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Keegan AC, Bose S, McDermott KM, Starks White MP, Stonko DP, Jeddah D, Lev-Ari E, Rutkowski J, Sherman R, Abularrage CJ, Selvin E, Hicks CW. Implementation of a patient-centered remote wound monitoring system for management of diabetic foot ulcers. Front Endocrinol (Lausanne) 2023; 14:1157518. [PMID: 37293494 PMCID: PMC10244728 DOI: 10.3389/fendo.2023.1157518] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
Background Regular clinical assessment is critical to optimize lower extremity wound healing. However, family and work obligations, socioeconomic, transportation, and time barriers often limit patient follow-up. We assessed the feasibility of a novel, patient-centered, remote wound management system (Healthy.io Minuteful for Wound Digital Management System) for the surveillance of lower extremity wounds. Methods We enrolled 25 patients from our outpatient multidisciplinary limb preservation clinic with a diabetic foot ulcer, who had undergone revascularization and podiatric interventions prior to enrollment. Patients and their caregivers were instructed on how to use the digital management system and asked to perform one at-home wound scan per week for a total of 8 weeks using a smartphone application. We collected prospective data on patient engagement, smartphone app useability, and patient satisfaction. Results Twenty-five patients (mean age 65.5 ± 13.7 years, 60.0% male, 52.0% Black) were enrolled over 3 months. Mean baseline wound area was 18.0 ± 15.2 cm2, 24.0% of patients were recovering from osteomyelitis, and post-surgical WiFi stage was 1 in 24.0%, 2 in 40.0%, 3 in 28.0%, and 4 in 8.00% of patients. We provided a smartphone to 28.0% of patients who did not have access to one that was compatible with the technology. Wound scans were obtained by patients (40.0%) and caregivers (60.0%). Overall, 179 wound scans were submitted through the app. The mean number of wound scans acquired per patient was 0.72 ± 0.63 per week, for a total mean of 5.80 ± 5.30 scans over the course of 8 weeks. Use of the digital wound management system triggered an early change in wound management for 36.0% of patients. Patient satisfaction was high; 94.0% of patients reported the system was useful. Conclusion The Healthy.io Minuteful for Wound Digital Management System is a feasible means of remote wound monitoring for use by patients and/or their caregivers.
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Affiliation(s)
- Alana C. Keegan
- Department of Surgery, Sinai Hospital of Baltimore, Baltimore, MD, United States
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University, Baltimore, MD, United States
| | - Sanuja Bose
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University, Baltimore, MD, United States
| | - Katherine M. McDermott
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University, Baltimore, MD, United States
| | - Midori P. Starks White
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University, Baltimore, MD, United States
| | - David P. Stonko
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University, Baltimore, MD, United States
| | - Danielle Jeddah
- Department of Clinical Development, Healthy.io Ltd., Tel Aviv, Israel
| | - Eilat Lev-Ari
- Department of Clinical Development, Healthy.io Ltd., Tel Aviv, Israel
| | - Joanna Rutkowski
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University, Baltimore, MD, United States
| | - Ronald Sherman
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University, Baltimore, MD, United States
| | - Christopher J. Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University, Baltimore, MD, United States
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Caitlin W. Hicks
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University, Baltimore, MD, United States
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Rodrigues CF, Bezerra SMG, Calçada DB. COMPUTER SYSTEMS TO AID IN WOUND HEALING: SCOPE REVIEW. ESTIMA 2023. [DOI: 10.30886/estima.v21.1260_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Objective: To investigate studies that present computational systems to aid healing and systems which refer to the use of low-level laser.Method: Scope review that aimed to answer the question: Which computer systems help in wound healing? A subquestion was: Which of the computer systems refer to the use of low-level laser? Results: From the search, applying the eligibility criteria, 49 articles made up the final sample. The systems served multiple purposes in support of wound healing; the majority presented the health professional as a user of the system; medicine was the most mentioned professional area despite nursing being involved in the management of care for people with wounds. Innovation in care using the computer system was frequently reported, demonstrating the importance of this type of tool for clinical practice. There was a high frequency of the mobile platform, showing that this is a current trend. Conclusion:Computer systems have been used as tools to support patients and especially professionals in wound healing. Regarding the systems aimed at the low intensity laser, there was a shortage of computer systems for this purpose, with a study.
