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Meidani Z, Omidvar A, Akbari H, Asghari F, Khajouei R, Nazemi Z, Nabovati E, Holl F. Evaluating the Usability and Quality of a Clinical Mobile App for Assisting Physicians in Head Computed Tomography Scan Ordering: Mixed Methods Study. JMIR Hum Factors 2024; 11:e55790. [PMID: 39250788 PMCID: PMC11420597 DOI: 10.2196/55790] [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: 01/01/2024] [Revised: 05/10/2024] [Accepted: 07/07/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Among the numerous factors contributing to health care providers' engagement with mobile apps, including user characteristics (eg, dexterity, anatomy, and attitude) and mobile features (eg, screen and button size), usability and quality of apps have been introduced as the most influential factors. OBJECTIVE This study aims to investigate the usability and quality of the Head Computed Tomography Scan Appropriateness Criteria (HAC) mobile app for physicians' computed tomography scan ordering. METHODS Our study design was primarily based on methodological triangulation by using mixed methods research involving quantitative and qualitative think-aloud usability testing, quantitative analysis of the Mobile Apps Rating Scale (MARS) for quality assessment, and debriefing across 3 phases. In total, 16 medical interns participated in quality assessment and testing usability characteristics, including efficiency, effectiveness, learnability, errors, and satisfaction with the HAC app. RESULTS The efficiency and effectiveness of the HAC app were deemed satisfactory, with ratings of 97.8% and 96.9%, respectively. MARS assessment scale indicated the overall favorable quality score of the HAC app (82 out of 100). Scoring 4 MARS subscales, Information (73.37 out of 100) and Engagement (73.48 out of 100) had the lowest scores, while Aesthetics had the highest score (87.86 out of 100). Analysis of the items in each MARS subscale revealed that in the Engagement subscale, the lowest score of the HAC app was "customization" (63.6 out of 100). In the Functionality subscale, the HAC app's lowest value was "performance" (67.4 out of 100). Qualitative think-aloud usability testing of the HAC app found notable usability issues grouped into 8 main categories: lack of finger-friendly touch targets, poor search capabilities, input problems, inefficient data presentation and information control, unclear control and confirmation, lack of predictive capabilities, poor assistance and support, and unclear navigation logic. CONCLUSIONS Evaluating the quality and usability of mobile apps using a mixed methods approach provides valuable information about their functionality and disadvantages. It is highly recommended to embrace a more holistic and mixed methods strategy when evaluating mobile apps, because results from a single method imperfectly reflect trustworthy and reliable information regarding the usability and quality of apps.
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Affiliation(s)
- Zahra Meidani
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Aydine Omidvar
- Department of Neurosurgery, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Akbari
- Department of Epidemiology & Biostatistics, Kashan University of Medical Sciences, Kashan, Iran
| | - Fatemeh Asghari
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Reza Khajouei
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Nazemi
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Ehsan Nabovati
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Felix Holl
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
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Xu Z, Meng Z. Health service requirements of mHealth app users: evidence from Hangzhou, China. J Health Organ Manag 2024; 38:800-820. [PMID: 39198956 DOI: 10.1108/jhom-01-2024-0026] [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: 09/01/2024]
Abstract
PURPOSE China's healthcare system is being burdened by the increasing prevalence of chronic diseases. Therefore, this study investigated the health service requirements of mobile health applications (mHealth apps) users in Hangzhou, China. This study aimed to propose suggestions and theoretical references to improve mHealth apps and promote their development, thereby meeting public medical and health needs and creating an efficient medical service system. DESIGN/METHODOLOGY/APPROACH We constructed a model of health service demands using a literature review, network survey, and semi-structured interviews. We analyzed the demand attributes using the Kano model and Better-Worse index and obtained the priority ranking of demands. FINDINGS The results revealed 25 demand elements in four dimensions: must-be (M), one-dimensional (O), attractive (A), and indifferent (I) requirements. The findings suggest that mHealth app developers can optimize health services by categorizing and managing health services, focusing on middle-aged users, enhancing the professionalism of health service providers, and improving the feedback mechanism. ORIGINALITY/VALUE Studies on mHealth apps user demands, particularly on health service needs, remain scarce. This study employed a mixed-methods approach, integrating both qualitative and quantitative research techniques, to establish a priority ranking of user health service needs for mHealth apps. The study offers recommendations and theoretical references to optimize and improve mHealth app services. HIGHLIGHTS Construct a better health service requirements model for mHealth app users.Obtain the prioritization of demand elements in the model.Propose some management suggestions to improve mHealth apps.
