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Sinyard RD, Cauley CE. Implementing mobile health in your surgical practice: Results of a multidisciplinary convening. Surgery 2024; 175:1608-1610. [PMID: 38458819 DOI: 10.1016/j.surg.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/08/2024] [Accepted: 01/24/2024] [Indexed: 03/10/2024]
Abstract
The perioperative journey remains complex and difficult to navigate for patients and caregivers. Poor communication and lack of care coordination lead to diminished patient satisfaction, outcomes, and system performance. Mobile health platforms have the potential to overcome some of these issues by improving care delivery through timely individualized assessments, improved patient education, and care coordination. Yet mobile health implementation in surgical practice remains limited. Based on a convening of experts using human-centered design techniques, an implementation guide for the integration of mobile health in perioperative care was created to assist with (1) identification of the use of mobile health within a specific surgical practice, (2) identification of the pathway to mobile health implementation, and (3) measurement of successful implementation including patient and surgical system impact. This article reviews those recommendations and provides references to additional literature, including the full implementation guide, to aid those seeking to implement mobile health in a surgical practice or system.
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Affiliation(s)
- Robert D Sinyard
- Ariadne Labs, Boston, MA; Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Christy E Cauley
- Ariadne Labs, Boston, MA; Department of Surgery, Massachusetts General Hospital, Boston, MA.
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2
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Doan X, Rossi A, Botes M, Selzer A. Comparing Attitudes Toward Different Consent Mediums: Semistructured Qualitative Study. JMIR Hum Factors 2024; 11:e53113. [PMID: 38687983 PMCID: PMC11094594 DOI: 10.2196/53113] [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: 10/13/2023] [Revised: 02/15/2024] [Accepted: 03/12/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND As consent for data sharing evolves with the digital age, plain-text consent is not the only format in which information can be presented. However, designing a good consent form is highly challenging. The addition of graphics, video, and other mediums to use can vary widely in effectiveness; and improper use can be detrimental to users. OBJECTIVE This study aims to explore the expectations and experiences of adults toward consent given in infographic, video, text, newsletter, and comic forms in a health data sharing scenario to better understand the appropriateness of different mediums and identify elements of each medium that most affect engagement with the content. METHODS We designed mock consent forms in infographic, video, text, newsletter, and comic versions. Semistructured interviews were conducted with adults who were interviewed about their expectations for consent and were then shown each consent medium and asked about engaging elements across mediums, preferences for consent mediums, and the value of document quality criteria. We transcribed and qualitatively co-coded to identify themes and perform analyses. RESULTS We interviewed 24 users and identified different thematic archetypes based on participant goals, such as the Trust Seeker, who considered their own understanding and trust in organizations when making decisions. The infographic was ranked first for enhancing understanding, prioritizing information, and maintaining the proper audience fit for serious consent in health data sharing scenarios. In addition, specific elements such as structure, step-by-step organization, and readability were preferred engaging elements. CONCLUSIONS We identified archetypes to better understand user needs and elements that can be targeted to enhance user engagement with consent forms; this can help inform the design of more effective consent in the future. Overall, preferences for mediums are highly contextual, and more research should be done.
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Affiliation(s)
- Xengie Doan
- SnT, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Arianna Rossi
- LIDER Lab, DIRPOLIS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Marietjie Botes
- SnT, University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Annika Selzer
- Fraunhofer Institute for Secure Information Technology, Darmstadt, Germany
- ATHENE, National Research Center for Applied Cybersecurity, Darmstadt, Germany
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Navas-Blanco JR, Kantola A, Whitton M, Johnson A, Shakibai N, Soto R, Muhammad S. Enhanced recovery after cardiac surgery: A literature review. Saudi J Anaesth 2024; 18:257-264. [PMID: 38654884 PMCID: PMC11033890 DOI: 10.4103/sja.sja_62_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 04/26/2024] Open
Abstract
Enhanced recovery after cardiac surgery (ERACS) represents a constellation of evidence-based peri-operative methods aimed to reduce the physiological and psychological stress patients experience after cardiac surgery, with the primary objective of providing an expedited recovery to pre-operative functional status. The method involves pre-operative, intra-operative, and post-operative interventions as well as direct patient engagement to be successful. Numerous publications in regard to the benefits of enhanced recovery have been presented, including decreased post-operative complications, shortened length of stay, decreased overall healthcare costs, and higher patient satisfaction. Implementing an ERACS program undeniably requires a culture change, a methodical shift in the approach of these patients that ultimately allows the team to achieve the aforementioned goals; therefore, team-building, planning, and anticipation of obstacles should be expected.
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Affiliation(s)
- Jose R. Navas-Blanco
- Department of Anesthesiology, Oakland University William Beaumont School of Medicine, Corewell Health East, Royal Oak, Michigan, USA
| | - Austin Kantola
- Department of Anesthesiology, Oakland University William Beaumont School of Medicine, Corewell Health East, Royal Oak, Michigan, USA
| | - Mark Whitton
- Department of Anesthesiology, Oakland University William Beaumont School of Medicine, Corewell Health East, Royal Oak, Michigan, USA
| | - Austin Johnson
- Department of Anesthesiology, Oakland University William Beaumont School of Medicine, Corewell Health East, Royal Oak, Michigan, USA
| | - Nasim Shakibai
- Department of Anesthesiology, Oakland University William Beaumont School of Medicine, Corewell Health East, Royal Oak, Michigan, USA
| | - Roy Soto
- Department of Anesthesiology, Oakland University William Beaumont School of Medicine, Corewell Health East, Royal Oak, Michigan, USA
| | - Sheryar Muhammad
- Department of Anesthesiology, Oakland University William Beaumont School of Medicine, Corewell Health East, Royal Oak, Michigan, USA
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Grant MC, Crisafi C, Alvarez A, Arora RC, Brindle ME, Chatterjee S, Ender J, Fletcher N, Gregory AJ, Gunaydin S, Jahangiri M, Ljungqvist O, Lobdell KW, Morton V, Reddy VS, Salenger R, Sander M, Zarbock A, Engelman DT. Perioperative Care in Cardiac Surgery: A Joint Consensus Statement by the Enhanced Recovery After Surgery (ERAS) Cardiac Society, ERAS International Society, and The Society of Thoracic Surgeons (STS). Ann Thorac Surg 2024; 117:669-689. [PMID: 38284956 DOI: 10.1016/j.athoracsur.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/27/2023] [Accepted: 12/09/2023] [Indexed: 01/30/2024]
Abstract
Enhanced Recovery After Surgery (ERAS) programs have been shown to lessen surgical insult, promote recovery, and improve postoperative clinical outcomes across a number of specialty operations. A core tenet of ERAS involves the provision of protocolized evidence-based perioperative interventions. Given both the growing enthusiasm for applying ERAS principles to cardiac surgery and the broad scope of relevant interventions, an international, multidisciplinary expert panel was assembled to derive a list of potential program elements, review the literature, and provide a statement regarding clinical practice for each topic area. This article summarizes those consensus statements and their accompanying evidence. These results provide the foundation for best practice for the management of the adult patient undergoing cardiac surgery.
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Affiliation(s)
- Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Cheryl Crisafi
- Heart and Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
| | - Adrian Alvarez
- Department of Anesthesia, Hospital Italiano, Buenos Aires, Argentina
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary E Brindle
- Departments of Surgery and Community Health Services, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - Subhasis Chatterjee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Joerg Ender
- Department of Anaesthesiology and Intensive Care Medicine, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Nick Fletcher
- Institute of Anesthesia and Critical Care, Cleveland Clinic London, London, United Kingdom; St George's University Hospital, London, United Kingdom
| | - Alexander J Gregory
- Department of Anesthesia, Perioperative and Pain Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - Serdar Gunaydin
- Department of Cardiovascular Surgery, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St George's Hospital, London, United Kingdom
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Kevin W Lobdell
- Regional Cardiovascular and Thoracic Quality, Education, and Research, Atrium Health, Charlotte, North Carolina
| | - Vicki Morton
- Clinical and Quality Outcomes, Providence Anesthesiology Associates, Charlotte, North Carolina
| | - V Seenu Reddy
- Centennial Heart & Vascular Center, Nashville, Tennessee
| | - Rawn Salenger
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael Sander
- Department of Anaesthesiology, Operative Intensive Care Medicine and Pain Therapy, Justus Liebig University of Giessen, Giessen, Germany
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Daniel T Engelman
- Heart and Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
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Almeida AM, Lima L, Martins T. Monitoring Patient-Reported Outcomes in Self-management of Postsurgical Symptoms in Oncology: A Scoping Review. Cancer Nurs 2024; Publish Ahead of Print:00002820-990000000-00147. [PMID: 37232525 DOI: 10.1097/ncc.0000000000001250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Surgery is used widely for cancer treatment, and in most types, after discharge, patients usually report multiple symptoms, which, if not controlled, can put postoperative recovery at risk. Understanding which patient-reported outcomes (PROs) should be monitored could have a significant impact on reducing the symptom burden associated with cancer and its treatment by playing a pivotal role in developing symptom self-management plans and designing tailored approaches to optimize patients' symptom self-management behaviors. OBJECTIVE To map the PROs used for patients' postsurgical symptom self-management after hospital discharge following cancer surgery. INTERVENTIONS/METHODS Our scoping review process was guided by the steps for conducting scoping reviews recommended by the Joanna Briggs Institute. RESULTS The search identified 97 potentially relevant studies, with 27 articles meeting the inclusion criteria. The most frequently assessed and monitored PROs were problems with surgical wounds, more general physical symptoms, psychological functioning outcomes, and quality of life. CONCLUSIONS Our results showed an overall uniformity among the PROs selected to be monitored in surgical cancer patients after hospital discharge. Monitoring through electronic platforms is widely used and seems useful to self-manage symptoms and optimize the recovery of cancer patients after discharge following surgery. IMPLICATIONS FOR PRACTICE This study provides knowledge about PROs that can be applied in oncologic patients after surgery to self-report their symptoms following discharge.
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Affiliation(s)
- Ana M Almeida
- Author Affiliations: Institute of Biomedical Sciences Abel Salazar of the University of Porto-ICBAS (Mrs Almeida); Imaging Sciences and Radiooncology Department, Portuguese Institute of Oncology of Porto (Mrs Almeida); Nursing School of Porto (Drs Martins and Lima); and Center for Health Technology and Services Research, (CINTESIS@RISE)(Drs Martins and Lima), Porto, Portugal
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Iqbal MP, Newman B, Ellis LA, Mears S, Harrison R. Characterising consumer engagement in virtual models of care: A systematic review and narrative synthesis. PATIENT EDUCATION AND COUNSELING 2023; 115:107922. [PMID: 37542823 DOI: 10.1016/j.pec.2023.107922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Widespread adoption of digital tools and technologies now support the delivery of virtual healthcare. Although, consumer engagement is central to care processes in virtual care models, there is paucity of evidence regarding the nature and outcomes of consumer engagement. This study aimed to determine the nature of consumer engagement used in virtual models of care, and its impact on quality and safety of care. METHODS A systematic review was undertaken with a narrative synthesis, with a search strategy applied to five electronic databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Web of Science) RESULTS: Fifty-eight studies were included in the review that utilised a variety of virtual models of care across care services. Consumer engagement, such as patients' active involvement in monitoring, capturing and reporting their health data, was a common feature of the identified virtual models. CONCLUSION Increasing use of virtual models of care requires consideration of the role of patients and their support persons in the use of technology and in wider care processes that occur at a distance from health professionals. Ensuring consumers are equipped with necessary support to effectively engage in virtual care is important to ensure equity in access to, and outcomes of, virtual care models.