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Zhang A, Spiegel T, Bundy A, Sullivan K, Green G, Chia S, Krishnamurthy R, Press VG. Evaluation of a transitions clinic to bridge emergency department and primary care. J Hosp Med 2023; 18:217-223. [PMID: 36737107 DOI: 10.1002/jhm.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/15/2022] [Accepted: 01/01/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Suboptimal transitions from the emergency department (ED) to ambulatory settings contribute to poor clinical outcomes and unnecessary nonurgent ED utilization. Care transition clinics (CTCs) are a potential solution by providing ED follow-up and facilitating the bridge to longer-term primary care. OBJECTIVE The objective was to evaluate the implementation of an ED transitions clinic on 30-day ED revisits and hospital readmissions. DESIGNS Retrospective cross-sectional study. SETTINGS AND PARTICIPANTS This study included adults 18 years and older discharged from the ED and reeferred to the CTC. MAIN OUTCOME AND MEASURES Appointment attendance, follow-up time, and frequencies of care type provided were computed to assess clinic utilization. Rates of 30-day ED revisit and hospital admission were compared between completed and missed appointments using logistic regression. RESULTS Between March 2021 and March 2022, 373 patients were referred to the CTC totaling 405 appointments. Half (53%) of appointments were completed with a median follow-up time of 4 days (IQR = [2, 7]). The most common care types provided were wound care (44%) and clinical problem management (33%), with wound care appointments more likely to be completed compared with clinical appointments (OR = 1.7, CI = [1.1, 2.8], p = .03). Patients who completed their CTC appointment were 50% less likely to return to the ED in 30 days compared with those who did not complete their appointment (OR = 0.51, CI = [0.27, 0.98], p < .05). No effect was seen for CTC appointment completion on hospital readmission. Transition clinics are a viable method to provide timely access to follow-up for patients discharged from the ED and may help reduce excess ED use for ambulatory care needs.
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Affiliation(s)
- Amanda Zhang
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Thomas Spiegel
- Department of Emergency Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Andrea Bundy
- Center for Care Transformation, University of Chicago Medicine, Chicago, Illinois, USA
| | - Kate Sullivan
- Center for Care Transformation, University of Chicago Medicine, Chicago, Illinois, USA
| | - Geneatra Green
- Center for Care Transformation, University of Chicago Medicine, Chicago, Illinois, USA
| | - Stephanie Chia
- Center for Care Transformation, University of Chicago Medicine, Chicago, Illinois, USA
| | | | - Valerie G Press
- Center for Care Transformation, University of Chicago Medicine, Chicago, Illinois, USA
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
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Rodrigues CF, Bezerra SMG, Calçada DB. SISTEMAS COMPUTACIONAIS PARA AUXÍLIO NA CICATRIZAÇÃO DE FERIDAS: REVISÃO DE ESCOPO. ESTIMA 2023. [DOI: 10.30886/estima.v21.1260_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Objetivo:Investigar estudos que apresentem sistemas computacionais de auxílio à cicatrização de feridas e quais sistemas se referem ao uso de laser de baixa intensidade. Método: Revisão de escopo que visou responder à questão de pesquisa: Quais sistemas computacionais auxiliam na cicatrização de feridas? Uma subquestão foi: quais sistemas computacionais se referem ao uso do laser de baixa intensidade? Resultados: A partir da busca, aplicando os critérios de elegibilidade, 49 artigos compuseram a amostra final. Os sistemas apresentaram várias finalidades de apoio à cicatrização de feridas, em que a maioria apresentou como usuário do sistema o profissional de saúde, sendo a medicina a área profissional mais mencionada, embora a enfermagem esteja envolvida com o manejo do cuidado às pessoas com feridas. Foi relatada com frequência a inovação na assistência a partir do uso do sistema computacional, o que demonstra a importância desse tipo de ferramenta para a prática clínica. Verificou-se com frequência o uso de plataforma mobile, como tendência da atualidade. Conclusão: Os sistemas computacionais têm sido utilizados como ferramentas para apoiar pacientes e principalmente profissionais na cicatrização de feridas. Quanto ao laser de baixa intensidade, houve escassez de sistemas computacionais com essa finalidade, com apenas um estudo.