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Affiliation(s)
- Zhongyang Xu
- School of Management, Hangzhou Dianzi University, Hangzhou, China
- Chinese Academy of Science and Education Evaluation, Hangzhou Dianzi University, Hangzhou, China
| | - Zhiqian Meng
- School of Business Administration, University of Science and Technology Liaoning, Anshan, China
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Khan ZA, Kidholm K, Pedersen SA, Haga SM, Drozd F, Sundrehagen T, Olavesen E, Halsteinli V. Developing a Program Costs Checklist of Digital Health Interventions: A Scoping Review and Empirical Case Study. PHARMACOECONOMICS 2024; 42:663-678. [PMID: 38530596 PMCID: PMC11126496 DOI: 10.1007/s40273-024-01366-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION The rate of development and complexity of digital health interventions (DHIs) in recent years has to some extent outpaced the methodological development in economic evaluation and costing. Particularly, the choice of cost components included in intervention or program costs of DHIs have received scant attention. The aim of this study was to build a literature-informed checklist of program cost components of DHIs. The checklist was next tested by applying it to an empirical case, Mamma Mia, a DHI developed to prevent perinatal depression. METHOD A scoping review with a structured literature search identified peer-reviewed literature from 2010 to 2022 that offers guidance on program costs of DHIs. Relevant guidance was summarized and extracted elements were organized into categories of main cost components and their associated activities following the standard three-step approach, that is, activities, resource use and unit costs. RESULTS Of the 3448 records reviewed, 12 studies met the criteria for data extraction. The main cost categories identified were development, research, maintenance, implementation and health personnel involvement (HPI). Costs are largely considered to be context-specific, may decrease as the DHI matures and vary with number of users. The five categories and their associated activities constitute the checklist. This was applied to estimate program costs per user for Mamma Mia Self-Guided and Blended, the latter including additional guidance from public health nurses during standard maternal check-ups. Excluding research, the program cost per mother was more than double for Blended compared with Self-Guided (€140.5 versus €56.6, 2022 Euros) due to increased implementation and HPI costs. Including research increased the program costs to €190.8 and €106.9, respectively. One-way sensitivity analyses showed sensitivity to changes in number of users, lifespan of the app, salaries and license fee. CONCLUSION The checklist can help increase transparency of cost calculation and improve future comparison across studies.
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Affiliation(s)
- Zareen Abbas Khan
- Center for Health Care Improvement, St. Olav Hospital, Trondheim University Hospital, 3250, Torgarden, 7006, Trondheim, Norway.
