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Choi JY, Kim H, Chun S, Jung YI, Yoo S, Oh IH, Kim GS, Ko JY, Lim JY, Lee M, Lee J, Kim KI. Information technology-supported integrated health service for older adults in long-term care settings. BMC Med 2024; 22:212. [PMID: 38807210 PMCID: PMC11134747 DOI: 10.1186/s12916-024-03427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/16/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND To examine the effectiveness and safety of a data sharing and comprehensive management platform for institutionalized older patients. METHODS We applied information technology-supported integrated health service platform to patients who live at long-term care hospitals (LTCHs) and nursing homes (NHs) with cluster randomized controlled study. We enrolled 555 patients aged 65 or older (461 from 7 LTCHs, 94 from 5 NHs). For the intervention group, a tablet-based platform comprising comprehensive geriatric assessment, disease management, potentially inappropriate medication (PIM) management, rehabilitation program, and screening for adverse events and warning alarms were provided for physicians or nurses. The control group was managed with usual care. Co-primary outcomes were (1) control rate of hypertension and diabetes, (2) medication adjustment (PIM prescription rate, proportion of polypharmacy), and (3) combination of potential quality-of-care problems (composite quality indicator) from the interRAI assessment system which assessed after 3-month of intervention. RESULTS We screened 1119 patients and included 555 patients (control; 289, intervention; 266) for analysis. Patients allocated to the intervention group had better cognitive function and took less medications and PIMs at baseline. The diabetes control rate (OR = 2.61, 95% CI 1.37-4.99, p = 0.0035), discontinuation of PIM (OR = 4.65, 95% CI 2.41-8.97, p < 0.0001), reduction of medication in patients with polypharmacy (OR = 1.98, 95% CI 1.24-3.16, p = 0.0042), and number of PIMs use (ꞵ = - 0.27, p < 0.0001) improved significantly in the intervention group. There was no significant difference in hypertension control rate (OR = 0.54, 95% CI 0.20-1.43, p = 0.2129), proportion of polypharmacy (OR = 1.40, 95% CI 0.75-2.60, p = 0.2863), and improvement of composite quality indicators (ꞵ = 0.03, p = 0.2094). For secondary outcomes, cognitive and motor function, quality of life, and unplanned hospitalization were not different significantly between groups. CONCLUSIONS The information technology-supported integrated health service effectively reduced PIM use and controlled diabetes among older patients in LTCH or NH without functional decline or increase of healthcare utilization. TRIAL REGISTRATION Clinical Research Information Service, KCT0004360. Registered on 21 October 2019.
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Affiliation(s)
- Jung-Yeon Choi
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hongsoo Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
- Institute of Aging, Seoul National University, Seoul, Republic of Korea
| | - Seungyeon Chun
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Young-Il Jung
- Department of Environmental Health, Korea National Open University, Seoul, Republic of Korea
| | - Sooyoung Yoo
- Healthcare ICT Research Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Gi-Soo Kim
- Department of Industrial Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Jin Young Ko
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minho Lee
- Healthcare Convergence R&D Center, ezCaretech Co. Ltd, Seoul, Republic of Korea
| | - Jongseon Lee
- Healthcare Convergence R&D Center, Healthconnect Co. Ltd, Seoul, Republic of Korea
| | - Kwang-Il Kim
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
- Departments of Internal Medicine, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Kyeongi-do, 13620, Republic of Korea.
