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Liljeroos M, Arkkukangas M, Strömberg A. The long-term effect of an m-health tool on self-care in patients with heart failure: a pre-post interventional study with a mixed-method analysis. Eur J Cardiovasc Nurs 2024; 23:470-477. [PMID: 38165027 DOI: 10.1093/eurjcn/zvad107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 01/03/2024]
Abstract
AIMS The aims of this study were (i) to evaluate the effects of using an m-health tool on self-care behaviour at 3 and 12 months and (ii) to explore the experiences and perceptions of heart failure (HF) patients about the m-health tool. METHODS AND RESULTS In this pre-post interventional study with a mixed-method analysis, 71 patients diagnosed with HF [49% female, mean age 76.7 years, New York Heart Association (NYHA) II 31%, NYHA III 69%] were enrolled and had the m-health tool installed in their home for 1 year. The tool consisted of a pre-programmed tablet including a weighing scale and interactive education about HF self-care. At baseline, and at 3 and 12 months, self-care was assessed using the European Heart Failure Self-care Behaviour (EHFScB-9) Scale, an eight-item self-administered questionnaire assessing the experiences of the m-health tool. The mean EHFScB-9 at baseline was 63.8 ± 2.8 and it improved to 67.6 ± 7.6 after 3 months (P < 0.05). After 1 year, the score had decreased to 63.2 ± 7.1 (P = 0.68). Most patients rated the tool as 'good', both at 3 months (92%) and after 12 months (93%). Some found the system to be unnecessary to some degree, and this number increased between 3 and 12 months (P < 0.001). Most patients felt that m-health increased their feelings of security, and 85% responded that the system increased their family members' sense of security. CONCLUSION The m-health tool significantly improved patients' self-care behaviour after 3 months, but this effect did not persist after 1 year. For achieving long-term effects and outcomes, additional and regularly updated self-care support may be needed. REGISTRATION ClinicalTrials.gov: NCT04955600.
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Affiliation(s)
- Maria Liljeroos
- Department of Health, Medicine and Caring Sciences, Linköping University, Campus US, Building 511, SE-58183, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, SE-631 88 Eskilstuna, Sweden
| | - Marina Arkkukangas
- Centre for Clinical Research Sörmland, Uppsala University, SE-631 88 Eskilstuna, Sweden
- School of Health and Welfare, Department of Medicine and Sport Sciences, Dalarna University, Falun 791 88, Sweden
- School of Health, Care and Social Welfare, Department of Physiotherapy, Mälardalen University, Vasteras 721 23, Sweden
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Campus US, Building 511, SE-58183, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
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Parikh RV, Axelrod AW, Ambrosy AP, Tan TC, Bhatt AS, Fitzpatrick JK, Lee KK, Adatya S, Vasadia JV, Dinh HH, Go AS. Association Between Participation in a Heart Failure Telemonitoring Program and Health Care Utilization and Death Within an Integrated Health Care Delivery System. J Card Fail 2023; 29:1642-1654. [PMID: 37220825 DOI: 10.1016/j.cardfail.2023.04.013] [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: 11/28/2022] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The clinical usefulness of remote telemonitoring to reduce postdischarge health care use and death in adults with heart failure (HF) remains controversial. METHODS AND RESULTS Within a large integrated health care delivery system, we matched patients enrolled in a postdischarge telemonitoring intervention from 2015 to 2019 to patients not receiving telemonitoring at up to a 1:4 ratio on age, sex, and calipers of a propensity score. Primary outcomes were readmissions for worsening HF and all-cause death within 30, 90, and 365 days of the index discharge; secondary outcomes were all-cause readmissions and any outpatient diuretic dose adjustments. We matched 726 patients receiving telemonitoring to 1985 controls not receiving telemonitoring, with a mean age of 75 ± 11 years and 45% female. Patients receiving telemonitoring did not have a significant reduction in worsening HF hospitalizations (adjusted rate ratio [aRR] 0.95, 95% confidence interval [CI] 0.68-1.33), all-cause death (adjusted hazard ratio 0.60, 95% CI 0.33-1.08), or all-cause hospitalization (aRR 0.82, 95% CI 0.65-1.05) at 30 days, but did have an increase in outpatient diuretic dose adjustments (aRR 1.84, 95% CI 1.44-2.36). All associations were similar at 90 and 365 days postdischarge. CONCLUSIONS A postdischarge HF telemonitoring intervention was associated with more diuretic dose adjustments but was not significantly associated with HF-related morbidity and mortality.
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Affiliation(s)
- Rishi V Parikh
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California
| | - Amir W Axelrod
- Department of Cardiology, Kaiser Permanente Vallejo Medical Center, Vallejo, California
| | - Andrew P Ambrosy
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Ankeet S Bhatt
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Jesse K Fitzpatrick
- Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Keane K Lee
- Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Sirtaz Adatya
- Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Jitesh V Vasadia
- Department of Cardiology, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, California
| | - Howard H Dinh
- Department of Cardiology, Kaiser Permanente South Sacramento Medical Center, Sacramento, California
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, California; Department of Medicine (Nephrology), Stanford University School of Medicine, Palo Alto, California.
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Masterson Creber R, Dodson JA, Bidwell J, Breathett K, Lyles C, Harmon Still C, Ooi SY, Yancy C, Kitsiou S. Telehealth and Health Equity in Older Adults With Heart Failure: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2023; 16:e000123. [PMID: 37909212 DOI: 10.1161/hcq.0000000000000123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Enhancing access to care using telehealth is a priority for improving outcomes among older adults with heart failure, increasing quality of care, and decreasing costs. Telehealth has the potential to increase access to care for patients who live in underresourced geographic regions, have physical disabilities or poor access to transportation, and may not otherwise have access to cardiologists with expertise in heart failure. During the COVID-19 pandemic, access to telehealth expanded, and yet barriers to access, including broadband inequality, low digital literacy, and structural barriers, prevented many of the disadvantaged patients from getting equitable access. Using a health equity lens, this scientific statement reviews the literature on telehealth for older adults with heart failure; provides an overview of structural, organizational, and personal barriers to telehealth; and presents novel interventions that pair telemedicine with in-person services to mitigate existing barriers and structural inequities.
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Lachar J, Avila CJ, Qayyum R. The Long-Term Effect of Financial Penalties on 30-Day Hospital Readmission Rates. Jt Comm J Qual Patient Saf 2023; 49:521-528. [PMID: 37394398 DOI: 10.1016/j.jcjq.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Although the immediate effect of financial penalties imposed by the Hospital Readmissions Reduction Program (HRRP) was a decrease in 30-day hospital readmission rates, the long-term effects are unclear. The authors studied 30-day readmissions before and immediately after HRRP penalties and during the most recent period before the COVID-19 pandemic and examined whether readmission trends differed between penalized and non-penalized hospitals. METHODS Centers for Medicare & Medicaid Services hospital archive data and US Census Bureau data were used to analyze hospital characteristics, including readmission penalty status, and hospital service area (HSA) demographic information, respectively. These two datasets were matched by HSA crosswalk files, available through the Dartmouth Atlas files. Using data from 2005-2008 as baseline, the authors examined hospital readmission trends before (2008-2011) and after penalties (during three periods: 2011-2014, 2014-2017, 2017-2019). Mixed linear models were used to examine readmission trends through periods, and differences by hospital penalty status without and with adjustment for hospital characteristics and HSA demographic information. RESULTS For all hospitals combined, rates for 2008-2011 vs. 2011-2014 were as follows: pneumonia, 18.6% vs. 17.0%; heart failure (HF), 24.8% vs. 22.0%; acute myocardial infarction (AMI), 19.7% vs. 17.0% (p < 0.001 for all three conditions). Rates for 2014-2017 vs. 2017-2019 were as follows: pneumonia, 16.8% vs. 16.8% (p = 0.87), HF, 21.7% vs. 21.9% (p < 0.001); AMI, 16.0% vs. 15.8% (p < 0.001). Compared to penalized hospitals, using difference-in-differences, non-penalized hospitals had a significantly greater increase for two conditions between the 2014-2017 and 2017-2019 periods: pneumonia 0.34%, p < 0.001; and HF 0.24%, p = 0.002. CONCLUSION Long-term readmission rates are lower than pre-HRRP rates, with recent trends decreasing further for AMI, stabilizing for pneumonia, and increasing for HF.
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Soh YY, Zhang H, Toh JJY, Li X, Wu XV. The effectiveness of tele-transitions of care interventions in high-risk older adults: A systematic review and meta-analysis. Int J Nurs Stud 2023; 139:104428. [PMID: 36682322 DOI: 10.1016/j.ijnurstu.2022.104428] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chronically ill older patients are often vulnerable to detrimental health outcomes and have increased risk of preventable readmission. Tele-transitions of care interventions utilizing telecommunications and surveillance technologies help monitor patients' conditions after discharge to prevent negative health outcomes. OBJECTIVES This systematic review and meta-analysis aimed to identify and synthesize available evidence on the effectiveness of tele-transitions of care interventions on various health outcomes in older adults at high risk for readmission discharged from acute setting. METHODS Published, unpublished studies and gray literatures were identified through searching PubMed, Medline, Embase, PsycINFO, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations and theses and Google Scholar from inception to December 2021. Only randomized controlled trials published in English language assessing tele-transitions of care interventions on high-risk older adults were included. Meta-analyses were performed using random-effects model in RevMan 5.4. Sensitivity and subgroup and narrative analyses were conducted. RESULTS Fourteen studies were included, of which thirteen were considered for meta-analyses. Tele-transitions of care interventions were effective in reducing readmission rate (RR = 0.59, 95%CI 0.50-0.69, z = 6.28, p < 0.00001), mortality rate (RR = 0.72, 95%CI 0.53-0.98, z = 2.12, p = 0.03), and improving health-related quality of life (SMD = 0.24, Z = 2.04, p = 0.04). However, reduction of emergency department visit (RR = 1.10, 95%CI 0.59-2.06, z = 0.31, p = 0.76) and improvement of functional status (SMD = -0.06, Z = 0.19, p = 0.85) was not observed following intervention. Subgroup analysis found that the positive effects of tele-transitions of care interventions persist up to 180 days even after the intervention. CONCLUSION This systematic review and meta-analysis concluded that tele-transitions of care interventions have promising effects on readmission, mortality rate and health-related quality of life. Tele-transitions of care interventions are cost-effective and suitable for large-scale implementation in healthcare settings. REGISTRATION The protocol was registered on PROSPERO (CRD42022295665). TWEETABLE ABSTRACT Systematic review demonstrates that monitoring older patients at high risk of readmission, following discharge from hospital, using telecommunication and surveillance technologies significantly reduces readmission and mortality rates and improves their quality of life.
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Affiliation(s)
- Yang Yue Soh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Hui Zhang
- St Andrew's Community Hospital, 8 Simei Street 3, Singapore.
| | - Janice Jia Yun Toh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, Hunan Province, People's Republic of China.
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, Singapore.
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Asim M, Hameed W, Khan B, Saleem S, Avan BI. Applying the COM-B Model to Understand the Drivers of Mistreatment During Childbirth: A Qualitative Enquiry Among Maternity Care Staff. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00267. [PMID: 36853644 PMCID: PMC9972373 DOI: 10.9745/ghsp-d-22-00267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/28/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Respectful maternity care (RMC) during childbirth is an integral component of quality of care. However, women's experiences of mistreatment are prevalent in many low- and middle-income countries. This is a complex phenomenon that has not been well explored from a behavioral science perspective. We aimed to understand the behavioral drivers of mistreatment during childbirth among maternity care staff at public health facilities in the Sindh province of Pakistan. METHODS Applying the COM-B (capability-opportunity-motivation that leads to behavior change) model, we conducted semistructured in-depth interviews among clinical and nonclinical staff in public health facilities in Thatta and Sujawal, Sindh, Pakistan. Data were analyzed using thematic deductive analysis, and findings were synthesized using the COM-B model. RESULTS We identified several behavioral drivers of mistreatment during childbirth: (1) institutional guidelines on RMC and training opportunities were absent, resulting in a lack of providers' knowledge and skills; (2) facilities lacked the infrastructure to maintain patient privacy and confidentiality and did not permit males as birth companions; (3) lack of provider performance monitoring system and patient feedback mechanism contributed to providers not feeling appreciated or recognized. Staff bias against patients from lower castes contributed to patient abuse and mistreatment. The perspectives of clinical and nonclinical staff overlapped regarding potential drivers of mistreatment during childbirth. CONCLUSIONS Addressing mistreatment during childbirth requires improving the knowledge and capacity of maternity staff on RMC and psychosocial support to enhance their understanding of RMC. At the health facility level, governance and accountability mechanisms in routine supervision and monitoring of staff need to be improved. Patients' feedback should be incorporated for continuous improvement in providing maternity care services that meet patients' preferences and needs.
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Affiliation(s)
- Muhammad Asim
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Waqas Hameed
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Bushra Khan
- Department of Psychology, University of Karachi, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Bilal Iqbal Avan
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Shibata S, Hoshide S. Current situation of telemedicine research for cardiovascular risk in Japan. Hypertens Res 2023; 46:1171-1180. [PMID: 36849580 PMCID: PMC9969376 DOI: 10.1038/s41440-023-01224-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 03/01/2023]
Abstract
Hypertension continues to be a principal risk factor for the occurrence of cardiovascular disorders, stroke, and kidney diseases. Although more than 40 million subjects suffer from hypertension in Japan, its optimal control is achieved only a subpopulation of patients, highlighting the need for novel approaches to manage this disorder. Toward the better control of blood pressure, the Japanese Society of Hypertension has developed the Future Plan, in which the application of the state-of-art information and communication technology, including web-based resources, artificial intelligence, and big data analysis, is considered as one of the promising solutions. In fact, the rapid advance of digital health technologies, as well as ongoing coronavirus disease 2019 pandemic, has triggered the structural changes in the healthcare system globally, increasing demand for the remote delivery of the medical services. Nonetheless, it is not entirely clear what evidence exists that support the widespread use of telemedicine in Japan. Here, we summarize the current status of telemedicine research, particularly in the field of hypertension and other cardiovascular risk factors. We note that there have been very few interventional studies in Japan that clearly showed the superiority or noninferiority of telemedicine over standard care, and that the methods of online consultation considerably varied among studies. Clearly, more evidence is necessary for wide implementation of telemedicine in hypertensive patients in Japan, and also those with other cardiovascular risk factors.
