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Kostovich CT, Etingen B, Wirth M, Patrianakos J, Kartje R, Baharestani M, Weaver FM. Outcomes of Telehealth for Wound Care: A Scoping Review. Adv Skin Wound Care 2022; 35:394-403. [PMID: 35170501 DOI: 10.1097/01.asw.0000821916.26355.fa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To synthesize the literature on delivering wound care via telehealth and compare clinical, healthcare utilization, and cost outcomes when wound care is provided via telehealth (telewound) modalities compared with in-person care. DATA SOURCES An electronic search of PubMed, CINAHL, and Cochrane Clinical Trials databases for articles published from 1999 to 2019 was conducted using the following MeSH search terms: telewound, wound, wound care, remote care, telehealth, telemedicine, eHealth, mobile health, pressure injury, and ulcer. STUDY SELECTION Articles were included if they were a scientific report of a single study; evaluated a telehealth method; identified the type of wound of focus; and provided data on clinical, healthcare utilization, or cost outcomes of telewound care. In total, 26 articles met these criteria. DATA EXTRACTION Data were extracted and grouped into 13 categories, including study design, wound type, telehealth modality, treatment intervention, and outcomes measured, among others. DATA SYNTHESIS Of the 26 studies, 19 reported on clinical outcomes including overall healing and healing time; 17 studies reported on healthcare utilization including hospitalizations and length of stay; and 12 studies reported costs. CONCLUSIONS Evidence regarding the use of telewound care is weak, and findings related to the impact of telewound care on outcomes are inconsistent but indicate that it is not inferior to in-person care. Greater use of telehealth as a result of the COVID-19 pandemic points to further development of navigation and education models of telehealth for wound care. However, additional studies using rigorous research design and leveraging robust sample sizes are needed to demonstrate value.
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Affiliation(s)
- Carol T Kostovich
- Carol T. Kostovich, PhD, RN, CHSE, is Research Health Scientist, Edward Hines, Jr. VA Hospital, Hines, IL; and Associate Professor, Assistant Dean of Innovative Educational Strategies, Marcella Niehoff School of Nursing, Loyola University, Chicago, IL. At the Hines VA Hospital, Bella Etingen, PhD, is Research Health Scientist, Center of Innovation for Complex Chronic Healthcare; Marissa Wirth, MPH, is Research Health Science Specialist; Jamie Patrianakos, MA, is Research Health Science Specialist; and Rebecca Kartje, MD, MS, is Analyst. Mona Baharestani, PhD, APN, CWON, FACCWS, is Associate Chief, Wound Care & Research, James H. Quillen VAMC, Johnson City (Mountain Home), Johnson City, TN. Frances M. Weaver, PhD, is Research Health Scientist, Hines VA Hospital, and Professor, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL. Acknowledgment: This work was supported by the US Department of Veterans Affairs, Diffusion of Excellence Office, and Office of Research and Development, Health Services Research and Development Service, Quality Enhancement Research Initiative Program (PEC 19-310). Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views, position, or policy of the Department of Veterans Affairs or the US Government. The authors have disclosed no other financial relationships related to this article. Submitted June 8, 2021; accepted in revised form July 23, 2021; published online ahead of print February 14, 2022
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Weigelt MA, Lev-Tov HA, Tomic-Canic M, Lee WD, Williams R, Strasfeld D, Kirsner RS, Herman IM. Advanced Wound Diagnostics: Toward Transforming Wound Care into Precision Medicine. Adv Wound Care (New Rochelle) 2022; 11:330-359. [PMID: 34128387 DOI: 10.1089/wound.2020.1319] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Significance: Nonhealing wounds are an ever-growing global pandemic, with mortality rates and management costs exceeding many common cancers. Although our understanding of the molecular and cellular factors driving wound healing continues to grow, standards for diagnosing and evaluating wounds remain largely subjective and experiential, whereas therapeutic strategies fail to consistently achieve closure and clinicians are challenged to deliver individualized care protocols. There is a need to apply precision medicine practices to wound care by developing evidence-based approaches, which are predictive, prescriptive, and personalized. Recent Advances: Recent developments in "advanced" wound diagnostics, namely biomarkers (proteases, acute phase reactants, volatile emissions, and more) and imaging systems (ultrasound, autofluorescence, spectral imaging, and optical coherence tomography), have begun to revolutionize our understanding of the molecular wound landscape and usher in a modern age of therapeutic strategies. Herein, biomarkers and imaging systems with the greatest evidence to support their potential clinical utility are reviewed. Critical Issues: Although many potential biomarkers have been identified and several imaging systems have been or are being developed, more high-quality randomized controlled trials are necessary to elucidate the currently questionable role that these tools are playing in altering healing dynamics or predicting wound closure within the clinical setting. Future Directions: The literature supports the need for the development of effective point-of-care wound assessment tools, such as a platform diagnostic array that is capable of measuring multiple biomarkers at once. These, along with advances in telemedicine, synthetic biology, and "smart" wearables, will pave the way for the transformation of wound care into a precision medicine. Clinical Trial Registration number: NCT03148977.