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Putrik P, Grobler L, Lalor A, Ramsay H, Gorelik A, Karnon J, Parker D, Morgan M, Buchbinder R, O'Connor D. Models for delivery and co-ordination of primary or secondary health care (or both) to older adults living in aged care facilities. Cochrane Database Syst Rev 2024; 3:CD013880. [PMID: 38426600 PMCID: PMC10905654 DOI: 10.1002/14651858.cd013880.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND The number of older people is increasing worldwide and public expenditure on residential aged care facilities (ACFs) is expected to at least double, and possibly triple, by 2050. Co-ordinated and timely care in residential ACFs that reduces unnecessary hospital transfers may improve residents' health outcomes and increase satisfaction with care among ACF residents, their families and staff. These benefits may outweigh the resources needed to sustain the changes in care delivery and potentially lead to cost savings. Our systematic review comprehensively and systematically presents the available evidence of the effectiveness, safety and cost-effectiveness of alternative models of providing health care to ACF residents. OBJECTIVES Main objective To assess the effectiveness and safety of alternative models of delivering primary or secondary health care (or both) to older adults living in ACFs. Secondary objective To assess the cost-effectiveness of the alternative models. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers (WHO ICTRP, ClinicalTrials.gov) on 26 October 2022, together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA We included individual and cluster-randomised trials, and cost/cost-effectiveness data collected alongside eligible effectiveness studies. Eligible study participants included older people who reside in an ACF as their place of permanent abode and healthcare professionals delivering or co-ordinating the delivery of healthcare at ACFs. Eligible interventions focused on either ways of delivering primary or secondary health care (or both) or ways of co-ordinating the delivery of this care. Eligible comparators included usual care or another model of care. Primary outcomes were emergency department visits, unplanned hospital admissions and adverse effects (defined as infections, falls and pressure ulcers). Secondary outcomes included adherence to clinical guideline-recommended care, health-related quality of life of residents, mortality, resource use, access to primary or specialist healthcare services, any hospital admissions, length of hospital stay, satisfaction with the health care by residents and their families, work-related satisfaction and work-related stress of ACF staff. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias and certainty of evidence using GRADE. The primary comparison was any alternative model of care versus usual care. MAIN RESULTS We included 40 randomised trials (21,787 participants; three studies only reported number of beds) in this review. Included trials evaluated alternative models of care aimed at either all residents of the ACF (i.e. no specific health condition; 11 studies), ACF residents with mental health conditions or behavioural problems (12 studies), ACF residents with a specific condition (e.g. residents with pressure ulcers, 13 studies) or residents requiring a specific type of care (e.g. residents after hospital discharge, four studies). Most alternative models of care focused on 'co-ordination of care' (n = 31). Three alternative models of care focused on 'who provides care' and two focused on 'where care is provided' (i.e. care provided within ACF versus outside of ACF). Four models focused on the use of information and communication technology. Usual care, the comparator in all studies, was highly heterogeneous across studies and, in most cases, was poorly reported. Most of the included trials were susceptible to some form of bias; in particular, performance (89%), reporting (66%) and detection (42%) bias. Compared to usual care, alternative models of care may make little or no difference to the proportion of residents with at least one emergency department visit (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.84 to 1.20; 7 trials, 1276 participants; low-certainty evidence), but may reduce the proportion of residents with at least one unplanned hospital admission (RR 0.74, 95% CI 0.56 to 0.99, I2 = 53%; 8 trials, 1263 participants; low-certainty evidence). We are uncertain of the effect of alternative models of care on adverse events (proportion of residents with a fall: RR 1.15, 95% CI 0.83 to 1.60, I² = 74%; 3 trials, 1061 participants; very low-certainty evidence) and adherence to guideline-recommended care (proportion of residents receiving adequate antidepressant medication: RR 5.29, 95% CI 1.08 to 26.00; 1 study, 65 participants) as the certainty of the evidence is very low. Compared to usual care, alternative models of care may have little or no effect on the health-related quality of life of ACF residents (MD -0.016, 95% CI -0.036 to 0.004; I² = 23%; 12 studies, 4016 participants; low-certainty evidence) and probably make little or no difference to the number of deaths in residents of ACFs (RR 1.03, 95% CI 0.92 to 1.16, 24 trials, 3881 participants, moderate-certainty evidence). We did not pool the cost-effectiveness or cost data as the specific costs associated with the various alternative models of care were incomparable, both across models of care as well as across settings. Based on the findings of five economic evaluations (all interventions focused on co-ordination of care), we are uncertain of the cost-effectiveness of alternative models of care compared to usual care as the certainty of the evidence is very low. AUTHORS' CONCLUSIONS Compared to usual care, alternative models of care may make little or no difference to the number of emergency department visits but may reduce unplanned hospital admissions. We are uncertain of the effect of alternative care models on adverse events (i.e. falls, pressure ulcers, infections) and adherence to guidelines compared to usual care, as the certainty of the evidence is very low. Alternative models of care may have little or no effect on health-related quality of life and probably have no effect on mortality of ACF residents compared to usual care. Importantly, we are uncertain of the cost-effectiveness of alternative models of care due to the limited, disparate data available.