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Kristian Kidholm
- Center for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark
| | - Sindre Andre Pedersen
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Silje Marie Haga
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Filip Drozd
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Thea Sundrehagen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Ellen Olavesen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Vidar Halsteinli
- Center for Health Care Improvement, St. Olav Hospital, Trondheim University Hospital, 3250, Torgarden, 7006, Trondheim, Norway
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Gomis-Pastor M, Berdún J, Borrás-Santos A, De Dios López A, Fernández-Montells Rama B, García-Esquirol Ó, Gratacòs M, Ontiveros Rodríguez GD, Pelegrín Cruz R, Real J, Bachs i Ferrer J, Comella A. Clinical Validation of Digital Healthcare Solutions: State of the Art, Challenges and Opportunities. Healthcare (Basel) 2024; 12:1057. [PMID: 38891132 PMCID: PMC11171879 DOI: 10.3390/healthcare12111057] [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: 03/28/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Digital health technologies (DHTs) at the intersection of health, medical informatics, and business aim to enhance patient care through personalised digital approaches. Ensuring the efficacy and reliability of these innovations demands rigorous clinical validation. A PubMed literature review (January 2006 to July 2023) identified 1250 papers, highlighting growing academic interest. A focused narrative review (January 2018 to July 2023) delved into challenges, highlighting issues such as diverse regulatory landscapes, adoption issues in complex healthcare systems, and a plethora of evaluation frameworks lacking pragmatic guidance. Existing frameworks often omit crucial criteria, neglect empirical evidence, and clinical effectiveness is rarely included as a criterion for DHT quality. The paper underscores the urgency of addressing challenges in accreditation, adoption, business models, and integration to safeguard the quality, efficacy, and safety of DHTs. A pivotal illustration of collaborative efforts to address these challenges is exemplified by the Digital Health Validation Center, dedicated to generating clinical evidence of innovative healthcare technologies and facilitating seamless technology transfer. In conclusion, it is necessary to harmonise evaluation approaches and frameworks, improve regulatory clarity, and commit to collaboration to integrate rigorous clinical validation and empirical evidence throughout the DHT life cycle.
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Affiliation(s)
- Mar Gomis-Pastor
- Digital Health Validation Center, Hospital de la Santa Creu i Sant Pau, Sant Pau Campus Salut Barcelona, 08041 Barcelona, Spain; (J.B.); (A.B.-S.); (A.D.D.L.); (B.F.-M.R.); (G.D.O.R.); (R.P.C.); (J.R.); (A.C.)
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77 79, 08041 Barcelona, Spain
| | - Jesús Berdún
- Digital Health Validation Center, Hospital de la Santa Creu i Sant Pau, Sant Pau Campus Salut Barcelona, 08041 Barcelona, Spain; (J.B.); (A.B.-S.); (A.D.D.L.); (B.F.-M.R.); (G.D.O.R.); (R.P.C.); (J.R.); (A.C.)
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77 79, 08041 Barcelona, Spain
| | - Alicia Borrás-Santos
- Digital Health Validation Center, Hospital de la Santa Creu i Sant Pau, Sant Pau Campus Salut Barcelona, 08041 Barcelona, Spain; (J.B.); (A.B.-S.); (A.D.D.L.); (B.F.-M.R.); (G.D.O.R.); (R.P.C.); (J.R.); (A.C.)
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77 79, 08041 Barcelona, Spain
| | - Anna De Dios López
- Digital Health Validation Center, Hospital de la Santa Creu i Sant Pau, Sant Pau Campus Salut Barcelona, 08041 Barcelona, Spain; (J.B.); (A.B.-S.); (A.D.D.L.); (B.F.-M.R.); (G.D.O.R.); (R.P.C.); (J.R.); (A.C.)
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77 79, 08041 Barcelona, Spain
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, 08041 Barcelona, Spain
| | - Beatriz Fernández-Montells Rama
- Digital Health Validation Center, Hospital de la Santa Creu i Sant Pau, Sant Pau Campus Salut Barcelona, 08041 Barcelona, Spain; (J.B.); (A.B.-S.); (A.D.D.L.); (B.F.-M.R.); (G.D.O.R.); (R.P.C.); (J.R.); (A.C.)
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77 79, 08041 Barcelona, Spain
| | | | - Mònica Gratacòs
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari Per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08028 Barcelona, Spain;
| | - Gerardo D. Ontiveros Rodríguez
- Digital Health Validation Center, Hospital de la Santa Creu i Sant Pau, Sant Pau Campus Salut Barcelona, 08041 Barcelona, Spain; (J.B.); (A.B.-S.); (A.D.D.L.); (B.F.-M.R.); (G.D.O.R.); (R.P.C.); (J.R.); (A.C.)
