1
|
de Siqueira Silva Í, de Araújo AJ, Lopes RH, Silva CRDV, Xavier PB, de Figueirêdo RC, Brito EWG, Lapão LV, Martiniano CS, de Araújo Nunes VM, da Costa Uchôa SA. Digital home care interventions and quality of primary care for older adults: a scoping review. BMC Geriatr 2024; 24:507. [PMID: 38858634 PMCID: PMC11163791 DOI: 10.1186/s12877-024-05120-z] [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: 01/12/2024] [Accepted: 05/29/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Population aging is forcing the transformation of health care. Long-term care in the home is complex and involves complex communication with primary care services. In this scenario, the expansion of digital health has the potential to improve access to home-based primary care; however, the use of technologies can increase inequalities in access to health for an important part of the population. The aim of this study was to identify and map the uses and types of digital health interventions and their impacts on the quality of home-based primary care for older adults. METHODS This is a broad and systematized scoping review with rigorous synthesis of knowledge directed by the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The quantitative data were analyzed through descriptive statistics, and the qualitative data were analyzed through basic qualitative content analysis, considering the organizational, relational, interpersonal and technical dimensions of care. The preliminary results were subjected to consultation with stakeholders to identify strengths and limitations, as well as potential forms of socialization. RESULTS The mapping showed the distribution of publications in 18 countries and in the Sub-Saharan Africa region. Older adults have benefited from the use of different digital health strategies; however, this review also addresses limitations and challenges, such as the need for digital literacy and technological infrastructure. In addition to the impacts of technologies on the quality of health care. CONCLUSIONS The review gathered priority themes for the equitable implementation of digital health, such as access to home caregivers and digital tools, importance of digital literacy and involvement of patients and their caregivers in health decisions and design of technologies, which must be prioritized to overcome limitations and challenges, focusing on improving quality of life, shorter hospitalization time and autonomy of older adults.
Collapse
Affiliation(s)
- Ísis de Siqueira Silva
- Postgraduate in Collective Health, Federal University of Rio Grande Do Norte, Natal, Brazil.
| | | | | | | | - Pedro Bezerra Xavier
- Postgraduate in Health Sciences, Federal University of Rio Grande Do Norte, Natal, Brazil
| | | | | | - Luís Velez Lapão
- WHO Collaborating Center on Health Workforce Policy and Planning, IHMT, Universidade Nova de Lisboa, Lisbon, Portugal
- UNIDEMI, Department of Mechanical and Industrial Engineering, Nova School of Science and Technology, Caparica, Portugal
- Laboratório Associado de Sistemas Inteligentes, Escola de Engenharia Universidade do Minho, Campus Azurém, 4800-058, Guimarães, Portugal
| | | | | | | |
Collapse
|
2
|
Lee KCS, Breznen B, Ukhova A, Martin SS, Koehler F. Virtual healthcare solutions in heart failure: a literature review. Front Cardiovasc Med 2023; 10:1231000. [PMID: 37745104 PMCID: PMC10513031 DOI: 10.3389/fcvm.2023.1231000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
The widespread adoption of mobile technologies offers an opportunity for a new approach to post-discharge care for patients with heart failure (HF). By enabling non-invasive remote monitoring and two-way, real-time communication between the clinic and home-based patients, as well as a host of other capabilities, mobile technologies have a potential to significantly improve remote patient care. This literature review summarizes clinical evidence related to virtual healthcare (VHC), defined as a care team + connected devices + a digital solution in post-release care of patients with HF. Searches were conducted on Embase (06/12/2020). A total of 171 studies were included for data extraction and evidence synthesis: 96 studies related to VHC efficacy, and 75 studies related to AI in HF. In addition, 15 publications were included from the search on studies scaling up VHC solutions in HF within the real-world setting. The most successful VHC interventions, as measured by the number of reported significant results, were those targeting reduction in rehospitalization rates. In terms of relative success rate, the two most effective interventions targeted patient self-care and all-cause hospital visits in their primary endpoint. Among the three categories of VHC identified in this review (telemonitoring, remote patient management, and patient self-empowerment) the integrated approach in remote patient management solutions performs the best in decreasing HF patients' re-admission rates and overall hospital visits. Given the increased amount of data generated by VHC technologies, artificial intelligence (AI) is being investigated as a tool to aid decision making in the context of primary diagnostics, identifying disease phenotypes, and predicting treatment outcomes. Currently, most AI algorithms are developed using data gathered in clinic and only a few studies deploy AI in the context of VHC. Most successes have been reported in predicting HF outcomes. Since the field of VHC in HF is relatively new and still in flux, this is not a typical systematic review capturing all published studies within this domain. Although the standard methodology for this type of reviews was followed, the nature of this review is qualitative. The main objective was to summarize the most promising results and identify potential research directions.
