Meadows M, Roberts JM, Gazit T, Zaleski AL, Craig KJT, Serra SJ, Dunn P, Michos ED. Comprehensive Cardiovascular Risk Factor Control With a Mobile Health Cardiovascular Risk Self-Management Program. J Am Heart Assoc 2024; 13:e033328. [PMID: 38757455 PMCID: PMC11179803 DOI: 10.1161/jaha.123.033328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/04/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Mobile health technology's impact on cardiovascular risk factor control is not fully understood. This study evaluates the association between interaction with a mobile health application and change in cardiovascular risk factors. METHODS AND RESULTS Participants with hypertension with or without dyslipidemia enrolled in a workplace-deployed mobile health application-based cardiovascular risk self-management program between January 2018 and December 2022. Retrospective evaluation explored the influence of application engagement on change in blood pressure (BP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and weight. Multiple regression analyses examined the influence of guideline-based, nonpharmacological lifestyle-based digital coaching on outcomes adjusting for confounders. Of 102 475 participants, 49.1% were women. Median age was 53 (interquartile range, 43-61) years, BP was 134 (interquartile range, 124-144)/84 (interquartile range, 78-91) mm Hg, TC was 183 (interquartile range, 155-212) mg/dL, LDL-C was 106 (82-131) mg/dL, and body mass index was 30 (26-35) kg/m2. At 2 years, participants with baseline systolic BP ≥140 mm Hg reduced systolic BP by 18.6 (SEM, 0.3) mm Hg. At follow up, participants with baseline TC ≥240 mg/dL reduced TC by 65.7 (SEM, 4.6) mg/dL, participants with baseline LDL-C≥160 mg/dL reduced LDL-C by 66.6 (SEM, 6.2) mg/dL, and participants with baseline body mass index ≥30 kg/m2 lost 12.0 (SEM, 0.3) pounds, or 5.1% of body weight. Interaction with digital coaching was associated with greater reduction in all outcomes. CONCLUSIONS A mobile health application-based cardiovascular risk self-management program was associated with favorable reductions in BP, TC, LDL-C, and weight, highlighting the potential use of this technology in comprehensive cardiovascular risk factor control.
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Affiliation(s)
- Edo Paz
- Hello Heart, Inc Menlo Park CA USA
| | | | | | | | | | | | - Amanda L Zaleski
- Clinical Evidence Development, Aetna Medical Affairs, CVS Health® Hartford CT USA
| | | | - Steven J Serra
- Aetna Commercial, Clinical Business Support CVS Health Philadelphia PA USA
| | - Pat Dunn
- American Heart Association Dallas TX USA
| | - Erin D Michos
- Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD USA
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Narita K. Therapeutic intervention exploring hypertensive patients who respond to health coaching behavior modification therapy. Hypertens Res 2024; 47:1229-1230. [PMID: 38360952 DOI: 10.1038/s41440-024-01601-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/13/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Keisuke Narita
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
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Katz ME, Mszar R, Grimshaw AA, Gunderson CG, Onuma OK, Lu Y, Spatz ES. Digital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2356070. [PMID: 38353950 PMCID: PMC10867699 DOI: 10.1001/jamanetworkopen.2023.56070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/21/2023] [Indexed: 02/16/2024] Open
Abstract
Importance Hypertension remains a leading factor associated with cardiovascular disease, and demographic and socioeconomic disparities in blood pressure (BP) control persist. While advances in digital health technologies have increased individuals' access to care for hypertension, few studies have analyzed the use of digital health interventions in vulnerable populations. Objective To assess the association between digital health interventions and changes in BP and to characterize tailored strategies for populations experiencing health disparities. Data Sources In this systematic review and meta-analysis, a systematic search identified studies evaluating digital health interventions for BP management in the Cochrane Library, Ovid Embase, Google Scholar, Ovid MEDLINE, PubMed, Scopus, and Web of Science databases from inception until October 30, 2023. Study Selection Included studies were randomized clinical trials or cohort studies that investigated digital health interventions for managing hypertension in adults; presented change in systolic BP (SBP) or baseline and follow-up SBP levels; and emphasized social determinants of health and/or health disparities, including a focus on marginalized populations that have historically been underserved or digital health interventions that were culturally or linguistically tailored to a population with health disparities. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Data Extraction and Synthesis Two reviewers extracted and verified data. Mean differences in BP between treatment and control groups were analyzed using a random-effects model. Main Outcomes and Measures Primary outcomes included mean differences (95% CIs) in SBP and diastolic BP (DBP) from baseline to 6 and 12 months of follow-up between digital health intervention and control groups. Shorter- and longer-term follow-up durations were also assessed, and sensitivity analyses accounted for baseline BP levels. Results A total of 28 studies (representing 8257 participants) were included (overall mean participant age, 57.4 years [range, 46-71 years]; 4962 [60.1%], female). Most studies examined multicomponent digital health interventions incorporating remote BP monitoring (18 [64.3%]), community health workers or skilled nurses (13 [46.4%]), and/or cultural tailoring (21 [75.0%]). Sociodemographic characteristics were similar between intervention and control groups. Between the intervention and control groups, there were statistically significant mean differences in SBP at 6 months (-4.24 mm Hg; 95% CI, -7.33 to -1.14 mm Hg; P = .01) and SBP changes at 12 months (-4.30 mm Hg; 95% CI, -8.38 to -0.23 mm Hg; P = .04). Few studies (4 [14.3%]) reported BP changes and hypertension control beyond 1 year. Conclusions and Relevance In this systematic review and meta-analysis of digital health interventions for hypertension management in populations experiencing health disparities, BP reductions were greater in the intervention groups compared with the standard care groups. The findings suggest that tailored initiatives that leverage digital health may have the potential to advance equity in hypertension outcomes.
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Affiliation(s)
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Alyssa A. Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Craig G. Gunderson
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven
| | - Oyere K. Onuma
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Yuan Lu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
| | - Erica S. Spatz
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
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Wang Y, Guo F, Wang J, Li Z, Tan W, Xie M, Yang X, Duan S, Song L, Cheng S, Liu Z, Liu H, Qiao J, Wang Y, Zhou L, Zhou X, Jiang H, Yu L. Efficacy of a WeChat-Based Multimodal Digital Transformation Management Model in New-Onset Mild to Moderate Hypertension: Randomized Clinical Trial. J Med Internet Res 2023; 25:e52464. [PMID: 38048156 PMCID: PMC10728790 DOI: 10.2196/52464] [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: 09/05/2023] [Revised: 10/10/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The advantages of multimodal digitally transformed mobile health management for patients diagnosed with mild to moderate hypertension are not yet established. OBJECTIVE We aim to evaluate the therapeutic benefits of a novel WeChat-based multimodal digital transforming management model in mobile health blood pressure (BP) management. METHODS This randomized controlled clinical trial included 175 individuals with new-onset mild to moderate hypertension who were admitted to our center between September and October 2022. The patients were randomly assigned to either the multimodal intervention group (n=88) or the usual care group (n=87). The primary composite outcome was home and office BP differences after 6 months. The major secondary outcomes were 6-month quality-of-life scores, including the self-rating anxiety scale, self-rating depression scale, and Pittsburgh Sleep Quality Index. RESULTS The mean home BP decreased from 151.74 (SD 8.02)/94.22 (SD 9.32) to 126.19 (SD 8.45)/82.28 (SD 9.26) mm Hg in the multimodal intervention group and from 150.78 (SD 7.87)/91.53 (SD 9.78) to 133.48 (SD 10.86)/84.45 (SD 9.19) mm Hg in the usual care group, with a mean difference in systolic blood pressure and diastolic blood pressure of -8.25 mm Hg (95% CI -11.71 to -4.78 mm Hg; P<.001) and -4.85 mm Hg (95% CI -8.41 to -1.30 mm Hg; P=.008), respectively. The mean office BP decreased from 153.64 (SD 8.39)/93.56 (SD 8.45) to 127.81 (SD 8.04)/ 82.16 (SD 8.06) mm Hg in the multimodal intervention group and from 151.48 (SD 7.14)/(91.31 (SD 9.61) to 134.92 (SD 10.11)/85.09 (SD 8.26) mm Hg in the usual care group, with a mean difference in systolic blood pressure and diastolic blood pressure of -9.27 mm Hg (95% CI -12.62 to -5.91 mm Hg; P<.001) and -5.18 mm Hg (95% CI -8.47 to -1.89 mm Hg; P=.002), respectively. From baseline to 6 months, home BP control <140/90 mm Hg was achieved in 64 (72.7%) patients in the multimodal intervention group and 46 (52.9%) patients in the usual care group (P=.007). Meanwhile, home BP control <130/80 mm Hg was achieved in 32 (36.4%) patients in the multimodal intervention group and 16 (18.4%) patients in the usual care group (P=.008). After 6 months, there were significant differences in the quality-of-life total and graded scores, including self-rating anxiety scale scores (P=.04), self-rating depression scale scores (P=.03), and Pittsburgh Sleep Quality Index scores (P<.001), in the multimodal intervention group compared with the usual care group. CONCLUSIONS The WeChat-based multimodal intervention model improved the BP control rates and lowered the BP levels more than the usual care approach. The multimodal digital transforming management model for hypertension represents an emerging medical practice that utilizes the individual's various risk factor profiles for primary care and personalized therapy decision-making in patients with hypertension. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200063550; https://www.chictr.org.cn/showproj.html?proj=175816.