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Affiliation(s)
- Polina Putrik
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Liesl Grobler
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Aislinn Lalor
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Helen Ramsay
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alexandra Gorelik
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Deborah Parker
- Faculty of Health, The University of Technology Sydney, Sydney, NSW, Australia
| | - Mark Morgan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Denise O'Connor
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Tian Y, Wang S, Zhang Y, Meng L, Li X. Effectiveness of information and communication technology-based integrated care for older adults: a systematic review and meta-analysis. Front Public Health 2024; 11:1276574. [PMID: 38249380 PMCID: PMC10797014 DOI: 10.3389/fpubh.2023.1276574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
Background Information and communication technology (ICT) is a key factor in advancing the implementation of integrated care for older adults in the context of an aging society and the normalization of epidemics. This systematic review aims to comprehensively evaluate the effectiveness of ICT-based integrated care for older adults to provide input for the construction of intelligent integrated care models suitable for the context of an aging population in China. Methods A systematic review and meta-analysis were conducted using PubMed, Web of Science Core Collection, Scopus, MEDLINE, EBSCO, EMBASE, CINAHL with full text, ProQuest, and Cochrane Library databases, along with the Google Scholar search engine, for papers published between January 1, 2000, and July 25, 2022, to include randomized controlled trials and quasi-experimental studies of ICT-based integrated care for older adults. Two reviewers independently performed literature screening, quality assessment (JBI standardized critical appraisal tool), and data extraction. The results were pooled using a random effects model, and narrative synthesis was used for studies with insufficient outcome data. Results We included 32 studies (21 interventions) with a total of 30,200 participants (14,289 in the control group and 15,911 in the intervention group). However, the quality of the literature could be improved. The meta-analysis results showed that ICT-based integrated care significantly improved the overall perceived health status of older adults (n=3 studies, MD 1.29 (CI 0.11 to 2.46), no heterogeneity) and reduced the number of emergency department visits (n=11 studies, OR 0.46 (CI 0.25 to 0.86), high heterogeneity) but had no significant effect on improving quality of life, mobility, depression, hospital admissions and readmissions, or mortality in older adults, with a high degree of study heterogeneity. Narrative analysis showed that the overall quality of care, primary care service use, and functional status of older adults in the intervention group improved, but the cost-effectiveness was unclear. Conclusions ICT-based integrated care is effective in improving health outcomes for older adults, but the quality and homogeneity of the evidence base need to be improved. Researchers should develop intelligent integrated care programs in the context of local health and care welfare provision systems for older adults, along with the preferences and priorities of the older adults.
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Affiliation(s)
- Yutong Tian
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Shanshan Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yan Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Lixue Meng
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaohua Li
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
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Palm K, Kronlid C, Brantnell A, Elf M, Borg J. Identifying and Addressing Barriers and Facilitators for the Implementation of Internet of Things in Distributed Care: Protocol for a Case Study. JMIR Res Protoc 2023; 12:e44562. [PMID: 37768725 PMCID: PMC10570898 DOI: 10.2196/44562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/14/2023] [Accepted: 07/19/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The internet of things (IoT) is recognized as a valuable approach to supporting health care to achieve quality and person-centered care. This study aims to identify the facilitators and barriers associated with implementing IoT solutions in health care within a Scandinavian context. It addresses the pressing need to adapt health care systems to the demographic changes occurring in Scandinavia. The vision of "Vision eHealth 2025," a long-term strategic direction for digitalization in Sweden, serves as the background for this project. The implementation of IoT solutions is a crucial aspect of achieving the vision's goal of making Sweden a global leader in using digitalization and eHealth opportunities by 2025. IoT is recognized as a valuable approach to supporting health care to achieve quality and person-centered care. Previous research has shown that there is a gap in our understanding of social and organizational challenges related to IoT and that the implementation and introduction of new technology in health care is often problematic. OBJECTIVE In this study, we will identify facilitating and hindering factors for the implementation of IoT solutions in social and health care. METHODS We will use an explorative design with a case study approach. The data collection will comprise questionnaires and qualitative interviews. Also, a literature review will be conducted at the start of the project. Thus, quantitative and qualitative data will be collected concurrently and integrated into a convergent mixed methods approach. RESULTS As of June 2023, data for the review and 22 interviews with the stakeholders have been performed. The co-design with stakeholders will be performed in the fall of 2023. CONCLUSIONS This study represents a unique and innovative opportunity to gain new knowledge relevant and useful for future implementation of new technology at health care organizations so they can continue to offer high-quality, person-centered care. The outcomes of this research will contribute to a better understanding of the conditions necessary to implement and fully use the potential of IoT solutions. By developing cocreated implementation strategies, the study seeks to bridge the gap between theory and practice. Ultimately, this project aims to facilitate the adoption of IoT solutions in health care for promoting improved patient care and using technology to meet the evolving needs of health care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44562.