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Jella TK, Cwalina TB, Schmidt JE, Wu VS, Haglin JM, Kamath AF. Do Americans Lacking a Local Orthopaedic Surgeon Have Adequate Broadband for Telehealth? Clin Orthop Relat Res 2023; 481:347-355. [PMID: 36040749 PMCID: PMC9831156 DOI: 10.1097/corr.0000000000002374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 08/02/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although telehealth holds promise in expanding access to orthopaedic surgical care, high-speed internet connectivity remains a major limiting factor for many communities. Despite persistent federal efforts to study and address the health information technology needs of patients, there is limited information regarding the current high-speed internet landscape as it relates to access to orthopaedic surgical care. QUESTIONS/PURPOSES (1) What is the distribution of practicing orthopaedic surgeons in the United States relative to the presence of broadband internet access? (2) What geographic, demographic, and socioeconomic factors are associated with the absence of high-speed internet and access to a local orthopaedic surgeon? METHODS The Federal Communications Commission (FCC) Mapping Broadband in America interactive tool was used to determine the proportion of county residents with access to broadband-speed internet for all 3141 US counties. Data regarding the geographic distribution of orthopaedic surgeons and county-level characteristics were obtained from the 2015 Physician Compare National Downloadable File and the Area Health Resource File, respectively. The FCC mapping broadband public use files are considered the most comprehensive datasets describing high-speed internet infrastructure within the United States. The year 2015 represents the most recently available FCC data for which county-level broadband penetration estimates are available. Third-party audits of the FCC data have shown that broadband expansion has been slow over the past decade and that many large improvements have been driven by changes in the reporting methodology. Therefore, we believe the 2015 FCC data still hold relevance. The primary outcome measure was the simultaneous absence of at least 50% broadband penetration and at least one orthopaedic surgeon practicing in county limits. Statistical analyses using Kruskal-Wallis tests and multivariable logistic regression were conducted to assess for factors associated with inaccessibility to orthopaedic telehealth. All statistical tests were two-sided with a significance threshold of p < 0.05. RESULTS In 2015, 14% (448 of 3141) of counties were considered "low access" in that they both had no orthopaedic surgeons and possessed less than 50% broadband access. A total of 4,660,559 people lived within these low-access counties, representing approximately 1.4% (4.6 million of 320.7 million) of the US population. After controlling for potential confounding variables, such as the age, sex, income level, and educational attainment, lower population density per square mile (OR 0.92 [95% confidence interval (CI) 0.90 to 0.94]; p < 0.01), a lower number of primary care physicians per 100,000 (OR 0.88 [95% CI 0.81 to 0.97]; p < 0.01), a higher unemployment level (OR 1.3 [95% CI 1.2 to 1.4]; p < 0.01), and greater number preventable hospital stays per 100,000 (OR 1.01 [95% CI 1.01 to 1.02]; p < 0.01) were associated with increased odds of being a low-access county (though the effect size of the finding was small for population density and number of primary care physicians). Stated another way, each additional person per square mile was associated with an 8% (95% CI 6% to 10%; p < 0.01) decrease in the odds of being a low-access county, and each additional percentage point of unemployment was associated with a 30% (95% CI 20% to 40%) increase in the odds of being a low-access county. CONCLUSION Despite the potential for telehealth programs to improve the delivery of high-quality orthopaedic surgical care, broadband internet access remains a major barrier to implementation. Until targeted investments are made to expand broadband infrastructure across the country, health systems, policymakers, and surgeon leaders must capitalize on existing federal subsidy programs, such as the lifeline or affordability connectivity initiatives, to reach unemployed patients living in economically depressed regions. The incorporation of internet access questions into clinic-based social determinants screening may facilitate the development of alternative follow-up protocols for patients unable to participate in synchronous videoconferencing. CLINICAL RELEVANCE Some orthopaedic patients lack the broadband capacity necessary for telehealth visits, in which case surgeons may pursue alternative methods of follow-up such as mobile phone-based surveillance of postoperative wounds, surgical sites, and clinical symptoms.