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77 79, 08041 Barcelona, Spain
| | - Rebeca Pelegrín Cruz
- Digital Health Validation Center, Hospital de la Santa Creu i Sant Pau, Sant Pau Campus Salut Barcelona, 08041 Barcelona, Spain; (J.B.); (A.B.-S.); (A.D.D.L.); (B.F.-M.R.); (G.D.O.R.); (R.P.C.); (J.R.); (A.C.)
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77 79, 08041 Barcelona, Spain
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, 08041 Barcelona, Spain
| | - Jordi Real
- Digital Health Validation Center, Hospital de la Santa Creu i Sant Pau, Sant Pau Campus Salut Barcelona, 08041 Barcelona, Spain; (J.B.); (A.B.-S.); (A.D.D.L.); (B.F.-M.R.); (G.D.O.R.); (R.P.C.); (J.R.); (A.C.)
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77 79, 08041 Barcelona, Spain
| | - Jordi Bachs i Ferrer
- Departament d’Economia i Organització d’Empreses, Universitat de Barcelona (UB), 08036 Barcelona, Spain;
| | - Adrià Comella
- Digital Health Validation Center, Hospital de la Santa Creu i Sant Pau, Sant Pau Campus Salut Barcelona, 08041 Barcelona, Spain; (J.B.); (A.B.-S.); (A.D.D.L.); (B.F.-M.R.); (G.D.O.R.); (R.P.C.); (J.R.); (A.C.)
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Carrera A, Manetti S, Lettieri E. Rewiring care delivery through Digital Therapeutics (DTx): a machine learning-enhanced assessment and development (M-LEAD) framework. BMC Health Serv Res 2024; 24:237. [PMID: 38395905 PMCID: PMC10885456 DOI: 10.1186/s12913-024-10702-z] [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: 12/04/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Digital transformation has sparked profound change in the healthcare sector through the development of innovative digital technologies. Digital Therapeutics offer an innovative approach to disease management and treatment. Care delivery is increasingly patient-centered, data-driven, and based on real-time information. These technological innovations can lead to better patient outcomes and support for healthcare professionals, also considering resource scarcity. As these digital technologies continue to evolve, the healthcare field must be ready to integrate them into processes to take advantage of their benefits. This study aims to develop a framework for the development and assessment of Digital Therapeutics. METHODS The study was conducted relying on a mixed methodology. 338 studies about Digital Therapeutics resulting from a systematic literature review were analyzed using descriptive statistics through RStudio. Machine learning algorithms were applied to analyze variables and find patterns in the data. The results of these analytical analyses were summarized in a framework qualitatively tested and validated through expert opinion elicitation. RESULTS The research provides M-LEAD, a Machine Learning-Enhanced Assessment and Development framework that recommends best practices for developing and assessing Digital Therapeutics. The framework takes as input Digital Therapeutics characteristics, regulatory aspects, study purpose, and assessment domains. The framework produces as outputs recommendations to design the Digital Therapeutics study characteristics. CONCLUSIONS The framework constitutes the first step toward standardized guidelines for the development and assessment of Digital Therapeutics. The results may support manufacturers and inform decision-makers of the relevant results of the Digital Therapeutics assessment.
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Hamann P, Knitza J, Kuhn S, Knevel R. Recommendation to implementation of remote patient monitoring in rheumatology: lessons learned and barriers to take. RMD Open 2023; 9:e003363. [PMID: 38056918 DOI: 10.1136/rmdopen-2023-003363] [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: 08/04/2023] [Accepted: 11/15/2023] [Indexed: 12/08/2023] Open
Abstract
Remote patient monitoring (RPM) leverages advanced technology to monitor and manage patients' health remotely and continuously. In 2022 European Alliance of Associations for Rheumatology (EULAR) points-to-consider for remote care were published to foster adoption of RPM, providing guidelines on where to position RPM in our practices. Sample papers and studies describe the value of RPM. But for many rheumatologists, the unanswered question remains the 'how to?' implement RPM.Using the successful, though not frictionless example of the Southmead rheumatology department, we address three types of barriers for the implementation of RPM: service, clinician and patients, with subsequent learning points that could be helpful for new teams planning to implement RPM. These address, but are not limited to, data governance, selecting high quality cost-effective solutions and ensuring compliance with data protection regulations. In addition, we describe five lacunas that could further improve RPM when addressed: establishing quality standards, creating a comprehensive database of available RPM tools, integrating data with electronic patient records, addressing reimbursement uncertainties and improving digital literacy among patients and healthcare professionals.