Collapse
Affiliation(s)
| | - Boris Breznen
- Evidence Synthesis, Evidinno Outcomes Research Inc., Vancouver, BC, Canada
| | | | - Seth Shay Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Friedrich Koehler
- Deutsches Herzzentrum der Charité (DHZC), Centre for Cardiovascular Telemedicine, Campus Charité Mitte, Berlin, Germany
- Division of Cardiology and Angiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
3
|
Jackson TN, Sreedhara M, Bostic M, Spafford M, Popat S, Lowe Beasley K, Jordan J, Ahn R. Telehealth Use to Address Cardiovascular Disease and Hypertension in the United States: A Systematic Review and Meta-Analysis, 2011-2021. TELEMEDICINE REPORTS 2023; 4:67-86. [PMID: 37283852 PMCID: PMC10240316 DOI: 10.1089/tmr.2023.0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 06/08/2023]
Abstract
Background The use of telehealth for the management and treatment of hypertension and cardiovascular disease (CVD) has increased across the United States (U.S.), especially during the COVID-19 pandemic. Telehealth has the potential to reduce barriers to accessing health care and improve clinical outcomes. However, implementation, outcomes, and health equity implications related to these strategies are not well understood. The purpose of this review was to identify how telehealth is being used by U.S. health care professionals and health systems to manage hypertension and CVD and to describe the impact these telehealth strategies have on hypertension and CVD outcomes, with a special focus on social determinants of health and health disparities. Methods This study comprised a narrative review of the literature and meta-analyses. The meta-analyses included articles with intervention and control groups to examine the impact of telehealth interventions on changes to select patient outcomes, including systolic and diastolic blood pressure. A total of 38 U.S.-based interventions were included in the narrative review, with 14 yielding data eligible for the meta-analyses. Results The telehealth interventions reviewed were used to treat patients with hypertension, heart failure, and stroke, with most interventions employing a team-based care approach. These interventions utilized the expertise of physicians, nurses, pharmacists, and other health care professionals to collaborate on patient decisions and provide direct care. Among the 38 interventions reviewed, 26 interventions utilized remote patient monitoring (RPM) devices mostly for blood pressure monitoring. Half the interventions used a combination of strategies (e.g., videoconferencing and RPM). Patients using telehealth saw significant improvements in clinical outcomes such as blood pressure control, which were comparable to patients receiving in-person care. In contrast, the outcomes related to hospitalizations were mixed. There were also significant decreases in all-cause mortality when compared to usual care. No study explicitly focused on addressing social determinants of health or health disparities through telehealth for hypertension or CVD. Conclusions Telehealth appears to be comparable to traditional in-person care for managing blood pressure and CVD and may be seen as a complement to existing care options for some patients. Telehealth can also support team-based care delivery and may benefit patients and health care professionals by increasing opportunities for communication, engagement, and monitoring outside a clinical setting.
Collapse
Affiliation(s)
| | - Meera Sreedhara
- Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, Atlanta, Georgia, USA
- Cherokee Nation Operational Solutions, Tulsa, Oklahoma, USA
| | - Myles Bostic
- Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, Atlanta, Georgia, USA
- Veritas Management Group, Inc., Atlanta, Georgia, USA
| | | | - Shena Popat
- NORC at the University of Chicago, Chicago, Illinois, USA
| | - Kincaid Lowe Beasley
- Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, Atlanta, Georgia, USA
| | - Julia Jordan
- Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, Atlanta, Georgia, USA
| | - Roy Ahn
- NORC at the University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
4
|
Rosenlund M, Kinnunen UM, Saranto K. The Use of Digital Health Services Among Patients and Citizens Living at Home: Scoping Review. J Med Internet Res 2023; 25:e44711. [PMID: 36972122 PMCID: PMC10131924 DOI: 10.2196/44711] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/31/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND The development of digital health services reflects not only the technical development of services but also a change in attitude and the way of thinking. It has become a cornerstone for engaging and activating patients and citizens in health management while living at home. Digital health services are also aimed at enhancing the efficiency and quality of services, while simultaneously providing services more cost-effectively. In 2020, the COVID-19 pandemic accelerated worldwide the development and use of digital services in response to requirements for social distancing and other regulations. OBJECTIVE The aim of this review is to identify and summarize how digital health services are being used among patients and citizens while living at home. METHODS The Joanna Briggs Institute (JBI) methodology for scoping reviews was used as guidance. A search conducted in 3 databases (CINAHL, PubMed, Scopus) resulted in 419 papers. The reporting was conducted by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review (PRISMA-ScR), and the analysis of the included papers was performed using a framework consisting of 5 clusters describing the use of digital health services. After screening and excluding papers that did not match the inclusion criteria, 88 (21%) papers from 2010 to 2022 were included in the final analysis. RESULTS Results indicated that digital health services are used in different situations and among different kinds of populations. In most studies, digital health services were used in the form of video visits or consultations. The telephone was also used regularly for consultations. Other services, such as remote monitoring and transmitting of recorded information and the use the of internet or portals for searching information, were observed as well. Alerts, emergency systems, and reminders were observed to offer possibilities of use, for example, among older people. The digital health services also showed to have potential for use in patient education. CONCLUSIONS The development of digital services reflects a shift toward the provision of care regardless of time and place. It also reflects a shift toward emphasis on patient-centered care, meaning activating and engaging patients in their own care as they use digital services for various health-related purposes. Despite the development of digital services, many challenges (eg, adequate infrastructure) still prevail worldwide.
