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Van Der Donckt J, Vandenbussche N, Van Der Donckt J, Chen S, Stojchevska M, De Brouwer M, Steenwinckel B, Paemeleire K, Ongenae F, Van Hoecke S. Mitigating data quality challenges in ambulatory wrist-worn wearable monitoring through analytical and practical approaches. Sci Rep 2024; 14:17545. [PMID: 39079945 PMCID: PMC11289092 DOI: 10.1038/s41598-024-67767-3] [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: 12/27/2023] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
Chronic disease management and follow-up are vital for realizing sustained patient well-being and optimal health outcomes. Recent advancements in wearable technologies, particularly wrist-worn devices, offer promising solutions for longitudinal patient monitoring, replacing subjective, intermittent self-reporting with objective, continuous monitoring. However, collecting and analyzing data from wearables presents several challenges, such as data entry errors, non-wear periods, missing data, and wearable artifacts. In this work, we explore these data analysis challenges using two real-world datasets (mBrain21 and ETRI lifelog2020). We introduce practical countermeasures, including participant compliance visualizations, interaction-triggered questionnaires to assess personal bias, and an optimized pipeline for detecting non-wear periods. Additionally, we propose a visualization-oriented approach to validate processing pipelines using scalable tools such as tsflex and Plotly-Resampler. Lastly, we present a bootstrapping methodology to evaluate the variability of wearable-derived features in the presence of partially missing data segments. Prioritizing transparency and reproducibility, we provide open access to our detailed code examples, facilitating adaptation in future wearable research. In conclusion, our contributions provide actionable approaches for improving wearable data collection and analysis.
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Affiliation(s)
- Jonas Van Der Donckt
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium.
| | - Nicolas Vandenbussche
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Basic and Applied Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Stephanie Chen
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
| | - Marija Stojchevska
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
| | - Mathias De Brouwer
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
| | - Bram Steenwinckel
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Basic and Applied Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Femke Ongenae
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
| | - Sofie Van Hoecke
- IDLab, Ghent University - Imec, Technologiepark-Zwijnaarde, 9052, Ghent, Belgium
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2
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Gunn R, Watkins SL, Boston D, Rosales AG, Massimino S, Navale S, Fitzpatrick SL, Dickerson J, Gold R, Lee G, McMullen CK. Evaluation of a Remote Patient Monitoring Program During the COVID-19 Pandemic: Retrospective Case Study With a Mixed Methods Explanatory Sequential Design. JMIR Form Res 2024; 8:e55732. [PMID: 38980716 PMCID: PMC11267095 DOI: 10.2196/55732] [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: 12/21/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Community health center (CHC) patients experience a disproportionately high prevalence of chronic conditions and barriers to accessing technologies that might support the management of these conditions. One such technology includes tools used for remote patient monitoring (RPM), the use of which surged during the COVID-19 pandemic. OBJECTIVE The aim of this study was to assess how a CHC implemented an RPM program during the COVID-19 pandemic. METHODS This retrospective case study used a mixed methods explanatory sequential design to evaluate a CHC's implementation of a suite of RPM tools during the COVID-19 pandemic. Analyses used electronic health record-extracted health outcomes data and semistructured interviews with the CHC's staff and patients participating in the RPM program. RESULTS The CHC enrolled 147 patients in a hypertension RPM program. After 6 months of RPM use, mean systolic blood pressure (BP) was 13.4 mm Hg lower and mean diastolic BP 6.4 mm Hg lower, corresponding with an increase in hypertension control (BP<140/90 mm Hg) from 33.3% of patients to 81.5%. Considerable effort was dedicated to standing up the program, reinforced by organizational prioritization of chronic disease management, and by a clinician who championed program implementation. Noted barriers to implementation of the RPM program were limited initial training, lack of sustained support, and complexities related to the RPM device technology. CONCLUSIONS While RPM technology holds promise for addressing chronic disease management, successful RPM program requires substantial investment in implementation support and technical assistance.
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Affiliation(s)
- Rose Gunn
- OCHIN, Inc, Portland, OR, United States
| | | | | | - A Gabriela Rosales
- Kaiser Permanente Center for Health Research, Kaiser Permanente, Portland, OR, United States
| | - Stefan Massimino
- Kaiser Permanente Center for Health Research, Kaiser Permanente, Portland, OR, United States
| | | | - Stephanie L Fitzpatrick
- Kaiser Permanente Center for Health Research, Kaiser Permanente, Portland, OR, United States
| | - John Dickerson
- Kaiser Permanente Center for Health Research, Kaiser Permanente, Portland, OR, United States
| | - Rachel Gold
- OCHIN, Inc, Portland, OR, United States
- Kaiser Permanente Center for Health Research, Kaiser Permanente, Portland, OR, United States
| | - George Lee
- Asian Health Services, Oakland, CA, United States
| | - Carmit K McMullen
- Kaiser Permanente Center for Health Research, Kaiser Permanente, Portland, OR, United States
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3
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Weijers J, Prins MLM, van Dam DGHA, van Nieuwkoop C, Alsma J, Haak HR, V Uffen JW, Kaasjager KAH, Kremers MNT, Nanayakkara PWB, Stassen PM, Groeneveld GH. Patients' Perspectives and Feasibility of Home Monitoring in Acute Care: The AcuteCare@Home Flash Mob Study. Telemed J E Health 2024. [PMID: 38938204 DOI: 10.1089/tmj.2024.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Objective: To determine patients' perspectives on home monitoring at emergency department (ED) presentation and shortly after admission and compare these with their physicians' perspectives. Methods: Forty Dutch hospitals participated in this prospective flash mob study. Adult patients with acute medical conditions, treated by internal medicine specialties, presenting at the ED or admitted at the admission ward within the previous 24 h were included. The primary outcome was the proportion of patients who were able and willing to undergo home monitoring. Secondary outcomes included identifying barriers to home monitoring, patient's prerequisites, and assessing the agreement between the perspectives of patients and treating physicians. Results: On February 2, 2023, in total 665 patients [median age 69 (interquartile range: 55-78) years; 95.5% community dwelling; 29.3% Modified Early Warning Score ≥3; 29.5% clinical frailty score ≥5] were included. In total, 19.6% of ED patients were admitted and 26% of ward patients preferred home monitoring as continuation of care. Guaranteed readmission (87.8%), ability to contact the hospital 24/7 (77.3%), and a family caregiver at home (55.7%) were the most often reported prerequisites. Barriers for home monitoring were feeling too severely ill (78.8%) and inability to receive the required treatment at home (64.4%). The agreement between patients and physicians was fair (Cohens kappa coefficient 0.26). Conclusions: A substantial proportion of acutely ill patients stated that they were willing and able to be monitored at home. Guaranteed readmission, availability of a treatment team (24/7), and a home support system are needed for successful implementation of home monitoring in acute care.
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Affiliation(s)
- Jari Weijers
- Division of Acute Medicine, Department of Internal Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Manon L M Prins
- Division of Acute Medicine, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Davy G H A van Dam
- Division of Acute Medicine, Department of Internal Medicine, St Jans Gasthuis, Weert, The Netherlands
| | - Cees van Nieuwkoop
- Division of Acute Medicine, Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - Jelmer Alsma
- Division of Acute Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Harm R Haak
- Division of Acute Medicine, Department of Internal Medicine, Máxima Medical Center, Veldhoven, The Netherlands
| | - Jan Willem V Uffen
- Division of Acute Medicine, Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Karin A H Kaasjager
- Division of Acute Medicine, Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjolein N T Kremers
- Division of Acute Medicine, Department of Internal Medicine, Máxima Medical Center, Veldhoven, The Netherlands
| | - Prabath W B Nanayakkara
- Division of Acute Medicine, Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Patricia M Stassen
- Division of Acute Medicine, Department of Internal Medicine, School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Geert H Groeneveld
- Division of Acute Medicine, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
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4
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Claggett J, Petter S, Joshi A, Ponzio T, Kirkendall E. An Infrastructure Framework for Remote Patient Monitoring Interventions and Research. J Med Internet Res 2024; 26:e51234. [PMID: 38815263 PMCID: PMC11176884 DOI: 10.2196/51234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/12/2023] [Accepted: 04/09/2024] [Indexed: 06/01/2024] Open
Abstract
Remote patient monitoring (RPM) enables clinicians to maintain and adjust their patients' plan of care by using remotely gathered data, such as vital signs, to proactively make medical decisions about a patient's care. RPM interventions have been touted as a means to improve patient care and well-being while reducing costs and resource needs within the health care ecosystem. However, multiple interworking components must be successfully implemented for an RPM intervention to yield the desired outcomes, and the design and key driver of each component can vary depending on the medical context. This viewpoint and perspective paper presents a 4-component RPM infrastructure framework based on a synthesis of existing literature and practice related to RPM. Specifically, these components are identified and considered: (1) data collection, (2) data transmission and storage, (3) data analysis, and (4) information presentation. Interaction points to consider between components include transmission, interoperability, accessibility, workflow integration, and transparency. Within each of the 4 components, questions affecting research and practice emerge that can affect the outcomes of RPM interventions. This framework provides a holistic perspective of the technologies involved in RPM interventions and how these core elements interact to provide an appropriate infrastructure for deploying RPM in health systems. Further, it provides a common vocabulary to compare and contrast RPM solutions across health contexts and may stimulate new research and intervention opportunities.