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Affiliation(s)
- Maha Pervaz Iqbal
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
| | - Bronwyn Newman
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Stephen Mears
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Cooper Z, Cleary S, Stelmach W, Zheng Z. Patient engagement in perioperative settings: A mixed method systematic review. J Clin Nurs 2023; 32:5865-5885. [PMID: 37073113 PMCID: PMC10946744 DOI: 10.1111/jocn.16709] [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: 09/04/2022] [Revised: 01/31/2023] [Accepted: 03/20/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Patient engagement has emerged as a key focus in the research literature to facilitate patients' recovery. The term is commonly used by researchers, yet without working definitions. This lack of clarity is further complicated by the interchangeable use of a few terms. OBJECTIVES This systematic review aimed at identifying how patient engagement was conceptualised and operationalised in perioperative settings. METHODS MEDLINE, EMBASE, CINAHL and the Cochrane Library were searched for publications in English discussing patient engagement during the perioperative phase. Three reviewers conducted study selection and methodological assessment using Joanna Briggs Institute mixed methods review framework. Reflexive thematic analysis was used to analyse qualitative data and descriptive analysis for quantitative data. FINDINGS Twenty-nine studies were included with a total sample of 6289. Study types included qualitative (n = 14) and quantitative (n = 15) with different types of surgery. Sample sizes ranged from n = 7 to n = 1315. Only 38% (n = 11) of included studies offered an explicit definition. Four themes associated with operationalisation included provision of information, which was most studied theme, communication, decision-making and action-taking behaviours. All four themes were interconnected and co-dependent on each other. CONCLUSIONS Patient engagement in perioperative settings is a complex and multifaceted concept. The conceptual void in the literature calls for more theoretically informed and comprehensive approaches to researching surgical patient engagement. Future research should aim to better understand the factors that influence patient engagement, as well as the impact of different forms of engagement on patient outcomes through the whole surgical journey of a patient.
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Affiliation(s)
- Zahra Cooper
- School of Health and Biomedical Sciences, College of Science, Technology, Engineering and Mathematics (STEM)RMIT UniversityVictoriaBundooraAustralia
| | - Sonja Cleary
- School of Health and Biomedical Sciences, College of Science, Technology, Engineering and Mathematics (STEM)RMIT UniversityVictoriaBundooraAustralia
| | - Wanda Stelmach
- Department of SurgeryNorthern HealthVictoriaEppingAustralia
| | - Zhen Zheng
- School of Health and Biomedical Sciences, College of Science, Technology, Engineering and Mathematics (STEM)RMIT UniversityVictoriaBundooraAustralia
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McLean KA, Knight SR, Diehl TM, Varghese C, Ng N, Potter MA, Zafar SN, Bouamrane MM, Harrison EM. Readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review and clinical innovation network analysis. Lancet Digit Health 2023; 5:e295-e315. [PMID: 37100544 DOI: 10.1016/s2589-7500(23)00026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 04/28/2023]
Abstract
An increasing number of digital health interventions (DHIs) for remote postoperative monitoring have been developed and evaluated. This systematic review identifies DHIs for postoperative monitoring and evaluates their readiness for implementation into routine health care. Studies were defined according to idea, development, exploration, assessment, and long-term follow-up (IDEAL) stages of innovation. A novel clinical innovation network analysis used coauthorship and citations to examine collaboration and progression within the field. 126 DHIs were identified, with 101 (80%) being early stage innovations (IDEAL stage 1 and 2a). None of the DHIs identified had large-scale routine implementation. There is little evidence of collaboration, and there are clear omissions in the evaluation of feasibility, accessibility, and the health-care impact. Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality supporting evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.
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Affiliation(s)
- Kenneth A McLean
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Stephen R Knight
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas M Diehl
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Nathan Ng
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mark A Potter
- Colorectal Unit, Western General Hospital, Edinburgh, UK
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matt-Mouley Bouamrane
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
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Ni R, Liu M, Huang S, Yang J. Effects of eHealth Interventions on Quality of Life and Psychological Outcomes in Cardiac Surgery Patients: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e40090. [PMID: 35972792 PMCID: PMC9428777 DOI: 10.2196/40090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/12/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients undergoing heart surgery may experience a range of physiological changes, and the postoperative recovery time is long. Patients and their families often have concerns about quality of life (QoL) after discharge. eHealth interventions may improve patient participation, ensure positive and effective health management, improve the quality of at-home care and the patient's quality of life, and reduce rates of depression. OBJECTIVE The purpose of this study was to evaluate the effects of eHealth interventions on the physiology, psychology, and compliance of adult patients after cardiac surgery to provide a theoretical basis for clinical practice. METHODS We conducted systematic searches of the following 4 electronic databases: PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Mean (SD) values were used to calculate the pooled effect sizes for all consecutive data, including QoL, anxiety, and depression. Where the same results were obtained using different instruments, we chose the standardized mean difference with a 95% CI to represent the combined effect size; otherwise, the mean difference (MD) with a 95% CI was used. Odds ratios were used to calculate the combined effect size for all dichotomous data. The Cohen Q test for chi-square distribution and an inconsistency index (I2) were used to test for heterogeneity among the studies. We chose a fixed-effects model to estimate the effect size if there was no significant heterogeneity in the data (I2≤50%); otherwise, a random-effects model was used. The quality of the included studies was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2). RESULTS The search identified 3632 papers, of which 19 met the inclusion criteria. In terms of physical outcomes, the score of the control group was lower than that of the intervention group (MD 0.15, 95% CI 0.03-0.27, I2=0%, P=.02). There was no significant difference in the mental outcomes between the intervention and control groups (MD 0.10, 95% CI -0.03 to 0.24, I2=46.4%, P=.14). The control group's score was lower than that of the intervention group for the depression outcomes (MD -0.53, 95% CI -0.89 to -0.17, I2=57.1%, P=.004). Compliance outcomes improved in most intervention groups. The results of the sensitivity analysis were robust. Nearly half of the included studies (9/19, 47%) had a moderate to high risk of bias. The quality of the evidence was medium to low. CONCLUSIONS eHealth improved the physical component of quality of life and depression after cardiac surgery; however, there was no statistical difference in the mental component of quality of life. The effectiveness of eHealth on patient compliance has been debated. Further high-quality studies on digital health are required. TRIAL REGISTRATION PROSPERO CRD42022327305; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327305.
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Affiliation(s)
- Ruping Ni
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.,College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Maobai Liu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.,College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Shunmin Huang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.,College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Jing Yang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.,College of Pharmacy, Fujian Medical University, Fuzhou, China
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Dave MG, Chudyk AM, Oravec N, Kent DE, Duhamel TA, Schultz AS, Arora RC. Putting patient value first: Using a modified nominal group technique for the implementation of enhanced recovery after cardiac surgery recommendations. JTCVS OPEN 2022; 12:306-314. [PMID: 36590723 PMCID: PMC9801247 DOI: 10.1016/j.xjon.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 01/04/2023]
Abstract
Objective In 2019, the Society for Enhanced Recovery After Cardiac Surgery (ERAS-CS) published perioperative guidelines to optimize the care of patients undergoing cardiac surgery. For centers with limited capacity, a sequential approach to the implementation of the full guidelines may be more feasible. Therefore, we aimed to explore the priority of implementation of the ERAS-CS guideline recommendations from a patient and caregiver perspective. Methods Using a modified nominal group technique, individuals who previously underwent cardiac surgery and their caregivers ranked ERAS-CS recommendations within 3 time points (ie, preoperative, intraoperative, and postoperative) and across 2 to 3 voting rounds. Final round rankings (median, mean and first quartile) were used to determine relative priorities. Results Seven individuals (5 patients and 2 caregivers) participated in the study. Patient engagement tools (2, 2.29, and 1.50), surgical site infection reduction (2, 1.67, and 1.25), and postoperative systematic delirium screening (1, 2.43, and 1.00) were the top-ranked ERAS-CS recommendations in the preoperative, intraoperative, and postoperative time points, respectively. Conclusions Exploration of patient and caregiver priorities may provide important insights to guide the healthcare team with clinical pathway development and implementation. Further study is needed to understand the impact of the integration of patient and caregiver values on effective and sustainable clinical pathway implementation.
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Affiliation(s)
- Mudra G. Dave
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada,Cardiac Sciences Manitoba, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Anna M. Chudyk
- St Boniface Research Centre, Health Services & Structural Determinants of Health Research, Winnipeg, Manitoba, Canada,College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nebojša Oravec
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David E. Kent
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada,Cardiac Sciences Manitoba, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Todd A. Duhamel
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada,Institute of Cardiovascular Sciences, Alberchtsen Research Centre, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Annette S.H. Schultz
- St Boniface Research Centre, Health Services & Structural Determinants of Health Research, Winnipeg, Manitoba, Canada,College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rakesh C. Arora
- Cardiac Sciences Manitoba, St Boniface Hospital, Winnipeg, Manitoba, Canada,Institute of Cardiovascular Sciences, Alberchtsen Research Centre, St Boniface Hospital, Winnipeg, Manitoba, Canada,Section of Cardiac Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada,Address for reprints: Rakesh C. Arora, MD, PhD, IH Asper Clinical Research Institute, St Boniface Hospital, CR3015–369 Taché Ave, Winnipeg, MB, Canada R2H 2A6.
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Eriksen J, Bygholm A, Bertelsen P. The association between patient-reported outcomes (PROs) and patient participation in chronic care: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:1852-1864. [PMID: 35090802 DOI: 10.1016/j.pec.2022.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Patient-reported outcomes (PROs) are increasingly applied in chronic care due to their many functionalities and synergies with current healthcare policies. The participatory potential of PROs is especially emphasised in the Danish context. This review scrutinises the association between PRO and patient participation in chronic care. METHODS This scoping review adheres to PRISMA-ScR guidelines, and the synthesis is based on narrative and thematic analyses. RESULTS Eighty-four articles were deemed eligible. The association between PRO and patient participation regards seven themes: PRO development, response rates and patient burden, patient empowerment and self-management, display and quality of data, patient-clinician communication, shared decision-making, and organisational and attitudinal aspects. Lack of knowledge, actor attitudes, organisational setup, and technological infrastructure act as the main barriers. CONCLUSION The connection between PROs and patient participation is dialectic and unfolds in three phases-before, during, and after patient-clinician consultation. Knowledge regarding the last phase is particularly scarce. Henceforth, studies should address how to include a broader segment of patients, PROs participatory effects over time and PROs impact on patients' everyday lives. PRACTICE IMPLICATIONS The review provides knowledge concerning the association between PROs and patient participation to enhance future chronic care, research, and discussions in the area.
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Affiliation(s)
- Jeppe Eriksen
- Department of Planning, Techno-Anthropology, Aalborg University, Aalborg, Denmark.
| | - Ann Bygholm
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark.
| | - Pernille Bertelsen
- Department of Planning, Techno-Anthropology, Aalborg University, Aalborg, Denmark.