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Affiliation(s)
- Philip Hamann
- Faculty of Health Science, University of Bristol, Bristol, UK
| | - Johannes Knitza
- Institute of Digital Medicine, University Hospital Giessen-Marburg, Philipps University, Marburg, Germany
| | - Sebastian Kuhn
- Institute of Digital Medicine, University Hospital Giessen-Marburg, Philipps University, Marburg, Germany
| | - Rachel Knevel
- Rheumatology, Leiden Universitair Medisch Centrum, Leiden, The Netherlands
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Weber SJ, Mulvaney SA, Faiola A, Brown M, Koyama T, Sun L, Goggans SL, Hull PC. Commercially Available Mobile Apps With Family Behavioral Goal Setting and Tracking for Parents: Review and Quality Evaluation. JMIR Pediatr Parent 2023; 6:e41779. [PMID: 37831486 PMCID: PMC10612003 DOI: 10.2196/41779] [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: 03/01/2023] [Revised: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Goal setting and tracking are well established behavior change techniques. Little is known about the extent to which commercially available mobile apps are designed to guide parents in using these strategies, their evidence base, and their quality. OBJECTIVE This study aims to review commercially available apps that target parents in relation to setting and tracking behavioral goals for their children. The objectives were to classify the apps' general characteristics, features, evidence base, and target behaviors and assess app quality overall and separately for apps that target health-related behaviors (HRBs) and apps without a health-related behavior (WHRB). METHODS Apps were identified using keyword searches in the Apple App Store and Google Play in the United States. Apps were included if their primary purpose was to assist with setting goals, tracking goals, tracking behaviors, or giving feedback pertaining to goals for children by parents. App characteristics and common features were documented and summarized. Two reviewers assessed app quality using the Mobile App Rating Scale (MARS). Descriptive statistics summarized the MARS total score, 4 quality subscales, and 6 app-specific items that reflect the perceived impact of the app on goal setting and tracking, overall and with subgroup analysis for HRB and WHRB apps. RESULTS Of the 21 apps identified, 16 (76%) met the review criteria. Overall, 9 apps defined and targeted the following HRBs: nutrition and mealtime (6/16, 38%), physical activity and screen time (5/16, 31%), sleep (7/16, 44%), and personal hygiene (6/16, 38%). Three apps targeted specific age groups (2 apps were for children aged 6-13 years and 1 app was for children aged ≥4 years). None of the apps provided tailored assessments or guidance for goal setting. None of the apps indicated that they were intended for the involvement of a health professional or had been tested for efficacy. The MARS total score indicated moderate app quality overall (mean 3.42, SD 0.49) and ranged from 2.5 to 4.2 out of 5 points. The Habitz app ranked highest on the MARS total score among HRB apps (score=4.2), whereas Thumsters ranked highest (score=3.9) among the WHRB apps. Subgroup analysis revealed a pattern of higher quality ratings in the HRB group than the WHRB group, including the mean MARS total score (mean 3.67, SD 0.34 vs mean 3.09, SD 0.46; P=.02); the engagement and information subscales; and the app-specific items about perceived impact on knowledge, attitudes, and behavior change. CONCLUSIONS Several high-quality commercially available apps target parents to facilitate goal setting and tracking for child behavior change related to both health and nonhealth behaviors. However, the apps lack evidence of efficacy. Future research should address this gap, particularly targeting parents of young children, and consider individually tailored guided goal setting and involvement of health professionals.