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Affiliation(s)
- Jennifer Claggett
- School of Business, Wake Forest University, Winston-Salem, NC, United States
- Center for Healthcare Innovation, School of Medicine, Wake Forest University, Winston-Salem, NC, United States
| | - Stacie Petter
- School of Business, Wake Forest University, Winston-Salem, NC, United States
| | - Amol Joshi
- School of Business, Wake Forest University, Winston-Salem, NC, United States
- Center for Healthcare Innovation, School of Medicine, Wake Forest University, Winston-Salem, NC, United States
| | - Todd Ponzio
- Health Science Center, University of Tennessee, Memphis, TN, United States
| | - Eric Kirkendall
- Center for Healthcare Innovation, School of Medicine, Wake Forest University, Winston-Salem, NC, United States
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5
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O'Connor L, Behar S, Tarrant S, Stamegna P, Pretz C, Wang B, Savage B, Scornavacca T, Shirshac J, Wilkie T, Hyder M, Zai A, Toomey S, Mullen M, Fisher K, Tigas E, Wong S, McManus DD, Alper E, Lindenauer PK, Dickson E, Broach J, Kheterpal V, Soni A. Rationale and Design of Healthy at Home for COPD: an Integrated Remote Patient Monitoring and Virtual Pulmonary Rehabilitation Pilot Study. RESEARCH SQUARE 2024:rs.3.rs-3901309. [PMID: 38746125 PMCID: PMC11092828 DOI: 10.21203/rs.3.rs-3901309/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a common, costly, and morbid condition. Pulmonary rehabilitation, close monitoring, and early intervention during acute exacerbations of symptoms represent a comprehensive approach to improve outcomes, but the optimal means of delivering these services is uncertain. Logistical, financial, and social barriers to providing healthcare through face-to-face encounters, paired with recent developments in technology, have stimulated interest in exploring alternative models of care. The Healthy at Home study seeks to determine the feasibility of a multimodal, digitally enhanced intervention provided to participants with COPD longitudinally over six months. This paper details the recruitment, methods, and analysis plan for the study, which is recruiting 100 participants in its pilot phase. Participants were provided with several integrated services including a smartwatch to track physiological data, a study app to track symptoms and study instruments, access to a mobile integrated health program for acute clinical needs, and a virtual comprehensive pulmonary support service. Participants shared physiologic, demographic, and symptom reports, electronic health records, and claims data with the study team, facilitating a better understanding of their symptoms and potential care needs longitudinally. The Healthy at Home study seeks to develop a comprehensive digital phenotype of COPD by tracking and responding to multiple indices of disease behavior and facilitating early and nuanced responses to changes in participants' health status. This study is registered at Clinicaltrials.gov (NCT06000696).
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6
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Ginsburg GS, Picard RW, Friend SH. Key Issues as Wearable Digital Health Technologies Enter Clinical Care. N Engl J Med 2024; 390:1118-1127. [PMID: 38507754 DOI: 10.1056/nejmra2307160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Geoffrey S Ginsburg
- From the All of Us Research Program, National Institutes of Health, Bethesda, MD (G.S.G.); the MIT Media Lab, Cambridge, and Empatica, Boston - both in Massachusetts (R.W.P.); the Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.H.F.), and 4YouandMe, Seattle (S.H.F.)
| | - Rosalind W Picard
- From the All of Us Research Program, National Institutes of Health, Bethesda, MD (G.S.G.); the MIT Media Lab, Cambridge, and Empatica, Boston - both in Massachusetts (R.W.P.); the Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.H.F.), and 4YouandMe, Seattle (S.H.F.)
| | - Stephen H Friend
- From the All of Us Research Program, National Institutes of Health, Bethesda, MD (G.S.G.); the MIT Media Lab, Cambridge, and Empatica, Boston - both in Massachusetts (R.W.P.); the Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.H.F.), and 4YouandMe, Seattle (S.H.F.)
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7
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Eisenkraft A. Threat Agnostic Approach to Epidemic Management Using Continuous Remote Patient Monitoring. Health Secur 2024; 22:156-158. [PMID: 38483338 PMCID: PMC11044856 DOI: 10.1089/hs.2023.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Affiliation(s)
- Arik Eisenkraft
- Arik Eisenkraft, MD, MHA, is a Senior Researcher, The Institute for Research in Military Medicine, The Department of Military Medicine, The Hebrew University Faculty of Medicine and the IDF Medical Corps, Jerusalem, Israel
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8
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Snoswell CL, Vitangcol KJ, Haydon HM, Gray LC, Leedie F, Smith AC, Caffery LJ. Cost-effectiveness of remote patient monitoring for First Nations peoples living with diabetes in regional Australia. J Telemed Telecare 2023; 29:3S-7S. [PMID: 38007695 DOI: 10.1177/1357633x231214019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
The aim of this study was to determine the cost-effectiveness of remote patient monitoring (RPM) with First Nations peoples living with diabetes. This study was set at the Goondir Health Service (GHS), an Aboriginal and Torres Strait Islander Community-Controlled Health in South-West Queensland. Electronic medical records and RPM data were provided by the GHS. Clinical effectiveness was determined by comparing mean HbA1c before and after enrolment in the RPM service. Our analysis found no statistically significant effect between the mean HbA1c before and after enrolment, so this analysis focused on net-benefit and return on investment for costs from the perspective of the GHS. The 6-month RPM service for 84 clients cost AUD $67,841 to cover RPM equipment, ongoing technology costs, and a dedicated Virtual Care Manager, equating to $808 per client. There were 199 additional client-clinician interactions in the period after enrolment resulting in an additional $4797 revenue for the GHS. Therefore, the program cost the GHS $63,044 to deliver, representing a return on investment of around 7 cents for every dollar they spent. Whilst the diabetes RPM service was equally effective as usual care and resulted in increased interactions with clients, the cost for the service was substantially more than the additional revenue generated from increased interactions. This evidence highlights the need for alternative funding models for RPM services and demonstrates the need to focus future research on long-term clinical effects and the extra-clinical benefits resulting from services of this type.
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Affiliation(s)
- Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Kathryn J Vitangcol
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Leonard C Gray
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | | | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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9
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Tang M, Nakamoto CH, Stern AD, Zubizarreta JR, Marcondes FO, Uscher-Pines L, Schwamm LH, Mehrotra A. Effects of Remote Patient Monitoring Use on Care Outcomes Among Medicare Patients With Hypertension : An Observational Study. Ann Intern Med 2023; 176:1465-1475. [PMID: 37931262 DOI: 10.7326/m23-1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Remote patient monitoring (RPM) is a promising tool for improving chronic disease management. Use of RPM for hypertension monitoring is growing rapidly, raising concerns about increased spending. However, the effects of RPM are still unclear. OBJECTIVE To estimate RPM's effect on hypertension care and spending. DESIGN Matched observational study emulating a longitudinal, cluster randomized trial. After matching, effect estimates were derived from a regression analysis comparing changes in outcomes from 2019 to 2021 for patients with hypertension at high-RPM practices versus those at matched control practices with little RPM use. SETTING Traditional Medicare. PATIENTS Patients with hypertension. INTERVENTION Receipt of care at a high-RPM practice. MEASUREMENTS Primary outcomes included hypertension medication use (medication fills, adherence, and unique medications received), outpatient visit use, testing and imaging use, hypertension-related acute care use, and total hypertension-related spending. RESULTS 192 high-RPM practices (with 19 978 patients with hypertension) were matched to 942 low-RPM control practices (with 95 029 patients with hypertension). Compared with patients with hypertension at matched low-RPM practices, patients with hypertension at high-RPM practices had a 3.3% (95% CI, 1.9% to 4.8%) relative increase in hypertension medication fills, a 1.6% (CI, 0.7% to 2.5%) increase in days' supply, and a 1.3% (CI, 0.2% to 2.4%) increase in unique medications received. Patients at high-RPM practices also had fewer hypertension-related acute care encounters (-9.3% [CI, -20.6% to 2.1%]) and reduced testing use (-5.9% [CI, -11.9% to 0.0%]). However, these patients also saw increases in primary care physician outpatient visits (7.2% [CI, -0.1% to 14.6%]) and a $274 [CI, $165 to $384]) increase in total hypertension-related spending. LIMITATION Lacked blood pressure data; residual confounding. CONCLUSION Patients in high-RPM practices had improved hypertension care outcomes but increased spending. PRIMARY FUNDING SOURCE National Institute of Neurological Disorders and Stroke.
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Affiliation(s)
- Mitchell Tang
- Harvard Graduate School of Arts and Sciences, Cambridge; and Harvard Business School, Boston, Massachusetts (M.T.)
| | - Carter H Nakamoto
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts (C.H.N.)
| | - Ariel D Stern
- Harvard Business School, Boston; and Harvard-MIT Center for Regulatory Science, Boston, Massachusetts (A.D.S.)
| | - Jose R Zubizarreta
- Department of Health Care Policy, Harvard Medical School, Boston; Department of Biostatistics, Harvard School of Public Health, Boston; and Department of Statistics, Harvard University, Cambridge, Massachusetts (J.R.Z.)
| | - Felippe O Marcondes
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts (F.O.M.)
| | | | - Lee H Schwamm
- Stroke Division, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts (L.H.S.)
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston; and Beth Israel Deaconess Medical Center, Boston, Massachusetts (A.M.)
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10
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DeBolt CL, Rheuban KS, Harris D. Telehealth Services: Improving Equity in Pulmonary Health Outcomes. Clin Chest Med 2023; 44:651-660. [PMID: 37517842 DOI: 10.1016/j.ccm.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Expansion of telehealth services has the potential to attenuate health inequities in pulmonary medicine, by improving access to care and health outcomes in patients with lung disease. These telehealth services include remote patient monitoring, synchronous telemedicine, and remote pulmonary rehabilitation. Currently, patients who are White, well-educated, wealthy, and from urban areas are the most likely to benefit from telehealth services. Without clear policy decisions and planning to overcome the "Digital Divide," telehealth services will only exacerbate existing disparities within the pulmonary disease. We describe the benefits and limitations of these new technologies and their impact on improving equity in pulmonary medicine.