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Affiliation(s)
- Tarun K Jella
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Thomas B Cwalina
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jenna E Schmidt
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Victoria S Wu
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jack M Haglin
- Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Diehl TM, Barrett JR, Van Doorn R, Cherney Stafford LM, Hanlon BM, Weber SM, Voils CI, Abbott DE. Promoting patient engagement during care transitions after surgery using mobile technology: Lessons learned from the MobiMD pilot study. Surgery 2022; 172:219-225. [PMID: 35086727 PMCID: PMC11064743 DOI: 10.1016/j.surg.2021.12.018] [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: 07/20/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Poorly coordinated transitions of care in complex abdominal surgery patients contribute to frequent hospital readmissions and inflated healthcare spending. Mobile health (mHealth) transitional care technologies may reduce surgical readmissions yet remain understudied in high-risk surgical populations. METHODS We conducted a single-group, prepost study of a mHealth transitional care app in 50 complex surgical patients. Eligible patients were adults undergoing complex abdominal surgery in the divisions of Surgical Oncology and Colorectal Surgery. The main outcome was app engagement, calculated by notification response rate (number of participant-entered datapoints divided by the total number of app-requested datapoints) over the 30-day postoperative period. Secondary outcomes included changes in engagement over time and by individual app feature. RESULTS A total of 85% (50/59) of eligible patients enrolled. Most participants were male (58%, n = 29), and mean age was 50 years (range 24-80 years). Overall notification response rate was 28%. Among the 58% of participants (29/50) who engaged with the app at least once after discharge (app users), the average notification response rate was 45%. The mean notification response rate among app users decreased over time from 50% to 32% between weeks 1 and 4 after hospital discharge. Engagement with individual app features ranged from 48-81%, with highest engagement for symptom reports and lowest engagement for wound care instructions. CONCLUSION mHealth transitional care is feasible in complex surgical patients using only patients' existing smart devices. Randomized controlled trials are required to determine the impact on hospital readmissions, surgical outcomes, patient satisfaction, and overall resource utilization.
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Affiliation(s)
- Thomas M Diehl
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI. http://www.twitter.com/tomdiehlMD
| | - James R Barrett
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI
| | - Rachel Van Doorn
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI
| | - Linda M Cherney Stafford
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI
| | - Bret M Hanlon
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI; Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI
| | - Sharon M Weber
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI
| | - Corrine I Voils
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI. http://www.twitter.com/VoilsCorrine
| | - Daniel E Abbott
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI.
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Diehl TM, Barrett JR, Abbott DE, Cherney Stafford LM, Hanlon BM, Yang Q, Van Doorn R, Weber SM, Voils CI. Protocol for the MobiMD trial: A randomized controlled trial to evaluate the effect of a self-monitoring mobile app on hospital readmissions for complex surgical patients. Contemp Clin Trials 2022; 113:106658. [PMID: 34954099 PMCID: PMC8844087 DOI: 10.1016/j.cct.2021.106658] [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: 09/13/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hospital readmissions are estimated to cost $17.4 billion per year in the Medicare population alone, with readmission rates as high as 30% for patients undergoing complex abdominal surgery. Improved transitional care and self-monitoring may reduce preventable readmissions for such high-risk populations. In this study, we will conduct a single-institution randomized controlled trial (RCT) to assess the effect of a novel transitional care mobile app, MobiMD, on hospital readmission in complex abdominal surgery patients. METHODS Three hundred patients will be randomized 1:1 to standard of care (SOC) versus SOC plus MobiMD app in a parallel, single-blinded, two-arm RCT. Eligible patients are those who undergo complex abdominal surgery in the division of Surgical Oncology, Colorectal Surgery or Transplant Surgery. The MobiMD app provides push notification reminders directly to the patient's smart device, prompting them to enter clinical data and patient-reported outcomes. Clinical data collected via the MobiMD app include vital signs, red flag symptoms, daily wound and surgical drain images, ostomy output, drain output, medication compliance, and wound care compliance. These data are reviewed daily by a physician. The primary outcome is the proportion of participants readmitted to the hospital within 30 days of surgery. Secondary outcomes are 90-day hospital readmission, emergency department and urgent care visits, complication severity, and total readmission cost. DISCUSSION If effective, mobile health apps such as MobiMD could be routinely integrated into surgical transitional care programs to minimize unnecessary hospital readmissions, emergency department visits and healthcare resource utilization. Clinical trials identifier: NCT04540315.