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Affiliation(s)
- Maximillian A. Weigelt
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hadar A. Lev-Tov
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marjana Tomic-Canic
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - W. David Lee
- Precision Healing, Inc., Newton, Massachusetts, USA
| | | | | | - Robert S. Kirsner
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ira M. Herman
- Precision Healing, Inc., Newton, Massachusetts, USA
- Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
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Gamus A, Keren E, Kaufman H, Brandin G, Peles D, Chodick G. Telemedicine versus face-to-face care for treatment of patients with lower extremity ulcers. J Wound Care 2021; 30:916-921. [PMID: 34747216 DOI: 10.12968/jowc.2021.30.11.916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Lower extremity ulcers (LEUs) are associated with a decline in patients' quality of life (QoL). Better healthcare availability in remote regions, facilitated by telemedicine (TM), may improve patient wellbeing. The aim of this study was to compare the QoL of patients treated via synchronous video TM with that of patients treated with standard face-to-face (FTF) care. METHOD The study was performed in a large health services provider in Israel (Maccabi Healthcare Services). TM was used in four remote locations; the FTF method was applied in two regional clinics. The treatment protocol was performed by a nurse and supervised by the regional physician in both treatment modes. A validated Wound-QoL questionnaire in Hebrew was used to assess patient outcomes. RESULTS A total of 83 patients were treated via TM and 94 patients were treated FTF. The mean QoL for patients treated via TM was 0.546±0.249 compared with 0.507±0.238 for the FTF group. A similarity relating to outcomes in both treatment methods was demonstrated by a difference of 0.039 (95% confidence interval -0.33-0.111) and p=0.291. The probability of the difference being within the limits of the interval in a replicated study was 83.4%. The equivalence/non-inferiority was established within the accepted Δ=0.12 range. CONCLUSION The results indicated no reduced QoL for patients with LEUs treated with telemedicine versus with standard FTF care. DECLARATION OF INTEREST The authors have no conflicts of interest.