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Affiliation(s)
- Klas Palm
- Department of Civil and Industrial Engineering, Uppsala University, Uppsala, Sweden
| | - Carl Kronlid
- Department of Civil and Industrial Engineering, Uppsala University, Uppsala, Sweden
| | - Anders Brantnell
- Department of Civil and Industrial Engineering, Uppsala University, Uppsala, Sweden
| | - Marie Elf
- School of Health and Social Sciences, Dalarna University, Falun, Sweden
| | - Johan Borg
- School of Health and Social Sciences, Dalarna University, Falun, Sweden
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Xie F, Wen S, Deng A, Chen J, Xiong R. Evaluation of a community-based integrated care model (CIE) for frail older people in rural Foshan, China: study protocol for a stepped-wedge cluster randomized controlled trial {1}. Trials 2023; 24:315. [PMID: 37158975 PMCID: PMC10165829 DOI: 10.1186/s13063-023-07328-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND While community-based eldercare has proven to be effective in qualitative studies, there is limited evidence on the effectiveness of this geriatric care model in rural communities where caring for older people is traditionally the responsibility of family members, but a formal long-term care was recently introduced in China. CIE is a rural community-embedded intervention using multidisciplinary team, to provide evidenced-based integrated care services for frail older people including social care services and allied primary healthcare and community-based rehabilitation services. METHODS CIE is a prospective stepped-wedge cluster randomized trial conducted at 5 community eldercare centers in rural China. The multifaceted CIE intervention, guided by chronic care model and integrated care model, consists of five components: comprehensive geriatric assessment, individualized care planning, community-based rehabilitation, interdisciplinary case management, and care coordination. The intervention is rolled out in a staggered manner in these clusters of centers at an interval of 1 month. The primary outcomes include functional status, quality of life, and social support. Process evaluation will also be conducted. Generalized linear mixed model is employed for binary outcomes. DISCUSSION This study is expected to provide important new evidence on clinical effectiveness and implementation process of an integrated care model for frail older people. The CIE model is also unique as the first registered trial implementing a community-based eldercare model using multidisciplinary team to promote individualized social care services integrated with primary healthcare and community-based rehabilitation services for frail older people in rural China, where formal long-term care was recently introduced. TRIAL REGISTRATION {2A}: China Clinical Trials Register ( http://www.chictr.org.cn/historyversionpub.aspx?regno=ChiCTR2200060326 ). May 28th, 2022.
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Affiliation(s)
- Fengjiao Xie
- Department of General Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Shuang Wen
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Aiwen Deng
- Department of Rehabilitation, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
| | - Jianhao Chen
- Department of Rehabilitation, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
| | - Ribo Xiong
- Department of Rehabilitation, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China.
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Yutong T, Yan Z, Qingyun C, Lixue M, Mengke G, Shanshan W. Information and Communication Technology Based Integrated Care for Older Adults: A Scoping Review. Int J Integr Care 2023; 23:2. [PMID: 37033366 PMCID: PMC10077997 DOI: 10.5334/ijic.6979] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/09/2023] [Indexed: 04/05/2023] Open
Abstract
Background Integrated care is an important initiative to respond positively to the ageing of society and information and communication technology(ICT) plays an important role in facilitating the integration of functional and normative health and social care. The scoping review aims to synthesize evidence on the experience and practice of ICT-based implementation of integrated care for older adults. Methods This study followed the research framework developed by Arksey and O'malley for the scoping review and systematically searched for relevant studies published between 1 January 2000 and 30 March 2022 from nine electronic databases, three specialist journals, three key institutional websites, 11 integrated care project websites, google scholar and references of the studies to be included. Two reviewers independently screened and extracted data and used thematic analysis to sort out and summarize the core elements, hindrances and facilitators of ICT-based integrated care. Results A total of 77 studies were included in this study, including 36 ICT-based practice models of integrated care with seven core elements of implementation including single entry point, comprehensive geriatric assessment, personalized care planning, multidisciplinary case conferences, coordinated care, case management and patient empowerment, which generally had a positive effect on improving quality of life, caregiver burden and primary care resource utilization for older adults, but effectiveness evaluations remained Heterogeneity exists. The barriers and facilitators to ICT-based implementation of integrated care were grouped into four themes: demand-side factors, provider factors, technology factors and system factors. Conclusion The implementation of ICT-based integrated care for the elderly is expected to improve the health status of both the supply and demand of services, but there is still a need to strengthen the supply of human resources, team training and collaboration, ICT systems and financial support in order to promote the wider use of ICT in integrated care.