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Affiliation(s)
| | - Karen S Rheuban
- Department of Pediatrics, University of Virginia, Center for Telehealth, Charlottesville, VA, USA
| | - Drew Harris
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
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11
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Minty E, Bray E, Bachus CB, Everett B, Smith KM, Matijevich E, Hajizadeh M, Armstrong DG, Liden B. Preventative Sensor-Based Remote Monitoring of the Diabetic Foot in Clinical Practice. SENSORS (BASEL, SWITZERLAND) 2023; 23:6712. [PMID: 37571496 PMCID: PMC10422561 DOI: 10.3390/s23156712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023]
Abstract
Diabetes and its complications, particularly diabetic foot ulcers (DFUs), pose significant challenges to healthcare systems worldwide. DFUs result in severe consequences such as amputation, increased mortality rates, reduced mobility, and substantial healthcare costs. The majority of DFUs are preventable and treatable through early detection. Sensor-based remote patient monitoring (RPM) has been proposed as a possible solution to overcome limitations, and enhance the effectiveness, of existing foot care best practices. However, there are limited frameworks available on how to approach and act on data collected through sensor-based RPM in DFU prevention. This perspective article offers insights from deploying sensor-based RPM through digital DFU prevention regimens. We summarize the data domains and technical architecture that characterize existing commercially available solutions. We then highlight key elements for effective RPM integration based on these new data domains, including appropriate patient selection and the need for detailed clinical assessments to contextualize sensor data. Guidance on establishing escalation pathways for remotely monitored at-risk patients and the importance of predictive system management is provided. DFU prevention RPM should be integrated into a comprehensive disease management strategy to mitigate foot health concerns, reduce activity-associated risks, and thereby seek to be synergistic with other components of diabetes disease management. This integrated approach has the potential to enhance disease management in diabetes, positively impacting foot health and the healthspan of patients living with diabetes.
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Affiliation(s)
- Evan Minty
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Emily Bray
- Orpyx Medical Technologies, Inc., Calgary, AB T2G 1M8, Canada (E.M.); (M.H.)
| | - Courtney B. Bachus
- Orpyx Medical Technologies, Inc., Calgary, AB T2G 1M8, Canada (E.M.); (M.H.)
| | - Breanne Everett
- Orpyx Medical Technologies, Inc., Calgary, AB T2G 1M8, Canada (E.M.); (M.H.)
| | - Karen M. Smith
- Orpyx Medical Technologies, Inc., Calgary, AB T2G 1M8, Canada (E.M.); (M.H.)
| | - Emily Matijevich
- Orpyx Medical Technologies, Inc., Calgary, AB T2G 1M8, Canada (E.M.); (M.H.)
| | - Maryam Hajizadeh
- Orpyx Medical Technologies, Inc., Calgary, AB T2G 1M8, Canada (E.M.); (M.H.)
| | - David G. Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- USC Limb Preservation Program, Los Angeles, CA 90033, USA
- Southwestern Academic Limb Salvage Alliance (SALSA), Los Angeles, CA 90033, USA
- USC Center to Stream Healthcare in Place (C2SHIP), Los Angeles, CA 90033, USA
| | - Brock Liden
- Cutting Edge Research, Circleville, OH 43113, USA
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12
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Clay-Williams R, Hibbert P, Carrigan A, Roberts N, Austin E, Fajardo Pulido D, Meulenbroeks I, Nguyen HM, Sarkies M, Hatem S, Maka K, Loy G, Braithwaite J. The diversity of providers' and consumers' views of virtual versus inpatient care provision: a qualitative study. BMC Health Serv Res 2023; 23:724. [PMID: 37400807 DOI: 10.1186/s12913-023-09715-x] [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: 10/05/2022] [Accepted: 06/16/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND A broad-based international shift to virtual care models over recent years has accelerated following COVID-19. Although there are increasing numbers of studies and reviews, less is known about clinicians' and consumers' perspectives concerning virtual modes in contrast to inpatient modes of delivery. METHODS We conducted a mixed-methods study in late 2021 examining consumers' and providers' expectations of and perspectives on virtual care in the context of a new facility planned for the north-western suburbs of Sydney, Australia. Data were collected via a series of workshops, and a demographic survey. Recorded qualitative text data were analysed thematically, and surveys were analysed using SPSS v22. RESULTS Across 12 workshops, 33 consumers and 49 providers from varied backgrounds, ethnicities, language groups, age ranges and professions participated. Four advantages, strengths or benefits of virtual care reported were: patient factors and wellbeing, accessibility, better care and health outcomes, and additional health system benefits, while four disadvantages, weaknesses or risks of virtual care were: patient factors and wellbeing, accessibility, resources and infrastructure, and quality and safety of care. CONCLUSIONS Virtual care was widely supported but the model is not suitable for all patients. Health and digital literacy and appropriate patient selection were key success criteria, as was patient choice. Key concerns included technology failures or limitations and that virtual models may be no more efficient than inpatient care models. Considering consumer and provider views and expectations prior to introducing virtual models of care may facilitate greater acceptance and uptake.
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Affiliation(s)
- Robyn Clay-Williams
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia.
| | - Peter Hibbert
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
- Centre for Elite Performance, Macquarie University, Expertise & Training, Sydney, NSW, Australia
| | - Natalie Roberts
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Isabelle Meulenbroeks
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Hoa Mi Nguyen
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Mitchell Sarkies
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Katherine Maka
- Western Sydney Local Health District, Sydney, NSW, Australia
| | - Graeme Loy
- Western Sydney Local Health District, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
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13
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Smith JM, Pearson KK, Roberson AE. Interface of Clinical Nurse Specialist Practice and Healthcare Technology. CLIN NURSE SPEC 2023; 37:169-176. [PMID: 37410561 DOI: 10.1097/nur.0000000000000755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
PURPOSE This article demonstrates the leadership role of the clinical nurse specialist in developing and implementing healthcare technology across the continuum of care. DESCRIPTION Three virtual nursing practices-facilitated self-care, remote patient monitoring, and virtual acute care nursing-illustrate how the clinical nurse specialist is well suited to transform traditional practice models to ones that use healthcare technology effectively. These 3 practices use interactive healthcare technology to gather patient data and allow communication and coordination with the healthcare team to meet patient-specific needs. OUTCOME Use of healthcare technology in virtual nursing practices led to early care team intervention, optimized care team processes, proactive patient outreach, timely access to care, and reduction in healthcare-associated errors and near-miss events. CONCLUSION Clinical nurse specialists are well positioned to develop innovative, effective, accessible, and high-quality virtual nursing practices. Integrating healthcare technology with nursing practice augments care for various patients, ranging from those with low illness severity in the outpatient setting to acutely ill patients in the inpatient hospital environment.
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Affiliation(s)
- Justin M Smith
- Author Affiliations: Department of Nursing, Mayo Clinic, Rochester, Minnesota
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14
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Nowell WB, Curtis JR. Remote Therapeutic Monitoring in Rheumatic and Musculoskeletal Diseases: Opportunities and Implementation. MEDICAL RESEARCH ARCHIVES 2023; 11:3957. [PMID: 38550526 PMCID: PMC10972608 DOI: 10.18103/mra.v11i7.2.3957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2024]
Abstract
Therapeutic Monitoring (RTM) is a new program in the United States that began in 2022 allowing electronic patient-reported outcomes (ePRO) and other patient-generated data to be reviewed by clinical staff between visits so that patients can receive clinical attention as needed. Remote Therapeutic Monitoring simultaneously enhances the capacity to generate prospective longitudinal data that may be useful for secondary research purposes. As many governmental and private insurance programs in the United States now provide reimbursement for Remote Therapeutic Monitoring, increasing numbers of rheumatologists may be incentivized to provide this service for their patient populations. Launched in 2015, the ArthritisPower® Research Registry and associated mobile and desktop application, registered with the Food & Drug Administration (FDA) as a Class I medical device, enables patients to track their disease across dozens of domains and to securely participate in voluntary research studies. ArthritisPower, in partnership with Illumination Health, has developed infrastructure and a clinical workflow for Remote Therapeutic Monitoring that will help rheumatologists more closely track their patients' disease activity and flares, identify primary non-adherence, record changes in key health domains (e.g. fatigue, pain, physical function, mental health) and meet the needs for other data elements important for clinical care identified by individual providers. Ultimately, the approach to use digital health tools between visits seeks to improve clinical outcomes for patients with rheumatic and musculoskeletal diseases. This editorial review discusses the evolution of remote monitoring in rheumatologic care, describes the opportunities for physician reimbursement as of 2023, and provides a suggested workflow in order to establish Remote Therapeutic Monitoring within rheumatology practices.
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Affiliation(s)
| | - Jeffrey R Curtis
- Illumination Health, Hoover, AL, USA
- University of Alabama at Birmingham, Birmingham, AL, USA
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15
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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.
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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
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16
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Shurlock J, Brown S, Dayer M, Furniss G. Rapid Roll Out of a Pacemaker Home Monitoring Programme: A Patient Perspective. Heart Lung Circ 2023:S1443-9506(23)00151-8. [PMID: 37150706 DOI: 10.1016/j.hlc.2023.03.015] [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: 09/27/2022] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To assess the safety, efficacy, and patient acceptability of a pacemaker home monitoring (HM) service. METHODS All patients receiving a new Biotronik (Biotronik, Berlin, Germany) pacemaker between March 2020 and February 2021 were contacted for participation. Participants were surveyed on their experience of pacemaker HM. HM alerts and remote wound monitoring rates were also assessed. RESULTS Of the patients contacted, 77% responded, with a mean age of 80.6±9.9 years. Of these, 95.8% agreed that the home monitoring (HM) has been beneficial. Two thirds preferred HM to face-to-face follow-up and two thirds felt safe with HM. Three themes were identified from the comments: reassurance, technology and data security. Forty-one percent (41%) of respondents would like more reassurance that their HM is working, 18% mentioned technology with mixed responses, and 4.7% cited cybersecurity or the use of their personal data as a concern. The average one-way patient journey saved was 24.3±16.7 km (15.1±10.4 miles). One in three HM alerts required action but only 3.4% were urgent. Remote wound review was successful in 59%. CONCLUSIONS The majority of patients prefer HM and almost all think it has been beneficial. It saves significant travel time and provides actionable alerts. The patient experience could be improved by reassuring patients that their device is being monitored.