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Affiliation(s)
- Summer Joy Weber
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Shelagh A Mulvaney
- School of Nursing, Vanderbilt University, Nashville, TN, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Anthony Faiola
- Department of Health and Clinical Sciences, University of Kentucky, Lexington, KY, United States
| | - Madeline Brown
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lili Sun
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Pamela Carmen Hull
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, United States
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Listorti E, Ferrara L, Adinolfi A, Gerardi MC, Ughi N, Tozzi VD, Epis OM. Joining telehealth in rheumatology: a survey on the role played by personalized experience from patients' perspective. BMC Health Serv Res 2023; 23:682. [PMID: 37349713 DOI: 10.1186/s12913-023-09575-5] [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: 10/25/2022] [Accepted: 05/18/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND The beginning of the Covid-19 pandemic has forced many hospital departments worldwide to implement telehealth strategies for the first time. Telehealth represents the opportunity to increase value for all stakeholders, including patients and healthcare staff, but its success constitutes a challenge for all of them and particularly patients play a crucial role for their needed adherence. This study focuses on the experience of the Rheumatology Unit of Niguarda Hospital in Milan (Italy), where telehealth projects have been implemented for more than a decade with structured design and organized processes. The case study is paradigmatic because patients have experimented personalized mixes of telehealth channels, including e-mails and phone calls, Patient Reported Outcomes questionnaires, and home delivery of drugs. Given all these peculiarities, we decided to deepen patients' perspective through three main aspects related to the adoption of telehealth: (i) the benefits perceived, (ii) the willingness to enrol in future projects, (iii) the preference on the service-mix between remote contacts and in-person visits. Most importantly, we investigated differences in the three areas among all patients based on the mix of telehealth channels experienced. METHODS We conducted a survey from November 2021 to January 2022, enrolling consecutively patients attending the Rheumatology Unit of Niguarda Hospital in Milan (Italy). Our survey comprised an introductory set of questions related to personal, social, clinical and ICT skills information, followed by the central part on telehealth. All the answers were analysed with descriptive statistics and regression models. RESULTS A complete response was given by 400 patients: 283 (71%) were female, 237 (59%) were 40-64 years old, 213 (53%) of them declared to work, and the disease most represented was Rheumatoid Arthritis (144 patients, 36%). Descriptive statistics and regression results revealed that (i) non-users imagined wide-ranging benefits compared to users; (ii) other things being equal, having had a more intense experience of telehealth increased the odds of accepting to participate to future projects by 3.1 times (95% C.I. 1.04-9.25), compared to non-users; (iii) the more telehealth was experienced, the higher the willingness to substitute in-person with online contacts. CONCLUSIONS Our study contributes to enlighten the crucial role played by the telehealth experience in determining patients' preferences.
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Affiliation(s)
| | - Lucia Ferrara
- CERGAS SDA Bocconi, Bocconi University, Milan, Italy
| | - Antonella Adinolfi
- Rheumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Nicola Ughi
- Rheumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Oscar M Epis
- Rheumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Desterbecq C, Tubeuf S. Inclusion of Environmental Spillovers in Applied Economic Evaluations of Healthcare Products. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023:S1098-3015(23)00106-7. [PMID: 36967027 DOI: 10.1016/j.jval.2023.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/14/2023] [Accepted: 03/15/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Climate change and environmental factors have an impact on human health and the ecosystem. The healthcare sector is responsible for substantial environmental pollution. Most healthcare systems rely on economic evaluation to select efficient alternatives. Nevertheless, environmental spillovers of healthcare treatments are rarely considered whether it is from a cost or a health perspective. The objective of this article is to identify economic evaluations of healthcare products and guidelines that have included any environmental dimensions. METHODS Electronic searches of 3 literature databases (PubMed, Scopus, and EMBASE) and official health agencies guidelines were conducted. Documents were considered eligible if they assessed the environmental spillovers within the economic evaluation of a healthcare product or provided any recommendations on the inclusion of environmental spillovers in the health technology assessment process. RESULTS From the 3878 records identified, 62 documents were deemed eligible and 18 were published in 2021 and 2022. The environmental spillovers considered were carbon dioxide (CO2) emissions, water or energy consumption, and waste disposal. The environmental spillovers were mainly assessed using the lifecycle assessment (LCA) approach while the economic analysis was mostly limited to costs. Only 9 documents, including the guidelines of 2 health agencies presented theoretical and practical ways to include environmental spillovers into the decision-making process. CONCLUSIONS There is a clear lack of methods on whether environmental spillovers should be included in health economic evaluation and how this should be done. If healthcare systems want to reduce their environment footprint, the development of methodology which integrates environmental dimensions in health technology assessment will be key.