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Kim H, Choi H, Jung YI, Kim E, Lee W, Yi JY. Evaluation of a technology-enhanced, integrated community health and wellness program for seniors (HWePS): protocol of a non-randomized comparison trial. BMC Public Health 2023; 23:25. [PMID: 36604644 PMCID: PMC9813466 DOI: 10.1186/s12889-022-14921-z] [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: 09/15/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Healthy aging for all in the community is a shared public health agenda for countries with aging populations, but there is a lack of empirical evidence on community-wide preventive models that promote the health of older people residing in socially-disadvantaged communities. The Health and Wellness Program for Seniors (HWePS) is a technology-enhanced, multi-level, integrated health equity intervention model. This study evaluates the effect of the HWePS on the health and well-being of older adults residing in urban, low-income communities. METHODS/DESIGN: HWePS is a prospective, non-randomized comparison trial conducted in an intervention and a control neighborhood (dong) in Seoul, South Korea, over 12 months. Older people who reside in the small areas and meet the inclusion/exclusion criteria are eligible to participate. The multi-level, multi-faceted HWePS intervention is a preventive community care model for older residents guided by the expanded chronic care model, the comprehensive health literacy intervention model, and the Systems for Person-centered Elder Care model along with health equity frameworks. HWePS consists of four components: a health literacy intervention based on individual and community needs assessments, personalized (self-)care management featuring nurse coaching and peer support, a healthy-living and healthy-aging community initiative, and information and communication technology (ICT) systems. The primary outcomes are self-reported health and health-related quality of life. Outcome assessors and data analysts are blinded to group assignment. Process evaluation will be also conducted. DISCUSSION As a multi-level health equity project, HWePS has adopted a novel study design that simultaneously targets individual- and community-level factors known to contribute to health inequality in later life in the community. The study will provide insights into the effectiveness and implementation process of an integrated, multi-level, preventive community care model, which in turn can help improve the health outcomes of older residents and reduce disparities in underserved urban communities. TRIAL REGISTRATION ISRCTN29103760. Registered 2 September 2021, https://www.isrctn.com/ISRCTN29103760.
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Affiliation(s)
- Hongsoo Kim
- grid.31501.360000 0004 0470 5905Department of Public Health Science, Graduate School of Public Health, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul, South Korea ,grid.31501.360000 0004 0470 5905Institute of Health and Environment, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul, South Korea ,grid.31501.360000 0004 0470 5905Seoul National University Institute of Aging, 1 Gwanak-Ro, Gwanak-Gu, Seoul, South Korea
| | - Hyoungshim Choi
- grid.443782.e0000 0004 0647 3634College of Nursing, Hansei University, 30 Hansei-Ro, Gunpo-Shi, Gyeonggi-Do, South Korea
| | - Young-il Jung
- Department of Environmental Health, National Open University, 86 Daehak-Ro, Jongno-Gu, Seoul, South Korea
| | - Eunji Kim
- grid.31501.360000 0004 0470 5905Department of Public Health Science, Graduate School of Public Health, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul, South Korea
| | - Woojoo Lee
- grid.31501.360000 0004 0470 5905Department of Public Health Science, Graduate School of Public Health, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul, South Korea
| | - Jae Yoon Yi
- grid.31501.360000 0004 0470 5905Department of Public Health Science, Graduate School of Public Health, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul, South Korea
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Molinari-Ulate M, Mahmoudi A, Parra-Vidales E, Muñoz-Sánchez JL, Franco-Martín MA, van der Roest HG. Digital health technologies supporting the application of comprehensive geriatric assessments in long-term care settings or community care: A systematic review. Digit Health 2023; 9:20552076231191008. [PMID: 37529535 PMCID: PMC10388630 DOI: 10.1177/20552076231191008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/13/2023] [Indexed: 08/03/2023] Open
Abstract
Objective To provide high-quality elderly care, digital health technologies (DHTs) can potentially assist in reaching the full capacity of comprehensive geriatric assessments (CGAs) to improve communication and data transfer on patients' medical and treatment plan information and health decision-making. This systematic review aimed to describe the evidence on the feasibility and usability, efficacy and effectiveness, and implementation outcomes of DHTs developed to facilitate the administration of CGAs for long-term care settings or community care and to describe their technical features and components. Methods A search strategy was conducted in three databases, targeting studies evaluating the DHTs facilitating the administration of CGAs used in long-term care settings or community care. Studies in English and Spanish published up to 5 April 2023 were considered. Results Four DHTs supporting the administration of the CGAs were identified. Limited information was found on the technical features and required hardware. Some of the barriers identified regarding usability can be overcome with novel technologies; however, training of health professionals on the assessments and staff knowledge regarding the purpose of the data collected are not technology related and need to be addressed. Conclusions Barriers regarding usability were related to experienced difficulties navigating the software, unstable network connectivity, and length of the assessment. Feasibility obstacles were associated with the lack of training to use the DHT, availability and accessibility to hardware (e.g. laptops), and lack of insight into the clinical benefits of collected data. Further research must focus on these areas to improve the implementation and usefulness of these DHTs.