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Affiliation(s)
| | - Stewart Brown
- Cardiology department, Musgrove Park Hospital, Taunton, UK
| | - Mark Dayer
- Cardiology department, Musgrove Park Hospital, Taunton, UK
| | - Guy Furniss
- Cardiology department, Musgrove Park Hospital, Taunton, UK
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17
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Zhang Y, Peña MT, Fletcher LM, Lal L, Swint JM, Reneker JC. Economic evaluation and costs of remote patient monitoring for cardiovascular disease in the United States: a systematic review. Int J Technol Assess Health Care 2023; 39:e25. [PMID: 37114456 DOI: 10.1017/s0266462323000156] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Remote patient monitoring (RPM) has emerged as a viable and valuable care delivery method to improve chronic disease management. In light of the high prevalence and substantial economic burden of cardiovascular disease (CVD), this systematic review examines the cost and cost-effectiveness of using RPM to manage CVD in the United States. METHODS We systematically searched databases to identify potentially relevant research. Findings were synthesized for cost and cost-effectiveness by economic study type with consideration of study perspective, intervention, clinical outcome, and time horizon. The methodological quality was assessed using the Joanna Briggs Institute Checklist for Economic Evaluations. RESULTS Thirteen articles with fourteen studies published between 2011 and 2021 were included in the final review. Studies from the provider perspective with a narrow scope of cost components identified higher costs and similar effectiveness for the RPM group relative to the usual care group. However, studies from payer and healthcare sector perspectives indicate better clinical effectiveness of RPM relative to usual care, with two cost-utility analysis studies suggesting that RPM relative to usual care is a cost-effective tool for CVD management even at the conservative $50,000 per Quality-Adjusted Life-Year threshold. Additionally, all model-based studies revealed that RPM is cost-effective in the long run. CONCLUSIONS Full economic evaluations identified RPM as a potentially cost-effective tool, particularly for long-term CVD management. In addition to the current literature, rigorous economic analysis with a broader perspective is needed in evaluating the value and economic sustainability of RPM.
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Affiliation(s)
- Yunxi Zhang
- Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS39216, USA
| | - Maria T Peña
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX78712, USA
| | - Lauren M Fletcher
- Brown University Library, Brown University, Providence, RI02912, USA
- Rowland Medical Library, University of Mississippi Medical Center, Jackson, MS39216, USA
| | - Lincy Lal
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX78712, USA
| | - J Michael Swint
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX78712, USA
- Center for Clinical Research and Evidence-Based Medicine, John P and Katherine G McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX77030, USA
| | - Jennifer C Reneker
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS39216, USA
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18
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Curtis J, Willig J. Uptake of Remote Physiologic Monitoring in the U.S. Medicare Program: A Serial Cross-Sectional Analysis. JMIR Mhealth Uhealth 2023; 11:e46046. [PMID: 37040464 DOI: 10.2196/46046] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/04/2023] [Accepted: 04/10/2023] [Indexed: 04/13/2023] Open
Abstract
UNSTRUCTURED n/a (Research Letter).
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Affiliation(s)
- Jeffrey Curtis
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, 1825 University Blvd, Birmingham, US
| | - James Willig
- University of Alabama at Birmingham, Birmingham, US
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19
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Whitehead D, Conley J. The Next Frontier of Remote Patient Monitoring: Hospital at Home. J Med Internet Res 2023; 25:e42335. [PMID: 36928088 PMCID: PMC10132045 DOI: 10.2196/42335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/09/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Remote patient monitoring (RPM) has shown promise in aiding safe and efficient remote care for chronic conditions; however, its use remains more limited within the hospital at home (HaH) model of care despite a significant opportunity to increase patient eligibility, improve safety, and decrease costs. HaH could achieve these goals by further adopting the 3 primary modalities of RPM (ie, vital sign, continuous single-lead electrocardiogram, and fall monitoring). With only 2 in-person vital sign checks required per day, HaH patient eligibility is currently often limited to lower-acuity cases. The use of vital sign RPM within HaH could better match the standard clinical practice of vital sign checks every 4-8 hours and enable safe care for appropriate moderate-acuity medical and surgical floor-level patients not traditionally enrolled in HaH. Robust, efficient collection of more frequent vital signs via RPM could expand patient eligibility for HaH and create a digital health safety net that enables high quality care. Similarly, our experience at Massachusetts General Hospital has demonstrated that appropriate use of continuous single-lead electrocardiogram RPM can also expand HaH enrollment, particularly for patients with acute decompensated heart failure. Through increasing enrollment of patients in HaH, RPM stands to enable more patients to reap the potential safety benefits of home hospitalization, including decreased rates of delirium and hospital-acquired infections, and better avoid aspects of posthospital syndrome. Furthermore, instituting fall detection RPM allows care teams to further HaH patient safety during their episode of acute care and develop enhanced mitigation strategies to avoid falls post home hospitalization. RPM also has the potential to assist HaH in achieving greater economies of scale and decreasing direct variable costs. By expanding HaH eligibility, RPM could enable HaH programs, which have traditionally operated under capacity, to care for a larger census and decrease allocated fixed costs per hospitalization. Additionally, RPM for HaH could further optimize hybrid in-home and remote nurse or physician evaluations, decreasing costs on a per-episode basis by up to an estimated 3.5%. Overall, RPM holds great promise to increase patient eligibility and patient safety while decreasing costs. However, it is in its infancy in achieving its potential to advance the HaH model of care; further research and experience that inform operational and technical as well as policy considerations are needed.
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Affiliation(s)
- David Whitehead
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Jared Conley
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Healthcare Transformation Lab, Massachusetts General Hospital, Boston, MA, United States
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20
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Hayes CJ, Dawson L, McCoy H, Hernandez M, Andersen J, Ali MM, Bogulski CA, Eswaran H. Utilization of Remote Patient Monitoring Within the United States Health Care System: A Scoping Review. Telemed J E Health 2023; 29:384-394. [PMID: 35819861 DOI: 10.1089/tmj.2022.0111] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Limited information exists on the landscape of studies and policies for remote patient monitoring (RPM) in the United States. Methods: We conducted a scoping review to assess (1) for which adult patient populations and health care needs is RPM being used and (2) the landscape of national- and state-level reimbursement policies for RPM. This study was guided by the Arksey and O'Malley methodological framework for scoping reviews and the Joanna Briggs Institute Manual for Evidence Synthesis. Results: A total of 399 articles were included in our final sample: 268 study articles and 131 articles of gray literature (e.g., websites, legislative bills). RPM-related articles rose drastically from 2015 to 2021, and the vast majority of articles were peer-reviewed journal articles. Of the study articles, prospective cohort studies were the most common study method, with m-health/smart watches being the most common RPM modality. RPM was found to be most commonly tested within patients with cardiovascular diseases, and the most common outcomes measured were usability and feasibility. Gray literature found 36 U.S. state Medicaid programs had reimbursement policies for RPM in 2021; however, 28 of those had at least one restriction on reimbursement (e.g., limited to specific providers). Conclusions: Despite the rapid growth in the literature on RPM and the adoption of reimbursement policies, retrospective, population-level studies, large randomized controlled trials, studies with a focus on additional favorable outcomes (e.g., quality of life), and studies evaluating trends in RPM reimbursement policies are lacking in the current literature.
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Affiliation(s)
- Corey J Hayes
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA.,Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Leah Dawson
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hannah McCoy
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Michelle Hernandez
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jennifer Andersen
- Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, Arkansas, USA
| | - Mir M Ali
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cari A Bogulski
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hari Eswaran
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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21
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Roberts N, Carrigan A, Clay-Williams R, Hibbert PD, Mahmoud Z, Pomare C, Fajardo Pulido D, Meulenbroeks I, Knaggs GT, Austin EE, Churruca K, Ellis LA, Long JC, Hutchinson K, Best S, Nic Giolla Easpaig B, Sarkies MN, Francis Auton E, Hatem S, Dammery G, Nguyen MT, Nguyen HM, Arnolda G, Rapport F, Zurynski Y, Maka K, Braithwaite J. Innovative models of healthcare delivery: an umbrella review of reviews. BMJ Open 2023; 13:e066270. [PMID: 36822811 PMCID: PMC9950590 DOI: 10.1136/bmjopen-2022-066270] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE To undertake a synthesis of evidence-based research for seven innovative models of care to inform the development of new hospitals. DESIGN Umbrella review. SETTING Interventions delivered inside and outside of acute care settings. PARTICIPANTS Children and adults with one or more identified acute or chronic health conditions. DATA SOURCES PsycINFO, Ovid MEDLINE and CINAHL. PRIMARY AND SECONDARY OUTCOME MEASURES Clinical indicators and mortality, healthcare utilisation, quality of life, self-management and self-care and patient knowledge. RESULTS A total of 66 reviews were included, synthesising evidence from 1272 primary studies across the 7 models of care. Virtual care was the most common model studied, addressed by 47 (73%) of the reviews. Common outcomes evaluated across reviews were clinical indicators and mortality, healthcare utilisation, self-care and self-management, patient knowledge, quality of life and cost-effectiveness. The findings indicate that the innovative models of healthcare we identified in this review may be effective in managing patients with a range of acute and chronic conditions. Most of the included reviews reported evidence of comparable or improved care. CONCLUSIONS A consideration of local infrastructure and individual patient characteristics, such as health literacy, may be critical in determining the suitability of models of care for patients and their implementation in local health systems. TRIAL REGISTRATION NUMBER 10.17605/OSF.IO/PS6ZU.