Collapse
Affiliation(s)
- Milla Rosenlund
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Ulla-Mari Kinnunen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland
| | - Kaija Saranto
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland
| |
Collapse
|
5
|
Chu C, Stamenova V, Fang J, Shakeri A, Tadrous M, Bhatia RS. The Association Between Telemedicine Use and Changes in Health Care Usage and Outcomes in Patients With Congestive Heart Failure: Retrospective Cohort Study. JMIR Cardio 2022; 6:e36442. [PMID: 35881831 PMCID: PMC9359304 DOI: 10.2196/36442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background Telemedicine use has become widespread owing to the COVID-19 pandemic, but its impact on patient outcomes remains unclear. Objective We sought to investigate the effect of telemedicine use on changes in health care usage and clinical outcomes in patients diagnosed with congestive heart failure (CHF). Methods We conducted a population-based retrospective cohort study using administrative data in Ontario, Canada. Patients were included if they had at least one ambulatory visit between March 14 and September 30, 2020, and a heart failure diagnosis any time prior to March 14, 2020. Telemedicine users were propensity score–matched with unexposed users based on several baseline characteristics. Monthly use of various health care services was compared between the 2 groups during 12 months before to 3 months after their index in-person or telemedicine ambulatory visit after March 14, 2020, using generalized estimating equations. Results A total of 11,131 pairs of telemedicine and unexposed patients were identified after matching (49% male; mean age 78.9, SD 12.0 years). All patients showed significant reductions in health service usage from pre- to postindex visit. There was a greater decline across time in the unexposed group than in the telemedicine group for CHF admissions (ratio of slopes for high- vs low-frequency users 1.02, 95% CI 1.02-1.03), cardiovascular admissions (1.03, 95% CI 1.02-1.04), any-cause admissions (1.03, 95% CI 1.02-1.04), any-cause ED visits (1.03, 95% CI 1.03-1.04), visits with any cardiologist (1.01, 95% CI 1.01-1.02), laboratory tests (1.02, 95% CI 1.02-1.03), diagnostic tests (1.04, 95% CI 1.03-1.05), and new prescriptions (1.02, 95% CI 1.01-1.03). However, the decline in primary care visit rates was steeper among telemedicine patients than among unexposed patients (ratio of slopes 0.99, 95% CI 0.99-1.00). Conclusions Overall health care usage over time appeared higher among telemedicine users than among low-frequency users or nonusers, suggesting that telemedicine was used by patients with the greatest need or that it allowed patients to have better access or continuity of care among those who received it.
Collapse
Affiliation(s)
- Cherry Chu
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada
| | - Vess Stamenova
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada
| | - Jiming Fang
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Ahmad Shakeri
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Mina Tadrous
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - R Sacha Bhatia
- Ontario Health, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| |
Collapse
|
6
|
Thammana RV, Goodlin SJ. Telecommunication for Advance Care Planning in Heart Failure. Card Fail Rev 2022; 8:e11. [PMID: 35433031 PMCID: PMC9006123 DOI: 10.15420/cfr.2021.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/10/2022] [Indexed: 12/23/2022] Open
Abstract
Heart failure is a chronic illness that carries a significant burden for patients, caregivers and health systems alike. The integration of palliative care and telehealth is a growing area of interest in heart failure management to help alleviate these burdens. This review focuses on the incorporation of advance care planning for complex decision-making in heart failure in the setting of increasing virtual care and telehealth. The review will also consider the role of virtual education for advance care planning and serious illness communication. Telecommunication for clinical care and clinical education are both described as non-inferior to in-person methods. Nevertheless, more research is needed to discern best practices and the optimal integration of methods.