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Affiliation(s)
- Mauricio Molinari-Ulate
- Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca, University of Salamanca, Salamanca, Spain
- Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain
| | - Aysan Mahmoudi
- Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca, University of Salamanca, Salamanca, Spain
- Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain
| | - Esther Parra-Vidales
- Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain
| | - Juan-Luis Muñoz-Sánchez
- Psychiatry and Mental Health Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Manuel A Franco-Martín
- Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca, University of Salamanca, Salamanca, Spain
- Psychiatric and Mental Health Department, Zamora Healthcare Complex, Zamora, Spain
| | - Henriëtte G van der Roest
- Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands
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Gyamfi J, Cooper C, Barber A, Onakomaiya D, Lee WY, Zanowiak J, Mansu M, Diaz L, Thompson L, Abrams R, Schoenthaler A, Islam N, Ogedegbe G. Needs assessment and planning for a clinic-community-based implementation program for hypertension control among blacks in New York City: a protocol paper. Implement Sci Commun 2022; 3:96. [PMID: 36068611 PMCID: PMC9450294 DOI: 10.1186/s43058-022-00340-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertension (HTN) control among Blacks in the USA has become a major public health challenge. Barriers to HTN control exist at multiple levels including patient, physician, and the health system. Patients also encounter significant community-level barriers, such as poor linkage to social services that impact health (unstable housing, food access, transportation). We describe a multi-component needs assessment to inform the development, implementation, and evaluation of a program to improve HTN management within a large healthcare system in New York City (NYC). METHODS Guided by the Community-Based Participatory Research (CBPR) and Consolidated Framework for Implementation Research (CFIR) frameworks, data will be collected from four main sources: (1) quantitative surveys with health systems leadership, providers, and staff and with community-based organizations (CBOs) and faith-based organizations (FBOs); (2) qualitative interviews and focus groups with health systems leadership, providers, and staff and with CBOs and FBOs; (3) NYC Community Health Survey (CHS); and (4) New York University (NYU) Health system Epic Electronic Health Record (EHR) system. The data sources will allow for triangulation and synthesis of findings. DISCUSSION Findings from this comprehensive needs assessment will inform the development of a clinic-community-based practice facilitation program utilizing three multi-level evidence-based interventions (nurse case management, remote blood pressure (BP) monitoring, and social determinants of health (SDoH) support) integrated as a community-clinic linkage model for improved HTN control in Black patients. Integration of stakeholders' priorities, perspectives, and practices into the development of the program will improve adoption, sustainability, and the potential for scale-up. TRIAL REGISTRATION NCT05208450; registered on January 26, 2022.