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Affiliation(s)
- Shigeru Shibata
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
| | - Satoshi Hoshide
- grid.410804.90000000123090000Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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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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Caillon M, Sabatier R, Legallois D, Courouve L, Donio V, Boudevin F, de Chalus T, Hauchard K, Belin A, Milliez P. A telemonitoring programme in patients with heart failure in France: a cost-utility analysis. BMC Cardiovasc Disord 2022; 22:441. [PMID: 36217130 PMCID: PMC9549824 DOI: 10.1186/s12872-022-02878-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Certain telemedicine programmes for heart failure (HF) have been shown to reduce all-cause mortality and heart failure-related hospitalisations, but their cost-effectiveness remains controversial. The SCAD programme is a home-based interactive telemonitoring service for HF, which is one of the largest and longest-running telemonitoring programmes for HF in France. The objective of this cost-utility analysis was to evaluate the cost-effectiveness of the SCAD programme with respect to standard hospital-based care in patients with HF. METHODS A Markov model simulating hospitalisations and mortality in patients with HF was constructed to estimate outcomes and costs. The model included six distinct health states (three 'not hospitalised' states, two 'hospitalisation for heart failure' states, both depending on the number of previous hospitalisations, and one death state). The model lifetime in the base case was 10 years. Model inputs were based on published literature. Outputs (costs and QALYs) were compared between SCAD participants and standard care. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty in the input parameters of the model. RESULTS The number of quality-adjusted life years (QALYs) was 3.75 in the standard care setting and 4.41 in the SCAD setting. This corresponds to a gain in QALYs provided by the SCAD programme of 0.65 over the 10 years lifetime of the model. The estimated total cost was €30,932 in the standard care setting and €35,177 in the SCAD setting, with an incremental cost of €4245. The incremental cost-effectiveness ratio (ICER) for the SCAD programme over standard care was estimated at €4579/QALY. In the deterministic sensitivity analysis, the variables that had the most impact on the ICER were HF management costs. The likelihood of the SCAD programme being considered cost-effective was 90% at a willingness-to-pay threshold of €11,800. CONCLUSIONS Enrolment of patients into the SCAD programme is highly cost-effective. Extension of the programme to other hospitals and more patients would have a limited budget impact but provide important clinical benefits. This finding should also be taken into account in new public health policies aimed at encouraging a shift from inpatient to ambulatory care.
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Affiliation(s)
| | - Rémi Sabatier
- Service de Cardiologie et de Pathologie Vasculaire, CHU de Caen Normandie, Caen, France.,Université de Caen-Normandie, Caen, France.,APRIC (Association pour l'Amélioration de la Prise en charge de l'Insuffisance Cardiaque), Ouistreham, France
| | - Damien Legallois
- Service de Cardiologie et de Pathologie Vasculaire, CHU de Caen Normandie, Caen, France.,Université de Caen-Normandie, Caen, France
| | | | | | | | | | | | - Annette Belin
- Service de Cardiologie et de Pathologie Vasculaire, CHU de Caen Normandie, Caen, France.,APRIC (Association pour l'Amélioration de la Prise en charge de l'Insuffisance Cardiaque), Ouistreham, France
| | - Paul Milliez
- Service de Cardiologie et de Pathologie Vasculaire, CHU de Caen Normandie, Caen, France.,Université de Caen-Normandie, Caen, France
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Hafkamp FJ, Tio RA, Otterspoor LC, de Greef T, van Steenbergen GJ, van de Ven ART, Smits G, Post H, van Veghel D. Optimal effectiveness of heart failure management - an umbrella review of meta-analyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure. Heart Fail Rev 2022; 27:1683-1748. [PMID: 35239106 PMCID: PMC8892116 DOI: 10.1007/s10741-021-10212-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) is a major health concern, which accounts for 1-2% of all hospital admissions. Nevertheless, there remains a knowledge gap concerning which interventions contribute to effective prevention of HF (re)hospitalization. Therefore, this umbrella review aims to systematically review meta-analyses that examined the effectiveness of interventions in reducing HF-related (re)hospitalization in HFrEF patients. An electronic literature search was performed in PubMed, Web of Science, PsycInfo, Cochrane Reviews, CINAHL, and Medline to identify eligible studies published in the English language in the past 10 years. Primarily, to synthesize the meta-analyzed data, a best-evidence synthesis was used in which meta-analyses were classified based on level of validity. Secondarily, all unique RCTS were extracted from the meta-analyses and examined. A total of 44 meta-analyses were included which encompassed 186 unique RCTs. Strong or moderate evidence suggested that catheter ablation, cardiac resynchronization therapy, cardiac rehabilitation, telemonitoring, and RAAS inhibitors could reduce (re)hospitalization. Additionally, limited evidence suggested that multidisciplinary clinic or self-management promotion programs, beta-blockers, statins, and mitral valve therapy could reduce HF hospitalization. No, or conflicting evidence was found for the effects of cell therapy or anticoagulation. This umbrella review highlights different levels of evidence regarding the effectiveness of several interventions in reducing HF-related (re)hospitalization in HFrEF patients. It could guide future guideline development in optimizing care pathways for heart failure patients.
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Affiliation(s)
| | - Rene A. Tio
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Luuk C. Otterspoor
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Tineke de Greef
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | | | - Arjen R. T. van de Ven
- Netherlands Heart Network, Veldhoven, The Netherlands
- St. Anna Hospital, Geldrop, The Netherlands
| | - Geert Smits
- Netherlands Heart Network, Veldhoven, The Netherlands
- Primary care group Pozob, Veldhoven, The Netherlands
| | - Hans Post
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Dennis van Veghel
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
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11
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Mohan B, Singh B, Singh K, Naik N, Roy A, Goyal A, SIngh G, Aggarwal S, Saini A, Tandon R, Chhabra ST, Aslam N, Wander GS, Prabhakaran D. Impact of a nurse-led teleconsultation strategy for cardiovascular disease management during COVID-19 pandemic in India: a pyramid model feasibility study. BMJ Open 2022; 12:e056408. [PMID: 35798525 PMCID: PMC9263376 DOI: 10.1136/bmjopen-2021-056408] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic necessitated the use of telemedicine to maintain continuity of care for patients with cardiovascular diseases (CVDs). This study aimed to demonstrate the feasibility of implementing a nurse-led teleconsultation strategy for CVD management during the COVID-19 pandemic in India and evaluated the impact of nurse-led teleconsultations on patient treatment satisfaction. DESIGN, SETTING AND PARTICIPANTS We developed a two-stage teleconsultation strategy and tested the feasibility of implementing a nurse-led teleconsultation strategy to manage CVD in a northern state (Punjab) in India. A multidisciplinary team of experts developed the treatment protocol used for teleconsultations to manage CVD. Nurses were trained to provide teleconsultation, triaging of patients and referrals to the physicians. Patients with CVD who had an outpatient visit or hospitalisation between September 2019 and March 2020 at the Dayanand Medical College Hospital, Ludhiana, India, were contacted by phone and offered teleconsultations. Telemedicine strategy comprised: stage 1 nurse-led teleconsultations and stage 2 physician-led teleconsultations. Descriptive analysis was performed to report the proportion of patients triaged by the two-stage telemedicine strategy, and patient's clinical characteristics, and treatment satisfaction between the nurse-led versus physician-led teleconsultations. RESULTS Overall, nurse-led stage 1 teleconsultations were provided to 12 042 patients with CVD. The mean (SD) age of the participants was 58.9 years (12.8), and men were 65.4%. A relatively small proportion of patients (6.3%) were referred for the stage-2 physician-led teleconsultations and of these only 8.4% required hospitalisations. During stage 1 nurse-led teleconsultations, patients were referred to the physicians due to uncontrolled diabetes (24.9%), uncontrolled hypertension (18.7%) and congestive heart failure (16.2%). The patient's treatment satisfaction was similar between the nurse-led versus physician-led teleconsultations (p=0.07). CONCLUSION This study showed that a nurse-led telemedicine strategy is feasible to implement in a resource-constraint setting for triaging patients with CVD and reduces physician's burden.
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Affiliation(s)
- Bishav Mohan
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Bhupinder Singh
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Kavita Singh
- Centre for Chronic Conditions and Injuries, Public Health Foundation, Gurugram, India
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Nitish Naik
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Goyal
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Gurbhej SIngh
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Shivaansh Aggarwal
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Aftabh Saini
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Rohit Tandon
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India
| | | | - Naved Aslam
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation, Gurugram, India
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12
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Kirakalaprathapan A, Oremus M. Efficacy of telehealth in integrated chronic disease management for older, multimorbid adults with heart failure: A systematic review. Int J Med Inform 2022; 162:104756. [PMID: 35381436 DOI: 10.1016/j.ijmedinf.2022.104756] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/02/2022] [Accepted: 03/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND We conducted a systematic review to assess the comparative efficacy of integrated telehealth versus other strategies of chronic disease management in older, multimorbid adults with heart failure (HF) in primary care and community settings. Specific efficacy outcomes included CVD-related hospitalizations, rehospitalizations, and mortality. MATERIALS AND METHODS We searched for randomized controlled trials (RCTs) in MEDLINE, Scopus, EMBASE, CINAHL, and CENTRAL from the date of each database's inception to January 2020. The literature search retrieved 9,181 articles, which were screened by two independent raters. Twenty-two of these articles were included in the systematic review. Data extraction, risk of bias assessment, and narrative synthesis followed article screening. RESULTS This systematic review found that integrated telehealth is efficacious in reducing CVD-related hospitalizations, rehospitalizations, and mortality in older, multimorbid adults within primary care and community settings. However, numerous discrepancies existed between the studies, due largely to differences in telehealth modalities and risk of bias. Overall, the combinations of modalities were so diverse that the reviewed literature did not suggest an optimal integrated telehealth strategy. At most, no more than three studies featured the same combination of telehealth modalities and outcomes. Furthermore, only 3 of the 22 included RCTs scored low on the Cochrane risk of bias tool. CONCLUSIONS Researchers should focus on the quality of future RCTs to better assess the efficacy of different telehealth modalities in multimorbid older adults with HF. Also, since all the included RCTs focused on HF, a knowledge gap exists with regard to the efficacy of using integrated telehealth to manage other cardiovascular diseases (CVD).
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Affiliation(s)
| | - Mark Oremus
- School of Public Health Sciences, University of Waterloo, Canada.
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13
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Zhu X, Williams M, Finuf K, Patel V, Sinvani L, Wolf-Klein G, Marziliano A, Nouryan C, Makaryus A, Zeltser R, Tortez L, Shkolnikov T, Myers A, Pekmezaris R. Home Telemonitoring of Patients With Type 2 Diabetes: A Meta-Analysis and Systematic Review. Diabetes Spectr 2022; 35:118-128. [PMID: 35308155 PMCID: PMC8914593 DOI: 10.2337/ds21-0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Telehealth has emerged as an evolving care management strategy that is playing an increasingly vital role, particularly with the onset of the coronavirus disease 2019 pandemic. A meta-analysis of 20 randomized controlled trials was conducted to test the effectiveness of home telemonitoring (HTM) in patients with type 2 diabetes in reducing A1C, blood pressure, and BMI over a median 180-day study duration. HTM was associated with a significant reduction in A1C by 0.42% (P = 0.0084). Although we found statistically significant changes in both systolic and diastolic blood pressure (-0.10 mmHg [P = 0.0041] and -0.07 mmHg [P = 0.044], respectively), we regard this as clinically nonsignificant in the context of HTM. Comparisons across different methods of transmitting vital signs suggest that patients logging into systems with moderate interaction with the technology platform had significantly higher reductions in A1C than those using fully automatic transmission methods or fully manual uploading methods. A1C did not vary significantly by study duration (from 84 days to 5 years). HTM has the potential to provide patients and their providers with timely, up-to-date information while simultaneously improving A1C.