Collapse
Affiliation(s)
- Rekha V Thammana
- Geriatrics and Palliative Care, Rehabilitation and Long Term Care, Veterans Affairs Portland Health Care System, Portland, OR, US; School of Medicine, Hematology and Medical Oncology, Oregon Health and Sciences University, Portland, OR, US
| | - Sarah J Goodlin
- Geriatrics and Palliative Care, Rehabilitation and Long Term Care, Veterans Affairs Portland Health Care System, Portland, OR, US
| |
Collapse
|
7
|
Nguyen OT, Alishahi Tabriz A, Huo J, Hanna K, Shea CM, Turner K. Impact of Asynchronous Electronic Communication-Based Visits on Clinical Outcomes and Health Care Delivery: Systematic Review. J Med Internet Res 2021; 23:e27531. [PMID: 33843592 PMCID: PMC8135030 DOI: 10.2196/27531] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/02/2021] [Accepted: 04/11/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Electronic visits (e-visits) involve asynchronous communication between clinicians and patients through a secure web-based platform, such as a patient portal, to elicit symptoms and determine a diagnosis and treatment plan. E-visits are now reimbursable through Medicare due to the COVID-19 pandemic. The state of evidence regarding e-visits, such as the impact on clinical outcomes and health care delivery, is unclear. OBJECTIVE To address this gap, we examine how e-visits have impacted clinical outcomes and health care quality, access, utilization, and costs. METHODS We conducted a systematic review; MEDLINE, Embase, and Web of Science were searched from January 2000 through October 2020 for peer-reviewed studies that assessed e-visits' impacts on clinical and health care delivery outcomes. RESULTS Out of 1859 papers, 19 met the inclusion criteria. E-visit usage was associated with improved or comparable clinical outcomes, especially for chronic disease management (eg, diabetes care, blood pressure management). The impact on quality of care varied across conditions. Quality of care was equivalent or better for chronic conditions, but variable quality was observed in infection management (eg, appropriate antibiotic prescribing). Similarly, the impact on health care utilization varied across conditions (eg, lower utilization for dermatology but mixed impact in primary care). Health care costs were lower for e-visits than those for in-person visits for a wide range of conditions (eg, dermatology and acute visits). No studies examined the impact of e-visits on health care access. It is difficult to draw firm conclusions about effectiveness or impact on care delivery from the studies that were included because many used observational designs. CONCLUSIONS Overall, the evidence suggests e-visits may provide clinical outcomes that are comparable to those provided by in-person care and reduce health care costs for certain health care conditions. At the same time, there is mixed evidence on health care quality, especially regarding infection management (eg, sinusitis, urinary tract infections, conjunctivitis). Further studies are needed to test implementation strategies that might improve delivery (eg, clinical decision support for antibiotic prescribing) and to assess which conditions can be managed via e-visits.
Collapse
Affiliation(s)
- Oliver T Nguyen
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
| | - Jinhai Huo
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Karim Hanna
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Christopher M Shea
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
| |
Collapse
|
8
|
Nilsson MY, Andersson S, Magnusson L, Hanson E. Ambient assisted living technology-mediated interventions for older people and their informal carers in the context of healthy ageing: A scoping review. Health Sci Rep 2021; 4:e225. [PMID: 33392394 PMCID: PMC7770427 DOI: 10.1002/hsr2.225] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS There is a growing demand for health and social care services to provide technology-mediated interventions that promote the health and well-being of older people with health or care needs and of their informal carers. The objectives of this study were to scope and review the nature and extent of prior intervention studies involving ambient assisted living technology-mediated interventions for older people and their informal carers, and how and in what ways (if any) the goals and aims of these interventions reflected the domains of the World Health Organization framework for healthy ageing. METHODS We conducted a scoping review. Data were collected between June and October 2018 with an updated search in October 2020. A total of 85 articles were eligible for inclusion. RESULTS Nine categories described the aims and content of the included studies. The healthy ageing domain "Ability to meet basic needs" was mirrored in four categories, whereas "Ability to contribute to society" was not addressed at all. CONCLUSION The ways in which domains of healthy ageing are mirrored suggest that there is an emphasis on individual factors and individual responsibility, and a lack of attention given to broader, environmental factors affecting healthy ageing. Only a few of the studies used a dyadic approach when assessing health outcomes concerning older people and their informal carers.