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Affiliation(s)
- Natalie Roberts
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Zeyad Mahmoud
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- LEMNA, F-44000, Universite de Nantes, Nantes, France
| | - Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Isabelle Meulenbroeks
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gilbert Thomas Knaggs
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Stephanie Best
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Genomics, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Brona Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mitchell N Sarkies
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Emilie Francis Auton
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Genevieve Dammery
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mai-Tran Nguyen
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hoa Mi Nguyen
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Katherine Maka
- Western Sydney Local Health District, Wentworthville, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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22
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Abstract
PURPOSE OF REVIEW Home oxygen monitoring and therapy have been increasingly used in the management of patients with chronic diseases. The COVID-19 pandemic has prompted the rapid uptake of remote monitoring programmes to support people with COVID-19 at home. This review discusses the recent evidence and learning in home oxygen monitoring and therapy from the pandemic. RECENT FINDINGS Many home oxygen monitoring programmes were established around the world during the pandemic, mostly in high-income countries to support early detection of hypoxaemia and/or early hospital discharge. The characteristics of these programmes vary widely in the type of monitoring (self-monitoring or clinician-monitoring) and the patient risk groups targeted. There is a lack of evidence for benefits on clinical outcomes, including mortality, and on reductions in healthcare utilisation or cost-effectiveness, but programmes are viewed positively by patients. Recent studies have highlighted the potential bias in pulse oximetry in people with darker skin. SUMMARY Recent evidence indicates that home oxygen monitoring therapy programmes are feasible in acute disease, but further research is needed to establish whether they improve patient outcomes, are cost-effective and to understand their equity impact.
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Affiliation(s)
| | - Jonathan Clarke
- Department of Mathematics, Imperial College London, London, UK
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23
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Patel H, Hassell A, Keniston A, Davis C. Impact of Remote Patient Monitoring on Length of Stay for Patients with COVID-19. Telemed J E Health 2023; 29:298-303. [PMID: 35687378 DOI: 10.1089/tmj.2021.0510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Remote patient monitoring (RPM) can be deployed as part of a tiered approach to open up hospital bed availability by allowing earlier discharge of patients with continued virtual monitoring. We describe the impact of RPM on length of stay (LOS) for patients with COVID-19. Methods: We deployed RPM during two COVID-19 surges at a tertiary academic hospital from March to June 2020 as a feasibility pilot to establish the infrastructure for RPM including electronic health record changes and virtual health center (VHC) protocols, and October 2020 to February 2021, during the second surge of COVID-19. Discharging patients received a wearable vital sign monitoring device, allowing real-time data transmission to the VHC using a smart phone application. The data, monitored 24 h a day for 8 days by a technician, had built-in escalation protocols to nurses and/or attending physicians. Results: We compared patients discharged with RPM with those discharged without RPM during both phases using a two-to-one-matched case-control design including age, sex, Charlson comorbidity index, and limited English proficiency. After including discharge with home oxygen therapy as an effect modifier, there was a significant association between shorter LOS and RPM for patients discharging without home oxygen (p = 0.0075) compared with patients not discharging on RPM. Discussion: Our study shows a strong association between a reduction in LOS for patients discharging with RPM but without home oxygen therapy, which can assist with hospital capacity. Conclusions: Home telemonitoring after discharge for patients with COVID-19 may reduce LOS.
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Affiliation(s)
- Hemali Patel
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Angela Keniston
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christopher Davis
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
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24
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Hidefjäll P, Laurell H, Johansson J, Barlow J. Institutional logics and the adoption and implementation of remote patient monitoring. INNOVATION-ORGANIZATION & MANAGEMENT 2023. [DOI: 10.1080/14479338.2022.2162907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Patrik Hidefjäll
- Department of Learning, Informatics, Management and Ethics, Unit for Bioentrepreneurship, Karolinska Institutet, LIME, Stockholm, Sweden
- School of Business, Innovation and Sustainability, Halmstad University, Halmstad, Sweden
| | - Hélène Laurell
- School of Business, Innovation and Sustainability, Halmstad University, Halmstad, Sweden
| | - Jeaneth Johansson
- School of Business, Innovation and Sustainability, Halmstad University, Halmstad, Sweden
- Department of Social Sciences, Technology and Arts, Luleå University of Technology, Luleå, Sweden
| | - James Barlow
- School of Business, Innovation and Sustainability, Halmstad University, Halmstad, Sweden
- Imperial College Business School, Centre for Health Economics & Policy Innovation, London, UK
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Casariego-Vales E, Palencia-Vizcarra R, Bolaño J, Cámera L, Valdez P. Executive summary on the use of telemedicine in the hospital setting: Recommendations from the International Forum on Internal Medicine. Rev Clin Esp 2023; 223:50-55. [PMID: 35618572 DOI: 10.1016/j.rceng.2021.12.007] [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: 12/19/2021] [Accepted: 12/29/2021] [Indexed: 02/01/2023]
Abstract
The implementation of telemedicine as another tool for patient care in the hospital setting is a challenge for any healthcare system. Given the difficulties and limitations, the International Forum on Internal Medicine (FIMI, for its initials in Spanish) has sponsored this consensus document with 20 scientific societies from 17 countries in Europe and the Americas. The aim was to propose a general framework that allows for the development and implementation of telemedicine in hospital clinical care that would be useful to FIMI member countries. The document we present includes recommendations from the FIMI in its executive summary that intend to guarantee effective, safe, efficient, sustainable, and proportional healthcare interventions based on the best scientific evidence available. The authors believe that this document must be updated within a maximum period of two years.
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Affiliation(s)
- E Casariego-Vales
- Sociedad Española de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | | | - J Bolaño
- Sociedad Argentina de Medicina, Universidad Nacional del Nordeste, Hospital Perrando, Resistencia Chaco, Argentina
| | - L Cámera
- Sociedad Argentina de Medicina, Universidad de Buenos Aires, Hospital Italiano de Buenos Aires, Caba, Argentina
| | - P Valdez
- Sociedad Argentina de Medicina, Universidad de Buenos Aires, Universidad Nacional de La Matanza, Hospital Vélez Sarsfield, Caba, Argentina
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Dubey A, Tiwari A. Artificial intelligence and remote patient monitoring in US healthcare market: a literature review. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2205618. [PMID: 37151736 PMCID: PMC10158563 DOI: 10.1080/20016689.2023.2205618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND Artificial intelligence (AI) enables remote patient monitoring (RPM) which reduces costs by triaging patients to optimize hospitalization and avoid complications. The FDA regulates AI in medical devices and aims to ensure patient safety, effectiveness, and transparent AI solutions. OBJECTIVES Identify and summarize FDA approved RPM devices to provide information for the US medical device industry based on previous approvals and the markets' needs. METHODS We searched publicly available databases on FDA-approved RPM devices. Selection criteria were established to classify a solution as AI. Technical information was analyzed on pre-identified 16 parameters for the qualified solutions. RESULTS A total of 47 RPM devices were reviewed, among which 12.8% were classified as a De Novo product and the remaining devices fell under the 510(K) FDA category. The cardiovascular (74%) AI RPM solutions dominated the US market, followed by ECG-based arrhythmia detection algorithms (59.4%), and Hemodynamics and Vital Sign monitoring algorithms (21.9%). The trend observed in the FDA rejected devices was their inability to be classified into clinically relevant categories (Criteria 2 and 3). CONCLUSION The market needs more innovative RPM solutions under the De Novo category, as there are very few. The transparency is low on the technical aspect of AI algorithms. The market needs AI algorithms that can effectively classify patients rather than merely improve device functionality.
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Affiliation(s)
- Ayushmaan Dubey
- Independent Researcher, Rising Junior
- CONTACT Ayushmaan Dubey Researcher, 2471 Sunrise Road 52, Round Rock, TX, USA
| | - Anuj Tiwari
- Market Access Advisor, Medspacetech, Tilburg, The Netherlands
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Bacchin D, Pernice GFA, Pierobon L, Zanella E, Sardena M, Malvestio M, Gamberini L. Co-Design in Electrical Medical Beds with Caregivers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16353. [PMID: 36498422 PMCID: PMC9738800 DOI: 10.3390/ijerph192316353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Among the plethora of instruments present in healthcare environments, the hospital bed is undoubtedly one of the most important for patients and caregivers. However, their design usually follows a top-down approach without considering end-users opinions and desires. Exploiting Human-centered design (HCD) permits these users to have a substantial role in the final product outcome. This study aims to empower caregivers to express their opinion about the hospital bed using a qualitative approach. For a holistic vision, we conducted six focus groups and six semi-structured interviews with nurses, nursing students, social-health operators and physiotherapists belonging to many healthcare situations. We then used thematic analysis to extract the themes that participants faced during the procedures, providing a comprehensive guide to designing the future electrical medical bed. These work results could also help overcome many issues that caregivers face during their everyday working life. Moreover, we identified the User Experience features that could represent the essential elements to consider.
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Affiliation(s)
- Davide Bacchin
- Department of General Psychology, University of Padova, 35131 Padova, Italy
| | | | - Leonardo Pierobon
- Human Inspired Technology (HIT) Research Centre, University of Padova, 35121 Padova, Italy
| | - Elena Zanella
- Human Inspired Technology (HIT) Research Centre, University of Padova, 35121 Padova, Italy
| | | | | | - Luciano Gamberini
- Human Inspired Technology (HIT) Research Centre, University of Padova, 35121 Padova, Italy
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28
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Chan A, Cohen R, Robinson KM, Bhardwaj D, Gregson G, Jutai JW, Millar J, Ríos Rincón A, Roshan Fekr A. Evidence and User Considerations of Home Health Monitoring for Older Adults: Scoping Review. JMIR Aging 2022; 5:e40079. [PMID: 36441572 DOI: 10.2196/40079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Home health monitoring shows promise in improving health outcomes; however, navigating the literature remains challenging given the breadth of evidence. There is a need to summarize the effectiveness of monitoring across health domains and identify gaps in the literature. In addition, ethical and user-centered frameworks are important to maximize the acceptability of health monitoring technologies. OBJECTIVE This review aimed to summarize the clinical evidence on home-based health monitoring through a scoping review and outline ethical and user concerns and discuss the challenges of the current user-oriented conceptual frameworks. METHODS A total of 2 literature reviews were conducted. We conducted a scoping review of systematic reviews in Scopus, MEDLINE, Embase, and CINAHL in July 2021. We included reviews examining the effectiveness of home-based health monitoring in older adults. The exclusion criteria included reviews with no clinical outcomes and lack of monitoring interventions (mobile health, telephone, video interventions, virtual reality, and robots). We conducted a quality assessment using the Assessment of Multiple Systematic Reviews (AMSTAR-2). We organized the outcomes by disease and summarized the type of outcomes as positive, inconclusive, or negative. Second, we conducted a literature review including both systematic reviews and original articles to identify ethical concerns and user-centered frameworks for smart home technology. The search was halted after saturation of the basic themes presented. RESULTS The scoping review found 822 systematic reviews, of which 94 (11%) were included and of those, 23 (24%) were of medium or high quality. Of these 23 studies, monitoring for heart failure or chronic obstructive pulmonary disease reduced exacerbations (4/7, 57%) and hospitalizations (5/6, 83%); improved hemoglobin A1c (1/2, 50%); improved safety for older adults at home and detected changing cognitive status (2/3, 66%) reviews; and improved physical activity, motor control in stroke, and pain in arthritis in (3/3, 100%) rehabilitation studies. The second literature review on ethics and user-centered frameworks found 19 papers focused on ethical concerns, with privacy (12/19, 63%), autonomy (12/19, 63%), and control (10/19, 53%) being the most common. An additional 7 user-centered frameworks were studied. CONCLUSIONS Home health monitoring can improve health outcomes in heart failure, chronic obstructive pulmonary disease, and diabetes and increase physical activity, although review quality and consistency were limited. Long-term generalized monitoring has the least amount of evidence and requires further study. The concept of trade-offs between technology usefulness and acceptability is critical to consider, as older adults have a hierarchy of concerns. Implementing user-oriented frameworks can allow long-term and larger studies to be conducted to improve the evidence base for monitoring and increase the receptiveness of clinicians, policy makers, and end users.