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Use of a mobile health application by adult non-congenital cardiac surgery patients: A feasibility study. PLOS DIGITAL HEALTH 2022; 1:e0000055. [PMID: 36812537 PMCID: PMC9931304 DOI: 10.1371/journal.pdig.0000055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/28/2022] [Indexed: 11/19/2022]
Abstract
Mobile Health (mHealth) technologies are becoming integral to our healthcare system. This study evaluated the feasibility (compliance, usability and user satisfaction) of a mHealth application (app) for delivering Enhanced Recovery Protocols (ERPs) information to Cardiac Surgery (CS) patients peri-operatively. This single centre, prospective cohort study involved patients undergoing CS. Patients received a mHealth app developed for the study at consent and for 6-8 weeks post-surgery. Patients completed system usability, patient satisfaction and quality of life surveys pre- and post-surgery. A total of 65 patients participated in the study (mean age of 64 years). The app achieved an overall utilization rate of 75% (68% vs 81% for <65 and ≥65 years respectively). Pre-surgery, the majority of patients found the app easy to use (94%), user-friendly (89%), and felt confident using the app (92%). The majority also found the app's educational information useful (90%) and easy to find (88%). 75% of patients reported that they would like to use the app frequently. This percentage decreased to 57% in the post-discharge survey. A lower percentage of patients ≥65 years indicated their preference for the app over printed information (51% vs 87%) and their recommendation for the app (84% vs 100% for >65 and <65 years respectively) in the post-surgery survey. MHealth technology is feasible for peri-operative CS patient education, including older adult patients. The majority of patients were satisfied with the app and would recommend using it over the use of printed materials.
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13
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Pilot implementation to assess the feasibility and care team impact of an app-based interactive care plan to remotely monitor breast cancer survivors. J Cancer Surviv 2022; 16:13-23. [PMID: 35107791 PMCID: PMC8809246 DOI: 10.1007/s11764-021-01136-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/06/2021] [Indexed: 01/22/2023]
Abstract
Purpose
To assess the feasibility of an app-based, electronic health record (EHR)-integrated, interactive care plan (ICP) for breast cancer (BC) survivors. Methods A single-arm pilot study was conducted with female BC survivors. ICP tasks included quarterly quality of life (QOL) questionnaire; monthly assessments of fatigue, insomnia, sexual dysfunction, hot flashes, and recurrence symptoms; and daily activity reminders. Embedded decision trees escalated recurrence symptoms to providers. On-demand education was available for self-management of treatment-related toxicities. The primary objective was to assess patients’ engagement with ICP tasks against feasibility thresholds of 75% completion rate. Secondary objectives were evaluation of the system’s functionality to track and escalate symptoms appropriately, and care team impact measured by volume of escalation messages generated. We report preliminary results 6 months after the last patient enrolled. Results Twenty-three patients enrolled August to November 2020. Mean age was 50.1 years. All patients engaged with at least one ICP task. The monthly average task completion rates were 62% for the QOL questionnaire, 59% for symptom assessments, and 37% for activity reminders. Task completion rate decreased over time. Eleven of 253 symptoms and QOL questionnaires (4.3%) generated messages for care escalation. Conclusion Implementation of an app-based, EHR-integrated ICP in BC survivors was feasible and created minimal provider burden; however, patient engagement was below the feasibility threshold suggesting that changes may enhance broad implementation and adoption. Implications for Cancer Survivors An ICP may facilitate remote monitoring, symptom control, and recurrence surveillance for cancer survivors as strategies to enhance patient engagement are applied. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01136-1.
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14
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McDonall J, Redley B, Livingston P, Hutchinson A, de Steiger R, Botti M. Implementation of a nurse-led multimedia intervention to increase patient participation in recovery following knee arthroplasty: Implementation study (Preprint). JMIR Hum Factors 2022; 9:e36959. [PMID: 35588363 PMCID: PMC9164095 DOI: 10.2196/36959] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/04/2022] [Accepted: 04/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Advances in digital technology and the use of multimedia platforms to deliver information provide clinicians with a unique opportunity to develop innovative ways to consistently provide high-quality, accessible, and evidence-based information to support patient participation. Introducing new technologies into everyday acute care clinical practice can be difficult. Objective The aim of this paper was to provide a description of an implementation strategy and the subsequent evaluation undertaken to examine the contextual factors important to the successful adoption of new technology by nurses in the context of acute postoperative care. Methods Implementation of the intervention and process evaluation was undertaken in 3 phases: phase 1, preimplementation stakeholder engagement and identification of barriers and enablers to implementation; phase 2, supported implementation of the intervention; and phase 3, evaluation of uptake, usability, and acceptability of the intervention in clinical practice. Results The outcomes of the implementation of the multimedia intervention in the context of acute postoperative care were positive. Of the 104 patients in the intervention group, 103 (99%) received the intervention. All 103 patients completed the 8-item intervention questionnaire and 93.3% (97/103) were interviewed on day 3 to evaluate usability, uptake, and acceptability. Of these 97 patients, almost all (n=94, 91%) found the program easy to use and most (n=64, 62%) could view the MyStay Total Knee Replacement program as often as they wanted. The findings also suggest that the time to implement the program was minimal (5-10 minutes). Collaboration with nurses and patients before and during implementation to identify potential barriers to successful implementation of the intervention was essential to develop timely strategies to overcome these barriers. To ensure end-user engagement, careful consideration was given to nurses’ views on who was responsible for facilitating this intervention. Conclusions The findings provide evidence that the structured implementation of the multimedia intervention was robust and successful in terms of patient participant recruitment and application; however, it was difficult to assess the level of engagement by nurse clinicians with the program. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614000340639; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000340639
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Affiliation(s)
- Jo McDonall
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
| | - Bernice Redley
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Deakin University, Geelong, Australia
| | - Patricia Livingston
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
| | - Ana Hutchinson
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
- Centre for Quality and Patient Safety Research-Epworth HealthCare Partnership, Geelong, Australia
| | - Richard de Steiger
- Epworth HealthCare, Epworth Victor Smorgon Chair of Surgery, Department of Surgery, Richmond, Australia
- The University of Melbourne, Melbourne, Australia
| | - Mari Botti
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
- Centre for Quality and Patient Safety Research-Epworth HealthCare Partnership, Geelong, Australia
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15
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Ben-Ali W, Lamarche Y, Carrier M, Demers P, Bouchard D, El-Hamamsy I, Cartier R, Pellerin M, Perrault LP. Use of Mobile-Based Application for Collection of Patient-Reported Outcomes in Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:536-544. [PMID: 34882492 DOI: 10.1177/15569845211045677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Application-based (app) technology has been studied for patient engagement and collecting patient-reported outcomes (PROs) in several surgical specialties with limited research in cardiac surgery. The aim of study was to determine the effectiveness of app-based technology for collecting PROs, improving the patient experience, and reducing health services utilization in a cardiac surgery center. METHODS Patients accessed an interactive app via smartphones. Patients were guided from 4 weeks preoperative to 4 weeks postoperative via reminders, tasks, PRO surveys, and evidence-based education. In the postoperative period, patients were engaged with daily health surveys to track warning signs and recovery milestones. Based on the patient's signs and symptoms, the app escalated lower risk issues to self-care education or higher risk issues to the care team (e.g., phone call to a nurse). RESULTS Sixty-six percent of patients (730 of 1,108) activated their app account. Two hundred seventy-seven patients completed an end-of-program feedback survey, with 94% of patients recommending the app and 98% of patients finding the app was helpful in recovery. Patients also reported using the app to avoid unnecessary health services utilization, with 45% of patients using the app to avoid at least 1 phone call and 28% of patients using the app to avoid at least 1 hospital visit. CONCLUSIONS App-based technology for patient engagement is an effective modality to enhance the patient experience, better understand the trajectory of recovery, and reduce unnecessary health services utilization in cardiac surgery.
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Affiliation(s)
- Walid Ben-Ali
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Yoan Lamarche
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Michel Carrier
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Philippe Demers
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Denis Bouchard
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Ismail El-Hamamsy
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Raymond Cartier
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Michel Pellerin
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Louis P Perrault
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
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16
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Chudyk AM, Ragheb S, Kent D, Duhamel TA, Hyra C, Dave MG, Arora RC, Schultz AS. Patient Engagement in the Design of a Mobile Health App That Supports Enhanced Recovery Protocols for Cardiac Surgery: Development Study. JMIR Perioper Med 2021; 4:e26597. [PMID: 34851299 PMCID: PMC8672287 DOI: 10.2196/26597] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/04/2021] [Accepted: 10/25/2021] [Indexed: 02/01/2023] Open
Abstract
Background Despite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. Objective The aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. Methods Engagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. Results The advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. Conclusions Patient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users.
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Affiliation(s)
- Anna M Chudyk
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sandra Ragheb
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - David Kent
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
| | - Todd A Duhamel
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada.,Institute of Cardiovascular Sciences, St Boniface Hospital, Winnipeg, MB, Canada
| | - Carole Hyra
- Healthy Heart Patient and Caregiver Researcher Group, Institute of Cardiovascular Sciences, St Boniface Hospital, Winnipeg, MB, Canada
| | - Mudra G Dave
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
| | - Rakesh C Arora
- Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Annette Sh Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Health Services & Structural Determinants of Health Research, St Boniface Research Centre, Winnipeg, MB, Canada
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17
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Zeng Y, Guo Y, Li L, Hong YA, Li Y, Zhu M, Zeng C, Zhang H, Cai W, Liu C, Wu S, Chi P, Monroe-Wise A, Hao Y, Ho RTH. Relationship Between Patient Engagement and Depressive Symptoms Among People Living With HIV in a Mobile Health Intervention: Secondary Analysis of a Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e20847. [PMID: 33118956 PMCID: PMC7661233 DOI: 10.2196/20847] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/30/2020] [Accepted: 09/22/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Associations between higher levels of patient engagement and better health outcomes have been found in face-to-face interventions; studies on such associations with mobile health (mHealth) interventions have been limited and the results are inconclusive. OBJECTIVE The objective of this study is to investigate the relationship between patient engagement in an mHealth intervention and depressive symptoms using repeated measures of both patient engagement and patient outcomes at 4 time points. METHODS Data were drawn from a randomized controlled trial (RCT) of an mHealth intervention aimed at reducing depressive symptoms among people living with HIV and elevated depressive symptoms. We examined the association between patient engagement and depressive symptoms in the intervention group (n=150) where participants received an adapted cognitive-behavioral stress management (CBSM) course and physical activity promotion on their WeChat social media app. Depressive symptoms were repeatedly measured using the Patient Health Questionnaire (PHQ-9) at baseline and 1 month, 2 months, and 3 months. Patient engagement was correspondingly measured by the completion rate, frequency of items completed, and time spent on the program at 1 month, 2 months, and 3 months. Latent growth curve models (LGCMs) were used to explore the relationship between patient engagement and depressive symptoms at multiple time points in the intervention. RESULTS The mean PHQ-9 scores were 10.2 (SD 4.5), 7.7 (SD 4.8), 6.5 (SD 4.7), and 6.7 (SD 4.1) at baseline, 1 month, 2 months, and 3 months, respectively. The mean completion rates were 50.6% (SD 31.8%), 51.5% (SD 32.2%), and 50.8% (SD 33.7%) at 1, 2, and 3 months, respectively; the average frequencies of items completed were 18.0 (SD 14.6), 32.6 (SD 24.8), and 47.5 (SD 37.2) at 1, 2, and 3 months, respectively, and the mean times spent on the program were 32.7 (SD 66.7), 65.4 (SD 120.8), and 96.4 (SD 180.4) minutes at 1, 2, and 3 months, respectively. LGCMs showed good model fit and indicated that a higher completion rate (β at 3 months=-2.184, P=.048) and a greater frequency of items completed (β at 3 months=-0.018, P=.04) were associated with fewer depressive symptoms at 3 months. Although not significant, similar trends were found in the abovementioned relationships at 1 and 2 months. There was no significant relationship between time spent on the program and depressive symptoms. CONCLUSIONS This study revealed a positive association between patient engagement and health outcomes at 3 months of an mHealth intervention using LGCMs and repeated measures data. The results underscore the importance of improving patient engagement in mHealth interventions to improve patient-centered health outcomes. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://tinyurl.com/yxb64mef. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12889-018-5693-1.