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Affiliation(s)
- Alexander Gamus
- Maccabi Health Services, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Epidemiology and Database Research Unit, Israel
| | - Elad Keren
- Maccabi Health Services, Israel.,Soroka Medical Center, Beer-Sheba, Israel
| | | | | | | | - Gabriel Chodick
- Maccabi Health Services, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Epidemiology and Database Research Unit, Israel
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Do data security measures, privacy regulations, and communication standards impact the interoperability of patient health information? A cross-country investigation. Int J Med Inform 2021; 148:104401. [PMID: 33571743 DOI: 10.1016/j.ijmedinf.2021.104401] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/19/2021] [Accepted: 01/23/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The lack of interoperability is one of the biggest obstacles to the complete digitalization of patient health information in electronic medical records (EMR). The high volume of data breaches has put pressure on care providers to adopt data protection measures to remain compliant with legal requirements. Extreme data protection measures can impede information flow, but they also instill confidence in secure information sharing. This study investigates how the adoption of security measures, privacy regulations, and communication standards has impacted patient health information interoperability at technical (TI), semantic (SI), and organizational (OI) levels within the hospitals. METHODS The study utilizes a quasi-experimental research design to probe the relationships of interest. Secondary data from a survey of randomly selected 773 hospitals conducted by the European Commission in over 30 countries in Europe is used to understand the relationships. The study counters selection bias and accounts for systematic differences in adopting treatments of interest in the hospitals using the propensity score-based approaches for the observational data. RESULTS The empirical models that account for selection bias explain more observational data variations than those that did not. Access control measures on workstations are linked to 44 % lesser odds of experiencing TI problems. However, hospitals with regional and organizational level privacy regulations have 85 % and 76 % higher odds of experiencing SI and OI problems, respectively. On the other hand, hospitals with a single hospital-wide EMR are 53 % and 43 % less likely to experience TI and SI problems, respectively, in comparison to those with multiple EMR systems. CONCLUSION The study highlights the differential impacts of data protection measures on the hospitals' three key types of interoperability problems (i.e., TI, SI, and OI). Homogenous EMR systems type and substantial investment in technology are critical to supporting health information interoperability within the hospitals. The study findings inform policy considerations for improving specific aspects of health information's interoperability while preserving patient data privacy and security.
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Chen L, Cheng L, Gao W, Chen D, Wang C, Ran X. Telemedicine in Chronic Wound Management: Systematic Review And Meta-Analysis. JMIR Mhealth Uhealth 2020; 8:e15574. [PMID: 32584259 PMCID: PMC7381084 DOI: 10.2196/15574] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/28/2019] [Accepted: 05/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Chronic wounds have been a great burden to patients and the health care system. The popularity of the internet and smart devices, such as mobile phones and tablets, has made it possible to adopt telemedicine (TM) to improve the management of chronic wounds. However, studies conducted by different researchers have reported contradictory results on the effect of TM on chronic wound management. OBJECTIVE The aim of this work was to evaluate the efficacy and safety of TM in chronic wound management. METHODS We systematically searched multiple electronic databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]) to identify eligible studies published from inception to June 12, 2019. Inclusion criteria were randomized controlled trials (RCTs) and interventional cohort studies that investigated the use of TM in chronic wound management. RCT and observational data were analyzed separately. A meta-analysis and qualitative analysis were conducted to estimate endpoints. RESULTS A total of 6 RCTs and 6 cohort studies including 3913 patients were included. Of these, 4 studies used tablets or mobile phones programmed with apps, such as Skype and specialized interactive systems, whereas the remaining 8 studies used email, telephone, and videoconferencing to facilitate the implementation of TM using a specialized system. Efficacy outcomes in RCTs showed no significant differences in wound healing (hazard ratio [HR] 1.16, 95% CI 0.96-1.39; P=.13), and wound healing around 1 year (risk ratio [RR] 1.05, 95% CI 0.89-1.23; P=.15). Noninferiority criteria of TM were met. A decreased risk of amputation in patients receiving TM was revealed (RR 0.45, 95% CI 0.29-0.71; P=.001). The result of cohort studies showed that TM was more effective than standard care (HR 1.74, 95% CI 1.43-2.12; P<.001), whereas the outcome efficacy RR of wound healing around 1 year (RR 1.21, 95% CI 0.96-1.53; P=.56) and 3 months (RR 1.24, 95% CI 0.47-3.3; P=.67) was not significantly different between TM and standard care. Noninferiority criteria of TM were met for wound healing around 1 year in cohort studies. CONCLUSIONS Currently available evidence suggests that TM seems to have similar efficacy and safety, and met noninferiority criteria with conventional standard care of chronic wounds. Large-scale, well-designed RCTs are warranted.
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Affiliation(s)
- Lihong Chen
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Lihui Cheng
- Department of Clinical Laboratory, Nuclear Industry 416 Hospital, the 2nd Affiliated Hospital of Chengdu Medical College, Chengdu, China.,School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Wei Gao
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Dawei Chen
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Chun Wang
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Xingwu Ran
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
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