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Affiliation(s)
- Xu Zhu
- Department of Medicine, Northwell Health, Manhasset, NY
- Institute for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY
- Corresponding author: Xu Zhu,
| | - Myia Williams
- Department of Medicine, Northwell Health, Manhasset, NY
- Institute for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY
- David and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
- The Feinstein Institute for Medical Research, Manhasset, NY
| | - Kayla Finuf
- Department of Medicine, Northwell Health, Manhasset, NY
- Institute for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY
| | - Vidhi Patel
- Department of Medicine, Northwell Health, Manhasset, NY
- Institute for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY
| | - Liron Sinvani
- Department of Medicine, Northwell Health, Manhasset, NY
- Institute for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY
- David and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
- The Feinstein Institute for Medical Research, Manhasset, NY
- Geriatric Hospitalist Service, Northwell Health, Manhasset, NY
| | - Gisele Wolf-Klein
- Institute for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY
- David and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Allison Marziliano
- Institute for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY
- David and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
- The Feinstein Institute for Medical Research, Manhasset, NY
| | - Christian Nouryan
- Department of Medicine, Northwell Health, Manhasset, NY
- Institute for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY
- David and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
- The Feinstein Institute for Medical Research, Manhasset, NY
| | - Amgad Makaryus
- David and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
- The Feinstein Institute for Medical Research, Manhasset, NY
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY
- Department of Cardiology, Northwell Health, Manhasset, NY
| | - Roman Zeltser
- David and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
- The Feinstein Institute for Medical Research, Manhasset, NY
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY
- Department of Cardiology, Northwell Health, Manhasset, NY
| | - Leanne Tortez
- Department of Psychology, William James College, Williamsburg, VA
| | | | - Alyson Myers
- Institute for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY
- David and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
- The Feinstein Institute for Medical Research, Manhasset, NY
- Department of Internal Medicine, Division of Endocrinology, North Shore University Hospital, Manhasset, NY
| | - Renee Pekmezaris
- Department of Medicine, Northwell Health, Manhasset, NY
- Institute for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY
- David and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
- The Feinstein Institute for Medical Research, Manhasset, NY
- Division of Health Services Research, Center for Health Innovations and Outcomes Research, Department of Medicine, Manhasset, NY
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Cao G, Fan C, Liu Y, Huang H, Li J, Liang J, Tao B, Yuan J. A telehealth program benefits discharged patients with heart failure. Acta Cardiol 2022; 78:195-202. [PMID: 34979861 DOI: 10.1080/00015385.2021.1999571] [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: 11/01/2022]
Abstract
BACKGROUND Heart failure (HF) remains a major cause of mortality, hospitalisations, and poor quality of life. The mortality and readmission rate of HF patients after discharge are still high due to poor self-care and adherence, or inability to detect signs of deterioration. Telehealth programs may benefit a broad range of patients and reduce the suffering from HF. We aimed to investigate the impact of a 12-week telehealth program on outcomes among discharged patients with HF. METHODS Study population was consisted of 425 patients discharged between Jan 2020 to Aug 2020. All enrolled participants were diagnosed as HF and underwent standard treatments. At discharge, they were randomised into the telehealth or control group. The intervention was based on telephone support biweekly. After 12-week follow-up, patients' outcomes including mortality, readmission, disease condition, adherence, self-care behaviours, and mental health were compared between the groups. RESULTS The telehealth program significantly improved the HF symptoms in patients (p < 0.001). Patients in telehealth group showed better adherence compared to control (p = 0.002). Moreover, the intervention enhanced patients' self-care skills, indicated by the increased ratio of individuals knowing how to evaluate the cardiac function (p = 0.009) and purchasing medicines (p = 0.03). In addition, the telehealth program significantly improved the mental health status of patients (p = 0.03). CONCLUSION The telehealth program is beneficial for improving HF symptoms, adherence, self-care skills and mental health status of discharged patients and support the future use of this program to manage patients and reduce the burden attributed to the condition.
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Affiliation(s)
- Guilan Cao
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Heart Failure Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cheng Fan
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Liu
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Heart Failure Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haixia Huang
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Heart Failure Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Li
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Heart Failure Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Liang
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Heart Failure Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Baoming Tao
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Heart Failure Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Yuan
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Heart Failure Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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15
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Dawson NL, Hull BP, Vijapura P, Dumitrascu AG, Ball CT, Thiemann KM, Maniaci MJ, Burton MC. Home Telemonitoring to Reduce Readmission of High-Risk Patients: a Modified Intention-to-Treat Randomized Clinical Trial. J Gen Intern Med 2021; 36:3395-3401. [PMID: 33506388 PMCID: PMC8606403 DOI: 10.1007/s11606-020-06589-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/30/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Home telemonitoring has been used with discharged patients in an attempt to reduce 30-day readmissions with mixed results. OBJECTIVE To assess whether home 30-day telemonitoring after discharge for patients at high risk of readmission would reduce readmissions or mortality. DESIGN Prospective, randomized controlled trial. PATIENTS We compared 30-day readmission rates and mortality for patients at high risk for readmission who received home telemonitoring versus standard care between November 1, 2014, and November 30, 2018, in 2 tertiary care hospitals. INTERVENTIONS The intervention group received home-installed equipment to measure blood pressure, heart rate, pulse oximetry, weight if heart failure was present, and glucose if diabetes was present. Results were transmitted daily and reviewed by a nurse. Both groups received standard care. MAIN MEASURES The primary outcome was a composite end point of hospital readmission or death within 30 days after discharge. The secondary outcome was an emergency department visit within 30 days after discharge. KEY RESULTS A total of 1380 participants (mean [SD] age, 66 [14] years; 722 [52.3%] men and 658 [47.7%] women) participated in this study. Using a modified intention-to-treat analysis, the risk of readmission or death within 30 days among patients at high readmission risk was 23.7% (137/578) in the control group and 18.2% (87/477) in the telemonitoring group (absolute risk difference, - 5.5% [95% CI, - 10.4 to - 0.6%]; relative risk, 0.77 [95% CI, 0.61 to 0.98]; P = .03). Emergency department visits occurred within 30 days after discharge in 14.2% (81/570) of patients in the control group and 8.6% (40/464) of patients in the telemonitoring group (absolute risk difference, - 5.6% [95% CI, - 9.4 to - 1.8%]; relative risk, 0.61 [95% CI, 0.42 to 0.87]; P = .005). CONCLUSIONS Thirty days of postdischarge telemonitoring may reduce readmissions of high-risk patients. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02136186.
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Affiliation(s)
- Nancy L Dawson
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
| | - Bryan P Hull
- Division of Hospital Internal Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Priyanka Vijapura
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Adrian G Dumitrascu
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Colleen T Ball
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Kay M Thiemann
- Shared Services Administration, Mayo Clinic, Rochester, MN, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - M Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
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16
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Castelyn G, Laranjo L, Schreier G, Gallego B. Predictive performance and impact of algorithms in remote monitoring of chronic conditions: A systematic review and meta-analysis. Int J Med Inform 2021; 156:104620. [PMID: 34700194 DOI: 10.1016/j.ijmedinf.2021.104620] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/27/2021] [Accepted: 10/09/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The use of telehealth interventions, such as the remote monitoring of patient clinical data (e.g. blood pressure, blood glucose, heart rate, medication use), has been proposed as a strategy to better manage chronic conditions and to reduce the impact on patients and healthcare systems. The use of algorithms for data acquisition, analysis, transmission, communication and visualisation are now common in remote patient monitoring. However, their use and impact on chronic disease management has not been systematically investigated. OBJECTIVES To investigate the use, impact, and performance of remote monitoring algorithms across various types of chronic conditions. METHODS A literature search of MEDLINE complete, CINHAL complete, and EMBASE was performed using search terms relating to the concepts of remote monitoring, chronic conditions, and data processing algorithms. Comparable outcomes from studies describing the impact on process measures and clinical and patient-reported outcomes were pooled for a summary effect and meta-analyses. A comparison of studies reporting the predictive performance of algorithms was also conducted using the Youden Index. RESULTS A total of 89 articles were included in the review. There was no evidence of a positive impact on healthcare utilisation [OR 1.09 (0.90 to 1.31); P = .35] and mortality [OR 0.83 (0.63 to 1.10); P = .208], but there was a positive effect on generic health status [SDM 0.2912 (0.06 to 0.51); P = .010] and diabetes control [SDM -0.53 (-0.74 to -0.33); P < .001; I2 = 15.71] (with two of the three diabetes studies being identified as having a high risk of bias). While the majority of impact studies made use of heuristic threshold-based algorithms (n = 27,87%), most performance studies (n = 36, 62%) analysed non-sequential machine learning methods. There was considerable variance in the quality, sample size and performance amongst these studies. Overall, algorithms involved in diagnosis (n = 22, 47%) had superior performance to those involved in predicting a future event (n = 25, 53%). Detection of arrythmia and ischaemia utilising ECG data showed particularly promising results. CONCLUSION The performance of data processing algorithms for the diagnosis of a current condition, particularly those related to the detection of arrythmia and ischaemia, is promising. However, there appears to exist minimal testing in experimental studies, with only two included impact studies citing a performance study as support for the intervention algorithm used. Because of the disconnect between performance and impact studies, there is currently limited evidence of the effect of integrating advanced inference algorithms in remote monitoring interventions. If the field of remote patient monitoring is to progress, future impact studies should address this disconnect by evaluating high performance validated algorithms in robust clinical trials.
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Affiliation(s)
| | - Liliana Laranjo
- Westmead Applied Research Centre, Sydney Medical School, The University of Sydney, Sydney, Australia; NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - Günter Schreier
- Digital Health Information Systems, Center for Health and Bioresources, AIT Austrian Institute of Technology GmbH, Graz, Austria.
| | - Blanca Gallego
- Centre for Big Data Research in Health (CBDRH), Faculty of Medicine & Health, University of New South Wales, Sydney, Australia.
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Greffin K, Muehlan H, van den Berg N, Hoffmann W, Ritter O, Oeff M, Schomerus G, Schmidt S. Setting-Sensitive Conceptualization and Assessment of Quality of Life in Telemedical Care-Study Protocol of the Tele-QoL Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910454. [PMID: 34639754 PMCID: PMC8507616 DOI: 10.3390/ijerph181910454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
Quality of life (QoL) is a core patient-reported outcome in healthcare research, alongside primary clinical outcomes. A conceptual, operational, and psychometric elaboration of QoL in the context of TM is needed, because standardized instruments to assess QoL do not sufficiently represent essential aspects of intended outcomes of telemedical applications (TM). The overall aim is to develop an instrument that can adequately capture QoL in TM. For that purpose, an extended working model of QoL will be derived. Subsequently, an instrument will be developed and validated that captures those aspects of QoL that are influenced by TM. The initial exploratory study section includes (a) a systematic literature review, (b) a qualitative survey for concept elicitation, and (c) pre-testings using cognitive debriefings with patients and an expert workshop. The second quantitative section consists of an online expert survey and two patient surveys for piloting and validation of the newly developed instrument. The resulting questionnaire will assess central experiences of patients regarding telemedical applications and its impact on QoL more sensitively. Its use as adjunct instrument will lead to a more appropriate evaluation of TM and contribute to the improvement of care tailored to patients’ individual needs.
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Affiliation(s)
- Klara Greffin
- Department of Psychology, University of Greifswald, 17489 Greifswald, Germany; (H.M.); (S.S.)
- Correspondence: ; Tel.: +49-3834-420-3808
| | - Holger Muehlan
- Department of Psychology, University of Greifswald, 17489 Greifswald, Germany; (H.M.); (S.S.)
| | - Neeltje van den Berg
- Department of Health Care Epidemiology and Community Health, Institute of Community Medicine, University Medicine Greifswald, 17489 Greifswald, Germany; (N.v.d.B.); (W.H.)
| | - Wolfgang Hoffmann
- Department of Health Care Epidemiology and Community Health, Institute of Community Medicine, University Medicine Greifswald, 17489 Greifswald, Germany; (N.v.d.B.); (W.H.)
| | - Oliver Ritter
- Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany;
- Department of Cardiology, Brandenburg City Hospital, 14770 Brandenburg an der Havel, Germany;
| | - Michael Oeff
- Department of Cardiology, Brandenburg City Hospital, 14770 Brandenburg an der Havel, Germany;
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University Medicine Leipzig, 04103 Leipzig, Germany;
| | - Silke Schmidt
- Department of Psychology, University of Greifswald, 17489 Greifswald, Germany; (H.M.); (S.S.)
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18
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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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Chiem AT, Lim GW, Tabibnia AP, Takemoto AS, Weingrow DM, Shibata JE. Feasibility of patient-performed lung ultrasound self-exams (Patient-PLUS) as a potential approach to telemedicine in heart failure. ESC Heart Fail 2021; 8:3997-4006. [PMID: 34288549 PMCID: PMC8497224 DOI: 10.1002/ehf2.13493] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/23/2021] [Accepted: 06/12/2021] [Indexed: 01/14/2023] Open
Abstract
Aims Patient‐performed lung ultrasound (LUS) in a heart failure (HF) telemedicine model may be used to monitor worsening pulmonary oedema and to titrate therapy, potentially reducing HF admission. The aim of the study was to assess the feasibility of training HF patients to perform a LUS self‐exam in a telemedicine model. Methods and results A pilot study was conducted at a public hospital involving subjects with a history of HF. After a 15 min training session involving a tutorial video, subjects performed a four‐zone LUS using a handheld ultrasound. Exams were saved on a remote server and independently reviewed by two LUS experts. Studies were determined interpretable according to a strict definition: the presence of an intercostal space, and the presence of A‐lines, B‐lines, or both. Subjects also answered a questionnaire to gather feedback and assess self‐efficacy. The median age of 44 subjects was 53 years (range, 36–64). Thirty (68%) were male. Last educational level attained was high school or below for 31 subjects (70%), and one‐third used Spanish as their preferred language. One hundred fifty of 175 lung zones (85%) were interpretable, with expert agreement of 87% and a kappa of 0.49. 98% of subjects reported that they could perform this LUS self‐exam at home. Conclusions This pilot study reports that training HF patients to perform a LUS self‐exam is feasible, with reported high self‐efficacy. This supports further investigation into a telemedicine model using LUS to reduce emergency department visits and hospitalizations associated with HF.
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Affiliation(s)
- Alan T Chiem
- Emergency Medicine, Olive View-UCLA Medical Center, 14445 Olive View Drive North Annex, Sylmar, Los Angeles, California, 91342, USA
| | - George W Lim
- Emergency Medicine and Anesthesiology, Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | - Amir P Tabibnia
- Emergency Medicine, Olive View-UCLA Medical Center, 14445 Olive View Drive North Annex, Sylmar, Los Angeles, California, 91342, USA
| | - Andrea S Takemoto
- Emergency Medicine, Olive View-UCLA Medical Center, 14445 Olive View Drive North Annex, Sylmar, Los Angeles, California, 91342, USA
| | - Daniel M Weingrow
- Emergency Medicine, Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | - Jacqueline E Shibata
- Emergency Medicine, Olive View-UCLA Medical Center, 14445 Olive View Drive North Annex, Sylmar, Los Angeles, California, 91342, USA
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20
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Greffin K, Schmidt S, van den Berg N, Hoffmann W, Ritter O, Oeff M, Schomerus G, Muehlan H. Same same-but different: using qualitative studies to inform concept elicitation for quality of life assessment in telemedical care: a request for an extended working model. Health Qual Life Outcomes 2021; 19:175. [PMID: 34225737 PMCID: PMC8256487 DOI: 10.1186/s12955-021-01807-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background Although telemedical applications are increasingly used in the area of both mental and physical illness, there is no quality of life (QoL) instrument that takes into account the specific context of the healthcare setting. Therefore, the aim of this study was to determine a concept of quality of life in telemedical care to inform the development of a setting-sensitive patient-reported outcome measure.