Collapse
Affiliation(s)
- Maria Y. Nilsson
- Department of Health and Caring SciencesSwedish Family Care Competence Centre, Linnaeus UniversityKalmarSweden
| | - Stefan Andersson
- Department of Health and Caring SciencesSwedish Family Care Competence Centre, Linnaeus UniversityKalmarSweden
| | - Lennart Magnusson
- Department of Health and Caring SciencesSwedish Family Care Competence Centre, Linnaeus UniversityKalmarSweden
| | - Elizabeth Hanson
- Department of Health and Caring SciencesSwedish Family Care Competence Centre, Linnaeus UniversityKalmarSweden
| |
Collapse
|
9
|
Smithson R, Roche E, Wicker C. Virtual models of chronic disease management: lessons from the experiences of virtual care during the COVID-19 response. AUST HEALTH REV 2021; 45:311-316. [PMID: 33583487 DOI: 10.1071/ah20190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022]
Abstract
Objective This study examined Gold Coast staff and patient experiences with the rapid expansion of a virtual model of chronic disease management during the COVID-19 pandemic. Methods The study undertook a survey of enrolled patients (n=24) and focus groups with clinical and administrative staff (n=44) delivering chronic disease programs at Gold Coast Health in Queensland. The study also examined routinely collected activity data for the chronic disease programs before COVID (January-February 2020) and for the first 3 months of the COVID-19 response (March-May 2020). Results Chronic disease programs continued to provide similar numbers of appointments over the COVID-19 response period, but there was a marked increase in the proportion of appointments that were delivered virtually, either by telephone or video conference. Most patients were satisfied with their virtual care experiences and felt that their health care needs were met. Conclusions The COVID-19 response provided an opportunity to learn and further develop models of virtual care. Staff and patients were generally supportive of continuing to include virtual appointments in the future. Ongoing concerns were predominantly around the support available to patients and staff to ensure they are trained and equipped to manage the technology and new mode of communicating. What is known about the topic? Emerging evidence suggests that virtual models of health care delivery, such as telephone and video consultations and remote patient monitoring, can be safe and cost-effective alternatives to traditional face-to-face chronic disease management programs. Virtual care is associated with equal or improved clinical outcomes, as well as efficiency improvements, such as reduced failure to attend rates. What does this paper add? The increasing burden of chronic disease across Australia, as well as the need to minimise the risk of vulnerable patient groups attending in-hospital appointments where it is safe and appropriate to do so, means that expanding the delivery of virtual chronic disease management will become increasingly necessary. The results of this study provide an opportunity to learn from a rapid rollout of virtual care for these staff and patient groups and will help inform advances in this area. What are the implications for practitioners? Existing evidence, demographic pressures and the COVID-19 pandemic response all point to virtual care as a viable and safe alternative to traditional models of chronic disease management. The lessons presented here provide more detailed guidance on the support that staff and patients require to ensure virtual care is a seamless and safe alternative or adjunct to traditional chronic disease management programs.
Collapse
Affiliation(s)
- Rachael Smithson
- Transformation and Digital, Gold Coast Health, Gold Coast University Hospital, Block D, Level 6, 1 Hospital Boulevard, Southport, Qld 4215, Australia. ; ; and Corresponding author.
| | - Elisha Roche
- Transformation and Digital, Gold Coast Health, Gold Coast University Hospital, Block D, Level 6, 1 Hospital Boulevard, Southport, Qld 4215, Australia. ;
| | - Christina Wicker
- Transformation and Digital, Gold Coast Health, Gold Coast University Hospital, Block D, Level 6, 1 Hospital Boulevard, Southport, Qld 4215, Australia. ;
| |
Collapse
|
10
|
Heyman N. Identifying features of apps to support using evidence-based language intervention with children. Assist Technol 2020; 32:306-316. [PMID: 30570449 DOI: 10.1080/10400435.2018.1553078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
This study investigated the features of apps that speech-language pathologists (SLPs) deem to be beneficial for language intervention with children. The study employed an explanatory, sequential mixed-method approach. A self-developed online survey was distributed to SLPs (n = 338) who use apps. This was followed by a semi-structured interview with some participants (n = 16) in order to obtain further insights from the survey. The findings indicated that SLPs view apps as an engaging and motivating tool for therapy to facilitate their intervention goals. Specific content and design features of apps may support effective language intervention. However, these features need to be carefully evaluated in terms of the underlying principles of language intervention, multimedia learning, and learning. In addition, features of apps that may impede effective intervention must also be considered. The findings from the study highlight the need for SLPs to engage more deeply with the theory underlying multimedia learning and identify the active ingredients used in treatment. This information can be used to contribute to evidence-based practice when using apps for intervention. A feature-matching checklist was developed in order to guide SLPs in selecting apps based on the features of the app to facilitate language intervention.
Collapse
Affiliation(s)
- Nikki Heyman
- Faculty of Humanities, Department of Speech Pathology and Audiology, University of the Witwatersrand , Johannesburg, South Africa
| |
Collapse
|
11
|
Kao D, Larson C, Fletcher D, Stegner K. Clinical Decision Support May Link Multiple Domains to Improve Patient Care: Viewpoint. JMIR Med Inform 2020; 8:e20265. [PMID: 33064106 PMCID: PMC7600021 DOI: 10.2196/20265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 11/13/2022] Open
Abstract
Integrating clinical decision support (CDS) across the continuum of population-, encounter-, and precision-level care domains may improve hospital and clinic workflow efficiency. Due to the diversity and volume of electronic health record data, complexity of medical and operational knowledge, and specifics of target user workflows, the development and implementation of comprehensive CDS is challenging. Additionally, many providers have an incomplete understanding of the full capabilities of current CDS to potentially improve the quality and efficiency of care delivery. These varied requirements necessitate a multidisciplinary team approach to CDS development for successful integration. Here, we present a practical overview of current and evolving applications of CDS approaches in a large academic setting and discuss the successes and challenges. We demonstrate that implementing CDS tools in the context of linked population-, encounter-, and precision-level care provides an opportunity to integrate complex algorithms at each level into a unified mechanism to improve patient management.