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Affiliation(s)
- Yu Zeng
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan Guo
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Center for Global Health, Guangzhou, China
| | - Linghua Li
- Department of Infectious Diseases, Guangzhou Number Eight People's Hospital, Guangzhou, China
| | - Y Alicia Hong
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Yiran Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Mengting Zhu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chengbo Zeng
- South Carolina SmartState Center of Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Hanxi Zhang
- National Center of AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Weiping Cai
- Department of Infectious Diseases, Guangzhou Number Eight People's Hospital, Guangzhou, China
| | - Cong Liu
- Department of Infectious Diseases, Guangzhou Number Eight People's Hospital, Guangzhou, China
| | - Shaomin Wu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Peilian Chi
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, China
| | - Aliza Monroe-Wise
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Center for Global Health, Guangzhou, China
| | - Rainbow Tin Hung Ho
- Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong, China.,Centre on Behavioral Health, The University of Hong Kong, Hong Kong, China
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18
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Digital Orthopaedics: A Glimpse Into the Future in the Midst of a Pandemic. J Arthroplasty 2020; 35:S68-S73. [PMID: 32416956 PMCID: PMC7175889 DOI: 10.1016/j.arth.2020.04.048] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The response to COVID-19 catalyzed the adoption and integration of digital health tools into the health care delivery model for musculoskeletal patients. The change, suspension, or relaxation of Medicare and federal guidelines enabled the rapid implementation of these technologies. The expansion of payment models for virtual care facilitated its rapid adoption. The authors aim to provide several examples of digital health solutions utilized to manage orthopedic patients during the pandemic and discuss what features of these technologies are likely to continue to provide value to patients and clinicians following its resolution. CONCLUSION The widespread adoption of new technologies enabling providers to care for patients remotely has the potential to permanently change the expectations of all stakeholders about the way care is provided in orthopedics. The new era of Digital Orthopaedics will see a gradual and nondisruptive integration of technologies that support the patient's journey through the successful management of their musculoskeletal disease.
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Pickens R, Cochran A, Tezber K, Berry R, Bhattacharya E, Koo D, King L, Iannitti DA, Martinie JB, Baker EH, Ocuin LM, Hunt J, Vrochides D. Using a Mobile Application for Real-Time Collection of Patient-Reported Outcomes in Hepatopancreatobiliary Surgery within an ERAS® Pathway. Am Surg 2020. [DOI: 10.1177/000313481908500847] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Patient-reported outcomes (PROs) are essential for patient-centered health care. This pilot study implemented a mobile application customized to an hepatopancreatobiliary Enhanced Recovery After Surgery (ERAS®) program—a novel environment—for real-time collection of PROs, including ERAS® pathway compliance. Patients undergoing hepatectomy, distal pancreatectomy, or pancreaticoduodenectomy through the ERAS® program were prospectively enrolled over 10 months. The application provided education and questionnaires before surgery through 30 days postdischarge. Thresholds were set for initial adoption of the application (75%), PRO response rate (50%), and patient satisfaction (75%). Daily postdischarge health checks integrated customized responses to guide out-of-hospital care. Of 165 enrolled patients, 122 met inclusion criteria. Application adoption was 93 per cent (114/122) and in-hospital engagement remained high at 88 per cent (107/122). Patients completed 62 per cent of PRO on quality of life, postoperative pain, nausea, opioid consumption, and compliance to ERAS® pathway items, including ambulation and breathing exercises. During postcharge tracking, 12 patients reported that the application prevented a phone call to the hospital and three patients reported prevention of an emergency room visit. PRO collection through this mobile device created an integrated platform for comprehensive perioperative care, patient-initiated outcome tracking with automatic reporting, and real-time feedback for process change. Improving proactive outpatient management of complex patients through mobile technology could help restructure health-care delivery and improve resource utilization for all patients.
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Affiliation(s)
- Ryan Pickens
- Division ofHPB Surgery, Department of Surgery, Atrium Health, Charlotte, North Carolina
| | - Allyson Cochran
- Department of Surgery, Atrium Health, Carolinas Center for Surgical Outcomes Science, Charlotte, North Carolina
| | - Kendra Tezber
- Division ofHPB Surgery, Department of Surgery, Atrium Health, Charlotte, North Carolina
| | - Renna Berry
- Information and Analytics Services, Atrium Health, Charlotte, North Carolina; and
| | | | | | - Lacey King
- Division ofHPB Surgery, Department of Surgery, Atrium Health, Charlotte, North Carolina
| | - David A. Iannitti
- Division ofHPB Surgery, Department of Surgery, Atrium Health, Charlotte, North Carolina
| | - John B. Martinie
- Division ofHPB Surgery, Department of Surgery, Atrium Health, Charlotte, North Carolina
| | - Erin H. Baker
- Division ofHPB Surgery, Department of Surgery, Atrium Health, Charlotte, North Carolina
| | - Lee M. Ocuin
- Division ofHPB Surgery, Department of Surgery, Atrium Health, Charlotte, North Carolina
| | - Jarrett Hunt
- Information and Analytics Services, Atrium Health, Charlotte, North Carolina; and
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20
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Metal-on-Metal Total Hip Revisions: Pearls and Pitfalls. J Arthroplasty 2020; 35:S68-S72. [PMID: 32081501 DOI: 10.1016/j.arth.2020.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND At the turn of the 21st century, there was a re-emergence of metal-on-metal (MoM) articulation with 35% of all total hip arthroplasty implants having MoM articulation. Approximately 10 years after its peak use, MoM articulation began to decrease dramatically as revisions became more apparent because of adverse reaction to metal debris. Today, there are surveillance guidelines and reconstructive clinical pearls a surgeon should recognize. METHODS This article gives a literature-based overview of clinical pearls and discusses how to avoid pitfalls when performing revision of a metal-on-metal total hip arthroplasty. RESULTS Patients with MoM can be risk-stratified based on symptom, implant, and testing variables. Those patients who are symptomatic and/or develop adverse reaction to metal debris with local tissue destruction will require a revision. The revision of MoM can be challenging due to bone and soft tissue destruction. Constraint may be needed in cases of abductor deficiency. CONCLUSION Although MoM implants for THA have declined significantly, surgeons are still faced with the revision burden from a decade of high use. Risk stratification tools are available to aid in revision decision making, and the surgeon should be prepared to address the challenges these revisions present.
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21
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Holmes MM, Stanescu S, Bishop FL. The Use of Measurement Systems to Support Patient Self-Management of Long-Term Conditions: An Overview of Opportunities and Challenges. Patient Relat Outcome Meas 2019; 10:385-394. [PMID: 31908555 PMCID: PMC6924578 DOI: 10.2147/prom.s178488] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/27/2019] [Indexed: 12/30/2022] Open
Abstract
Long-term conditions are a major public health concern that present many challenges for patients living with them. There is increasing policy focus on promoting patient self-management and supporting patients to take ownership of managing their conditions. Because long term conditions often fluctuate over time, ongoing monitoring of disease activity is necessary for self-management; this can be achieved through using Patient Reported Outcome Measures (PROMs). PROMs can provide additional information about patients' symptoms, functioning, and emotional wellbeing, informing clinical care for patients. Measurement systems are an innovative method to gather and report PROMs throughout a patient's course of care, to support clinical practice and improve overall quality of care. Measurement systems are often delivered via a digital platform, which can convey patient-reported information to healthcare professionals and provide tailored self-management advice to patients, all based on information collected via PROMs. There are a number of potential benefits of this approach to self-management. Measurement systems can improve clinical practice, creating efficient clinical encounters and positively influencing patient-clinician interactions. The use of monitoring throughout a patient's care is also thought to empower patients, by improving their knowledge of their condition, increasing their engagement with their health, and influencing their overall management of their condition. Challenges associated with using measurement systems in this way include finding appropriate PROMs, provisioning of suitable technology, and limiting the burden for patients. To increase the implementation of measurement systems into practice it is important to consider how to engage and educate healthcare professionals and patients to empower their use. Overall, adopting measurement systems into clinical practice may improve clinicians' ability to support patient self-management of long-term conditions.
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Affiliation(s)
- Michelle M Holmes
- AECC University College, Bournemouth, Dorset, UK
- Department of Psychology, University of Southampton, Southampton, Hampshire, UK
| | - Sabina Stanescu
- Department of Psychology, University of Southampton, Southampton, Hampshire, UK
| | - Felicity L Bishop
- Department of Psychology, University of Southampton, Southampton, Hampshire, UK
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22
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McDonall J, Hutchinson AF, Redley B, Livingston PM, Botti M. Usability and feasibility of multimedia interventions for engaging patients in their care in the context of acute recovery: A narrative review. Health Expect 2019; 22:1187-1198. [PMID: 31778023 PMCID: PMC6882257 DOI: 10.1111/hex.12957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 08/02/2019] [Accepted: 08/11/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of this narrative review was to examine the usability and feasibility of multimedia intervention as a platform to enable patient participation in the context of acute recovery and to discover what outcomes have been measured. DATA SOURCES A narrative review of primary research articles identified through a search of four electronic databases (MEDLINE, CINAHL, EMBASE and PsycInfo) identified peer-reviewed research evidence published in English language with no limitation placed on time period or publication type. Two authors independently assessed articles for inclusion. From the 277 articles identified through the search, 10 papers reporting the outcomes of seven studies were included in this review. REVIEW METHODS Articles were independently assessed for quality and relevance by two authors. The most appropriate method for data synthesis for this review was a narrative synthesis. RESULTS From the narrative synthesis of study outcomes, two findings emerged as follows: (a) multimedia interventions are feasible and usable in the context of acute care, and (b) multimedia interventions can improve patients' perception of care-related knowledge. Identified gaps included a lack of evidence in relation to the effect of interventions on enhancing patients' ability to participate in their care and the impact on patients' health-related outcomes. CONCLUSIONS In conclusion, there is some evidence of the feasibility and usability of multimedia interventions in acute care. That is, patients can use these types of platforms in this context and are satisfied with doing so. Multimedia platforms have a role in the delivery of information for patients during acute recovery; however, the effectiveness of these platforms to engage and enhance patients' capability to participate in their recovery and the impact on outcomes needs to be rigorously evaluated.