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Affiliation(s)
- Joyce Gyamfi
- New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA.
| | - Claire Cooper
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Aigna Barber
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Deborah Onakomaiya
- Vilcek Institute of Graduate Biomedical Sciences, New York University Grossman School of Medicine, New York, NY, USA
| | - Wen-Yu Lee
- NYU Grossman School of Medicine, NYU Langone Health, 180 Madison Avenue, New York, NY, 10016, USA
| | - Jennifer Zanowiak
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Moses Mansu
- Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, USA
| | - Laura Diaz
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Linda Thompson
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Roger Abrams
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, USA
| | - Nadia Islam
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Gbenga Ogedegbe
- Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, USA
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10
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Using health information technology in residential aged care homes: An integrative review to identify service and quality outcomes. Int J Med Inform 2022; 165:104824. [DOI: 10.1016/j.ijmedinf.2022.104824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022]
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11
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Bally ELS, van Grieken A, Ye L, Ferrando M, Fernández-Salido M, Dix R, Zanutto O, Gallucci M, Vasiljev V, Carroll A, Darley A, Gil-Salmerón A, Ortet S, Rentoumis T, Kavoulis N, Mayora-Ibarra O, Karanasiou N, Koutalieris G, Hazelzet JA, Roozenbeek B, Dippel DWJ, Raat H. 'Value-based methodology for person-centred, integrated care supported by Information and Communication Technologies' (ValueCare) for older people in Europe: study protocol for a pre-post controlled trial. BMC Geriatr 2022; 22:680. [PMID: 35978306 PMCID: PMC9386998 DOI: 10.1186/s12877-022-03333-8] [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: 12/01/2021] [Accepted: 07/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background Older people receive care from multiple providers which often results in a lack of coordination. The Information and Communication Technology (ICT) enabled value-based methodology for integrated care (ValueCare) project aims to develop and implement efficient outcome-based, integrated health and social care for older people with multimorbidity, and/or frailty, and/or mild to moderate cognitive impairment in seven sites (Athens, Greece; Coimbra, Portugal; Cork/Kerry, Ireland; Rijeka, Croatia; Rotterdam, the Netherlands; Treviso, Italy; and Valencia, Spain). We will evaluate the implementation and the outcomes of the ValueCare approach. This paper presents the study protocol of the ValueCare project; a protocol for a pre-post controlled study in seven large-scale sites in Europe over the period between 2021 and 2023. Methods A pre-post controlled study design including three time points (baseline, post-intervention after 12 months, and follow-up after 18 months) and two groups (intervention and control group) will be utilised. In each site, (net) 240 older people (120 in the intervention group and 120 in the control group), 50–70 informal caregivers (e.g. relatives, friends), and 30–40 health and social care practitioners will be invited to participate and provide informed consent. Self-reported outcomes will be measured in multiple domains; for older people: health, wellbeing, quality of life, lifestyle behaviour, and health and social care use; for informal caregivers and health and social care practitioners: wellbeing, perceived burden and (job) satisfaction. In addition, implementation outcomes will be measured in terms of acceptability, appropriateness, feasibility, fidelity, and costs. To evaluate differences in outcomes between the intervention and control group (multilevel) logistic and linear regression analyses will be used. Qualitative analysis will be performed on the focus group data. Discussion This study will provide new insights into the feasibility and effectiveness of a value-based methodology for integrated care supported by ICT for older people, their informal caregivers, and health and social care practitioners in seven different European settings. Trial registration ISRCTN registry number is 25089186. Date of trial registration is 16/11/2021.
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Affiliation(s)
- E L S Bally
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A van Grieken
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - L Ye
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Ferrando
- R&D+I Consultancy, Kveloce I+D+i (Senior Europa SL), Valencia, Spain
| | - M Fernández-Salido
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - R Dix
- Fundación de La Comunidad Valenciana Para La Promoción Estratégica, El Desarrollo Y La Innovación Urbana (Las Naves), Valencia, Spain
| | - O Zanutto
- European Project Office Department, Istituto Per Servizi Di Ricovero E Assistenza Agli Anziani (Institute for Hospitalization and Care for the Elderly), Treviso, Italy
| | - M Gallucci
- Local Health Authority N.2 Treviso, Centre for Cognitive Disease and Dementia, Treviso, Italy
| | - V Vasiljev
- Faculty of Medicine, Department of Social Medcine and Epidemiology, University of Rijeka, Rijeka, Croatia
| | - A Carroll
- School of Medicine, University College Dublin, Dublin, Ireland
| | - A Darley
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | - S Ortet
- Innovation Department, Cáritas Diocesana de Coimbra, Coimbra, Portugal
| | - T Rentoumis
- Alliance for Integrated Care, Athens, Greece
| | | | - O Mayora-Ibarra
- Center for Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy
| | | | | | - J A Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B Roozenbeek