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Affiliation(s)
- Andrew Chan
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Rachel Cohen
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Katherine-Marie Robinson
- School of Engineering Design and Teaching Innovation, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada.,Department of Philosophy, Faculty of Arts, University of Ottawa, Ottawa, ON, Canada
| | - Devvrat Bhardwaj
- Department of Electrical Engineering and Computer Science, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Geoffrey Gregson
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Jeffrey W Jutai
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,LIFE Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jason Millar
- School of Engineering Design and Teaching Innovation, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada.,Department of Philosophy, Faculty of Arts, University of Ottawa, Ottawa, ON, Canada
| | - Adriana Ríos Rincón
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Atena Roshan Fekr
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Prokopowicz P, Mikołajewski D, Mikołajewska E. Intelligent System for Detecting Deterioration of Life Satisfaction as Tool for Remote Mental-Health Monitoring. SENSORS (BASEL, SWITZERLAND) 2022; 22:9214. [PMID: 36501916 PMCID: PMC9737854 DOI: 10.3390/s22239214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
The research described in this article is a continuation of work on a computational model of quality of life (QoL) satisfaction. In the proposed approach, overall life satisfaction is aggregated to personal life satisfaction (PLUS). The model described in the article is based on well-known and commonly used clinimetric scales (e.g., in psychiatry, psychology and physiotherapy). The simultaneous use of multiple scales, and the complexity of describing the quality of life with them, require complex fuzzy computational solutions. The aim of the study is twofold: (1) To develop a fuzzy model that allows for the detection of changes in life satisfaction scores (data on the influence of the COVID-19 pandemic and the war in the neighboring country were used). (2) To develop more detailed guidelines than the existing ones for further similar research on more advanced intelligent systems with computational models which allow for sensing, detecting and evaluating the psychical state. We are concerned with developing practical solutions with higher scientific and clinical utility for both small datasets and big data to use in remote patient monitoring. Two exemplary groups of specialists at risk of occupational burnout were assessed three times at different intervals in terms of life satisfaction. The aforementioned assessment was made on Polish citizens because the specific data could be gathered: before and during the pandemic and during the war in Ukraine (a neighboring country). That has a higher potential for presenting a better analysis and reflection on the practical application of the model. A research group (physiotherapists, n = 20) and a reference group (IT professionals, n = 20) participated in the study. Four clinimetric scales were used for assessment: the Perceived Stress Scale (PSS10), the Maslach Burnout Scale (MBI), the Satisfaction with Life Scale (SWLS), and the Nordic Musculoskeletal Questionnaire (NMQ). The assessment was complemented by statistical analyses and fuzzy models based on a hierarchical fuzzy system. Although several models for understanding changes in life satisfaction scores have been previously investigated, the novelty of this study lies in the use of data from three consecutive time points for the same individuals and the way they are analyzed, based on fuzzy logic. In addition, the new hierarchical structure of the model used in the study provides flexibility and transparency in the process of remotely monitoring changes in people's mental well-being and a quick response to observed changes. The aforementioned computational approach was used for the first time.
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Affiliation(s)
- Piotr Prokopowicz
- Institute of Computer Science, Kazimierz Wielki University, 85-064 Bydgoszcz, Poland
| | - Dariusz Mikołajewski
- Institute of Computer Science, Kazimierz Wielki University, 85-064 Bydgoszcz, Poland
- Laboratory of Neurophysiological Research, Medical University of Lublin, 20-059 Lublin, Poland
| | - Emilia Mikołajewska
- Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 87-100 Toruń, Poland
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Linton SC, De Boer C, Tian Y, Alayleh A, Bouchard ME, Figueroa A, Kwon S, Holl JL, Ghomrawi HM, Abdullah F. Effect of consumer-grade wearable device data on clinician decision making during post-discharge telephone calls after pediatric surgery. J Pediatr Surg 2022; 57:137-142. [PMID: 34732297 DOI: 10.1016/j.jpedsurg.2021.09.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/11/2021] [Accepted: 09/21/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND During post-discharge telephone calls after pediatric surgery, clinicians must rely on parents/caregivers' assessment of symptoms, which can be inaccurate and often lead to unnecessary emergency department (ED) visits. Physiology (heart rate and physical activity) data from consumer-grade wearables, e.g., Fitbit™, may inform clinical decision making, yet there has been little study of clinician interpretation of this data. This study assessed whether wearable data availability, during simulated telephone calls about postoperative, post-discharge pediatric patients, affects clinician decision making. METHODS Three simulated telephone call scenarios were presented to a diverse group of pediatric surgery clinicians. The scenarios were based on actual postoperative patients (scenarios 1 and 3 have worrisome symptoms and scenario 2 has non-worrisome symptoms) who had worn a Fitbit™ postoperatively. Each scenario was presented to clinicians (1) without any wearable data; (2) with "concerning" wearable data; and (3) with "reassuring" wearable data. Clinicians rated their likelihood, on a scale of 1-10, of recommending an emergency department (ED) visit for the three instances of each scenario, 10 being definitely ED. RESULTS Twenty-four (24) clinicians participated in the study. When presented with "reassuring" wearable data, clinicians' likelihood of recommending an ED visit decreased from a median score of 6 to 1 (p < 0.001) for scenario 1 and from 9 to 3 (p < 0.001) for scenario 3. When presented with "concerning" wearable data, the median likelihood of recommending an ED visit increased from 1 to 6 (p = 0.003) for scenario 2. CONCLUSION This study showed that wearable data affect clinicians' decision making and may be useful in triaging postoperative, post-discharge pediatric patients. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Samuel C Linton
- Division of Pediatric Surgery, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, United States; Department of Surgery, Northwestern School of Medicine, Northwestern University, Chicago, IL, United States
| | - Christopher De Boer
- Division of Pediatric Surgery, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, United States; Department of Surgery, Northwestern School of Medicine, Northwestern University, Chicago, IL, United States
| | - Yao Tian
- Surgical Outcomes Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Amin Alayleh
- Rosalind Franklin University of Medicine and Science, Chicago, IL, United States
| | - Megan E Bouchard
- Division of Pediatric Surgery, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, United States
| | - Angie Figueroa
- Division of Pediatric Surgery, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, United States
| | - Soyang Kwon
- Division of Pediatric Surgery, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, United States
| | - Jane L Holl
- Department of Neurology, Biological Sciences Division, University of Chicago, Chicago, IL, United States; Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL, United States
| | - Hassan Mk Ghomrawi
- Department of Surgery, Northwestern School of Medicine, Northwestern University, Chicago, IL, United States; Department of Medicine, Rheumatology division, Northwestern School of Medicine, Northwestern University, Chicago, IL, United States; Department of Pediatrics, Northwestern School of Medicine, Northwestern University, Chicago, IL, United States
| | - Fizan Abdullah
- Division of Pediatric Surgery, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, United States; Department of Surgery, Northwestern School of Medicine, Northwestern University, Chicago, IL, United States.
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Vilendrer S, Lestoquoy A, Artandi M, Barman L, Cannon K, Garvert DW, Halket D, Holdsworth LM, Singer S, Vaughan L, Winget M. A 360 degree mixed-methods evaluation of a specialized COVID-19 outpatient clinic and remote patient monitoring program. BMC PRIMARY CARE 2022; 23:151. [PMID: 35698064 PMCID: PMC9189794 DOI: 10.1186/s12875-022-01734-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Our goals are to quantify the impact on acute care utilization of a specialized COVID-19 clinic with an integrated remote patient monitoring program in an academic medical center and further examine these data with stakeholder perceptions of clinic effectiveness and acceptability. METHODS A retrospective cohort was drawn from enrolled and unenrolled ambulatory patients who tested positive in May through September 2020 matched on age, presence of comorbidities and other factors. Qualitative semi-structured interviews with patients, frontline clinician, and administrators were analyzed in an inductive-deductive approach to identify key themes. RESULTS Enrolled patients were more likely to be hospitalized than unenrolled patients (N = 11/137 in enrolled vs 2/126 unenrolled, p = .02), reflecting a higher admittance rate following emergency department (ED) events among the enrolled vs unenrolled, though this was not a significant difference (46% vs 25%, respectively, p = .32). Thirty-eight qualitative interviews conducted June to October 2020 revealed broad stakeholder belief in the clinic's support of appropriate care escalation. Contrary to beliefs the clinic reduced inappropriate care utilization, no difference was seen between enrolled and unenrolled patients who presented to the ED and were not admitted (N = 10/137 in enrolled vs 8/126 unenrolled, p = .76). Administrators and providers described the clinic's integral role in allowing health services to resume in other areas of the health system following an initial lockdown. CONCLUSIONS Acute care utilization and multi-stakeholder interviews suggest heightened outpatient observation through a specialized COVID-19 clinic and remote patient monitoring program may have contributed to an increase in appropriate acute care utilization. The clinic's role securing safe reopening of health services systemwide was endorsed as a primary, if unmeasured, benefit.