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Affiliation(s)
- Charlotte Desterbecq
- Institute of Health and Society (IRSS), Université Catholique de Louvain (UClouvain), Brussels, Belgium.
| | - Sandy Tubeuf
- Institute of Health and Society (IRSS), Université Catholique de Louvain (UClouvain), Brussels, Belgium; Institute of Economic and Social Research (IRES), Université Catholique de Louvain (UClouvain), Brussels, Belgium
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Malathi A, Jasim K. Validating the relationship between service quality, patient sensitivity and experience towards medical applications using SERVQUAL. Int J Med Inform 2022; 168:104883. [DOI: 10.1016/j.ijmedinf.2022.104883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
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Lantzsch H, Eckhardt H, Campione A, Busse R, Henschke C. Digital health applications and the fast-track pathway to public health coverage in Germany: challenges and opportunities based on first results. BMC Health Serv Res 2022; 22:1182. [PMID: 36131288 PMCID: PMC9490912 DOI: 10.1186/s12913-022-08500-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Evidence-based decision-making is the sine qua non for safe and effective patient care and the long-term functioning of health systems. Since 2020 Digital Health Applications (DiHA) in Germany have been undergoing a systematic pathway to be reimbursed by statutory health insurance (SHI) which is attracting attention in other European countries. We therefore investigate coverage decisions on DiHA and the underlying evidence on health care effects, which legally include both medical outcomes and patient-centred structural and procedural outcomes. METHODS Based on publicly available data of the Institute for Medicines and Medical Devices searched between 08/2021 and 02/2022, all DiHA listed in the corresponding registry and thus reimbursable by the SHI were systematically investigated and presented descriptively on the basis of predefined criteria, such as clinical condition, and costs. The clinical trials on DiHA permanently included in the registry were reviewed with regard to their study design, endpoints investigated, the survey instruments used, and whether an intention-to-treat analysis was performed. Risk of bias was assessed using the ROB II tool. RESULTS By February 2022, 30 DiHA had been included in the DiHA registry, one third of them permanently and two thirds conditionally. Most DiHA were therapeutic applications for mental illness based on cognitive behavioural therapy. For all permanently included DiHA, randomised controlled trials were conducted to demonstrate the impact on health care effects. While medical outcomes were investigated for all of these DiHA, patient-centred structural and procedural outcomes were rarely investigated. The majority of clinical trials showed a high risk of bias, mainly due to insufficient reporting quality. Overall, the prices for DiHA covered by SHI are on average around € 150 per month (min. € 40; max. € 248). CONCLUSIONS Evidence-based decision-making on coverage of DiHA leaves room for improvements both in terms of reporting-quality and the use of patient-centred structural and procedural outcomes in addition to medical outcomes. With appropriate evidence, DiHA can offer an opportunity as an adjunct to existing therapy while currently the high risk of bias of the trials raises doubts about the justification of its high costs.