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Affiliation(s)
- Jo McDonall
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety ResearchDeakin UniversityGeelongVicAustralia
| | - Anastasia F. Hutchinson
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety ResearchDeakin UniversityGeelongVicAustralia
| | - Bernice Redley
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety ResearchDeakin UniversityGeelongVicAustralia
| | - Patricia M. Livingston
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety ResearchDeakin UniversityGeelongVicAustralia
| | - Mari Botti
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety ResearchDeakin UniversityGeelongVicAustralia
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Engelman DT, Ben Ali W, Williams JB, Perrault LP, Reddy VS, Arora RC, Roselli EE, Khoynezhad A, Gerdisch M, Levy JH, Lobdell K, Fletcher N, Kirsch M, Nelson G, Engelman RM, Gregory AJ, Boyle EM. Guidelines for Perioperative Care in Cardiac Surgery. JAMA Surg 2019; 154:755-766. [DOI: 10.1001/jamasurg.2019.1153] [Citation(s) in RCA: 347] [Impact Index Per Article: 69.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Daniel T. Engelman
- Heart and Vascular Program, Baystate Medical Center, Springfield, Massachusetts
| | | | | | | | - V. Seenu Reddy
- Centennial Heart & Vascular Center, Nashville, Tennessee
| | - Rakesh C. Arora
- St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
- Now with Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | | | - Ali Khoynezhad
- MemorialCare Heart and Vascular Institute, Los Angeles, California
| | - Marc Gerdisch
- Franciscan Health Heart Center, Indianapolis, Indiana
| | | | - Kevin Lobdell
- Atrium Health, Department of Cardiovascular and Thoracic Surgery, North Carolina
| | - Nick Fletcher
- St Georges University of London, London, United Kingdom
| | - Matthias Kirsch
- Centre Hospitalier Universitaire Vaudois Cardiac Surgery Centre, Lausanne, Switzerland
| | | | | | | | - Edward M. Boyle
- Department of Cardiac Surgery, St Charles Medical Center, Bend, Oregon
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Goodridge D, McDonald M, New L, Scharf M, Harrison E, Rotter T, Watson E, Henry C, Penz ED. Building patient capacity to participate in care during hospitalisation: a scoping review. BMJ Open 2019; 9:e026551. [PMID: 31272973 PMCID: PMC6615828 DOI: 10.1136/bmjopen-2018-026551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 06/07/2019] [Accepted: 06/13/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To map the existing literature and describe interventions aimed at building the capacity of patients to participate in care during hospitalisation by: (1) describing and categorising the aspects of care targeted by these interventions and (2) identifying the behaviour change techniques (BCTs) used in these interventions. A patient representative participated in all aspects of this project. DESIGN Scoping review. DATA SOURCES MEDLINE, Embase and CINAHL (Inception -2017). STUDY SELECTION Studies reporting primary research studies on building the capacity of hospitalised adult patients to participate in care which described or included one or more structured or systematic interventions and described the outcomes for at least the key stakeholder group were included. DATA EXTRACTION Title and abstract screening and full text screening were conducted by pairs of trained reviewers. One reviewer extracted data, which were verified by a second reviewer. Interventions were classified according to seven aspects of care relevant to hospital settings. BCTs identified in the articles were assigned through consensus of three reviewers. RESULTS Database searches yielded a total 9899 articles, resulting in 87 articles that met the inclusion criteria. Interventions directed at building patient capacity to participate in care while hospitalised were categorised as those related to improving: patient safety (20.9%); care coordination (5.7%); effective treatment (5.7%) and/or patient-centred care using: bedside nursing handovers (5.7%); communication (29.1%); care planning (14%) or the care environment (19.8%). The majority of studies reported one or more positive outcomes from the defined intervention. Adding new elements (objects) to the environment and restructuring the social and/or physical environment were the most frequently identified BCTs. CONCLUSIONS The majority of studies to build capacity for participation in care report one or more positive outcomes, although a more comprehensive analysis is warranted.
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Affiliation(s)
- Donna Goodridge
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Meghan McDonald
- School of Nursing, Saskatchewan Polytechnic, Saskatoon, Saskatchewan, Canada
| | - Lucia New
- School of Nursing, Saskatchewan Polytechnic, Saskatoon, Saskatchewan, Canada
| | - Murray Scharf
- College of Education, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Elizabeth Harrison
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Thomas Rotter
- Healthcare Quality Programs, Queen’s University, Kingston, Ontario, Canada
| | - Erin Watson
- Leslie and Irene Dube Health Sciences Library, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Chrysanthus Henry
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Erika D Penz
- Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Kelly KJ, Doucet S, Luke A. Exploring the roles, functions, and background of patient navigators and case managers: A scoping review. Int J Nurs Stud 2019; 98:27-47. [PMID: 31271977 DOI: 10.1016/j.ijnurstu.2019.05.016] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patient navigators and case managers are health care workers who aim to provide individualized assistance to patients facing significant health concerns. Although these roles emerged from distinct historical need, the terms are often used interchangeably in the literature and are described to have overlapping functions. Differences in the way that these roles are conceptualized across countries has led to a lack of clarity regarding the exact functions that each offer to patients, caregivers, and the health care system. OBJECTIVES To differentiate the functions and backgrounds of patient navigators and case managers across settings and disease contexts. DESIGN This review was guided based on the PRISMA extension for scoping reviews using a five-step review process: identify the research questions; search and identify relevant studies; select studies based on a priori criterion; chart the data; and collate, summarize and report the results. DATA SOURCES A search of the literature was undertaken in peer-reviewed databases (Medline, CINAHL, and PubMed) and the grey literature (Google and unpublished articles in online repositories). REVIEW METHODS Extracted data included information on patient navigators and/or case managers related to their reported background, training, and/or knowledge; roles and/or specific functions; clinical setting; and targeted condition or disease type. RESULTS The search strategy resulted in 10,523 articles. After applying the eligibility criteria during title and abstract evaluation, 468 full-text articles were reviewed, resulting in a total of 160 articles. Functions of patient navigators and case managers were organized into nine emerging categories: (1) advocacy; (2) care coordination; (3) case monitoring and patient needs assessment; (4) community engagement; (5) education; (6) administration and research activities; (7) psychosocial support; (8) navigation of services; and (9) reduction of barriers. The background and knowledge areas of each role were compared and contrasted, and three categories related to the practice context of each role were identified: (1) typical setting and care trajectory; (2) target patient population; and (3) mode of service delivery. CONCLUSIONS The current study identified important differences in the functions between patient navigators and case managers. However, there remains significant ambiguity between the functions of these two roles. Standardized definitions detailing scope of practice, and allowing for inherent flexibility across different settings, are needed to improve service delivery.
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Affiliation(s)
- K J Kelly
- University of New Brunswick Saint John, 100 Tucker Park Road, P.O. Box 5050, E2L 4L5, Saint John, New Brunswick, Canada.
| | - S Doucet
- University of New Brunswick Saint John, 100 Tucker Park Road, P.O. Box 5050, E2L 4L5, Saint John, New Brunswick, Canada.
| | - A Luke
- University of New Brunswick Saint John, 100 Tucker Park Road, P.O. Box 5050, E2L 4L5, Saint John, New Brunswick, Canada.
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26
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A mobile device application (app) to improve adherence to an enhanced recovery program for colorectal surgery: a randomized controlled trial. Surg Endosc 2019; 34:742-751. [DOI: 10.1007/s00464-019-06823-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 05/03/2019] [Indexed: 12/24/2022]
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Haskins IN, Olson MA, Stewart TG, Rosen MJ, Poulose BK. Development and Validation of the Ventral Hernia Repair Outcomes Reporting App for Clinician and Patient Engagement (ORACLE). J Am Coll Surg 2019; 229:259-266. [PMID: 31054912 DOI: 10.1016/j.jamcollsurg.2019.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/16/2019] [Accepted: 03/16/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patient engagement is an increasingly important component of surgical decision making. Given the many factors associated with successful ventral hernia repair (VHR), we developed and validated the Outcomes Reporting App for Clinical and Patient Engagement (ORACLE) tool to help facilitate preoperative surgeon-patient discussions about VHR. METHODS All patients undergoing elective, VHR with 30-day follow-up data available within the Americas Hernia Society Quality Collaborative were eligible for study inclusion. Using bootstrapping and bias-corrected calibration, predictive models were generated and validated for 5 quality measures after VHR, including postoperative wound events, estimated length of hospital stay, unplanned 30-day readmission to the hospital, and risk of hernia recurrence at 1 year postoperatively. RESULTS A total of 10,690 patients met inclusion criteria. Based on comparison of the theoretical best to the observed calibration curves, the models for each of the 5 outcomes of interest have strong predictive strength as reflected in the Brier score for surgical site infection, surgical site occurrence requiring procedural intervention, and 30-day hospital readmission, the c-index for 1-year hernia recurrence and the R2 value for the model for predicted hospital length of stay. CONCLUSIONS Using a national data set for development, ORACLE can be used to facilitate patient engagement, with the goal of tailoring interventions for VHR given each patient's unique factors. With ongoing data input into the Americas Hernia Society Quality Collaborative and a continuous re-evaluation of these risk models, it is our intention that this tool will serve as an up-to-date resource for hernia surgeons and ventral hernia patients.
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Affiliation(s)
- Ivy N Haskins
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Molly A Olson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Thomas G Stewart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Michael J Rosen
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Benjamin K Poulose
- Center for Abdominal Core Health, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
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McDonall J, de Steiger R, Reynolds J, Redley B, Livingston PM, Hutchinson AF, Botti M. Patient activation intervention to facilitate participation in recovery after total knee replacement (MIME): a cluster randomised cross-over trial. BMJ Qual Saf 2019; 28:782-792. [PMID: 30975730 PMCID: PMC6860682 DOI: 10.1136/bmjqs-2018-008975] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 11/28/2022]
Abstract
Background Patient participation in care is a fundamental element of safe and high-quality healthcare with the potential to enhance health outcomes and improve patient satisfaction. Objectives To test the efficacy of a clinician-facilitated, bedside multimedia (MyStay) intervention designed to support patient participation in their recovery after total knee replacement surgery. The primary outcome was patients’ reported worst pain intensity on postoperative day 3. Secondary outcomes were patient activation, length of hospital stay, knee function and satisfaction with care. Methods Unmasked, cluster randomised, four-period cross-over trial with a simultaneous process evaluation within in a large private, not-for-profit, metropolitan teaching hospital. Statistical analyses used linear mixed models with random effects for wards, cohorts within wards and patients within cohorts and fixed effects for treatment and period. Results 241 patients were recruited between March 2014 and June 2015. Patients were admitted to intervention (104) or control (137) clusters. Intervention group patients reported significantly lower mean pain intensity scores on postoperative day 3 (6.1 vs 7.1, 95% CI −1.94 to −0.08, p=0.04). The percentages of patients who reported severe pain (score ≥7) were 43.7% and 64.2% in the intervention and control groups, respectively (χ2 9.89, p=0.002; generalised linear mixed model Wald test, p=0.05). Intervention group patients on average stayed in hospital one less day (5.3 vs 6.3, 95% CI 0.05 to 1.94, p=0.04), reported higher activation (45.1% vs 27.1% at level 4 activation) (p=0.04) and higher overall satisfaction with care (9.3 vs 8.6, 95% CI 1.09 to 0.219, p=0.01), and were more likely to refer family or friends to the health service (9.3 vs 8.7, 95% CI 1.07 to 0.13, p=0.02). Conclusion The clinician-facilitated, MyStay bedside multimedia intervention enhanced patients’ activation and participation in their care after surgery; pain intensity and length of stay in hospital were reduced and patients were more satisfied with their care. Trial registration ACTRN12614000340639 (http://www.anzctr.org.au/default.aspx).