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Affiliation(s)
- Stacie Vilendrer
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA.
| | - Anna Lestoquoy
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Maja Artandi
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Linda Barman
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Kendell Cannon
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Donn W Garvert
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Douglas Halket
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Laura M Holdsworth
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Sara Singer
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Laura Vaughan
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
| | - Marcy Winget
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, USA
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De Guzman KR, Snoswell CL, Taylor ML, Gray LC, Caffery LJ. Economic Evaluations of Remote Patient Monitoring for Chronic Disease: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:897-913. [PMID: 35667780 DOI: 10.1016/j.jval.2021.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to systematically review and summarize economic evaluations of noninvasive remote patient monitoring (RPM) for chronic diseases compared with usual care. METHODS A systematic literature search identified economic evaluations of RPM for chronic diseases, compared with usual care. Searches of PubMed, Embase, CINAHL, and EconLit using keyword synonyms for RPM and economics identified articles published from up until September 2021. Title, abstract, and full-text reviews were conducted. Data extraction of study characteristics and health economic findings was performed. Article reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. RESULTS This review demonstrated that the cost-effectiveness of RPM was dependent on clinical context, capital investment, organizational processes, and willingness to pay in each specific setting. RPM was found to be highly cost-effective for hypertension and may be cost-effective for heart failure and chronic obstructive pulmonary disease. There were few studies that investigated RPM for diabetes or other chronic diseases. Studies were of high reporting quality, with an average Consolidated Health Economic Evaluation Reporting Standards score of 81%. Of the final 34 included studies, most were conducted from the healthcare system perspective. Eighteen studies used cost-utility analysis, 4 used cost-effectiveness analysis, 2 combined cost-utility analysis and a cost-effectiveness analysis, 1 used cost-consequence analysis, 1 used cost-benefit analysis, and 8 used cost-minimization analysis. CONCLUSIONS RPM was highly cost-effective for hypertension and may achieve greater long-term cost savings from the prevention of high-cost health events. For chronic obstructive pulmonary disease and heart failure, cost-effectiveness findings differed according to disease severity and there was limited economic evidence for diabetes interventions.
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Affiliation(s)
- Keshia R De Guzman
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Monica L Taylor
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Leonard C Gray
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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Zhang Y, Pena MT, Fletcher LM, Swint JM, Reneker JC. Cost of remote patient monitoring for cardiovascular disease: a systematic review protocol. JBI Evid Synth 2022; 20:1585-1592. [PMID: 35142743 DOI: 10.11124/jbies-21-00322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This review aims to evaluate the costs and cost-effectiveness of remote patient monitoring for cardiovascular disease in the United States. INTRODUCTION Cardiovascular disease is a leading public health concern in the United States, resulting in a substantial economic burden. Remote patient monitoring has emerged as a viable and valuable care delivery method to improve cardiovascular disease management at home. However, there is limited systematic research of the cost and cost-effectiveness of using remote patient monitoring to manage the disease. INCLUSION CRITERIA This review will consider all studies evaluating the cost of remote patient monitoring for cardiovascular disease management in the United States. The population of interest includes all individuals with various types of chronic cardiovascular disease in the United States. METHODS The search strategy will locate both published and unpublished studies. Systematic searches will be completed in PubMed, Embase, Web of Science, CINAHL, Scopus, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, National Health Service Economic Evaluation Database, and the Cost-Effectiveness Analysis Registry. Two reviewers will independently screen titles and abstracts, followed by a full-text review against the inclusion criteria. Disagreements will be resolved through discussion between all study members. The JBI checklist for economic evaluations will be utilized to evaluate the methodological quality of studies. Data will be extracted using a modified version of the JBI data extraction form for economic evaluations. Reviewers will summarize studies and cost-related metrics. The Dominance Ranking Matrix will be used to synthesize full economic evaluation. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021270621.
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Affiliation(s)
- Yunxi Zhang
- School of Population Health, Faculty of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Maria T Pena
- Department of Management, Policy and Community Health, The University of Texas School of Public Health, Houston, TX, USA
| | - Lauren M Fletcher
- Academic Information Services, Faculty of Rowland Medical Library, University of Mississippi Medical Center, Jackson, MS, USA
| | - John M Swint
- School of Public Health, Faculty of Management, Policy and Community Health, The University of Texas School of Public Health, Houston, TX, USA
| | - Jennifer C Reneker
- School of Population Health, Faculty of Population Health Sciences, University of Mississippi Medical Center, Jackson, MS, USA
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Nashat H, Habibi H, Heng EL, Nicholson C, Gledhill JR, Obika BD, Yassaee AA, Markides V, McCleery P, Gatzoulis MA. Patient monitoring and education over a tailored digital application platform for congenital heart disease: A feasibility pilot study. Int J Cardiol 2022; 362:68-73. [DOI: 10.1016/j.ijcard.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/25/2022] [Accepted: 05/02/2022] [Indexed: 11/05/2022]
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Pépin JL, Degano B, Tamisier R, Viglino D. Remote Monitoring for Prediction and Management of Acute Exacerbations in Chronic Obstructive Pulmonary Disease (AECOPD). Life (Basel) 2022; 12:life12040499. [PMID: 35454991 PMCID: PMC9028268 DOI: 10.3390/life12040499] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/14/2022] [Accepted: 03/27/2022] [Indexed: 11/21/2022] Open
Abstract
The progression of chronic obstructive pulmonary disease (COPD) is characterized by episodes of acute exacerbation (AECOPD) of symptoms, decline in respiratory function, and reduction in quality-of-life increasing morbi-mortality and often requiring hospitalization. Exacerbations can be triggered by environmental exposures, changes in lifestyle, and/or physiological and psychological factors to greater or lesser extents depending on the individual’s COPD phenotype. The prediction and early detection of an exacerbation might allow patients and physicians to better manage the acute phase. We summarize the recent scientific data on remote telemonitoring (TM) for the prediction and management of acute exacerbations in COPD patients. We discuss the components of remote monitoring platforms, including the integration of environmental monitoring data; patient reported outcomes collected via interactive Smartphone apps, with data from wearable devices that monitor physical activity, heart rate, etc.; and data from medical devices such as connected non-invasive ventilators. We consider how telemonitoring and the deluge of data it potentially generates could be combined with electronic health records to provide personalized care and multi-disease management for COPD patients.
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Affiliation(s)
- Jean-Louis Pépin
- HP2 Laboratory, Grenoble Alpes University, INSERM U1300, 38000 Grenoble, France; (B.D.); (R.T.); (D.V.)
- EFCR Laboratory, Thorax and Vessels Division, University Hospital of Grenoble Alpes, 38043 Grenoble, France
- Correspondence:
| | - Bruno Degano
- HP2 Laboratory, Grenoble Alpes University, INSERM U1300, 38000 Grenoble, France; (B.D.); (R.T.); (D.V.)
- EFCR Laboratory, Thorax and Vessels Division, University Hospital of Grenoble Alpes, 38043 Grenoble, France
| | - Renaud Tamisier
- HP2 Laboratory, Grenoble Alpes University, INSERM U1300, 38000 Grenoble, France; (B.D.); (R.T.); (D.V.)
- EFCR Laboratory, Thorax and Vessels Division, University Hospital of Grenoble Alpes, 38043 Grenoble, France
| | - Damien Viglino
- HP2 Laboratory, Grenoble Alpes University, INSERM U1300, 38000 Grenoble, France; (B.D.); (R.T.); (D.V.)
- Emergency Department, University Hospital of Grenoble Alpes, 38043 Grenoble, France
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Resumen ejecutivo sobre el uso de la telemedicina en el ámbito hospitalario: recomendaciones del Foro Internacional de Medicina Interna. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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From Diagnosis to Satisfaction in Multiple Sclerosis: A Swiss Patient Survey Highlighting the Importance of the First Diagnostic Consultation. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2022. [DOI: 10.3390/ctn6010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: An early treatment start with disease modifying therapies (DMT) and long-term adherence is crucial in the treatment of people with multiple sclerosis (PwMS) to prevent future disability. Objectives: To gain information on the diagnostic process, decision making, treatment start and adherence with regard to DMT as well as satisfaction in PwMS in Switzerland to optimize management of PwMS. Methods: A survey was conducted between June 2017 and March 2018 in six hospital-based MS centres and eight private practices in Switzerland. PwMS according to the 2010 McDonald criteria, aged 18–60 years, having a clinical isolated syndrome, relapsing remitting MS, or secondary progressive MS were eligible. The survey contained 40 questions, covering participants’ background and circumstances, treatment decisions, therapy start, treatment adherence, and satisfaction (EKNZ Req-2016-00701). Results: 212 questionnaires were returned for analysis. Of these, 125 (59.0%) were answered by patients treated by practice-based neurologists and 85 (40.1%) by patients treated in hospitals. That PwMS were satisfied overall with current medical care, that they were free of relapses and disease progression, and that they were able to live independently were the main goals of patients. Satisfaction was reflected by an early therapy start and a high adherence to DMT in our cohort. The treating neurologist played a major role in this regard. Furthermore, a satisfactory first diagnostic consultation (FDC) was crucial for successful long-term patient care positively influencing an early treatment start, longer duration of the initial therapy, as well as adherence to treatments and general satisfaction. Conclusion: The treating neurologist and especially a satisfactory FDC play a major role for the successful long-term treatment of PwMS. Detailed information on various aspects of the disease and time with the treating neurologist seems to be of major importance.