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - D W J Dippel
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
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12
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Schmüdderich K, Kiwitt J, Palm R, Roes M, Holle B. Core elements and potential of nurse-led care models in residential long-term care: A scoping review. J Clin Nurs 2022; 32:1858-1884. [PMID: 35122351 DOI: 10.1111/jocn.16231] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/26/2021] [Accepted: 01/12/2022] [Indexed: 01/12/2023]
Abstract
AIMS AND OBJECTIVE To identify and summarise core elements, resident-, staff- and process-related outcomes and challenges of nurse-led care models in residential long-term care. BACKGROUND Due to demographic trends, the complexity of residential long-term care has increased. To address this complexity, the implementation of nurse-led care models has been recommended. DESIGN Scoping review. METHODS A systematic search was conducted of English and German articles in CINAHL via EBSCO, MEDLINE via PubMed, Cochrane Library and Scopus. Forward and backward citation tracking via reference lists and Google Scholar supplemented the search. The final update was made on 19 January 2021. To draw conclusions about the potential of nurse-led care models, evaluation studies of the described models for residents in nursing homes were included. Full texts were independently screened and assessed for methodological quality. Data were extracted and summarised in tables and synthesised for analysis. The core elements of the models were described using the Sustainable intEgrated chronic care modeLs for multimorbidity: delivery, FInancing and performancE (SELFIE) framework. The review followed the PRISMA-ScR guideline. RESULTS We included 13 studies of 12 nurse-led care models. The different models comprised many of the core elements suggested in the SELFIE framework, particularly in the components service delivery, workforce, and leadership and governance. The studies reported a broad range of resident-, staff- and process-related outcomes and challenges considered relevant to the success of the models. CONCLUSIONS Studies evaluating nurse-led care models in nursing homes are limited and of moderate quality. This review demonstrates that nurse-led care models include many elements for care coordination and could improve resident-, staff- and process-related outcomes. RELEVANCE TO CLINICAL PRACTICE This review highlights that nurse-led care models share common core elements despite their heterogeneity. It also shows that highly qualified nurses in nurse-led care models can advance nursing practice in nursing homes.
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Affiliation(s)
- Kathrin Schmüdderich
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Jörn Kiwitt
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Rebecca Palm
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Bernhard Holle
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
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Choi H, Jung YI, Kim H. Implementation fidelity of the Systems for Person-Centered Elder Care (SPEC): a process evaluation study. Implement Sci 2021; 16:52. [PMID: 33980251 PMCID: PMC8117605 DOI: 10.1186/s13012-021-01113-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Systems for Person-Centered Elder Care (SPEC), a complex intervention, was conducted to examine its effectiveness as a technology-enhanced, multidisciplinary, and integrated care model for frail older persons among ten nursing homes (NHs) in South Korea where formal long-term care has recently been introduced. The purpose of this study was to evaluate the implementation fidelity of the SPEC intervention and to identify moderating factors that influence the implementation fidelity. METHODS This study was a process evaluation based on an evidence-based framework for implementation fidelity using a mixed-methods design. Quantitative data from consultant logbooks, NH documentations, an information and communications technology (ICT) system, and a standardized questionnaire were collected from April 2015 to December 2016 and analyzed by calculating the descriptive statistics. Semi-structured focus group interviews were held with multidisciplinary teams from the participating NHs. Qualitative data from a semi-structured questionnaire and the focus group interviews were analyzed using content analysis. RESULTS The SPEC program demonstrated good implementation fidelity, and adherence to the SPEC program was strong in all aspects, such as content, coverage, frequency, and duration. Of the participating on-site coordinators, 60% reported that the SPEC model positively impacted needs assessment and the reporting system for resident care. The important facilitating factors were tailored facilitating strategies, assurance of the quality of delivery, and recruitment strategies. CONCLUSION The effectiveness of the SPEC program was driven by good implementation fidelity. The key factors of good implementation fidelity were tailored delivery of evidence-based interventions over process evaluation work, facilitating strategies, and ICT support. Larger implementation studies with a more user-friendly ICT system are recommended. TRIAL REGISTRATION ISRCTN registry, ISRCTN11972147 . Registered on 16 March 2015.
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Affiliation(s)
- Hyoungshim Choi
- Department of Nursing, Hansei University, 30 Hansei-ro, Gyeong-gi, South Korea
| | - Young-Il Jung
- Department of Environmental Health, Korea National Open University, 86 Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Hongsoo Kim
- Graduate School of Public Health, Department of Public Health Sciences, Institute of Aging, Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, South Korea.
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