Emotion sharing in remote patient monitoring of patients with chronic kidney disease

Operational Implementation of Remote Patient Monitoring Within a Large Ambulatory Health System: Multimethod Qualitative Case Study

BACKGROUND

Remote patient monitoring (RPM) technologies can support patients living with chronic conditions through self-monitoring of physiological measures and enhance clinicians' diagnostic and treatment decisions. However, to date, large-scale pragmatic RPM implementation within health systems has been limited, and understanding of the impacts of RPM technologies on clinical workflows and care experience is lacking.

OBJECTIVE

In this study, we evaluate the early implementation of operational RPM initiatives for chronic disease management within the ambulatory network of an academic medical center in New York City, focusing on the experiences of "early adopter" clinicians and patients.

METHODS

Using a multimethod qualitative approach, we conducted (1) interviews with 13 clinicians across 9 specialties considered as early adopters and supporters of RPM and (2) speculative design sessions exploring the future of RPM in clinical care with 21 patients and patient representatives, to better understand experiences, preferences, and expectations of pragmatic RPM use for health care delivery.

RESULTS

We identified themes relevant to RPM implementation within the following areas: (1) data collection and practices, including impacts of taking real-world measures and issues of data sharing, security, and privacy; (2) proactive and preventive care, including proactive and preventive monitoring, and proactive interventions and support; and (3) health disparities and equity, including tailored and flexible care and implicit bias. We also identified evidence for mitigation and support to address challenges in each of these areas.

CONCLUSIONS

This study highlights the unique contexts, perceptions, and challenges regarding the deployment of RPM in clinical practice, including its potential implications for clinical workflows and work experiences. Based on these findings, we offer implementation and design recommendations for health systems interested in deploying RPM-enabled health care.

Uptake of an app-based case management service for HIV-positive men who have sex with men in China: a process evaluation study (Preprint)

BACKGROUND

Men who have sex with men (MSM) in China are disproportionately affected by the HIV epidemic, and medication adherence to antiretroviral treatment in this vulnerable population is suboptimal. To address this issue, we developed an app-based case management service with multiple components, informed by the Information Motivation Behavioral skills model.

OBJECTIVE

We aimed to conduct a process evaluation for the implementation of an innovative app-based intervention guided by the Linnan and Steckler framework.

METHODS

Process evaluation was performed alongside a randomized controlled trial in the largest HIV clinic in Guangzhou, China. Eligible participants were HIV-positive MSM aged ≥18 years planning to initiate treatment on the day of recruitment. The app-based intervention had 4 components: web-based communication with case managers, educational articles, supportive service information (eg, information on mental health care and rehabilitation service), and hospital visit reminders. Process evaluation indicators of the intervention include dose delivered, dose received, fidelity, and satisfaction. The behavioral outcome was adherence to antiretroviral treatment at month 1, and Information Motivation Behavioral skills model scores were the intermediate outcome. Logistic and linear regression was used to investigate the association between intervention uptake and outcomes, controlling for potential confounders.

RESULTS

A total of 344 MSM were recruited from March 19, 2019, to January 13, 2020, and 172 were randomized to the intervention group. At month 1 follow-up, there was no significant difference in the proportion of adherent participants between the intervention and control groups (66/144, 45.8% vs 57/134, 42.5%; P=.28). In the intervention group, 120 participants engaged in web-based communication with case managers and 158 accessed at least 1 of the delivered articles. The primary concern captured in the web-based conversation was the side effects of the medication (114/374, 30.5%), which was also one of the most popular educational articles topics. The majority (124/144, 86.1%) of participants that completed the month 1 survey rated the intervention as "very helpful" or "helpful." The number of educational articles accessed was associated with adequate adherence in the intervention group (odds ratio 1.08, 95% CI 1.02-1.15; P=.009). The intervention also improved the motivation score after adjusting for baseline values (β=2.34, 95% CI 0.77-3.91; P=.004). However, the number of web-based conversations, regardless of conversation features, was associated with lower motivation scores in the intervention group.

CONCLUSIONS

The intervention was well-received. Delivering educational resources of interest may enhance medication adherence. The uptake of the web-based communication component could serve as an indicator of real-life difficulties and could be used by case managers to identify potential inadequate adherence.

TRIAL REGISTRATION

Clinicaltrial.gov NCT03860116; https://clinicaltrials.gov/ct2/show/NCT03860116.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12889-020-8171-5.

Privacy Policy Compliance of Chronic Disease Management Apps in China: Scale Development and Content Evaluation

Background

With the development of mobile health (mHealth), chronic disease management apps have brought not only the possibility of reducing the burden of chronic diseases but also huge privacy risks to patients’ health data.

Objective

The purpose of the study was to analyze the extent to which chronic disease management apps in China comply with the Personal Information Security Specification (PI Specification).