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Affiliation(s)
- Thomas M Diehl
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - James R Barrett
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Daniel E Abbott
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Linda M Cherney Stafford
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Bret M Hanlon
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA; Department of Biostatistics and Medical Informatics, University of Wisconsin, WARF Room 201, 610 Walnut Street, Madison, WI 53726, USA.
| | - Qiuyu Yang
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA; Department of Biostatistics and Medical Informatics, University of Wisconsin, WARF Room 201, 610 Walnut Street, Madison, WI 53726, USA.
| | - Rachel Van Doorn
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Sharon M Weber
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Corrine I Voils
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA; William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace (151), Madison, WI 53705, USA.
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Nair A, Kalbani S. Role of mobile applications for the success of enhanced recovery after surgery programme. Indian J Anaesth 2021; 65:914-915. [PMID: 35221369 PMCID: PMC8820338 DOI: 10.4103/ija.ija_471_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/13/2022] Open
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Koziatek CA, Rubin A, Lakdawala V, Lee DC, Swartz J, Auld E, Smith SW, Reddy H, Jamin C, Testa P, Femia R, Caspers C. Assessing the Impact of a Rapidly Scaled Virtual Urgent Care in New York City During the COVID-19 Pandemic. J Emerg Med 2020; 59:610-618. [PMID: 32737005 PMCID: PMC7290166 DOI: 10.1016/j.jemermed.2020.06.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/01/2020] [Accepted: 06/06/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The coronavirus disease (COVID)-19 pandemic quickly challenged New York City health care systems. Telemedicine has been suggested to manage acute complaints and divert patients from in-person care. OBJECTIVES The objective of this study was to describe and assess the impact of a rapidly scaled virtual urgent care platform during the COVID-19 pandemic. METHODS This was a retrospective cohort study of all patients who presented to a virtual urgent care platform over 1 month during the COVID-19 pandemic surge. We described scaling our telemedicine urgent care capacity, described patient clinical characteristics, assessed for emergency department (ED) referrals, and analyzed postvisit surveys. RESULTS During the study period, a total of 17,730 patients were seen via virtual urgent care; 454 (2.56%) were referred to an ED. The most frequent diagnoses were COVID-19 related or upper respiratory symptoms. Geospatial analysis indicated a wide catchment area. There were 251 providers onboarded to the platform; at peak, 62 providers supplied 364 h of coverage in 1 day. The average patient satisfaction score was 4.4/5. There were 2668 patients (15.05%) who responded to the postvisit survey; 1236 (49.35%) would have sought care in an ED (11.86%) or in-person urgent care (37.49%). CONCLUSIONS A virtual urgent care platform was scaled to manage a volume of more than 800 patients a day across a large catchment area during the pandemic surge. About half of the patients would otherwise have presented to an ED or urgent care in person. Virtual urgent care is an option for appropriate patients while minimizing in-person visits during the COVID-19 pandemic.