Collapse
Affiliation(s)
- David Kao
- Department of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | | | - Dana Fletcher
- Evida Clinical Consulting, Inc, Golden, CO, United States
| | - Kris Stegner
- G(x)P Advisors, Inc, Thornton, CO, United States
| |
Collapse
|
12
|
Guzman-Clark J, Yefimova M, Farmer MM, Wakefield BJ, Viernes B, Lee ML, Hahn TJ. Home Telehealth Technologies for Heart Failure: An Examination of Adherence Among Veterans. J Gerontol Nurs 2020; 46:26-34. [PMID: 32597998 PMCID: PMC7375894 DOI: 10.3928/00989134-20200605-05] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The current retrospective cohort study uses Department of Veterans Affairs (VA) clinical and facility data of Veterans with heart failure enrolled in the VA Home Tele-health (HT) Program. General estimating equations with facility as a covariate were used to model percent average adherence at 1, 3, 6, and 12 months post-enrollment. Most HT patients were White, male, and of older age (mean = 71 years). Average adherence increased the longer patients remained in the HT program. Number of weekly reports of HT use, not having depression, and being of older age were all associated with higher adherence. Compared to White Veterans, Black and other non-White Veterans had lower adherence. These findings identify subgroups of patients (e.g., those with depression, of younger age, non-White) that may benefit from additional efforts to improve adherence to HT technologies. [Journal of Gerontological Nursing, 46(7), 26-34.].
Collapse
|
13
|
Badowski ME, Wright EA, Bainbridge J, Michienzi SM, Nichols SD, Turner KM, Wicke C, Awad J, Thompkins A, Martin RD. Implementation and evaluation of comprehensive medication management in telehealth practices. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1210] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | | | | | | | | | | | | | - John Awad
- American College of Clinical Pharmacy; Lenexa Kansas
| | | | | |
Collapse
|
14
|
Marani H, Baranek H, Abrams H, McDonald M, Nguyen M, Posada JD, Ross H, Schofield T, Shaw J, Bhatia RS. Improving the design of heart failure care from the perspective of frontline providers and administrators: A qualitative case study of a large, urban health system. JOURNAL OF COMORBIDITY 2020; 10:2235042X20924172. [PMID: 32596163 PMCID: PMC7303776 DOI: 10.1177/2235042x20924172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 04/08/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heart failure patients often present with frailty and/or multi-morbidity, complicating care and service delivery. The Chronic Care Model (CCM) is a useful framework for designing care for complex patients. It assumes responsibility of several actors, including frontline providers and health-care administrators, in creating conditions for optimal chronic care management. This qualitative case study examines perceptions of care among providers and administrators in a large, urban health system in Canada, and how the CCM might inform redesign of care to improve health system functioning. METHODS Sixteen semi-structured interviews were conducted between August 2014 and January 2016. Interpretive analysis was conducted to identify how informants perceive care among this population and the extent to which the design of heart failure care aligns with elements of the CCM. RESULTS Current care approaches could better align with CCM elements. Key changes to improve health system functioning for complex heart failure patients that align with the CCM include closing knowledge gaps, standardizing treatment, improving interdisciplinary communication and improving patient care pathways following hospital discharge. CONCLUSIONS The CCM can be used to guide health system design and interventions for frail and multi-morbid heart failure patients. Addressing care- and service-delivery barriers has important clinical, administrative and economic implications.