Methods

The compliance of 45 popular chronic disease management apps was evaluated from the perspective of the information life cycle. To conduct a fine-grained evaluation, a scale based on the PI Specification was developed. Finally, 6 level 1 indicators, 22 level 2 indicators, and 61 level 3 indicators were defined.

Results

There were 33/45 apps (73%) with a privacy policy, and the average score of these apps was 40.4 out of 100. Items of level 1 indicators with high scores included general characteristics (mean 51.9% [SD 28.1%]), information collection and use (mean 51.1% [SD 36.7%]), and information sharing and transfer (mean 50.3% [SD 33.5%]). Information storage and protection had the lowest compliance with PI Specification (mean 29.4% [SD 32.4%]). Few personal information (PI) controllers have stated how to handle security incidents, including security incident reporting (7/33, 21%), security incident notification (10/33, 30%), and commitment to bear corresponding legal responsibility for PI security incidents (1/33, 3%). The performance of apps in the stage of information destruction (mean 31.8% [SD 40.0%]) was poor, and only 21% (7/33) apps would notify third parties to promptly delete PI after individuals cancelled their accounts. Moreover, the scoring rate for rights of PI subjects is generally low (mean 31.2% [SD 35.5%]), especially for obtaining copies of PI (15%) and responding to requests (25%).

Conclusions

Although most chronic disease management apps had a privacy policy, the total compliance rate of the policy content was low, especially in the stage of information storage and protection. Thus, the field has a long way to go with regard to compliance around personal privacy protection in China.

Reporting health data in waiting rooms with mobile technology: Patient expectation and confirmation

OBJECTIVES

Hospitals and medical staff use digital devices such as mobile phones and tablets to treat patients. Prior research has examined patient-reported outcomes, and the use of medical devices to do diagnosis and prognosis of patients, but not whether patients like using, and intend to use in future, mobile devices to self-report medical data. We address this research gap by developing a theoretical model based on the expectancy confirmation model (ECM) and testing it in an empirical study of patients using mobile technology to self-report data.

DESIGN

This study adopts a non-interventional cross-sectional research design. Randomly-selected patients provided data via survey and physical measurements. The target population comprises adults visiting a healthcare laboratory to get their blood drawn.

MATERIALS AND METHODS

We surveyed 190 randomly-selected patients waiting for treatment in the clinic. They were surveyed at two points in time - before and after their blood was drawn - on their demographic characteristics, research variables concerning their use of mobile devices to provide medical information, and perceived clinical data (blood pressure, height and weight). The research model was tested using structural equation modeling.

RESULTS

The study found strong support for the research model, with seven of eight hypotheses being supported. Both self-disclosure effort and feedback expectation positively affect both perceived feedback quality and confirmation. Contrary to expectations, perceived feedback quality was not found to affect confirmation. Perceived feedback quality, along with confirmation, was found to positively affect satisfaction, which was found to affect intention to disclose medical data through mobile technology.

CONCLUSIONS

The study's findings support the proposed path from feedback expectation and self-disclosure effort to confirmation to satisfaction to disclosure intention. Although perceived feedback does not affect confirmation, it affects satisfaction. Overall, we believe the results provide novel insights to both scientific research community and practitioners about using mobile technologies for self-reporting medical data.

How hospitals in mainland China responded to the outbreak of COVID-19 using information technology-enabled services: An analysis of hospital news webpages

OBJECTIVE

Many countries have implemented quarantine rules during the global outbreak of coronavirus disease 2019 (COVID-19). Understanding how hospitals can continue providing services in an effective manner under these circumstances is thus important. In this study, we investigate how information technology (IT) helped hospitals in mainland China better respond to the outbreak of the pandemic.

MATERIALS AND METHODS

We conducted a content analysis of pages published on the websites of the top 50 hospitals in mainland China between January 22 and February 21, 2020. In total, we analyzed 368 pages that the hospitals published during the initial days of the COVID-19 pandemic. The purpose was to identify common themes related to the utilization of IT by these hospitals in response to the pandemic's outbreak.

RESULTS

We identified 5 focal themes across the webpages published by the hospitals during our study period, including (1) popular medical science education, (2) digitalized hospital processes, (3) knowledge management for medical professionals, (4) telemedicine, and (5) new IT initiatives for healthcare services. Our analysis revealed that Chinese hospitals spent greater effort in promoting popular medical science education in the initial stages of our study period and more on telemedicine in the latter stages.

DISCUSSION

We propose a configurational approach for hospitals to design response strategies to pandemic outbreaks based on their available resources.

CONCLUSIONS

Our study provides rich insights for hospitals to better utilize their IT resources and some recommendations for policymaker to better support hospitals in the future.