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Affiliation(s)
- Christian A Koziatek
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Ada Rubin
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Viraj Lakdawala
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - David C Lee
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York; Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Jordan Swartz
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Elizabeth Auld
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Silas W Smith
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York; Institute for Innovations in Medical Education, New York University School of Medicine, New York, New York
| | - Harita Reddy
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Catherine Jamin
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Paul Testa
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
| | - Robert Femia
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Christopher Caspers
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
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Jim HSL, Hoogland AI, Brownstein NC, Barata A, Dicker AP, Knoop H, Gonzalez BD, Perkins R, Rollison D, Gilbert SM, Nanda R, Berglund A, Mitchell R, Johnstone PAS. Innovations in research and clinical care using patient-generated health data. CA Cancer J Clin 2020; 70:182-199. [PMID: 32311776 PMCID: PMC7488179 DOI: 10.3322/caac.21608] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 12/17/2022] Open
Abstract
Patient-generated health data (PGHD), or health-related data gathered from patients to help address a health concern, are used increasingly in oncology to make regulatory decisions and evaluate quality of care. PGHD include self-reported health and treatment histories, patient-reported outcomes (PROs), and biometric sensor data. Advances in wireless technology, smartphones, and the Internet of Things have facilitated new ways to collect PGHD during clinic visits and in daily life. The goal of the current review was to provide an overview of the current clinical, regulatory, technological, and analytic landscape as it relates to PGHD in oncology research and care. The review begins with a rationale for PGHD as described by the US Food and Drug Administration, the Institute of Medicine, and other regulatory and scientific organizations. The evidence base for clinic-based and remote symptom monitoring using PGHD is described, with an emphasis on PROs. An overview is presented of current approaches to digital phenotyping or device-based, real-time assessment of biometric, behavioral, self-report, and performance data. Analytic opportunities regarding PGHD are envisioned in the context of big data and artificial intelligence in medicine. Finally, challenges and solutions for the integration of PGHD into clinical care are presented. The challenges include electronic medical record integration of PROs and biometric data, analysis of large and complex biometric data sets, and potential clinic workflow redesign. In addition, there is currently more limited evidence for the use of biometric data relative to PROs. Despite these challenges, the potential benefits of PGHD make them increasingly likely to be integrated into oncology research and clinical care.
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Affiliation(s)
- Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Anna Barata
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Adam P Dicker
- Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Randa Perkins
- Department of Clinical Informatics and Clinical Systems, Moffitt Cancer Center, Tampa, Florida
| | - Dana Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Scott M Gilbert
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Ronica Nanda
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
- BayCare Health Systems Inc, Morton Plant Hospital, Clearwater, Florida
| | - Anders Berglund
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Ross Mitchell
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
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Use of a telehealth follow-up system to facilitate treatment and discharge of emergency department patients with severe cellulitis. Am J Emerg Med 2020; 41:184-189. [PMID: 32081554 DOI: 10.1016/j.ajem.2020.01.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Novel long-acting lipoglycopeptide antibiotics allow for the treatment and discharge of selected emergency department (ED) patients with cellulitis who require intravenous antibiotics. Telehealth systems have shown success in remote management of dermatologic conditions; we implemented a telehealth follow-up program for patients diagnosed with cellulitis in the ED, treated with single-dose dalbavancin, and discharged. METHODS This was a prospective, multi-center observational study. Patients were included based on clinical criteria and ability to complete follow-up using a smartphone and enroll in an online care portal. We examined the rate of successful telehealth follow-up at 24- and 72-hour intervals from discharge. We also examined the ED return rate within 14 days, reviewed any visits to determine cause of return, and for admission. RESULTS 55 patients were enrolled. 54/55 patients completed at least one telehealth follow up encounter (98.2%). 13 patients (23.6%) had a return ED visit within 14 days; no patients required admission for worsening cellulitis. Patient engagement in the telehealth program decreased over time; there was an approximately 11% decrease in engagement between the 24 and 72-hour follow-up call, and a 15% decrease in engagement between the 24 and 72-hour image upload. Patients over 65 had a lower rate of image upload (31%) than younger patients (80.6%). DISCUSSION A telehealth follow-up system for discharged emergency department patients with cellulitis demonstrated high rates of engagement. In these patients who -may have otherwise required admission for intravenous antibiotics, telehealth-facilitated outpatient management resulted in a low ED return rate and no inpatient admissions for cellulitis.
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