Methods Overall, 63 semi-structured single interviews and 15 focus groups with 68 participants have been conducted to determine the impact of telemedical care on QoL. Participants were patients with chronic physical or mental illnesses, with or without telemedicine supported healthcare as well as telemedical professionals. Mayring's content analysis approach was used to encode the qualitative data using MAXQDA software. Results The majority of aspects that influence the QoL of patients dealing with chronic conditions or mental illnesses could be assigned to an established working model of QoL. However, some aspects that were considered important (e. g. perceived safety) were not covered by the pre-existing domains. For that reason, we re-conceptualized the working model of QoL and added a sixth domain, referred to as healthcare-related domain. Conclusion Interviewing patients and healthcare professionals brought forth specific aspects of QoL evolving in telemedical contexts. These results reinforce the assumption that existing QoL measurements lack sensitivity to assess the intended outcomes of telemedical applications. We will address this deficiency by a telemedicine-related re-conceptualization of the assessment of QoL and the development of a suitable add-on instrument based on the resulting category system of this study. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01807-8.
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Affiliation(s)
- Klara Greffin
- Department of Psychology, Chair of Health and Prevention, University of Greifswald, Robert-Blum-Str. 13, 17489, Greifswald, Germany.
| | - Silke Schmidt
- Department of Psychology, Chair of Health and Prevention, University of Greifswald, Robert-Blum-Str. 13, 17489, Greifswald, Germany
| | - Neeltje van den Berg
- Institute of Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstraße 1-2, 17475, Greifswald, Germany
| | - Wolfgang Hoffmann
- Institute of Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstraße 1-2, 17475, Greifswald, Germany
| | - Oliver Ritter
- Brandenburg City Hospital, Brandenburg Medical School Theodor Fontane, Fehrbelliner Str. 38, 16816, Neuruppin, Germany
| | - Michael Oeff
- Brandenburg City Hospital, Hochstraße 29, 14770, Brandenburg an der Havel, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University Medicine Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Holger Muehlan
- Department of Psychology, Chair of Health and Prevention, University of Greifswald, Robert-Blum-Str. 13, 17489, Greifswald, Germany
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21
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Senarath S, Fernie G, Roshan Fekr A. Influential Factors in Remote Monitoring of Heart Failure Patients: A Review of the Literature and Direction for Future Research. SENSORS 2021; 21:s21113575. [PMID: 34063825 PMCID: PMC8196679 DOI: 10.3390/s21113575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/20/2022]
Abstract
With new advances in technology, remote monitoring of heart failure (HF) patients has become increasingly prevalent and has the potential to greatly enhance the outcome of care. Many studies have focused on implementing systems for the management of HF by analyzing physiological signals for the early detection of HF decompensation. This paper reviews recent literature exploring significant physiological variables, compares their reliability in predicting HF-related events, and examines the findings according to the monitored variables used such as body weight, bio-impedance, blood pressure, heart rate, and respiration rate. The reviewed studies identified correlations between the monitored variables and the number of alarms, HF-related events, and/or readmission rates. It was observed that the most promising results came from studies that used a combination of multiple parameters, compared to using an individual variable. The main challenges discussed include inaccurate data collection leading to contradictory outcomes from different studies, compliance with daily monitoring, and consideration of additional factors such as physical activity and diet. The findings demonstrate the need for a shared remote monitoring platform which can lead to a significant reduction of false alarms and help in collecting reliable data from the patients for clinical use especially for the prevention of cardiac events.
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Affiliation(s)
- Sashini Senarath
- The Kite Research Institute, Toronto Rehabilitation Institute—University Health Network, University of Toronto, Toronto, ON M5G 2A2, Canada; (G.F.); (A.R.F.)
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada
- Correspondence:
| | - Geoff Fernie
- The Kite Research Institute, Toronto Rehabilitation Institute—University Health Network, University of Toronto, Toronto, ON M5G 2A2, Canada; (G.F.); (A.R.F.)
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada
| | - Atena Roshan Fekr
- The Kite Research Institute, Toronto Rehabilitation Institute—University Health Network, University of Toronto, Toronto, ON M5G 2A2, Canada; (G.F.); (A.R.F.)
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada
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22
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Khan MS, Sreenivasan J, Lateef N, Abougergi MS, Greene SJ, Ahmad T, Anker SD, Fonarow GC, Butler J. Trends in 30- and 90-Day Readmission Rates for Heart Failure. Circ Heart Fail 2021; 14:e008335. [PMID: 33866827 DOI: 10.1161/circheartfailure.121.008335] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The impact of hospital readmission reduction program (HRRP) on heart failure (HF) outcomes has been debated. Limited data exist regarding trends of HF readmission rates beyond 30 days from all-payer sources. The aim of this study was to investigate temporal trends of 30- and 90-day HF readmissions rates from 2010 to 2017 in patients from all-payer sources. METHODS The National Readmission Database was utilized to identify HF hospitalizations between 2010 and 2017. In the primary analysis, a linear trend in 30-day and 90-day readmissions from 2010 to 2017 was assessed. While in the secondary analysis, a change in aggregated 30- and 90-day all-cause and HF-specific readmissions pre-HRRP penalty phase (2010-2012) and post-HRRP penalties (2013-2017) was compared. Subgroup analyses were performed based on (1) Medicare versus non-Medicare insurance, (2) low versus high HF volume, and (3) HF with reduced versus preserved ejection fraction (heart failure with reduced ejection fraction and heart failure with preserved ejection fraction). Multiple logistic and adjusted linear regression analyses were performed for annual trends. RESULTS A total of 6 669 313 index HF hospitalizations for 30-day, and 5 077 949 index HF hospitalizations for 90-day readmission, were included. Of these, 1 213 402 (18.2%) encounters had a readmission within 30 days, and 1 585 445 (31.2%) encounters had a readmission within 90 days. Between 2010 and 2017, both 30 and 90 days adjusted HF-specific and all-cause readmissions increased (8.1% to 8.7%, P trend 0.04, and 18.3% to 19.9%, P trend <0.001 for 30-day and 14.8% to 16.0% and 30.9% to 34.6% for 90-day, P trend <0.001 for both, respectively). Readmission rates were higher during the post-HRRP penalty period compared with pre-HRRP penalty phase (all-cause readmission 30 days: 18.6% versus 17.5%, P<0.001, all-cause readmission 90 days: 32.0% versus 29.9%, P<0.001) across all subgroups except among the low-volume hospitals. CONCLUSIONS The rates of adjusted HF-specific and all-cause 30- and 90-day readmissions have increased from 2010 to 2017. Readmissions rates were higher during the HRRP phase across all subgroups except the low-volume hospitals.
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Affiliation(s)
| | - Jayakumar Sreenivasan
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY (J.S.)
| | - Noman Lateef
- Department of Medicine, Creighton University, Nebraska, Omaha (N.L.)
| | - Marwan S Abougergi
- Department of Medicine, University of South Carolina School of Medicine, Columbia (M.S.A.)
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC (S.J.G.)
| | - Tariq Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (T.A.)
| | - Stefan D Anker
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Germany (S.D.A.)
| | - Gregg C Fonarow
- Division of Cardiology, Ronald Reagan-UCLA Medical Center (G.C.F.)
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson (J.B., M.S.K.)
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23
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Alotaibi S, Hernandez-Montfort J, Ali OE, El-Chilali K, Perez BA. Remote monitoring of implantable cardiac devices in heart failure patients: a systematic review and meta-analysis of randomized controlled trials. Heart Fail Rev 2021; 25:469-479. [PMID: 32002732 DOI: 10.1007/s10741-020-09923-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study aims to determine whether the use of remote monitoring (RM) in implantable cardiac devices decreases all-cause mortality and heart failure (HF)-related hospitalization. We sought to conduct a systematic review and a meta-analysis of published randomized controlled studies. The population is adult patients with a diagnosis of HF with implantable devices. The intervention is RM using implantable cardiac devices whether added or used alone compared to standard of care. The outcomes are HF-related hospitalization and all-cause mortality. Risk of bias was assessed using the criteria defined in the Revised Cochrane Collaboration's tool for assessment of risk of bias. Data were extracted and validity was assessed independently by two reviewers. Electronic databases EMBASE and MEDLINE (Ovid) were searched up to 14th of October 2019, supplemented by a second search in CENTRAL (Cochrane Central Register of Controlled Trials) and clinicaltrials.gov. Only randomized controlled studies published in peer-reviewed journals with full format text in English of adult HF patients with a minimum follow-up of 6 months reporting mortality and/or hospitalization. Observational studies and studies that did not meet inclusion criteria were excluded. Thirteen randomized controlled studies that enrolled a total of 7015 patients were identified, 7 of which reported on all-cause mortality only and included 4460 patients. Compared with standard of care, the pooled relative risk (RR) of all-cause mortality and HF-related hospitalization in patients with RM compared to those receiving standard of care was 0.88 (95% confidence interval (CI) 0.69 to 1.11) and 0.95 (95% CI 0.78-1.16), respectively. In the subgroup analysis, using pulmonary pressure for RM was associated with a decrease in HF-related hospitalization (RR 0.73; 95% CI 0.60-0.88). RM showed benefit in reducing HF-related hospitalization when compared to standard of care only when using pulmonary pressure monitoring.
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Affiliation(s)
- Sultan Alotaibi
- Cardiac Center, King Fahad Armed Forces Hospital, Jeddah, 23311, Saudi Arabia.,Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Jaime Hernandez-Montfort
- Department of Health Policy, London School of Economics and Political Science, London, UK.,Cleveland Clinic Florida, Weston, FL, USA
| | - Omar E Ali
- Department of Health Policy, London School of Economics and Political Science, London, UK.,School of Medicine, Wayne State University, Detroit, MI, 48202, USA.,Medical Director of Cardiac Catheterization Laboratory, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Karim El-Chilali
- Department of Cardiovascular and Pulmonary Medicine, Prosper Hospital, Recklinghausen, Germany
| | - Bernardo A Perez
- Department of Health Policy, London School of Economics and Political Science, London, UK. .,Wellian Inc., 2060 Broadway B1, Boulder, CO, 80302, USA.
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24
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Abstract
Despite favorable effects from telemedicine (TM) on cardiovascular diseases, outcome and comparative impact of TM on heart failure (HF) adults remain controversial. A meta-analysis was conducted to summarize the evidence from existing randomized controlled trials (RCTs) which compared potential impact of TM on HF with conventional healthcare. TM mainly included structure telephone support (STS), involving interactive vocal response monitoring and telemonitoring. PubMed, MEDLINE, EMBASE, and the Cochrane Library were searched to identify RCTs to fit our analysis (1999 to 2018). Odds ratio (OR) with its 95% confidence interval (CI) was used. Sensitivity analysis, subgroup analysis, and tests for publication bias were conducted. Heterogeneities were also evaluated by I2 tests. A total of 29 RCTs consisting of 10,981 HF adults were selected for meta-level synthesis, with follow-up range of 1-36 months. Telemonitoring is associated with the reduction in total number of all-cause hospitalization (OR 0.82, 95% CI 0.73-0.91, P = 0.0004) and cardiac hospitalization (OR 0.83, 95% CI 0.72-0.95, P = 0.007). Telemonitoring resulted in statistically significant risk reduction of all-cause mortality (OR 0.75, 95% CI 0.62-0.90, P = 0.003). However, the OR of HF-related mortality (OR 0.84, 95% CI 0.61-1.16, P = 0.28) is not significantly distinguishable from that of conventional healthcare. Receiving STS interventions is likely to reduce the hospitalization for all causes (OR 0.86, 95% CI 0.78-0.96, P = 0.006, I2 = 6%) and the hospitalization due to HF (OR 0.74, 95% CI 0.65-0.85, P < 0.0001, I2 = 0%), compared with interventions from conventional healthcare. OR of all-cause STS mortality (OR 0.96, 95% CI 0.83-1.11, P = 0.55) was identified in meta-analyses of eight cases. OR of STS cardiac mortality (OR 0.54, 95% CI 0.34-0.86, P = 0.009) was identified in meta-analyses of three cases. This work represents the comprehensive application of network meta-analysis to examine the comparative effectiveness of telemedicine interventions in improving HF patient outcomes. Compared with conventional healthcare, telemedicine systems with medical support prove to be more effective for HF adults, particularly in reducing all-cause hospitalization, cardiac hospitalization, all-cause mortality, cardiac mortality, and length of stay. While further research is required to confirm these observational findings and identify optimal telemedicine strategies and the duration of follow-up for which it confers benefits.
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Affiliation(s)
- Ye Zhu
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, Jiangsu, China
- Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Xiang Gu
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, Jiangsu, China.
- Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China.
| | - Chao Xu
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Science Center, Oklahoma City, OK, 73104, USA
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25
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Zhong C, Wong C, Cheung W, Yeoh EK, Hung CT, Yip B, Wong E, Wong S, Chung V. Peri-discharge complex interventions for reducing 30-day hospital readmissions among heart failure patients: overview of systematic reviews and network meta-analysis. Perspect Public Health 2021; 142:263-277. [PMID: 33719733 DOI: 10.1177/1757913920985258] [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: 11/16/2022]
Abstract
AIMS An overview of systematic reviews (SRs) and network meta-analysis (NMA) was conducted to synthesize evidence of comparative effectiveness of different peri-discharge complex interventions for reducing 30-day hospital readmissions among heart failure (HF) patients. METHODS We searched five databases for SRs from their inception to August 2019 and conducted additional search for randomized controlled trials (RCTs) published between 2003 and 2020. We used random-effect pairwise meta-analysis with pooled risk ratios (RRs) and 95% confidence intervals (CIs) to quantify the effect of complex interventions, and NMA to evaluate comparative effectiveness among complex interventions. Primary outcome was 30-day all-cause hospital readmissions, while secondary outcomes were 30-day HF-related hospital readmissions, 30-day mortality, and 30-day emergency department visits. RESULTS From 20 SRs and additional RCT search, 21 eligible RCTs (n = 5362) assessing eight different peri-discharge complex interventions were included. Pairwise meta-analysis showed no significant difference between peri-discharge complex interventions and controls on all outcomes, except that peri-discharge complex interventions were significantly more effective than controls in reducing 30-day mortality (pooled RR = 0.68, 95% CI: 0.49-0.95, 5 RCTs). NMA indicated that for reducing 30-day all-cause hospital readmissions, supportive-educative intervention had the highest probability to be the best intervention, followed by disease management; while for reducing 30-day HF-related hospital readmissions, disease management is likely to be the best intervention. CONCLUSIONS Our results suggest that disease management has the best potential to reduce 30-day all-cause and HF-related hospital readmissions. Benefits of the interventions may vary across health system contexts. Evidence-based complex interventions require local adaptation prior to implementation.