Collapse
Affiliation(s)
- Husayn Marani
- Women’s College Hospital Institute for Health Systems Solutions and
Virtual Care, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of
Toronto, Toronto, Ontario, Canada
| | - Hayley Baranek
- Women’s College Hospital Institute for Health Systems Solutions and
Virtual Care, Toronto, Ontario, Canada
| | - Howard Abrams
- OpenLab, University Health Network, Toronto, Ontario, Canada
| | - Michael McDonald
- Peter Munk Cardiac Centre, Toronto General Hospital, University
Health Network, Toronto, Ontario, Canada
| | - Megan Nguyen
- Women’s College Hospital Institute for Health Systems Solutions and
Virtual Care, Toronto, Ontario, Canada
| | - Juan Duero Posada
- Peter Munk Cardiac Centre, Toronto General Hospital, University
Health Network, Toronto, Ontario, Canada
| | - Heather Ross
- Peter Munk Cardiac Centre, Toronto General Hospital, University
Health Network, Toronto, Ontario, Canada
| | - Toni Schofield
- Peter Munk Cardiac Centre, Toronto General Hospital, University
Health Network, Toronto, Ontario, Canada
| | - James Shaw
- Women’s College Hospital Institute for Health Systems Solutions and
Virtual Care, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of
Toronto, Toronto, Ontario, Canada
| | - R Sacha Bhatia
- Women’s College Hospital Institute for Health Systems Solutions and
Virtual Care, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, Toronto General Hospital, University
Health Network, Toronto, Ontario, Canada
- Division of Cardiology, Women’s College Hospital, Toronto, Ontario,
Canada
- Department of Medicine, University of Toronto, Toronto, Ontario,
Canada
| |
Collapse
|
15
|
Effects of Telemonitoring and Hemodynamic Monitoring on Mortality in Heart Failure: a Systematic Review and Meta-analysis. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40138-019-00181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
16
|
Real-Time Fault-Tolerant mHealth System: Comprehensive Review of Healthcare Services, Opens Issues, Challenges and Methodological Aspects. J Med Syst 2018; 42:137. [PMID: 29936593 DOI: 10.1007/s10916-018-0983-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/18/2018] [Indexed: 10/28/2022]
Abstract
The burden on healthcare services in the world has increased substantially in the past decades. The quality and quantity of care have to increase to meet surging demands, especially among patients with chronic heart diseases. The expansion of information and communication technologies has led to new models for the delivery healthcare services in telemedicine. Therefore, mHealth plays an imperative role in the sustainable delivery of healthcare services in telemedicine. This paper presents a comprehensive review of healthcare service provision. It highlights the open issues and challenges related to the use of the real-time fault-tolerant mHealth system in telemedicine. The methodological aspects of mHealth are examined, and three distinct and successive phases are presented. The first discusses the identification process for establishing a decision matrix based on a crossover of 'time of arrival of patient at the hospital/multi-services' and 'hospitals' within mHealth. The second phase discusses the development of a decision matrix for hospital selection based on the MAHP method. The third phase discusses the validation of the proposed system.
Collapse
|
17
|
Mullins CD, Wingate LT, Edwards HA, Tofade T, Wutoh A. Transitioning from learning healthcare systems to learning health care communities. J Comp Eff Res 2018; 7:603-614. [PMID: 29478331 DOI: 10.2217/cer-2017-0105] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The learning healthcare system (LHS) model framework has three core, foundational components. These include an infrastructure for health-related data capture, care improvement targets and a supportive policy environment. Despite progress in advancing and implementing LHS approaches, low levels of participation from patients and the public have hampered the transformational potential of the LHS model. An enhanced vision of a community-engaged LHS redesign would focus on the provision of health care from the patient and community perspective to complement the healthcare system as the entity that provides the environment for care. Addressing the LHS framework implementation challenges and utilizing community levers are requisite components of a learning health care community model, version two of the LHS archetype.
Collapse
Affiliation(s)
- C Daniel Mullins
- Pharmaceutical Health Services Research, University of Maryland, Baltimore, 220 Arch Street, 12th Floor, Baltimore, MD 21201, USA
| | - La'Marcus T Wingate
- Department of Clinical & Administrative Pharmacy Sciences, Howard University College of Pharmacy, Washington, DC 20059, USA
| | - Hillary A Edwards
- Pharmaceutical Health Services Research, University of Maryland, Baltimore, 220 Arch Street, 12th Floor, Baltimore, MD 21201, USA
| | - Toyin Tofade
- Department of Clinical & Administrative Pharmacy Sciences, Howard University College of Pharmacy, Washington, DC 20059, USA
| | - Anthony Wutoh
- Department of Clinical & Administrative Pharmacy Sciences, Howard University College of Pharmacy, Washington, DC 20059, USA
| |
Collapse
|
18
|
Kalid N, Zaidan AA, Zaidan BB, Salman OH, Hashim M, Muzammil H. Based Real Time Remote Health Monitoring Systems: A Review on Patients Prioritization and Related "Big Data" Using Body Sensors information and Communication Technology. J Med Syst 2017; 42:30. [PMID: 29288419 DOI: 10.1007/s10916-017-0883-4] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/13/2017] [Indexed: 12/31/2022]
Abstract
The growing worldwide population has increased the need for technologies, computerised software algorithms and smart devices that can monitor and assist patients anytime and anywhere and thus enable them to lead independent lives. The real-time remote monitoring of patients is an important issue in telemedicine. In the provision of healthcare services, patient prioritisation poses a significant challenge because of the complex decision-making process it involves when patients are considered 'big data'. To our knowledge, no study has highlighted the link between 'big data' characteristics and real-time remote healthcare monitoring in the patient prioritisation process, as well as the inherent challenges involved. Thus, we present comprehensive insights into the elements of big data characteristics according to the six 'Vs': volume, velocity, variety, veracity, value and variability. Each of these elements is presented and connected to a related part in the study of the connection between patient prioritisation and real-time remote healthcare monitoring systems. Then, we determine the weak points and recommend solutions as potential future work. This study makes the following contributions. (1) The link between big data characteristics and real-time remote healthcare monitoring in the patient prioritisation process is described. (2) The open issues and challenges for big data used in the patient prioritisation process are emphasised. (3) As a recommended solution, decision making using multiple criteria, such as vital signs and chief complaints, is utilised to prioritise the big data of patients with chronic diseases on the basis of the most urgent cases.