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Affiliation(s)
- Jo McDonall
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Safety Research, Deakin University, Geelong, Victoria, Australia
| | - Richard de Steiger
- Department of Surgery, Epworth Healthcare, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Reynolds
- Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Bernice Redley
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Safety Research, Deakin University, Geelong, Victoria, Australia
| | - Patricia M Livingston
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Anastasia F Hutchinson
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Safety Research, Epworth Partnership, Deakin University, Geelong, Victoria, Australia
| | - Mari Botti
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Safety Research, Epworth Partnership, Deakin University, Geelong, Victoria, Australia
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Graffigna G, Barello S. Patient Health Engagement (PHE) model in enhanced recovery after surgery (ERAS): monitoring patients' engagement and psychological resilience in minimally invasive thoracic surgery. J Thorac Dis 2018; 10:S517-S528. [PMID: 29629198 DOI: 10.21037/jtd.2017.12.84] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In the last decade, the humanization of medicine has contributed to an important shift in medical paradigms (from a doctor-centered to a patient-centered approach to care). This paradigm shift promoted a greater acknowledgement of patient engagement as a crucial asset for healthcare due to its benefits on both clinical outcomes and healthcare sustainability. Particularly, patient engagement should be considered a vital parameter for the healthcare system as well as it is a marker of the patients' ability to be resilient to the illness experience and thus to be an effective manager of his/her own health after the diagnosis. For this reason, measuring and promoting patient engagement both in chronic and acute care is today a priority for healthcare systems all over the world. In this contribution, the authors propose the Patient Health Engagement (PHE) model and the PHE scale as scientific and reliable tools to orient clinical actions and organizational strategies based on the patient engagement score. Particularly, this work discusses the implication of the adoption of these scientific tools in the enhanced recovery after surgery (ERAS) experience and their potentialities for healthcare professionals working in thoracic surgery settings.
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Affiliation(s)
- Guendalina Graffigna
- Department of Psychology, EngageMinds Hub Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Serena Barello
- Department of Psychology, EngageMinds Hub Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
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Asagbra OE, Burke D, Liang H. Why hospitals adopt patient engagement functionalities at different speeds? A moderated trend analysis. Int J Med Inform 2017; 111:123-130. [PMID: 29425623 DOI: 10.1016/j.ijmedinf.2017.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/19/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate acute care hospitals' adoption speed of patient engagement health information technology (HIT) functionalities from 2008 to 2013 and how this speed is contingent on environmental factors and hospital characteristics. METHODS Data on non-government acute care hospitals located in the United States was obtained from merging three databases: the American Hospital Association's (AHA) annual survey information technology supplement, AHA annual survey, and the Area Health Resource File (AHRF). The variables obtained from these datasets were the amount of annually adopted patient engagement HIT functionalities and environmental and organizational characteristics. Environmental factors included were uncertainty, munificence, and complexity. Hospital characteristics included size, system membership, ownership, and teaching status. RESULTS A regression analysis of 4176 hospital-year observations revealed a positive trend in the adoption of HIT functionalities for patient engagement (β= 1.109, p < 0.05). Moreover, the study showed that large, system-affiliated, not-for-profit, teaching hospitals adopt patient engagement HIT functionalities at a faster speed than their counterparts. Environmental munificence and uncertainty were also associated with an accelerating speed of adoption. Environmental complexity however did not show a significant impact on the speed of adoption. DISCUSSION From 2008 to 2013, there was a significant acceleration in the speed of adopting patient engagement HIT functionalities. Further efforts should be made to ensure proper adoption and consistent use by patients in order to reap the benefits of these IT investments. CONCLUSION Hospitals adopted at least one HIT functionality for patient engagement per year. The adoption speed varied across hospitals, depending on both environmental and organizational factors.
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Affiliation(s)
- O Elijah Asagbra
- Department of Health Services and Information Management, College of Allied Health Sciences, East Carolina University,4340P Health Sciences Building, Greenville, NC, USA
| | - Darrell Burke
- Department of Health Services Administration, School of Health Professions, SHP Building 590G, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Huigang Liang
- Department of Management Information Systems, College of Business, East Carolina University, 303 Slay Hall, Greenville, NC, USA.
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Stoicea N, You T, Eiterman A, Hartwell C, Davila V, Marjoribanks S, Florescu C, Bergese SD, Rogers B. Perspectives of Post-Acute Transition of Care for Cardiac Surgery Patients. Front Cardiovasc Med 2017; 4:70. [PMID: 29230400 PMCID: PMC5712014 DOI: 10.3389/fcvm.2017.00070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/25/2017] [Indexed: 12/20/2022] Open
Abstract
Post-acute care (PAC) facilities improve patient recovery, as measured by activities of daily living, rehabilitation, hospital readmission, and survival rates. Seamless transitions between discharge and PAC settings continue to be challenges that hamper patient outcomes, specifically problems with effective communication and coordination between hospitals and PAC facilities at patient discharge, patient adherence and access to cardiac rehabilitation (CR) services, caregiver burden, and the financial impact of care. The objective of this review is to examine existing models of cardiac transitional care, identify major challenges and social factors that affect PAC, and analyze the impact of current transitional care efforts and strategies implemented to improve health outcomes in this patient population. We intend to discuss successful methods to address the following aspects: hospital-PAC linkages, improved discharge planning, caregiver burden, and CR access and utilization through patient-centered programs. Regular home visits by healthcare providers result in decreased hospital readmission rates for patients utilizing home healthcare while improved hospital-PAC linkages reduced hospital readmissions by 25%. We conclude that widespread adoption of improvements in transitional care will play a key role in patient recovery and decrease hospital readmission, morbidity, and mortality.
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Affiliation(s)
- Nicoleta Stoicea
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Tian You
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Andrew Eiterman
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Clifton Hartwell
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Victor Davila
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Stephen Marjoribanks
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - Sergio Daniel Bergese
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States.,Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Barbara Rogers
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Validating Performance of a Hospital Discharge Planning Decision Tool in Community Hospitals. Prof Case Manag 2017; 22:204-213. [PMID: 28777233 DOI: 10.1097/ncm.0000000000000233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF STUDY The Early Screen for Discharge Planning (ESDP) is a decision support tool developed in an urban academic medical center. High ESDP scores identify patients with nonroutine discharge plans who would benefit from early discharge planning intervention. We aimed to determine the predictive performance of the ESDP in a different practice setting. PRIMARY PRACTICE SETTING Rural regional community hospital. METHODOLOGY AND SAMPLE We designed a comparative, descriptive survey study and enrolled a convenience sample of 222 patients (identified at admission) who provided informed consent. Sample characteristics and ESDP scores were collected during enrollment. The Problems After Discharge Questionnaire, EuroQoL-5Dimensions quality-of-life measure, length of stay, and use of post-acute care services were recorded after discharge. We compared outcomes between patients with low and high ESDP scores. RESULTS More than half of the sample (51.8%) had a high ESDP score. Patients with high ESDP scores reported more problems after discharge (p = .02), reported lower quality of life (p < .001), had longer length of stays (p = .04), and used post-acute care services (p = .006) more than patients with low ESDP scores. The difference in the average percentage of unmet needs was not statistically significant (p = .12), but patients with high ESDP scores reported more unmet needs than patients with low ESDP scores. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE The value of systematically proactive approaches to discharge planning is increasingly recognized, but establishing the performance capacity of support tools is critical for optimizing benefit. These study findings support use of the ESDP in regional community hospitals, making it a useful, open-source decision support tool for various health care delivery systems.
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Renzi C, Fioretti C, Oliveri S, Mazzocco K, Zerini D, Alessandro O, Rojas DP, Jereczek-Fossa BA, Pravettoni G. A Qualitative Investigation on Patient Empowerment in Prostate Cancer. Front Psychol 2017; 8:1215. [PMID: 28798701 PMCID: PMC5526923 DOI: 10.3389/fpsyg.2017.01215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 07/03/2017] [Indexed: 12/04/2022] Open
Abstract
Purpose: Men with prostate cancer often describe low levels of empowerment. eHealth interventions may represent useful tools to deliver care and education and to meet patients' needs within an empowerment framework. In order to design a platform for cancer patients' empowerment within the H2020 iManageCancer project, the perspective of the target population for the platform was assessed. The present study aims to assess the qualitative experience of prostate cancer patients during treatment in order to provide insights for clinical practice with a particular focus on the design of a web platform to promote cancer patients' empowerment. Methods: Ten patients undergoing radiation therapy treatment took part in a semi-structured interview to explore different aspects of patient empowerment. Four main thematic areas were addressed: patient-healthcare providers' communication, decision-making, needs, and resources. A qualitative approach using thematic analysis was followed. Results: Half of the patients reported little to no possibility to share information and questions with healthcare providers. With regards to decision-making, the role of healthcare providers was perceived as directive/informative, but half of the patients perceived to assume an active role in at least one interaction. Difficulties and needs included the choice of the specialist or of the structure after diagnosis, clinicians' support in self-management, surgical consequences, and side effects, preparation for radiation therapy. Resources included family and social support both from a practical and from an emotional perspective, coping style, and work schedule management. Conclusions: These results suggest that relations with healthcare providers should be supported, especially immediately after diagnosis and after surgery. Support to self-management after surgery and at the beginning of radiation therapy treatment also constitutes a priority. The adoption of a personalized approach from the beginning of prostate cancer care flow may promote patient empowerment, overcoming the aforementioned needs and mobilizing resources. The social network represents an important resource that could be integrated in interventions. These considerations will be taken into account in the design of a cancer self-management platform aiming to increase patients' empowerment.