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Affiliation(s)
- Ccw Zhong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chl Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Rm 509, Prince of Wales Hospital, Shatin, Hong Kong
| | - Wkw Cheung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - E-K Yeoh
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - C T Hung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Bhk Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ely Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sys Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vch Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong; School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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26
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Kitsiou S, Vatani H, Paré G, Gerber BS, Buchholz SW, Kansal MM, Leigh J, Masterson Creber RM. Effectiveness of Mobile Health Technology Interventions for Patients With Heart Failure: Systematic Review and Meta-analysis. Can J Cardiol 2021; 37:1248-1259. [PMID: 33667616 DOI: 10.1016/j.cjca.2021.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Heart failure (HF) is a complex and serious condition associated with substantial morbidity, mortality, and health care costs. We conducted a systematic review and meta-analysis to evaluate the effects of mobile health (mHealth) interventions compared with usual care in patients with HF. METHODS We searched MEDLINE, CENTRAL, CINAHL, and EMBASE databases to identify eligible randomized controlled trials (RCTs) of mHealth interventions. Primary outcomes included: all-cause mortality, cardiovascular mortality, HF-related hospitalizations, and all-cause hospitalizations. Meta-analyses using a random effects model were performed for all outcomes. Risk of bias and quality of evidence were evaluated using the Cochrane Tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS Sixteen RCTs involving 4389 patients were included. Compared with usual care, mHealth interventions reduced the risk of all-cause mortality (risk ratio [RR], 0.80; 95% confidence interval [CI], 0.65-0.97; absolute risk reduction [ARR], 2.1%; high-quality evidence), cardiovascular mortality (RR, 0.70; 95% CI, 0.53-0.91; ARR, 2.9%; high-quality evidence), and HF hospitalizations (RR, 0.77; 95% CI, 0.67-0.88; ARR, 5%; high-quality evidence), but had no effect on all-cause hospitalizations. Results were driven by mHealth interventions with remote monitoring and clinical feedback, which were associated with larger reductions than stand-alone mHealth interventions. However, subgroup differences were not statistically significant. CONCLUSIONS mHealth interventions with remote monitoring and clinical feedback reduce mortality and HF-related hospitalizations, but might not reduce all-cause hospitalizations in patients with HF. Additional studies are needed to determine the efficacy of stand-alone mHealth interventions as well as active features of mHealth that contribute to efficacy.
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Affiliation(s)
- Spyros Kitsiou
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Haleh Vatani
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Guy Paré
- Research Chair in Diginal Health, HEC Montréal, Montréal, Quebec, Canada
| | - Ben S Gerber
- Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Susan W Buchholz
- Department of Adult Health and Gerontological Nursing, Rush University College of Nursing, Chicago, Illinois, USA
| | - Mayank M Kansal
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jonathan Leigh
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, USA; Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ruth M Masterson Creber
- Department of Population Health Sciences, Division of Health Informatics, Weill Cornell Medicine, New York, New York, USA
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27
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Pagliani L, Elisa N, Eduardo RD, Lorenza DC, Agnese DN, Antonini-Canterin F. Role of New Technologies in Supporting the Treatment of Complex Patients. Heart Fail Clin 2021; 17:279-287. [PMID: 33673952 DOI: 10.1016/j.hfc.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cardiology represents one of the privileged disciplinary areas for the experimentation and validation of the applications of telemedicine. Telemedicine, and the health technologies that go by the name of eHealth, identify the digital exchange of social and health information in order to support and optimize the care process remotely. Telemonitoring applied to cardiovascular diseases is defined as the recording, remote transmission, storage, and interpretation of cardiovascular parameters and diagnostic images. Meta-analyses have shown that telemedicine-supported models of care not only are effective but also cost-effective.
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Affiliation(s)
- Leopoldo Pagliani
- Cardiology Unit, High Specialization Rehabilitation Hospital Motta di Livenza, Via Padre Bello 3c, Motta di Livenza, Treviso 31045, Italy.
| | - Nicolosi Elisa
- Cardiology Unit, High Specialization Rehabilitation Hospital Motta di Livenza, Via Padre Bello 3c, Motta di Livenza, Treviso 31045, Italy
| | - Rivaben Dante Eduardo
- Cardiology Unit, High Specialization Rehabilitation Hospital Motta di Livenza, Via Padre Bello 3c, Motta di Livenza, Treviso 31045, Italy
| | - Dal Corso Lorenza
- Cardiology Unit, High Specialization Rehabilitation Hospital Motta di Livenza, Via Padre Bello 3c, Motta di Livenza, Treviso 31045, Italy
| | - Di Naro Agnese
- Cardiology Unit, High Specialization Rehabilitation Hospital Motta di Livenza, Via Padre Bello 3c, Motta di Livenza, Treviso 31045, Italy
| | - Francesco Antonini-Canterin
- Cardiology Unit, High Specialization Rehabilitation Hospital Motta di Livenza, Via Padre Bello 3c, Motta di Livenza, Treviso 31045, Italy
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28
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Antonini-Canterin F, Bossone E. Heart Failure: One, None, and a Hundred Thousand. Heart Fail Clin 2021; 17:xiii-xv. [PMID: 33673955 DOI: 10.1016/j.hfc.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Francesco Antonini-Canterin
- Division of Cardiology, High Specialization Rehabilitative Hospital, Via Padre Leonardo Bello, 3/c, 31045 Motta di Livenza, Italy.
| | - Eduardo Bossone
- Division of Cardiology, Cardarelli Hospital, Via A. Cardarelli, 9, Naples 80131, Italy.
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29
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Schenkel FA, Barr ML, McCloskey CC, Possemato T, O'Conner J, Sadeghi R, Bembi M, Duong M, Patel J, Hackmann AE, Ganesh S. Use of a Bluetooth tablet-based technology to improve outcomes in lung transplantation: A pilot study. Am J Transplant 2020; 20:3649-3657. [PMID: 32558226 PMCID: PMC7754459 DOI: 10.1111/ajt.16154] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 01/25/2023]
Abstract
The impact of remote patient monitoring platforms to support the postoperative care of solid organ transplant recipients is evolving. In an observational pilot study, 28 lung transplant recipients were enrolled in a novel postdischarge home monitoring program and compared to 28 matched controls during a 2-year period. Primary endpoints included hospital readmissions and total days readmitted. Secondary endpoints were survival and inflation-adjusted hospital readmission charges. In univariate analyses, monitoring was associated with reduced readmissions (incidence rate ratio [IRR]: 0.56; 95% confidence interval [CI]: 0.41-0.76; P < .001), days readmitted (IRR: 0.46; 95% CI: 0.42-0.51; P < .001), and hospital charges (IRR: 0.52; 95% CI: 0.51-0.54; P < .001). Multivariate analyses also showed that remote monitoring was associated with lower incidence of readmission (IRR: 0.38; 95% CI: 0.23-0.63; P < .001), days readmitted (IRR: 0.14; 95% CI: 0.05-0.37; P < .001), and readmission charges (IRR: 0.11; 95% CI: 0.03-0.46; P = .002). There were 2 deaths among monitored patients compared to 6 for controls; however, this difference was not significant. This pilot study in lung transplant recipients suggests that supplementing postdischarge care with remote monitoring may be useful in preventing readmissions, reducing subsequent inpatient days, and controlling hospital charges. A multicenter, randomized control trial should be conducted to validate these findings.
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Affiliation(s)
- Felicia A. Schenkel
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Mark L. Barr
- Division of Cardiothoracic SurgeryDepartment of SurgeryUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Tammie Possemato
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jeremy O'Conner
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Roya Sadeghi
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Maria Bembi
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Marian Duong
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jaynita Patel
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Amy E. Hackmann
- Division of Cardiothoracic SurgeryDepartment of SurgeryUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Sivagini Ganesh
- Division of Pulmonary and Critical Care MedicineDepartment of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Cooper CB, Sirichana W, Arnold MT, Neufeld EV, Taylor M, Wang X, Dolezal BA. Remote Patient Monitoring for the Detection of COPD Exacerbations. Int J Chron Obstruct Pulmon Dis 2020; 15:2005-2013. [PMID: 33061338 PMCID: PMC7519812 DOI: 10.2147/copd.s256907] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/15/2020] [Indexed: 12/13/2022] Open
Abstract
Background COPD exacerbations occur more frequently with disease progression and are associated with worse prognosis and higher healthcare expenditure. Purpose To utilize a networked system, optimized with statistical process control (SPC), for remote patient monitoring (RPM) and to identify potential predictors of COPD exacerbations. Methods Seventeen subjects, mean (SD) age of 69.7 (7.2) years, with moderate to severe COPD received RPM. Over 2618 patient-days (7.17 patient-years) of monitoring, we obtained daily symptom scores, treatment adherence, self-reported activity levels, daily spirometry (SVC, FEV1, FVC, PEF), inspiratory capacity (IC), and oxygenation (SpO2). These data were used to identify predictors of exacerbations defined using Anthonisen and other criteria. Results After implementation of SPC, concordance analysis showed substantial agreement between FVC (decrease below the 7-day rolling average minus 1.645 SD) and self-reported healthcare utilization events (κ=0.747, P<0.001) as well as between increased use of inhaled short-acting bronchodilators and exacerbations defined by two Anthonisen criteria (κ=0.611, P<0.001) or modified Anthonisen criteria (κ=0.622, P<0.001). There was a moderate agreement between FEV1 (decrease >1.645 SD below the 7-day rolling average) and self-reported healthcare utilization events (κ=0.475, P<0.001) and between SpO2 less than 90% and exacerbations defined by two Anthonisen criteria (κ=0.474, P<0.001) or modified Anthonisen criteria (κ=0.564, P<0.001). Conclusion Exacerbations were best predicted by FVC and FEV1 below the one-sided 95% confidence interval derived from SPC but also by increased use of inhaled short-acting bronchodilators and fall in oxygen saturation. An RPM program that captures these parameters may be used to guide appropriate interventions aimed at reducing healthcare utilization in COPD patients.
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Affiliation(s)
- Christopher B Cooper
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Worawan Sirichana
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Michael T Arnold
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Eric V Neufeld
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | - Xiaoyan Wang
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Brett A Dolezal
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Dawson S, Kunonga P, Beyer F, Spiers G, Booker M, McDonald R, Cameron A, Craig D, Hanratty B, Salisbury C, Huntley A. Does health and social care provision for the community dwelling older population help to reduce unplanned secondary care, support timely discharge and improve patient well-being? A mixed method meta-review of systematic reviews. F1000Res 2020; 9:857. [PMID: 34621521 PMCID: PMC8482050 DOI: 10.12688/f1000research.25277.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 11/20/2022] Open
Abstract
Background: This study aimed to identify and examine systematic review evidence of health and social care interventions for the community-dwelling older population regarding unplanned hospital admissions, timely hospital discharge and patient well-being. Methods: A meta-review was conducted using Joanna Briggs and PRISMA guidance. A search strategy was developed: eight bibliographic medical and social science databases were searched, and references of included studies checked. Searches were restricted to OECD countries and to systematic reviews published between January 2013-March 2018. Data extraction and quality appraisal was undertaken by one reviewer with a random sample screened independently by two others. Results: Searches retrieved 21,233 records; using data mining techniques, we identified 8,720 reviews. Following title and abstract and full-paper screening, 71 systematic reviews were included: 62 quantitative, seven qualitative and two mixed methods reviews. There were 52 reviews concerned with healthcare interventions and 19 reviews concerned with social care interventions. This meta-review summarises the evidence and evidence gaps of nine broad types of health and social care interventions. It scrutinises the presence of research in combined health and social care provision, finding it lacking in both definition and detail given. This meta-review debates the overlap of some of the person-centred support provided by community health and social care provision. Research recommendations have been generated by this process for both primary and secondary research. Finally, it proposes that research recommendations can be delivered on an ongoing basis if meta-reviews are conducted as living systematic reviews. Conclusions: This meta-review provides evidence of the effect of health and social care interventions for the community-dwelling older population and identification of evidence gaps. It highlights the lack of evidence for combined health and social care interventions and for the impact of social care interventions on health care outcomes. Registration: PROSPERO ID CRD42018087534; registered on 15 March 2018.
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Affiliation(s)
- Shoba Dawson
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Patience Kunonga
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Fiona Beyer
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Gemma Spiers
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Matthew Booker
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Ruth McDonald
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Ailsa Cameron
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Dawn Craig
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, UK, Newcastle, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Alyson Huntley
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
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Predictors for 30-Day and 90-Day Hospital Readmission Among Patients With Opioid Use Disorder. J Addict Med 2020; 13:306-313. [PMID: 30633044 DOI: 10.1097/adm.0000000000000499] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify the incidence, characteristics, and predictors for 30 and 90-day readmission among acutely hospitalized patients with opioid use disorder (OUD). METHODS This retrospective, cohort study evaluated consecutive adults with OUD admitted to an academic medical center over a 5-year period (10/1/11 to 9/30/16). Multivariable logistic regression was used to determine independent predictors for 30 and 90-day readmissions based on pertinent admission, hospital, and discharge variables collected via chart review and found to be different (with a P < 0.10) on univariate analysis. RESULTS Among the 470 adults (mean age 43.1 ± 12.8 years, past heroin use 77.9%; admission opioid agonist therapy use [buprenorphine 22.6%; methadone 27.0%]; medical [vs surgical] admission 75.3%, floor [vs ICU] admission 93.0%, in-hospital mortality 0.9%), 85 (18.2%) and 151 (32.1%) were readmitted within 30 and 90 days, respectively. Among the 90-day readmitted patients, median time to first readmission was 26 days. Buprenorphine use (vs no use) at index hospital admission was independently associated with reduced 30-day (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.24-0.93) and 90-day (OR 0.57, 95% CI 0.34-0.96) readmission; prior heroin (vs prescription opioid) use was associated with reduced 90-day readmission (OR 0.59, 95% CI 0.37-0.94) and length of hospital stay was associated with both greater 30-day (OR 1.02, 95% CI 1.01-1.05) and 90-day (OR 1.04, 95% CI 1.01-1.06) readmission rates. CONCLUSIONS Among patients with OUD taking buprenorphine at the time of hospital admission, 30-day and 90-day hospital readmission was reduced by 53% and 43%, respectively.