Collapse
Affiliation(s)
- Naser Kalid
- Computing Department, Universiti Pendidikan Sultan Idris, Tg Malim, 35900, Perak, Malaysia.,Department of Computer Engineering Techniques, Al-Nisour University, Al Adhmia - Haiba Khaton, Baghdad, Iraq
| | - A A Zaidan
- Computing Department, Universiti Pendidikan Sultan Idris, Tg Malim, 35900, Perak, Malaysia.
| | - B B Zaidan
- Computing Department, Universiti Pendidikan Sultan Idris, Tg Malim, 35900, Perak, Malaysia
| | - Omar H Salman
- Networking Department, Engineering College, Al Iraqia university, Baghdad, Iraq
| | - M Hashim
- Computing Department, Universiti Pendidikan Sultan Idris, Tg Malim, 35900, Perak, Malaysia
| | - H Muzammil
- Department of Computer Science, University of Management and Technology, Lahore, Pakistan
| |
Collapse
|
19
|
Gelfman LP, Bakitas M, Warner Stevenson L, Kirkpatrick JN, Goldstein NE. The State of the Science on Integrating Palliative Care in Heart Failure. J Palliat Med 2017; 20:592-603. [PMID: 29493362 DOI: 10.1089/jpm.2017.0178] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a chronic progressive illness associated with physical and psychological burdens, high morbidity, mortality, and healthcare utilization. Palliative care is interdisciplinary care that aims to relieve suffering and improve quality of life for persons with serious illness and their families. It is offered simultaneously with disease-oriented care, unlike hospice or end-of-life care. Despite the demonstrated benefits of palliative care in other populations, evidence for palliative care in the HF population is limited. OBJECTIVE The objective of this article is to describe the current evidence and the gaps in the evidence that will need to be improved to demonstrate the benefits of integrating palliative care into the care of patients with advanced HF and their family caregivers. METHODS We reviewed the literature to examine the state of the science and to identify gaps in palliative care integration for persons with HF and their families. We then convened an interdisciplinary working group at an NIH/NPCRC sponsored workshop to review the evidence base and develop a research agenda to address these gaps. RESULTS We identified four key research priorities to improve palliative care for patients with HF and their families: (1) to better understand patients' uncontrolled symptoms, (2) to better characterize and address the needs of the caregivers of advanced HF patients, (3) to improve patient and family understanding of HF disease trajectory and the importance of advance care planning, and (4) to determine the best models of palliative care, including models for those who want to continue life-prolonging therapies. CONCLUSIONS The goal of this research agenda is to motivate patient, provider, policy, and payor stakeholders, including funders, to identify the key research topics that have the potential to improve the quality of care for patients with HF and their families.
Collapse
Affiliation(s)
- Laura P Gelfman
- 1 Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,2 Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center , Bronx, New York
| | - Marie Bakitas
- 3 School of Nursing, University of Alabama at Birmingham , Birmingham, Alabama
| | - Lynne Warner Stevenson
- 4 Division of Cardiovascular Medicine, Brigham and Women's Hospital , Boston, Massachusetts
| | - James N Kirkpatrick
- 5 Division of Cardiology, Department of Bioethics and Humanities, University of Washington Medical Center , Seattle, Washington
| | - Nathan E Goldstein
- 1 Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,2 Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center , Bronx, New York
| |
Collapse
|
20
|
Maddox TM, Albert NM, Borden WB, Curtis LH, Ferguson TB, Kao DP, Marcus GM, Peterson ED, Redberg R, Rumsfeld JS, Shah ND, Tcheng JE. The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association. Circulation 2017; 135:e826-e857. [DOI: 10.1161/cir.0000000000000480] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The learning healthcare system uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery. To achieve these goals, the learning healthcare system requires systematic redesign of the current healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture. This scientific statement provides an overview of how these learning healthcare system domains can be realized in cardiovascular disease care. Current cardiovascular disease care innovations in informatics, data uses, patient engagement, continuous learning culture, and incentives are profiled. In addition, recommendations for next steps for the development of a learning healthcare system in cardiovascular care are presented.
Collapse
|
21
|
Wang S, Blazer D, Hoenig H. Can eHealth Technology Enhance the Patient-Provider Relationship in Rehabilitation? Arch Phys Med Rehabil 2016; 97:1403-1406. [DOI: 10.1016/j.apmr.2016.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 04/11/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
|