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Affiliation(s)
- Chiara Renzi
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy
| | - Chiara Fioretti
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy
| | - Serena Oliveri
- Interdisciplinary Research and Intervention on Decision, Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy.,Interdisciplinary Research and Intervention on Decision, Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Dario Zerini
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy
| | - Ombretta Alessandro
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy.,Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Damaris P Rojas
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy.,Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Barbara A Jereczek-Fossa
- Division of Radiation Oncology, European Institute of OncologyMilan, Italy.,Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of OncologyMilan, Italy.,Interdisciplinary Research and Intervention on Decision, Department of Oncology and Hemato-Oncology, University of MilanMilan, Italy
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Roberts S, Marshall A, Chaboyer W. Hospital staffs' perceptions of an electronic program to engage patients in nutrition care at the bedside: a qualitative study. BMC Med Inform Decis Mak 2017; 17:105. [PMID: 28693472 PMCID: PMC5504779 DOI: 10.1186/s12911-017-0495-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/28/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Advancements in technology are enabling patients to participate in their health care through self-monitoring and self-management of diet, exercise and chronic disease. Technologies allowing patients to participate in hospital care are still emerging but show promise. Our team is developing a program by which hospitalised patients can participate in their nutrition care. This study explores hospital staffs' perceptions of using this technology to engage patients in their care. METHODS This qualitative study involved semi-structured interviews with hospital staff providing routine nutrition care to patients (i.e. dietitians, nutrition assistants, nurses, doctors and foodservice staff) from five wards at a tertiary metropolitan teaching hospital in Australia. The hospital currently uses an electronic foodservice system (EFS) for patient meal ordering, accessed through personal screens at the bedside. Participants were shown the EFS program on an iPad and asked about their perceptions of the program, with questions from a semi-structured interview guide. Staff were interviewed individually or in small focus groups. Interviews lasted 15-30 min and were audio recorded and later transcribed. Data were analysed using thematic analysis. RESULTS Nineteen staff participated in interviews. Overall, they expressed positive views of the EFS program and wanted it to be implemented in practice. Their responses formed three themes, each with a number of subthemes: 1) Enacting patient participation in practice; 2) Optimising nutrition care; and 3) Considerations for implementing an EFS program in practice. Staff thought the program would improve various aspects of nutrition care and enable patient participation in care. Whilst they raised some concerns, they focused on overcoming barriers and facilitating implementation if the program were to be adopted into practice. CONCLUSIONS Staff found an EFS program designed to engage patients in their nutrition care acceptable, as they saw benefits to using it for both patients and staff. Staff recognised characteristics of the program itself, as well as allocation of roles and responsibilities in operationalising it, were pivotal for successful implementation in practice. Their perspectives will inform program and intervention design, and implementation and evaluation strategies.
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Affiliation(s)
- Shelley Roberts
- National Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD 4222 Australia
| | - Andrea Marshall
- Gold Coast Hospital and Health Service and School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Gold Coast, QLD 4222 Australia
| | - Wendy Chaboyer
- National Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD 4222 Australia
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Roberts S, Chaboyer W, Gonzalez R, Marshall A. Using technology to engage hospitalised patients in their care: a realist review. BMC Health Serv Res 2017; 17:388. [PMID: 28587640 PMCID: PMC5461760 DOI: 10.1186/s12913-017-2314-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 05/17/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Patient participation in health care is associated with improved outcomes for patients and hospitals. New technologies are creating vast potential for patients to participate in care at the bedside. Several studies have explored patient use, satisfaction and perceptions of health information technology (HIT) interventions in hospital. Understanding what works for whom, under what conditions, is important when considering interventions successfully engaging patients in care. This realist review aimed to determine key features of interventions using bedside technology to engage hospital patients in their care and analyse these in terms of context, mechanisms and outcomes. METHODS A realist review was chosen to explain how and why complex HIT interventions work or fail within certain contexts. The review was guided by Pawson's realist review methodology, involving: clarifying review scope; searching for evidence; data extraction and evidence appraisal; synthesising evidence and drawing conclusions. Author experience and an initial literature scope provided insight and review questions and theories (propositions) around why interventions worked were developed and iteratively refined. A purposive search was conducted to find evidence to support, refute or identify further propositions, which formed an explanatory model. Each study was 'mined' for evidence to further develop the propositions and model. RESULTS Interactive learning was the overarching theme of studies using technology to engage patients in their care. Several propositions underpinned this, which were labelled: information sharing; self-assessment and feedback; tailored education; user-centred design; and support in use of HIT. As studies were mostly feasibility or usability studies, they reported patient-centred outcomes including patient acceptability, satisfaction and actual use of HIT interventions. For each proposition, outcomes were proposed to come about by mechanisms including improved communication, shared decision-making, empowerment and self-efficacy; which acted as facilitators to patient participation in care. Overall, there was a stronger representation of health than IT disciplines in studies reviewed, with a lack of IT input in terms of theoretical underpinning, methodological design and reporting of outcomes. CONCLUSION HIT interventions have great potential for engaging hospitalised patients in their care. However, stronger interdisciplinary collaboration between health and IT researchers is needed for effective design and evaluation of HIT interventions.
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Affiliation(s)
- Shelley Roberts
- NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD 4222 Australia
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD 4222 Australia
| | - Ruben Gonzalez
- School of Information and Communication Technology, Griffith University, Gold Coast Campus, Gold Coast, QLD 4222 Australia
| | - Andrea Marshall
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD 4222 Australia
- Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Southport, QLD 4215 Australia
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Singh K, Drouin K, Newmark LP, Filkins M, Silvers E, Bain PA, Zulman DM, Lee JH, Rozenblum R, Pabo E, Landman A, Klinger EV, Bates DW. Patient-Facing Mobile Apps to Treat High-Need, High-Cost Populations: A Scoping Review. JMIR Mhealth Uhealth 2016; 4:e136. [PMID: 27993761 PMCID: PMC5206484 DOI: 10.2196/mhealth.6445] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/01/2016] [Accepted: 11/23/2016] [Indexed: 01/01/2023] Open
Abstract
Background Self-management is essential to caring for high-need, high-cost (HNHC) populations. Advances in mobile phone technology coupled with increased availability and adoption of health-focused mobile apps have made self-management more achievable, but the extent and quality of the literature supporting their use is not well defined. Objective The purpose of this review was to assess the breadth, quality, bias, and types of outcomes measured in the literature supporting the use of apps targeting HNHC populations. Methods Data sources included articles in PubMed and MEDLINE (National Center for Biotechnology Information), EMBASE (Elsevier), the Cochrane Central Register of Controlled Trials (EBSCO), Web of Science (Thomson Reuters), and the NTIS (National Technical Information Service) Bibliographic Database (EBSCO) published since 2008. We selected studies involving use of patient-facing iOS or Android mobile health apps. Extraction was performed by 1 reviewer; 40 randomly selected articles were evaluated by 2 reviewers to assess agreement. Results Our final analysis included 175 studies. The populations most commonly targeted by apps included patients with obesity, physical handicaps, diabetes, older age, and dementia. Only 30.3% (53/175) of the apps studied in the reviewed literature were identifiable and available to the public through app stores. Many of the studies were cross-sectional analyses (42.9%, 75/175), small (median number of participants=31, interquartile range 11.0-207.2, maximum 11,690), or performed by an app’s developers (61.1%, 107/175). Of the 175 studies, only 36 (20.6%, 36/175) studies evaluated a clinical outcome. Conclusions Most apps described in the literature could not be located on the iOS or Android app stores, and existing research does not robustly evaluate the potential of mobile apps. Whereas apps may be useful in patients with chronic conditions, data do not support this yet. Although we had 2-3 reviewers to screen and assess abstract eligibility, only 1 reviewer abstracted the data. This is one limitation of our study. With respect to the 40 articles (22.9%, 40/175) that were assigned to 2 reviewers (of which 3 articles were excluded), inter-rater agreement was significant on the majority of items (17 of 30) but fair-to-moderate on others.
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Affiliation(s)
- Karandeep Singh
- Departments of Learning Health Sciences and Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Kaitlin Drouin
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Lisa P Newmark
- Information Systems, Partners HealthCare System, Wellesley, MA, United States
| | - Malina Filkins
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Elizabeth Silvers
- Information Systems, Partners HealthCare System, Wellesley, MA, United States
| | - Paul A Bain
- Harvard Medical School, Boston, MA, United States
| | - Donna M Zulman
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, United States.,Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, United States
| | - Jae-Ho Lee
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ronen Rozenblum
- Harvard Medical School, Boston, MA, United States.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Erika Pabo
- Harvard Medical School, Boston, MA, United States.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Adam Landman
- Harvard Medical School, Boston, MA, United States.,Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Elissa V Klinger
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - David W Bates
- Harvard Medical School, Boston, MA, United States.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States.,Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA, United States
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Cowan RA, Suidan RS, Andikyan V, Rezk YA, Einstein MH, Chang K, Carter J, Zivanovic O, Jewell EJ, Abu-Rustum NR, Basch E, Chi DS. Electronic patient-reported outcomes from home in patients recovering from major gynecologic cancer surgery: A prospective study measuring symptoms and health-related quality of life. Gynecol Oncol 2016; 143:362-366. [PMID: 27637366 PMCID: PMC5535805 DOI: 10.1016/j.ygyno.2016.08.335] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/23/2016] [Accepted: 08/29/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE We previously reported on the feasibility of a Web-based system to capture patient-reported outcomes (PROs) in the immediate postoperative period. The purpose of this study was to update the experience of these patients and assess patient and provider satisfaction and feedback regarding the system. METHODS This is a prospective cohort study of patients scheduled to undergo laparotomy for presumed gynecologic malignancy. Patients completed a Web-based Symptom Tracking and Reporting (STAR) questionnaire preoperatively and weekly during a 6-week postoperative period. Email alerts were sent to study nurses when concerning patient responses were entered. The patient and the nurse assessments of STAR's usefulness were measured via an exit survey. RESULTS The study enrolled 96 eligible patients. Of these, 71 patients (74%) completed at least four of seven total sessions. Of the patients who completed the exit satisfaction survey, 98% found STAR easy to use; 84% found it useful; and 82% would recommend it to other patients. Despite positive feedback from patients, clinical personnel found that the STAR system increased their current workload without enhancing patient care. CONCLUSIONS Application of an electronic program for PROs in those recovering from major gynecologic cancer surgery is feasible, and acceptable to most patients. While most clinicians did not find STAR clinically helpful, the majority of patients reported a positive experience with the system and would recommend its use. The program helped many patients feel more empowered in their postoperative recovery.
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Affiliation(s)
- Renee A Cowan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rudy S Suidan
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vaagn Andikyan
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Youssef A Rezk
- University of Washington School of Medicine, Seattle, WA, USA
| | - M Heather Einstein
- University of Connecticut School of Medicine, Hartford Hospital, Hartford, CT, USA
| | - Kaity Chang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeanne Carter
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Ethan Basch
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Dennis S Chi
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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van der Meij E, Anema JR, Otten RHJ, Huirne JAF, Schaafsma FG. The Effect of Perioperative E-Health Interventions on the Postoperative Course: A Systematic Review of Randomised and Non-Randomised Controlled Trials. PLoS One 2016; 11:e0158612. [PMID: 27383239 PMCID: PMC4934874 DOI: 10.1371/journal.pone.0158612] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/17/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND E-health interventions have become increasingly popular, including in perioperative care. The objective of this study was to evaluate the effect of perioperative e-health interventions on the postoperative course. METHODS We conducted a systematic review and searched for relevant articles in the PUBMED, EMBASE, CINAHL and COCHRANE databases. Controlled trials written in English, with participants of 18 years and older who underwent any type of surgery and which evaluated any type of e-health intervention by reporting patient-related outcome measures focusing on the period after surgery, were included. Data of all included studies were extracted and study quality was assessed by using the Downs and Black scoring system. FINDINGS A total of 33 articles were included, reporting on 27 unique studies. Most studies were judged as having a medium risk of bias (n = 13), 11 as a low risk of bias, and three as high risk of bias studies. Most studies included patients undergoing cardiac (n = 9) or orthopedic surgery (n = 7). All studies focused on replacing (n = 11) or complementing (n = 15) perioperative usual care with some form of care via ICT; one study evaluated both type of interventions. Interventions consisted of an educational or supportive website, telemonitoring, telerehabilitation or teleconsultation. All studies measured patient-related outcomes focusing on the physical, the mental or the general component of recovery. 11 studies (40.7%) reported outcome measures related to the effectiveness of the intervention in terms of health care usage and costs. 25 studies (92.6%) reported at least an equal (n = 8) or positive (n = 17) effect of the e-health intervention compared to usual care. In two studies (7.4%) a positive effect on any outcome was found in favour of the control group. CONCLUSION Based on this systematic review we conclude that in the majority of the studies e-health leads to similar or improved clinical patient-related outcomes compared to only face to face perioperative care for patients who have undergone various forms of surgery. However, due to the low or moderate quality of many studies, the results should be interpreted with caution.