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Allida S, Du H, Xu X, Prichard R, Chang S, Hickman LD, Davidson PM, Inglis SC. mHealth education interventions in heart failure. Cochrane Database Syst Rev 2020; 7:CD011845. [PMID: 32613635 PMCID: PMC7390434 DOI: 10.1002/14651858.cd011845.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heart failure (HF) is a chronic disease with significant impact on quality of life and presents many challenges to those diagnosed with the condition, due to a seemingly complex daily regimen of self-care which includes medications, monitoring of weight and symptoms, identification of signs of deterioration and follow-up and interaction with multiple healthcare services. Education is vital for understanding the importance of this regimen, and adhering to it. Traditionally, education has been provided to people with heart failure in a face-to-face manner, either in a community or a hospital setting, using paper-based materials or video/DVD presentations. In an age of rapidly-evolving technology and uptake of smartphones and tablet devices, mHealth-based technology (defined by the World Health Organization as mobile and wireless technologies to achieve health objectives) is an innovative way to provide health education which has the benefit of being able to reach people who are unable or unwilling to access traditional heart failure education programmes and services. OBJECTIVES To systematically review and quantify the potential benefits and harms of mHealth-delivered education for people with heart failure. SEARCH METHODS We performed an extensive search of bibliographic databases and registries (CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, IEEE Xplore, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) Search Portal), using terms to identify HF, education and mHealth. We searched all databases from their inception to October 2019 and imposed no restriction on language of publication. SELECTION CRITERIA We included studies if they were conducted as a randomised controlled trial (RCT), involving adults (≥ 18 years) with a diagnosis of HF. We included trials comparing mHealth-delivered education such as internet and web-based education programmes for use on smartphones and tablets (including apps) and other mobile devices, SMS messages and social media-delivered education programmes, versus usual HF care. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed risks of bias, and extracted data from all included studies. We calculated the mean difference (MD) or standardised mean difference (SMD) for continuous data and the odds ratio (OR) for dichotomous data with a 95% confidence interval (CI). We assessed heterogeneity using the I2 statistic and assessed the quality of evidence using GRADE criteria. MAIN RESULTS We include five RCTs (971 participants) of mHealth-delivered education interventions for people with HF in this review. The number of trial participants ranged from 28 to 512 participants. Mean age of participants ranged from 60 years to 75 years, and 63% of participants across the studies were men. Studies originated from Australia, China, Iran, Sweden, and The Netherlands. Most studies included participants with symptomatic HF, NYHA Class II - III. Three studies addressed HF knowledge, revealing that the use of mHealth-delivered education programmes showed no evidence of a difference in HF knowledge compared to usual care (MD 0.10, 95% CI -0.2 to 0.40, P = 0.51, I2 = 0%; 3 studies, 411 participants; low-quality evidence). One study assessing self-efficacy reported that both study groups had high levels of self-efficacy at baseline and uncertainty in the evidence for the intervention (MD 0.60, 95% CI -0.57 to 1.77; P = 0.31; 1 study, 29 participants; very low-quality evidence).Three studies evaluated HF self-care using different scales. We did not pool the studies due to the heterogenous nature of the outcome measures, and the evidence is uncertain. None of the studies reported adverse events. Four studies examined health-related quality of life (HRQoL). There was uncertainty in the evidence for the use of mHealth-delivered education on HRQoL (MD -0.10, 95% CI -2.35 to 2.15; P = 0.93, I2 = 61%; 4 studies, 942 participants; very low-quality evidence). Three studies reported on HF-related hospitalisation. The use of mHealth-delivered education may result in little to no difference in HF-related hospitalisation (OR 0.74, 95% CI 0.52 to 1.06; P = 0.10, I2 = 0%; 3 studies, 894 participants; low-quality evidence). We downgraded the quality of the studies due to limitations in study design and execution, heterogeneity, wide confidence intervals and fewer than 500 participants in the analysis. AUTHORS' CONCLUSIONS We found that the use of mHealth-delivered educational interventions for people with HF shows no evidence of a difference in HF knowledge; uncertainty in the evidence for self-efficacy, self-care and health-related quality of life; and may result in little to no difference in HF-related hospitalisations. The identification of studies currently underway and those awaiting classification indicate that this is an area of research from which further evidence will emerge in the short and longer term.
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Affiliation(s)
- Sabine Allida
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Huiyun Du
- School of Nursing and Midwifery, Flinders University, Bedford Park, Australia
| | - Xiaoyue Xu
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Roslyn Prichard
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Sungwon Chang
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Louise D Hickman
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | | | - Sally C Inglis
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Halatchev IG, McDonald JR, Wu WC. A patient-centred, comprehensive model for the care for heart failure: the 360° heart failure centre. Open Heart 2020; 7:e001221. [PMID: 32624480 PMCID: PMC7337888 DOI: 10.1136/openhrt-2019-001221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 01/14/2023] Open
Affiliation(s)
- Ilia G Halatchev
- Cardiology, Saint Louis VA Medical Center John Cochran Division, Saint Louis, Missouri, USA
- Cardiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Jay R McDonald
- Infectious Diseases, Saint Louis VA Medical Center John Cochran Division, Saint Louis, Missouri, USA
- Infectious Diseases, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Wen-Chin Wu
- Cardiology, Providence VA Medical Center, Providence, Rhode Island, USA
- Cardiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
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A systematic review and meta-analysis of user acceptance of consumer-oriented health information technologies. COMPUTERS IN HUMAN BEHAVIOR 2020. [DOI: 10.1016/j.chb.2019.09.023] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Cooper CB, Sirichana W, Neufeld EV, Taylor M, Wang X, Dolezal BA. Statistical Process Control Improves The Feasibility Of Remote Physiological Monitoring In Patients With Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2019; 14:2485-2496. [PMID: 32009781 PMCID: PMC6859075 DOI: 10.2147/copd.s207626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/01/2019] [Indexed: 12/21/2022] Open
Abstract
Background Exacerbations of chronic obstructive pulmonary disease (COPD) occur with increasing frequency as the disease progresses and account for poor health status, worse prognosis, and higher healthcare expenditure. Methods We developed a networked system for remote physiological monitoring (RPM) at home and optimized it with statistical process control (SPC) with the goal of earlier detection of COPD exacerbations. We enrolled 17 patients with moderate to severe COPD with a mean (SD) age of 71.1 (7.2) years. We obtained daily symptom scores, treatment adherence and activity levels using a programmable device, and measured daily slow and forced spirometry (FEV1, FVC, PEF), inspiratory capacity (IC) and oxygenation (SpO2). To identify exacerbations, we developed rolling prediction intervals for FVC, FEV1, IC and SpO2 using SPC. Results The time taken to perform daily monitoring was reduced from 12.7 (5.4) minutes to 6.5 (2.6) minutes through software refinements during the study. Adherence to forced and slow spirometry was 62.6% and 62.4%, respectively. The within-subject coefficients of variation for FEV1, PEF and IC were 12.2%, 16.2%, and 13.1%, respectively. Event rates per patient-year for exacerbations were: self-reported 0.42, 2/3 Anthonisen Criteria (AC) 0.42, modified AC 2.23, systemic corticosteroid use 0.56, and antibiotic use 0.56. Conclusion We successfully implemented a networked system for RPM of symptoms, treatment adherence, and physiology at home in patients with COPD. We demonstrated that SPC improves the feasibility of RPM in COPD patients which may increase the likelihood of detecting COPD exacerbations.
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Affiliation(s)
- Christopher B Cooper
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Worawan Sirichana
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Eric V Neufeld
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | - Xiaoyan Wang
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Brett A Dolezal
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Lopes MACQ, Oliveira GMMD, Ribeiro ALP, Pinto FJ, Rey HCV, Zimerman LI, Rochitte CE, Bacal F, Polanczyk CA, Halperin C, Araújo EC, Mesquita ET, Arruda JA, Rohde LEP, Grinberg M, Moretti M, Caramori PRA, Botelho RV, Brandão AA, Hajjar LA, Santos AF, Colafranceschi AS, Etges APBDS, Marino BCA, Zanotto BS, Nascimento BR, Medeiros CR, Santos DVDV, Cook DMA, Antoniolli E, Souza Filho EMD, Fernandes F, Gandour F, Fernandez F, Souza GEC, Weigert GDS, Castro I, Cade JR, Figueiredo Neto JAD, Fernandes JDL, Hadlich MS, Oliveira MAP, Alkmim MB, Paixão MCD, Prudente ML, Aguiar Netto MAS, Marcolino MS, Oliveira MAD, Simonelli O, Lemos Neto PA, Rosa PRD, Figueira RM, Cury RC, Almeida RC, Lima SRF, Barberato SH, Constancio TI, Rezende WFD. Guideline of the Brazilian Society of Cardiology on Telemedicine in Cardiology - 2019. Arq Bras Cardiol 2019; 113:1006-1056. [PMID: 31800728 PMCID: PMC7020958 DOI: 10.5935/abc.20190205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Fernando Bacal
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Carisi Anne Polanczyk
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
- Instituto de Avaliação de Tecnologias em Saúde (IATS), Porto Alegre, RS - Brazil
| | | | | | | | | | | | - Max Grinberg
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Miguel Moretti
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | - Roberto Vieira Botelho
- Instituto do Coração do Triângulo (ICT), Uberlândia, MG - Brazil
- International Telemedical Systems do Brasil (ITMS), Uberlândia, MG - Brazil
| | | | - Ludhmila Abrahão Hajjar
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | | | | | - Bárbara Campos Abreu Marino
- Hospital Madre Teresa, Belo Horizonte, MG - Brazil
- Pontifícia Universidade Católica de Minas Gerais (PUCMG), Belo Horizonte, MG - Brazil
| | - Bruna Stella Zanotto
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
- Instituto de Avaliação de Tecnologias em Saúde (IATS), Porto Alegre, RS - Brazil
| | - Bruno Ramos Nascimento
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | | | | | - Daniela Matos Arrowsmith Cook
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brazil
- Hospital Copa Star, Rio de Janeiro, RJ - Brazil
- Hospital dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brazil
| | | | - Erito Marques de Souza Filho
- Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brazil
- Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ - Brazil
| | | | - Fabio Gandour
- Universidade de Brasília (UnB), Brasília, DF - Brazil
| | | | | | | | - Iran Castro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brazil
- Fundação Universitária de Cardiologia, Porto Alegre, RS - Brazil
| | | | | | | | - Marcelo Souza Hadlich
- Fleury Medicina e Saúde, Rio de Janeiro, RJ - Brazil
- Rede D'Or, Rio de Janeiro, RJ - Brazil
- Unimed-Rio, Rio de Janeiro, RJ - Brazil
| | | | - Maria Beatriz Alkmim
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | | | | | | | | | | | - Osvaldo Simonelli
- Conselho Regional de Medicina do Estado de São Paulo, São Paulo, SP - Brazil
- Instituto Paulista de Direito Médico e da Saúde (IPDMS), Ribeirão Preto, SP - Brazil
| | | | - Priscila Raupp da Rosa
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
- Hospital Sírio Libanês, São Paulo, SP - Brazil
| | | | | | | | | | - Silvio Henrique Barberato
- CardioEco-Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brazil
- Quanta Diagnóstico e Terapia, Curitiba, PR - Brazil
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Cichosz SL, Udsen FW, Hejlesen O. The impact of telehealth care on health-related quality of life of patients with heart failure: Results from the Danish TeleCare North heart failure trial. J Telemed Telecare 2019; 26:452-461. [PMID: 30975047 DOI: 10.1177/1357633x19832713] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIM The aim of this study was to assess the impact on health-related quality of life (HRQoL) of a telehealth care solution compared with usual practice of patients with heart failure (HF). METHODS A randomized controlled trial with a telehealth care solution (Telekit) as the intervention (with a focus on self-empowerment achieved by engaging patients in their own illness through self-monitoring) combined with usual care and usual care as the control. The primary outcome was a change in HRQoL as measured by the Short Form-36 (SF-36) questionnaire Physical Component Summary (PCS) score. Secondary outcomes were changes in HRQoL as measured by the SF-36 questionnaire Mental Component Summary (MSC) score and the HF disease-specific questionnaire Kansas City Cardiomyopathy Questionnaire 12 (KCCQ12) score, all of which were assessed from baseline to approximately 12 months' follow-up between the two groups. Outcomes were assessed via unadjusted and adjusted analyses. RESULTS At baseline, 299 (145 interventions, 154 controls) patients were enrolled. In the primary analysis (n = 299), the adjusted intervention effects were PCS -0.81 (95% CI -2.7-1.1), MCS 4.66 (95% CI 1.8-7.5) and KCCQ12 3.67 (95% CI -0.7-8.1). Only the change in MCS was statistically significant. An unadjusted analysis replicated the primary analysis. Complete case analyses (n = 193) generally resulted in a lower intervention effect on the PCS score, but the difference remained statistically insignificant. CONCLUSIONS Only the MCS score was significantly higher in the telehealth care group compared to the control group.ClinicalTrials.gov (NCT02860013), July 28, 2016.