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Pages N, Picard F, Barritault F, Amara W, Lafitte S, Maribas P, Abassade P, Labarre JP, Boulestreau R, Chaouky H, Abdennadher M, Lemieux H, Lasserre R, Bedel C, Betito L, Nisse-Durgeat S, Diebold B. Remote patient monitoring for chronic heart failure in France: When an innovative funding program (ETAPES) meets an innovative solution (Satelia® Cardio). Digit Health 2022; 8:20552076221116774. [PMID: 36034602 PMCID: PMC9403459 DOI: 10.1177/20552076221116774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/13/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Remote patient monitoring (RPM) is a telehealth activity to collect and analyze patient health or medical data. Its use has expanded in the past decade and has improved medical outcomes and care management of non-communicable chronic diseases. However, implementation of RPM into routine clinical activities has been limited. The objective of this study was to describe the French funding program for RPM (known as ETAPES) and one of the RPM solution providers (Satelia®) dedicated to chronic heart failure (CHF). Methods A descriptive assessment of both the ETAPES funding program and Satelia® RPM solution was conducted. Data were collected from official legal documents and information that was publicly available online from the French Ministry of Health. Results and Discussion ETAPES was formally created in 2016 based on previous legislation pertaining to the national health insurance funding strategy. However, it only started to operate in 2018. Patients with CHF were only eligible if they were at medium or high risk of re-hospitalization with a New York Heart Association (NYHA) score superior or equal to two and a BNP>100 pg/ml or NT pro BNP>1000 pg/ml. Medical monitoring was supported through the therapeutic education of a patient on the RPM model of care with a minimum of three training sessions during the first six months. The use of Satelia® Cardio is noteworthy since it relies only on symptomatic monitoring through which the patient manually reports their information by answering a simple questionnaire on a regular basis and does not rely on any connected devices. Conclusion Innovative funding programs and solutions for RPM need real-world evaluation in the future.
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Affiliation(s)
- N Pages
- Cardiology Department, Hôpital Haut Leveque, Pessac, France
| | - F Picard
- Cardiology Department, Hôpital Haut Leveque, Pessac, France
| | - F Barritault
- Cardiology Department, GCS Cardiologie, Hôpital de Bayonne, Bayonne, France
| | - W Amara
- Cardiology Department, Centre Hospitalier Intercommunal Le Raincy-Montfermeil, Le Raincy-Montfermeil, France
| | - S Lafitte
- Cardiology Department, Hôpital Haut Leveque, Pessac, France
| | - P Maribas
- Cardiology Department, Hôpital privé de Parly 2, Le Chesnay, France
| | - P Abassade
- Cardiology Department, Hôpital Saint Joseph, Paris, France
| | - J Ph Labarre
- Cardiology Department, Clinique du Pont de Chaume, Montauban,
France
| | - R Boulestreau
- Cardiology Department, Centre Hospitalier de Pau, Pau, France
| | - H Chaouky
- Cardiology Department, Centre Hospitalier de Pau, Pau, France
| | - M Abdennadher
- Cardiology Department, Centre Hospitalier de Bigorre, Tarbes,
France
| | - H Lemieux
- Cardiology Department, Clinique Esquirol St Hilaire, Agen, France
| | - R Lasserre
- Cardiology Department, Centre Hospitalier de Bigorre, Tarbes,
France
| | - C Bedel
- NP Medical, Bordeaux, France
| | | | | | - B Diebold
- Cardiology Department, Hôpital Cochin, Paris, France
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Contreras WH, Sarquella E, Binefa E, Entrambasaguas M, Stjerne A, Booth P. The Impact on Ambulance Mobilisations of an Increasing Age Profile of Telecare Service Users Receiving Advanced Proactive, Personalised Telecare in Spain—a Longitudinal Study 2014–2018. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2021; 6:153-173. [PMID: 35529538 PMCID: PMC9072606 DOI: 10.1007/s41666-021-00108-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/27/2022]
Abstract
Advanced proactive personalised telecare services in Spain have helped service users to live independently in their own homes for longer. Concern was however noted regarding potential impacts on ambulance mobilisations as time in the service, and mean age at cessation, increased. The purpose of this study was to investigate these impacts. A longitudinal study of a telecare service user population in Spain (n = 202.1 k to 247.9 k) was undertaken using anonymised operational data collected in the delivery of proactive and personalised telecare services over the period 2014–2018. For the studied population, ambulance mobilisation on a per-person/per-annum (pp/pa) basis reduced despite the increasing age profile at cessation and with the characteristics of the population at registration remaining otherwise similar over the period. The study identified the positive correlation coefficient between ambulance mobilisations and service user’s dependency levels, and marginal negative correlation in older age bands. In conclusion, the increasing age at cessation has not correlated with an increased proportion of higher dependency service users. Indeed, the share of those over 85 years in the high dependency level decreased. This indicates that the changes in the telecare service which appear to have contributed to increased time living independently may also have helped ensure those continuing to live independently remain in lower risk bands.
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Affiliation(s)
| | | | - Eva Binefa
- Televida Servicio Sociosanitario, Barcelona, Spain
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Thomas EE, Taylor ML, Banbury A, Snoswell CL, Haydon HM, Gallegos Rejas VM, Smith AC, Caffery LJ. Factors influencing the effectiveness of remote patient monitoring interventions: a realist review. BMJ Open 2021; 11:e051844. [PMID: 34433611 PMCID: PMC8388293 DOI: 10.1136/bmjopen-2021-051844] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Our recent systematic review determined that remote patient monitoring (RPM) interventions can reduce acute care use. However, effectiveness varied within and between populations. Clinicians, researchers, and policymakers require more than evidence of effect; they need guidance on how best to design and implement RPM interventions. Therefore, this study aimed to explore these results further to (1) identify factors of RPM interventions that relate to increased and decreased acute care use and (2) develop recommendations for future RPM interventions. DESIGN Realist review-a qualitative systematic review method which aims to identify and explain why intervention results vary in different situations. We analysed secondarily 91 studies included in our previous systematic review that reported on RPM interventions and the impact on acute care use. Online databases PubMed, EMBASE and CINAHL were searched in October 2020. Included studies were published in English during 2015-2020 and used RPM to monitor an individual's biometric data (eg, heart rate, blood pressure) from a distance. PRIMARY AND SECONDARY OUTCOME MEASURES Contextual factors and potential mechanisms that led to variation in acute care use (hospitalisations, length of stay or emergency department presentations). RESULTS Across a range of RPM interventions 31 factors emerged that impact the effectiveness of RPM innovations on acute care use. These were synthesised into six theories of intervention success: (1) targeting populations at high risk; (2) accurately detecting a decline in health; (3) providing responsive and timely care; (4) personalising care; (5) enhancing self-management, and (6) ensuring collaborative and coordinated care. CONCLUSION While RPM interventions are complex, if they are designed with patients, providers and the implementation setting in mind and incorporate the key variables identified within this review, it is more likely that they will be effective at reducing acute hospital events. PROSPERO REGISTRATION NUMBER CRD42020142523.
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Affiliation(s)
- Emma E Thomas
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Monica L Taylor
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Annie Banbury
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Victor M Gallegos Rejas
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Innovative Technology, University of Southern Denmark, Odense, Denmark
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
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Esteban C, Antón A, Moraza J, Iriberri M, Larrauri M, Mar J, Aramburu A, Quintana JM. Cost-effectiveness of a telemonitoring program (telEPOC program) in frequently admitted chronic obstructive pulmonary disease patients. J Telemed Telecare 2021; 30:1357633X211037207. [PMID: 34369172 DOI: 10.1177/1357633x211037207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chronic obstructive pulmonary disease is a typical disease among chronic and respiratory diseases. The costs associated with chronic disease care are rising dramatically, and this makes it necessary to redesign care processes, including new tools which allow the health system to be more sustainable without compromising on the quality of the care, compared to that currently provided. One approach may be to use information and communication technologies. In this context, we explored the cost-effectiveness of applying a telemonitoring system to a cohort of chronic obstructive pulmonary disease patients with frequent readmissions (the telEPOC programme).We conducted an intervention study with a control group. The inclusion criteria used were having chronic obstructive pulmonary disease (forced expiratory volume in the first second/forced vital capacity < 70%) and having been hospitalised for exacerbation at least twice in the last year or three times in the last 2 years. We estimated the costs incurred by patients in each group and calculated the quality-adjusted life years and incremental cost-effectiveness ratio.Overall, 77 patients were included in the control group and 86 in the intervention group. The raw cost-effectiveness analysis showed that the cost of the telEPOC intervention was significantly lower than that of usual care, while there were no significant differences between the groups in effectiveness.The incremental cost-effectiveness ratio for the intervention was €175,719.71 per quality-adjusted life-year gained.There were no differences between the intervention group (telemonitoring) and the control group (standard care) from the cost-effectiveness point of view. On the other hand, the intervention programme (telEPOC) was less expensive than routine clinical practice.
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Affiliation(s)
- Cristóbal Esteban
- Servicio de Neumología, 16250Hospital Galdakao, Spain
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Spain
- BioCrues-Bizkaia Health Research Institute, Spain
| | - Ane Antón
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Spain
- Unidad de Investigación, Hospital Galdakao, Spain
- Kronikgune Research Institute, Spain
| | - Javier Moraza
- Servicio de Neumología, 16250Hospital Galdakao, Spain
- BioCrues-Bizkaia Health Research Institute, Spain
| | - Milagros Iriberri
- BioCrues-Bizkaia Health Research Institute, Spain
- Servicio de Neumología, 16494Hospital de Cruces, Spain
| | - Mateo Larrauri
- BioCrues-Bizkaia Health Research Institute, Spain
- Atención Primaria. 470501Organización Sanitaria Integrada Barrualde (OSI-Barrualde), Spain
| | - Javier Mar
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Spain
- Clinical Management Unit, 486353OSI Alto Deba, Spain
- Biodonostia Health Research Institute, Spain
| | - Amaia Aramburu
- Servicio de Neumología, 16250Hospital Galdakao, Spain
- BioCrues-Bizkaia Health Research Institute, Spain
| | - José M Quintana
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Spain
- BioCrues-Bizkaia Health Research Institute, Spain
- Unidad de Investigación, Hospital Galdakao, Spain
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