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Affiliation(s)
- Eva van der Meij
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Johannes R. Anema
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Judith A. F. Huirne
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederieke G. Schaafsma
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Mobasheri MH, Johnston M, Syed UM, King D, Darzi A. The uses of smartphones and tablet devices in surgery: A systematic review of the literature. Surgery 2015; 158:1352-71. [DOI: 10.1016/j.surg.2015.03.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/02/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
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Patel V, Hale TM, Palakodeti S, Kvedar JC, Jethwani K. Prescription Tablets in the Digital Age: A Cross-Sectional Study Exploring Patient and Physician Attitudes Toward the Use of Tablets for Clinic-Based Personalized Health Care Information Exchange. JMIR Res Protoc 2015; 4:e116. [PMID: 26481906 PMCID: PMC4704891 DOI: 10.2196/resprot.3806] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 03/22/2015] [Accepted: 04/27/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND To reduce the cost of health care while increasing efficiency and quality, health systems are seeking innovative means to engage and empower patients. Improved use of information technology and electronic health record (EHR) infrastructure is essential, and required for "meaningful use" as mandated by the federal government. Providing personalized health information using tablets at the point of care could enhance the clinical experience and enable efficient collection of patient reported outcome measures to guide clinical decision making. OBJECTIVE The aim of this study is to explore patient and provider attitudes and interest in a proposed clinic-based tablet system for personal health information exchange. To provide a context to understand patients' use of tablets during their clinic visit, we also examine patients' current activities and time spent in the waiting room, and their use of health information resources. METHODS Surveys were administered to 84 patients in the waiting room of a community health center affiliated with Massachusetts General Hospital (MGH) in Boston, MA. This survey included a vignette and illustration describing a proposed tablet-based system in which the patient, upon sign in at the clinic, receives a tablet loaded with personalized information tailored to their specific medical conditions and preferences. Patients were queried about their interest in such a system in comparison to traditional forms of patient education as well as their current health information seeking behaviors and activities and time spent in the waiting room. Interviews with five MGH-affiliated health care providers were conducted to assess their opinions regarding the proposed tablet system. RESULTS The majority (>60%) of patients were "very" or "extremely" interested in the proposed tablet system and thought it would improve their knowledge about their medical condition (60%), assist them in making healthy choices (57%), and help them to feel more comfortable talking with their provider (55%). Patients thought the system would be more motivating, informative, and engaging than traditional printed health education materials. The tablet system was not considered more effective than face-to-face interaction with providers, though 44% thought it would improve their relationship with their physician. Overall, 91% of respondents were willing to learn how to use a tablet and 75% reported being "very" or "extremely" confident they could use one. Four of the five providers believed that the proposed tablet system would improve clinical workflow and patient education. Patients and providers were concerned about privacy and security of data collected using the tablets. CONCLUSIONS Both patients and providers were highly amenable to integrating tablets into the clinical experience, and tablets may be useful in improving patients' health knowledge, the collection of patient reported outcome measures, and improved patient-provider communication. Further research into operationalizing such systems and their validation is necessary before integration into standard clinical practice.
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Affiliation(s)
- Vishal Patel
- Kaiser Permanente, San Francisco, CA, United States
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Waller A, Forshaw K, Carey M, Robinson S, Kerridge R, Proietto A, Sanson-Fisher R. Optimizing Patient Preparation and Surgical Experience Using eHealth Technology. JMIR Med Inform 2015; 3:e29. [PMID: 26330206 PMCID: PMC4705017 DOI: 10.2196/medinform.4286] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 05/07/2015] [Accepted: 07/13/2015] [Indexed: 11/13/2022] Open
Abstract
With population growth and aging, it is expected that the demand for surgical services will increase. However, increased complexity of procedures, time pressures on staff, and the demand for a patient-centered approach continue to challenge a system characterized by finite health care resources. Suboptimal care is reported in each phase of surgical care, from the time of consent to discharge and long-term follow-up. Novel strategies are thus needed to address these challenges to produce effective and sustainable improvements in surgical care across the care pathway. The eHealth programs represent a potential strategy for improving the quality of care delivered across various phases of care, thereby improving patient outcomes. This discussion paper describes (1) the key functions of eHealth programs including information gathering, transfer, and exchange; (2) examples of eHealth programs in overcoming challenges to optimal surgical care across the care pathway; and (3) the potential challenges and future directions for implementing eHealth programs in this setting. The eHealth programs are a promising alternative for collecting patient-reported outcome data, providing access to credible health information and strategies to enable patients to take an active role in their own health care, and promote efficient communication between patients and health care providers. However, additional rigorous intervention studies examining the needs of potential role of eHealth programs in augmenting patients' preparation and recovery from surgery, and subsequent impact on patient outcomes and processes of care are needed to advance the field. Furthermore, evidence for the benefits of eHealth programs in supporting carers and strategies to maximize engagement from end users are needed.
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Affiliation(s)
- Amy Waller
- University of Newcastle & Hunter Medical Research Institute, Health Behaviour Research Group, Callaghan, Australia.
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Identifying hospitalized pediatric patients for early discharge planning: a feasibility study. J Pediatr Nurs 2015; 30:454-62. [PMID: 25617180 DOI: 10.1016/j.pedn.2014.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 12/17/2014] [Accepted: 12/19/2014] [Indexed: 11/20/2022]
Abstract
A screening tool utilized by nurses at a critical point in the discharge planning process has the potential to improve caregiver decisions and enhance communication. The Early Screen for Discharge Planning-Child version (ESDP-C) identifies pediatric patients early in their hospital stay who will benefit from early engagement of a discharge planner. This study used a quasi-experimental, non-equivalent comparison group design to evaluate the impact of the ESDP-C on important outcomes related to discharge planning. Findings from the study provide preliminary evidence that the integration of the ESDP-C into the pediatric discharge planning process may be clinically useful.
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Decision support tool use in colorectal surgery: what is the role? J Surg Res 2015; 194:69-76. [DOI: 10.1016/j.jss.2014.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/16/2014] [Accepted: 09/05/2014] [Indexed: 10/24/2022]
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Bornkessel A, Furberg R, Lefebvre RC. Social media: opportunities for quality improvement and lessons for providers-a networked model for patient-centered care through digital engagement. Curr Cardiol Rep 2015; 16:504. [PMID: 24947833 DOI: 10.1007/s11886-014-0504-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Social media brings a new dimension to health care for patients, providers, and their support networks. Increasing evidence demonstrates that patients who are more actively involved in their healthcare experience have better health outcomes and incur lower costs. In the field of cardiology, social media are proposed as innovative tools for the education and update of clinicians, physicians, nurses, and medical students. This article reviews the use of social media by healthcare providers and patients and proposes a model of "networked care" that integrates the use of digital social networks and platforms by both patients and providers and offers recommendations for providers to optimize their use and understanding of social media for quality improvement.
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Affiliation(s)
- Alexandra Bornkessel
- Center for Communication Science, RTI International, 6110 Executive Boulevard, Suite 902, Rockville, MD, 20852, USA,
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Tzeng A, Tzeng TH, Vasdev S, Grindy A, Saleh JK, Saleh KJ. The Role of Patient Activation in Achieving Better Outcomes and Cost-Effectiveness in Patient Care. JBJS Rev 2015; 3:01874474-201501000-00004. [PMID: 27501025 DOI: 10.2106/jbjs.rvw.n.00048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alice Tzeng
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA 02139
| | - Tony H Tzeng
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794
| | - Sonia Vasdev
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794
| | - Anna Grindy
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794
| | - Jamal K Saleh
- Department of Orthopaedic Surgery, University of California, 500 Parnassus Avenue, MU 320W, San Francisco, San Francisco, CA 94143-0728
| | - Khaled J Saleh
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794
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Petersen C, DeMuro P. Legal and regulatory considerations associated with use of patient-generated health data from social media and mobile health (mHealth) devices. Appl Clin Inform 2015; 6:16-26. [PMID: 25848410 DOI: 10.4338/aci-2014-09-r-0082] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 12/14/2014] [Indexed: 11/23/2022] Open
Abstract
Patient-generated health data are coming into broader use across the health care spectrum and hold great promise as a means to improve care and health outcomes. At the same time, rapid evolution in the social media and mobile health (mHealth) market has promoted an environment in which creation and transmission of personal health information is easy, quick, and appealing to patients. However, adoption of social media and mHealth by providers is hampered by legal and regulatory concerns with regard to data ownership and data use. This article defines common forms of patient-generated health data (PGHD) and describes how PGHD is used in clinical settings. It explores issues related to protection of personal health information, including that of children and adolescents, data security, and other potential barriers such as physician licensure. It also discusses regulatory and legal considerations providers and patients should consider before using social media and mobile health apps.
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Affiliation(s)
| | - P DeMuro
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University , Portland, Oregon, USA ; Schwabe, Williamson & Wyatt , Seattle, Washington, USA
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Cook DJ, Moradkhani A, Douglas KSV, Prinsen SK, Fischer EN, Schroeder DR. Patient education self-management during surgical recovery: combining mobile (iPad) and a content management system. Telemed J E Health 2014; 20:312-7. [PMID: 24443928 DOI: 10.1089/tmj.2013.0219] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The objective of this investigation was to assess whether a new electronic health (e-health) platform, combining mobile computing and a content management system, could effectively deliver modular and "just-in-time" education to older patients following cardiac surgery. SUBJECTS AND METHODS Patients were provided with iPad(®) (Apple(®), Cupertino, CA) tablets that delivered educational modules as part of a daily "to do" list in a plan of care. The tablet communicated wirelessly to a dashboard where data were aggregated and displayed for providers. RESULTS A surgical population of 149 patients with a mean age of 68 years utilized 5,267 of 6,295 (84%) of education modules delivered over a 5.3-day hospitalization. Increased age was not associated with decreased use. CONCLUSIONS We demonstrate that age, hospitalization, and major surgery are not significant barriers to effective patient education if content is highly consumable and relevant to patients' daily care experience. We also show that mobile technology, even if unfamiliar to many older patients, makes this possible. The combination of mobile computing with a content management system allows for dynamic, modular, personalized, and "just-in-time" education in a highly consumable format. This approach presents a means by which patients may become informed participants in new healthcare models.
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Affiliation(s)
- David J Cook
- 1 Department of Anesthesiology, Mayo Clinic , Rochester, Minnesota
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