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Affiliation(s)
- Simon L Cichosz
- Department of Health Science and Technology, Aalborg University, Denmark
| | - Flemming W Udsen
- Department of Health Science and Technology, Aalborg University, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Denmark
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Leng Chow W, Aung CYK, Tong SC, Goh GSL, Lee S, MacDonald MR, Ng ANK, Cao Y, Ahmad AE, Yap MF, Leong G, Bruege A, Tesanovic A, Riistama J, Pang SY, Erazo F. Effectiveness of telemonitoring-enhanced support over structured telephone support in reducing heart failure-related healthcare utilization in a multi-ethnic Asian setting. J Telemed Telecare 2019; 26:332-340. [DOI: 10.1177/1357633x18825164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims Our study aimed to compare the effectiveness of telemonitoring over structured telephone support in reducing heart failure-related healthcare utilization. Methods This was a non-randomised controlled study comparing 150 recently discharged heart failure patients enrolled into telemonitoring and 55 patients who only received structured telephone support after rejecting telemonitoring. Patient activation, knowledge and self-management levels were measured at baseline and the one year upon programme completion using the Patient Activation Measure, the Dutch Heart Failure Knowledge Scale and the Self-Care of Heart Failure Index respectively. Differences in heart failure-related and all-cause hospitalization rates, total bed days and mortality rates at 180 days and at one year, knowledge and self-management scores and total cost of care between groups at one year were analysed. Results Average age of telemonitoring was 57.9 years and 63.9 years for structured telephone support. Significant difference in adjusted 180-day all-cause bed days (telemonitoring: five days versus structured telephone support: 9.8 days), heart failure-related bed days (telemonitoring: 1.2 days versus structured telephone support: six days) and adjusted one-year heart failure-related bed days (telemonitoring: 2.2 days versus structured telephone support: 6.6 days) were observed. Telemonitoring was associated with reduced all-cause one-year mortality (hazard ratio 0.32, p = 0.02). Estimated mean maintenance and confidence scores were significantly higher in the telemonitoring group at one year. No differences in all-cause and HF-related readmission rates and knowledge levels were observed. The one-year total cost of care was predicted to be Singapore dollars (SG$) 2774.4 lower ( p = 0.07) in telemonitoring. Conclusion In conclusion, telemonitoring was associated with lower all-cause and heart failure-related total bed days at 180 days, lower heart failure-related total bed days and total cost of care at one year as compared with structured telephone support.
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Affiliation(s)
| | | | | | | | | | | | | | - Yan Cao
- Changi General Hospital, Singapore
| | | | | | | | | | | | | | - Sze Yunn Pang
- Health Informatics and Population Management, Philips ASEAN Pacific, Singapore
| | - Fernando Erazo
- Health Informatics and Population Management, Philips ASEAN Pacific, Singapore
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Lefler LL, Rhoads SJ, Harris M, Funderburg AE, Lubin SA, Martel ID, Faulkner JL, Rooker JL, Bell DK, Marshall H, Beverly CJ. Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study. JMIR Aging 2018; 1:e12178. [PMID: 31518257 PMCID: PMC6715011 DOI: 10.2196/12178] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Heart failure (HF) is associated with high rates of hospitalizations, morbidity, mortality, and costs. Remote patient monitoring (mobile health, mHealth) shows promise in improving self-care and HF management, thus increasing quality of care while reducing hospitalizations and costs; however, limited information exists regarding perceptions of older adults with HF about mHealth use. OBJECTIVE This study aimed to compare perspectives of older adults with HF who were randomized to either (1) mHealth equipment connected to a 24-hour call center, (2) digital home equipment, or (3) standard care, with regard to ease and satisfaction with equipment, provider communication and engagement, and ability to self-monitor and manage their disease. METHODS We performed a pilot study using a mixed-methods descriptive design with pre- and postsurveys, following participants for 12 weeks. We augmented these data with semistructured qualitative interviews to learn more about feasibility, satisfaction, communication, and self-management. RESULTS We enrolled 28 patients with HF aged 55 years and above, with 57% (16/28) male, 79% (22/28) non-Hispanic white, and with multiple comorbid conditions. At baseline, 50% (14/28) rated their health fair or poor and 36% (10/28) and 25% (7/28) were very often/always frustrated and discouraged by their health. At baseline, 46% (13/28) did not monitor their weight, 29% (8/28) did not monitor their blood pressure, and 68% (19/28) did not monitor for symptoms. Post intervention, 100% of the equipment groups home monitored daily. For technology anxiety, 36% (10/28) indicated technology made them nervous, and 32% (9/28) reported fear of technology, without significant changes post intervention. Technology usability post intervention scored high (91/100), reflecting ease of use. A majority indicated that a health care provider should be managing their health, and 71% reported that one should trust and not question the provider. Moreover, 57% (16/28) believed it was better to seek professional help than caring for oneself. Post intervention, mHealth users relied more on themselves, which was not mirrored in the home equipment or standard care groups. Participants were satisfied with communication and engagement with providers, yet many described access problems. Distressing symptoms were unpredictable and prevailed over the 12 weeks with 79 provider visits and 7 visits to emergency departments. The nurse call center received 872 readings, and we completed 289 telephone calls with participants. Narrative data revealed the following main themes: (1) traditional communication and engagement with providers prevailed, delaying access to care; (2) home monitoring with technology was described as useful, and mHealth users felt secure knowing that someone was observing them; (3) equipment groups felt more confident in self-monitoring and managing; and finally, (4) uncertainty and frustration with persistent health problems. CONCLUSIONS mHealth equipment is feasible with potential to improve patient-centered outcomes and increase self-management in older adults with HF.
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Affiliation(s)
- Leanne L Lefler
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Sarah J Rhoads
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Melodee Harris
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Ashley E Funderburg
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Sandra A Lubin
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Isis D Martel
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR, United States
| | - Jennifer L Faulkner
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Janet L Rooker
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Deborah K Bell
- Department of Cardiology, University of Arkansas for Medical Science, Little Rock, AR, United States
| | - Heather Marshall
- Department of Cardiology, University of Arkansas for Medical Science, Little Rock, AR, United States
| | - Claudia J Beverly
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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Pekmezaris R, Tortez L, Williams M, Patel V, Makaryus A, Zeltser R, Sinvani L, Wolf-Klein G, Lester J, Sison C, Lesser M, Kozikowski A. Home Telemonitoring In Heart Failure: A Systematic Review And Meta-Analysis. Health Aff (Millwood) 2018; 37:1983-1989. [DOI: 10.1377/hlthaff.2018.05087] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Renee Pekmezaris
- Renee Pekmezaris is vice president of the Division of Health Services Research and a professor in the Departments of Medicine and Population Health, Northwell Health, in Manhasset, New York
| | - Leanne Tortez
- Leanne Tortez is a research assistant in the Department of Medicine, Northwell Health, in Manhasset
| | - Myia Williams
- Myia Williams is a research assistant in the Department of Medicine, Northwell Health, in Manhasset
| | - Vidhi Patel
- Vidhi Patel is a research assistant in the Department of Medicine, Northwell Health, in Manhasset
| | - Amgad Makaryus
- Amgad Makaryus is chair of the Department of Cardiology, Nassau University Medical Center, in East Meadow, New York, and a cardiologist in the Department of Cardiology, Northwell Health, in Manhasset
| | - Roman Zeltser
- Roman Zeltser is a cardiologist in the Department of Cardiology, Nassau University Medical Center, and a cardiologist in the Department of Cardiology, Northwell Health, in Manhasset
| | - Liron Sinvani
- Liron Sinvani is a physician in the Department of Medicine, Northwell Health, in Great Neck, New York
| | - Gisele Wolf-Klein
- Gisele Wolf-Klein is a physician in the Department of Medicine, Division of Geriatrics and Palliative Care, Northwell Health, in New Hyde Park, New York
| | - Janice Lester
- Janice Lester is a health sciences librarian in the Clinical Medical Library, Northwell Health, in New Hyde Park
| | - Cristina Sison
- Cristina Sison is assistant director in the Department of Biostatistics, Feinstein Institute for Medical Research, in Manhasset
| | - Martin Lesser
- Martin Lesser is assistant vice president in the Department of Biostatistics, Feinstein Institute for Medical Research
| | - Andrzej Kozikowski
- Andrzej Kozikowski is a senior analyst in the Division of Health Services Research and an assistant professor in the Department of Medicine, Northwell Health, in Manhasset
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Penney LS, Nahid M, Leykum LK, Lanham HJ, Noël PH, Finley EP, Pugh J. Interventions to reduce readmissions: can complex adaptive system theory explain the heterogeneity in effectiveness? A systematic review. BMC Health Serv Res 2018; 18:894. [PMID: 30477576 PMCID: PMC6260570 DOI: 10.1186/s12913-018-3712-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/14/2018] [Indexed: 11/13/2022] Open
Abstract
Background Successfully transitioning patients from hospital to home is a complex, often uncertain task. Despite significant efforts to improve the effectiveness of care transitions, they remain a challenge across health care systems. The lens of complex adaptive systems (CAS) provides a theoretical approach for studying care transition interventions, with potential implications for intervention effectiveness. The aim of this study is to examine whether care transition interventions that are congruent with the complexity of the processes and conditions they are trying to improve will have better outcomes. Methods We identified a convenience sample of high-quality care transition intervention studies included in a care transition synthesis report by Kansagara and colleagues. After excluding studies that did not meet our criteria, we scored each study based on (1) the presence or absence of 5 CAS characteristics (learning, interconnections, self-organization, co-evolution, and emergence), as well as system-level interdependencies (resources and processes) in the intervention design, and (2) scored study readmission-related outcomes for effectiveness. Results Forty-four of the 154 reviewed articles met our inclusion criteria; these studies reported on 46 interventions. Nearly all the interventions involved a change in interconnections between people compared with care as usual (96% of interventions), and added resources (98%) and processes (98%). Most contained elements impacting learning (67%) and self-organization (69%). No intervention reflected either co-evolution or emergence. Almost 40% of interventions were rated as effective in terms of impact on hospital readmissions. Chi square testing for an association between outcomes and CAS characteristics was not significant for learning or self-organization, however interventions rated as effective were significantly more likely to have both of these characteristics (78%) than interventions rated as having no effect (32%, p = 0.005). Conclusions Interventions with components that influenced learning and self-organization were associated with a significant improvement in hospital readmissions-related outcomes. Learning alone might be necessary but not be sufficient for improving transitions. However, building self-organization into the intervention might help people effectively respond to problems and adapt in uncertain situations to reduce the likelihood of readmission. Electronic supplementary material The online version of this article (10.1186/s12913-018-3712-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauren S Penney
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA. .,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| | - Musarrat Nahid
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Luci K Leykum
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.,Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, 2110 Speedway Stop B6500, Austin, TX, 78712-1277, USA
| | - Holly Jordan Lanham
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.,Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, 2110 Speedway Stop B6500, Austin, TX, 78712-1277, USA.,Department of Family & Community Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Polly H Noël
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Family & Community Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Erin P Finley
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.,Department of Psychiatry, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Jacqueline Pugh
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
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Srivastava A, Do JM, Sales VL, Ly S, Joseph J. Impact of patient-centred home telehealth programme on outcomes in heart failure. J Telemed Telecare 2018; 25:425-430. [DOI: 10.1177/1357633x18775852] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Telehealth is a promising intervention to reduce readmissions and healthcare-associated costs in patients with heart failure. Methods We performed a retrospective analysis of the impact of telehealth on 197 heart failure patients who had successfully completed one year of home telehealth monitoring following a heart failure admission as part of a clinically mandated programme at a Veterans Affairs Medical Center. Outcomes were compared both within the group (one year before and one year after home telehealth monitoring), and to a contemporary control cohort of 870 heart failure patients who were admitted but not enrolled in home telehealth. The following outcomes were analysed: admissions for any cause, heart failure admissions, total hospital days per patient, average length of stay per admission, urgent care and emergency room visits, and primary care visits. Results Both the home telehealth and control cohorts consisted of older male patients. Total hospital days per patient was significantly reduced by home telehealth monitoring in the home telehealth group (2.4 ± 3.5) in comparison to the previous year without monitoring (4.1 ± 4.6, p < 0.0001) and to the control group (3.8 ± 5.3, p < 0.001). A significantly lower admission rate (1.1 ± 1.6) and length of stay (5.7 ± 11.3 days) were observed during home telehealth monitoring within the home telehealth group compared to the prior year (1.6 ± 1.7, p < 0.05 and 9.5 ± 14 days, p < 0.01 respectively) but not in comparison with the control group (1.4 ± 2.0, p < 0.07). The home telehealth group also had a significantly lower length of stay when compared to the control group (5.7 ± 11.3 vs 9.0 ± 14.9, p < 0.01). The number of urgent care and emergency room visits, or primary care visits, was not significantly different during home telehealth monitoring as compared to the prior year. Conclusions Personalised and patient-centred home telehealth monitoring in heart failure patients was successful in reducing outcomes without an increase in outpatient and urgent care visits.