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Affiliation(s)
- Hendrikje Lantzsch
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany.
| | - Helene Eckhardt
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Alessandro Campione
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
- Technische Universität Berlin, Berlin Centre of Health Economics Research, Berlin, Germany
| | - Cornelia Henschke
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
- Technische Universität Berlin, Berlin Centre of Health Economics Research, Berlin, Germany
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Torbica A, Tarricone R, Schreyögg J, Drummond M. Pushing the boundaries of evaluation, diffusion, and use of medical devices in Europe: Insights from the COMED project. HEALTH ECONOMICS 2022; 31 Suppl 1:1-9. [PMID: 36068719 DOI: 10.1002/hec.4600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
The field of medical devices has attracted considerable interest from scholarly research in health economics in recent years. Medical devices are indispensable tools for quality health care delivery, but their assessment and appropriate use pose significant challenges to healthcare systems. More research is needed to overcome existing gaps associated with evaluation of digital technologies, address challenges in the use of real-world data in generating evidence for decision-making and to uncover drivers of variation in access to medical devices across countries. Furthermore, the translation of the results and recommendations stemming from research projects into health technology assessment practices needs to be strengthened. The European Union (EU) project COMED aimed to address these gaps by improving existing research and developing new research streams on the methods for evaluation and diffusion of medical devices. The project also intended to provide directly applicable policy advice and tools to inform decision-making, with the aim of impacting public health in the EU. This Health Economics Supplement, together with references of other published outputs of the project, is intended to be the main source for researchers and policy makers seeking information on the COMED project.
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Affiliation(s)
- Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milano, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milano, Italy
| | - Jonas Schreyögg
- Hamburg Centre for Health Economics, University of Hamburg, Hamburg, Germany
| | - Mike Drummond
- Centre for Health Economics, University of York, York, UK
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Liu VDM, Kaila M, Koskela T. User initiated symptom assessment with an electronic symptom checker. Study protocol for mixed-methods validation. (Preprint). JMIR Res Protoc 2022. [PMID: 37467041 PMCID: PMC10398552 DOI: 10.2196/41423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The national Omaolo digital social welfare and health care service of Finland provides a symptom checker, Omaolo, which is a medical device (based on Duodecim Clinical Decision Support EBMEDS software) with a CE marking (risk class IIa), manufactured by the government-owned DigiFinland Oy. Users of this service can perform their triage by using the questions in the symptom checker. By completing the symptom checker, the user receives a recommendation for action and a service assessment with appropriate guidance regarding their health problems on the basis of a selected specific symptom in the symptom checker. This allows users to be provided with appropriate health care services, regardless of time and place. OBJECTIVE This study describes the protocol for the mixed methods validation process of the symptom checker available in Omaolo digital services. METHODS This is a mixed methods study using quantitative and qualitative methods, which will be part of the clinical validation process that takes place in primary health care centers in Finland. Each organization provides a space where the study and the nurse triage can be done in order to include an unscreened target population of users. The primary health care units provide walk-in model services, where no prior phone call or contact is required. For the validation of the Omaolo symptom checker, case vignettes will be incorporated to supplement the triage accuracy of rare and acute cases that cannot be tested extensively in real-life settings. Vignettes are produced from a variety of clinical sources, and they test the symptom checker in different triage levels by using 1 standardized patient case example. RESULTS This study plan underwent an ethics review by the regional permission, which was requested from each organization participating in the research, and an ethics committee statement was requested and granted from Pirkanmaa hospital district's ethics committee, which is in accordance with the University of Tampere's regulations. Of 964 clinical user-filled symptom checker assessments, 877 cases were fully completed with a triage result, and therefore, they met the requirements for clinical validation studies. The goal for sufficient data has been reached for most of the chief symptoms. Data collection was completed in September 2019, and the first feasibility and patient experience results were published by the end of 2020. Case vignettes have been identified and are to be completed before further testing the symptom checker. The analysis and reporting are estimated to be finalized in 2024. CONCLUSIONS The primary goals of this multimethod electronic symptom checker study are to assess safety and to provide crucial information regarding the accuracy and usability of the Omaolo electronic symptom checker. To our knowledge, this will be the first study to include real-life clinical cases along with case vignettes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41423.
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