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Affiliation(s)
- Yijun Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
| | - Fuding Guo
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
| | - Jun Wang
- Department of Cardiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Zeyan Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
| | - Wuping Tan
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
| | - Mengjie Xie
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
| | - Xiaomeng Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
| | - Shoupeng Duan
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
| | - Lingpeng Song
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
| | - Siyi Cheng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
| | - Zhihao Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
| | - Hengyang Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
| | - Jiaming Qiao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
| | - Yueyi Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
| | - Liping Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
| | - Xiaoya Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
| | - Lilei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Autonomic Nervous System Modulation, Wuhan, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China
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7
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Cho LD, Rabinowitz G, Goytia C, Andreadis K, Huang HH, Benda NC, Lin JJ, Horowitz C, Kaushal R, Ancker JS, Poeran J. Development of a novel instrument to characterize telemedicine programs in primary care. BMC Health Serv Res 2023; 23:1274. [PMID: 37978511 PMCID: PMC10657014 DOI: 10.1186/s12913-023-10130-5] [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: 04/28/2023] [Accepted: 10/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Given the rapid deployment of telemedicine at the onset of the COVID - 19 pandemic, updated assessment methods are needed to study and characterize telemedicine programs. We developed a novel semi - structured survey instrument to systematically describe the characteristics and implementation processes of telemedicine programs in primary care. METHODS In the context of a larger study aiming to describe telemedicine programs in primary care, a survey was developed in 3 iterative steps: 1) literature review to obtain a list of telemedicine features, facilitators, and barriers; 2) application of three evaluation frameworks; and 3) stakeholder engagement through a 2-stage feedback process. During survey refinement, items were tested against the evaluation frameworks while ensuring it could be completed within 20-25 min. Data reduction techniques were applied to explore opportunity for condensed variables/items. RESULTS Sixty initially identified telemedicine features were reduced to 32 items / questions after stakeholder feedback. Per the life cycle framework, respondents are asked to report a month in which their telemedicine program reached a steady state, i.e., "maturation". Subsequent questions on telemedicine features are then stratified by telemedicine services offered at the pandemic onset and the reported point of maturation. Several open - ended questions allow for additional telemedicine experiences to be captured. Data reduction techniques revealed no indication for data reduction. CONCLUSION This 32-item semi-structured survey standardizes the description of primary care telemedicine programs in terms of features as well as maturation process. This tool will facilitate evaluation of and comparisons between telemedicine programs across the United States, particularly those that were deployed at the pandemic onset.
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Affiliation(s)
- Logan D Cho
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
| | - Grace Rabinowitz
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
| | - Crispin Goytia
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA
| | - Katerina Andreadis
- Department of Population Health Sciences, Weill Cornell Medical College, 402 E. 67Th Street, New York, NY, 10065, USA
| | - Hsin-Hui Huang
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA
| | - Natalie C Benda
- Department of Population Health Sciences, Weill Cornell Medical College, 402 E. 67Th Street, New York, NY, 10065, USA
| | - Jenny J Lin
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, 17 E. 102nd Street Box 1087, New York, NY, 10029, USA
| | - Carol Horowitz
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA
| | - Rainu Kaushal
- Department of Population Health Sciences, Weill Cornell Medical College, 402 E. 67Th Street, New York, NY, 10065, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave., Rm 14122, Nashville, TN, USA
| | - Jashvant Poeran
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA.
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA.
- Department of Medicine, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue Box 1077, New York, NY, 10029, USA.
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