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Affiliation(s)
- Anshul Srivastava
- Medical Service, VA Boston Healthcare, USA
- Department of Medicine, Boston University School of Medicine, USA
| | | | - Virna L Sales
- Massachusetts Veterans Epidemiology Research and Information Center, USA
| | | | - Jacob Joseph
- Medical Service, VA Boston Healthcare, USA
- Department of Medicine, Boston University School of Medicine, USA
- Massachusetts Veterans Epidemiology Research and Information Center, USA
- Department of Medicine, Harvard Medical School, USA
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Kotooka N, Kitakaze M, Nagashima K, Asaka M, Kinugasa Y, Nochioka K, Mizuno A, Nagatomo D, Mine D, Yamada Y, Kuratomi A, Okada N, Fujimatsu D, Kuwahata S, Toyoda S, Hirotani SI, Komori T, Eguchi K, Kario K, Inomata T, Sugi K, Yamamoto K, Tsutsui H, Masuyama T, Shimokawa H, Momomura SI, Seino Y, Sato Y, Inoue T, Node K. The first multicenter, randomized, controlled trial of home telemonitoring for Japanese patients with heart failure: home telemonitoring study for patients with heart failure (HOMES-HF). Heart Vessels 2018; 33:866-876. [DOI: 10.1007/s00380-018-1133-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 02/02/2018] [Indexed: 12/19/2022]
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Koulaouzidis G, Barrett D, Mohee K, Clark AL. Telemonitoring in subjects with newly diagnosed heart failure with reduced ejection fraction: From clinical research to everyday practice. J Telemed Telecare 2018; 25:167-171. [PMID: 29419343 DOI: 10.1177/1357633x17751004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Heart failure is increasingly common, and characterised by frequent admissions to hospital. To try and reduce the risk of hospitalisation, techniques such as telemonitoring (TM) may have a role. We wanted to determine if TM in patients with newly diagnosed heart failure and ejection fraction <40% reduces the risk of readmission or death from any cause in a 'real-world' setting. METHODS This is a retrospective study of 124 patients (78.2% male; 68.6 ± 12.6 years) who underwent TM and 345 patients (68.5% male; 70.2 ± 10.7 years) who underwent the usual care (UC). The TM group were assessed daily by body weight, blood pressure and heart rate using electronic devices with automatic transfer of data to an online database. Follow-up was 12 months. RESULTS Death from any cause occurred in 8.1% of the TM group and 19% of the UC group ( p = 0.002). There was no difference between the two groups in all-cause hospitalisation, either in the number of subjects hospitalised ( p = 0.7) or in the number of admissions per patient ( p = 0.6). There was no difference in the number of heart-failure-related readmissions per person between the two groups ( p = 0.5), but the number of days in hospital per person was higher in the UC group ( p = 0.03). Also, there were a significantly greater number of days alive and out of hospital for the patients in the TM group compared with the UC group ( p = 0.0001). DISCUSSION TM is associated with lower any-cause mortality and also has the potential to reduce the number of days lost to hospitalisation and death.
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Affiliation(s)
- G Koulaouzidis
- 1 Academic Cardiology Unit, University of Hull, Castle Hill Hospital, UK
| | - D Barrett
- 2 Faculty of Health and Social Care, University of Hull, UK
| | - K Mohee
- 1 Academic Cardiology Unit, University of Hull, Castle Hill Hospital, UK
| | - A L Clark
- 1 Academic Cardiology Unit, University of Hull, Castle Hill Hospital, UK
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Abstract
Meta-analysis is a prominent method for estimating the effects of public health interventions, yet these interventions are often complex in ways that pose challenges to using conventional meta-analytic methods. This article discusses meta-analytic techniques that can be used in research syntheses on the effects of complex public health interventions. We first introduce the use of complexity frameworks to conceptualize public health interventions. We then present a menu of meta-analytic procedures for addressing various sources of complexity when answering questions about the effects of public health interventions in research syntheses. We conclude with a review of important practices and key resources for conducting meta-analyses on complex interventions, as well as future directions for research synthesis more generally. Overall, we argue that it is possible to conduct meaningful quantitative syntheses of research on the effects of public health interventions, though these meta-analyses may require the use of advanced techniques to properly consider and attend to issues of complexity.
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Affiliation(s)
- Emily E Tanner-Smith
- Peabody Research Institute, Vanderbilt University, Nashville, Tennessee 37203, USA.,Current affiliation: Department of Counseling Psychology and Human Services, University of Oregon, Eugene, Oregon 97403-1215, USA;
| | - Sean Grant
- RAND Corporation, Santa Monica, California 90407-2138, USA;
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El Amrani L, Oude Engberink A, Ninot G, Hayot M, Carbonnel F. Connected Health Devices for Health Care in French General Medicine Practice: Cross-Sectional Study. JMIR Mhealth Uhealth 2017; 5:e193. [PMID: 29269336 PMCID: PMC5754567 DOI: 10.2196/mhealth.7427] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 09/16/2017] [Accepted: 09/17/2017] [Indexed: 01/04/2023] Open
Abstract
Background The integration of Connected Health Devices (CHDs) is growing within mobile health (mHealth) and telemedicine, encouraged by institutions and industries. The idea is to improve lifestyle habits and health behaviors as a preventive goal in an aging population with fewer physicians available. However, their ill-defined place in health care does not promote their use in current medical practice. Objective The primary objective of this study was to quantify CHDs’ use rate by general practitioners (GPs). A secondary objective was to evaluate their benefits and limitations in usual care. Methods A cross-sectional study through an Internet-based survey was addressed to French GPs via regional medical unions and continuous education agencies, supplemented with an informative website, from March 2015 to July 2015. Surveys where either the form was insufficiently filled or the main question was left unanswered were excluded from the study. Results A total of 1084 answers were analyzed, of which 19.46% (211/1084, 95% CI 17.1-21.8) GPs used CHDs, and 10.15% (110/1084, 95% CI 8.5-12.1) prescribed a CHD. CHD users statistically prescribed more CHDs (7.38% [80/1084] in the user group vs 2.86% [31/1084] in nonusers; P<.001) and were more likely to use them in the future. Major interests in their utilization were in patient monitoring for 84.96% (921/1084) and patient education for 75.83% (822/1084), especially for diabetes (89.67%, 972/1084) and hypertension (84.13%, 912/1084). Generated data had to be managed securely by the patient primarily for 85.79% (930/1084) of the GPs. CHDs had to not constrain GPs outside clinical consultation, nor restrain their time for 75.83% (822/1084). Additional actors in patient care were not desired for 79.98% (867/1084) of the GPs. Questions about data management issues and technical difficulties were raised. Conclusions CHDs are little used by French GPs and even less prescribed to their patients, as only a few GPs use these tools. Their benefits as tools of patient empowerment, although expected, remain to be demonstrated in real-life setups.
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Affiliation(s)
- Leila El Amrani
- UFR Medecine site Nord, Department of General Practice, University of Montpellier, Montpellier, France.,Centre Hospitalier de Carcassonne, Department of Emergency Medicine, Carcassonne, France
| | - Agnes Oude Engberink
- UFR Medecine site Nord, Department of General Practice, University of Montpellier, Montpellier, France.,CEPS Platform, Universities of Montpellier, Montpellier, France.,Research Unit EA4556 Epsylon, University of Montpellier Paul Valery, University of Montpellier, Montpellier, France.,Avicenne Multiprofessional Health Center, Cabestany, France
| | - Gregory Ninot
- CEPS Platform, Universities of Montpellier, Montpellier, France.,Research Unit EA4556 Epsylon, University of Montpellier Paul Valery, University of Montpellier, Montpellier, France.,Institut du Cancer Montpellier, Montpellier, France
| | - Maurice Hayot
- PhyMedExp, University of Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - François Carbonnel
- UFR Medecine site Nord, Department of General Practice, University of Montpellier, Montpellier, France.,CEPS Platform, Universities of Montpellier, Montpellier, France.,Research Unit EA4556 Epsylon, University of Montpellier Paul Valery, University of Montpellier, Montpellier, France.,Avicenne Multiprofessional Health Center, Cabestany, France.,Institut du Cancer Montpellier, Montpellier, France
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Moertl D, Altenberger J, Bauer N, Berent R, Berger R, Boehmer A, Ebner C, Fritsch M, Geyrhofer F, Huelsmann M, Poelzl G, Stefenelli T. Disease management programs in chronic heart failure : Position statement of the Heart Failure Working Group and the Working Group of the Cardiological Assistance and Care Personnel of the Austrian Society of Cardiology. Wien Klin Wochenschr 2017; 129:869-878. [PMID: 29080104 PMCID: PMC5711993 DOI: 10.1007/s00508-017-1265-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 08/17/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Deddo Moertl
- Department of Internal Medicine 3, University Hospital St. Poelten, Karl Landsteiner Private University, St. Poelten, Austria.
- Institute for Research of Ischaemic Cardiac Diseases and Rhythmology, Karl Landsteiner Society, St. Pölten, Austria.
| | - Johann Altenberger
- Rehabilitation Center, Lehrkrankenhaus der PMU, Pensionsversicherung Grossgmain, Grossgmain, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
| | - Norbert Bauer
- Department of Internal Medicine, Hospital Hartberg, Hartberg, Styria, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
| | - Robert Berent
- Center for Cardiovascular Rehabilitation, Bad Ischl, Upper Austria, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
| | - Rudolf Berger
- Department for Internal Medicine I, Convent Hospital Barmherzige Brueder, Eisenstadt, Burgenland, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
| | - Armin Boehmer
- Department of Internal Medicine 1, University Clinic Krems, Krems, Lower Austria, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
| | - Christian Ebner
- Department of Internal Medicine 2, Convent Hospital Elisabethinen, Linz, Upper Austria, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
| | - Margarethe Fritsch
- Working Group for Preventive Medicine (AVOS), Salzburg, Austria
- Working Group of the Cardiological Assistance and Care Personnel, Austrian Society of Cardiology, Vienna, Austria
| | - Friedrich Geyrhofer
- Department of Internal Medicine 2, Convent Hospital Elisabethinen, Linz, Upper Austria, Austria
- Working Group of the Cardiological Assistance and Care Personnel, Austrian Society of Cardiology, Vienna, Austria
| | - Martin Huelsmann
- University Clinic of Internal Medicine II, Medical University Vienna, Vienna, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
| | - Gerhard Poelzl
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Tyrol, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
| | - Thomas Stefenelli
- Department of Internal Medicine 1, Donauspital/SMZ Ost, Vienna, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
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Voruganti T, Grunfeld E, Makuwaza T, Bender JL. Web-Based Tools for Text-Based Patient-Provider Communication in Chronic Conditions: Scoping Review. J Med Internet Res 2017; 19:e366. [PMID: 29079552 PMCID: PMC5681721 DOI: 10.2196/jmir.7987] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/24/2017] [Indexed: 01/30/2023] Open
Abstract
Background Patients with chronic conditions require ongoing care which not only necessitates support from health care providers outside appointments but also self-management. Web-based tools for text-based patient-provider communication, such as secure messaging, allow for sharing of contextual information and personal narrative in a simple accessible medium, empowering patients and enabling their providers to address emerging care needs. Objective The objectives of this study were to (1) conduct a systematic search of the published literature and the Internet for Web-based tools for text-based communication between patients and providers; (2) map tool characteristics, their intended use, contexts in which they were used, and by whom; (3) describe the nature of their evaluation; and (4) understand the terminology used to describe the tools. Methods We conducted a scoping review using the MEDLINE (Medical Literature Analysis and Retrieval System Online) and EMBASE (Excerpta Medica Database) databases. We summarized information on the characteristics of the tools (structure, functions, and communication paradigm), intended use, context and users, evaluation (study design and outcomes), and terminology. We performed a parallel search of the Internet to compare with tools identified in the published literature. Results We identified 54 papers describing 47 unique tools from 13 countries studied in the context of 68 chronic health conditions. The majority of tools (77%, 36/47) had functions in addition to communication (eg, viewable care plan, symptom diary, or tracker). Eight tools (17%, 8/47) were described as allowing patients to communicate with the team or multiple health care providers. Most of the tools were intended to support communication regarding symptom reporting (49%, 23/47), and lifestyle or behavior modification (36%, 17/47). The type of health care providers who used tools to communicate with patients were predominantly allied health professionals of various disciplines (30%, 14/47), nurses (23%, 11/47), and physicians (19%, 9/47), among others. Over half (52%, 25/48) of the tools were evaluated in randomized controlled trials, and 23 tools (48%, 23/48) were evaluated in nonrandomized studies. Terminology of tools varied by intervention type and functionality and did not consistently reflect a theme of communication. The majority of tools found in the Internet search were patient portals from 6 developers; none were found among published articles. Conclusions Web-based tools for text-based patient-provider communication were identified from a wide variety of clinical contexts and with varied functionality. Tools were most prevalent in contexts where intended use was self-management. Few tools for team-based communication were found, but this may become increasingly important as chronic disease care becomes more interdisciplinary.
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Affiliation(s)
- Teja Voruganti
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eva Grunfeld
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Tutsirai Makuwaza
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Jacqueline L Bender
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ELLICSR Health, Wellness & Cancer Survivorship Centre, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
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50
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Greenhalgh T, A’Court C, Shaw S. Understanding heart failure; explaining telehealth - a hermeneutic systematic review. BMC Cardiovasc Disord 2017; 17:156. [PMID: 28615004 PMCID: PMC5471857 DOI: 10.1186/s12872-017-0594-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/07/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Enthusiasts for telehealth extol its potential for supporting heart failure management. But randomised trials have been slow to recruit and produced conflicting findings; real-world roll-out has been slow. We sought to inform policy by making sense of a complex literature on heart failure and its remote management. METHODS Through database searching and citation tracking, we identified 7 systematic reviews of systematic reviews, 32 systematic reviews (including 17 meta-analyses and 8 qualitative reviews); six mega-trials and over 60 additional relevant empirical studies and commentaries. We synthesised these using Boell's hermeneutic methodology for systematic review, which emphasises the quest for understanding. RESULTS Heart failure is a complex and serious condition with frequent co-morbidity and diverse manifestations including severe tiredness. Patients are often frightened, bewildered, socially isolated and variably able to self-manage. Remote monitoring technologies are many and varied; they create new forms of knowledge and new possibilities for care but require fundamental changes to clinical roles and service models and place substantial burdens on patients, carers and staff. The policy innovation of remote biomarker monitoring enabling timely adjustment of medication, mediated by "activated" patients, is based on a modernist vision of efficient, rational, technology-mediated and guideline-driven ("cold") care. It contrasts with relationship-based ("warm") care valued by some clinicians and by patients who are older, sicker and less technically savvy. Limited uptake of telehealth can be analysed in terms of key tensions: between tidy, "textbook" heart failure and the reality of multiple comorbidities; between basic and intensive telehealth; between activated, well-supported patients and vulnerable, unsupported ones; between "cold" and "warm" telehealth; and between fixed and agile care programmes. CONCLUSION The limited adoption of telehealth for heart failure has complex clinical, professional and institutional causes, which are unlikely to be elucidated by adding more randomised trials of technology-on versus technology-off to an already-crowded literature. An alternative approach is proposed, based on naturalistic study designs, application of social and organisational theory, and co-design of new service models based on socio-technical principles. Conventional systematic reviews (whose goal is synthesising data) can be usefully supplemented by hermeneutic reviews (whose goal is deepening understanding).
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG UK
| | - Christine A’Court
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG UK
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG UK
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