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Tanguay A, Lebon J, Hébert D. Remote certification of out-of-hospital deaths in a Canadian Province: An 8-year experience of a novel practice. SAGE Open Med 2021; 9:20503121211001145. [PMID: 33796297 PMCID: PMC7970215 DOI: 10.1177/20503121211001145] [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: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: Certification of out-of-hospital deaths is challenging as physicians are
often unavailable at the scene. In these situations, emergency medical
services will generally transport the decedent to the nearest hospital. In
2011, a remote death certification program was implemented in the province
of Québec, Canada. The program was managed through an online medical control
center and enabled death certification by a remote physician. We sought to
evaluate the implementation and feasibility of the remote death
certification program and to describe the challenges we experienced. Methods: We retrospectively reviewed all remote death certification requests received
at the online medical control center between 2011 and 2019. Data were
collected from the online medical control center database and records.
Feasibility was determined by evaluating the remote death certification
rate. Results: Overall, 84.1% of remote death certification requests were realized,
producing a total of 9776 death certificates. Male decedents accounted for
61.5% of remote death certification requests and were more likely than
females to undergo a coroner’s investigation for cause of death (36.3% vs
20.8%, p = 0.017). Urban/mixed regions had higher rates of
achieved remote death certifications (mean 87.3% vs 76.9%,
p = 0.033) and putrefied bodies (mean 3.8% vs 2.2%,
p = 0.137) compared to rural regions. Among unrealized
remote death certification requests, the most common reason was failure of
relatives to designate a funeral home (36.8%). Conclusion: Our 8-year experience with the remote death certification program
demonstrates that despite facing numerous challenges, this process is
feasible and offers a valuable option to manage out-of-hospital deaths. The
remote death certification program is spreading in the remaining regions of
Québec. Future studies will aim to quantify how much time this process saves
for emergency medical services in each region of the province.
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Affiliation(s)
- Alain Tanguay
- Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU), Lévis, QC, Canada.,Centre de Recherche de l'Hôtel-Dieu de Lévis, Lévis, QC, Canada
| | - Johann Lebon
- Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU), Lévis, QC, Canada.,Centre de Recherche de l'Hôtel-Dieu de Lévis, Lévis, QC, Canada
| | - Denise Hébert
- Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU), Lévis, QC, Canada
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Guo X, Gu X, Jiang J, Li H, Duan R, Zhang Y, Sun L, Bao Z, Shen J, Chen F. A Hospital-Community-Family-Based Telehealth Program for Patients With Chronic Heart Failure: Single-Arm, Prospective Feasibility Study. JMIR Mhealth Uhealth 2019; 7:e13229. [PMID: 31833835 PMCID: PMC6935047 DOI: 10.2196/13229] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 06/06/2019] [Accepted: 09/26/2019] [Indexed: 12/16/2022] Open
Abstract
Background An increasing number of patients with chronic heart failure (CHF) are demanding more convenient and efficient modern health care systems, especially in remote areas away from central cities. Telehealth is receiving increasing attention, which may be useful to patients with CHF. Objective This study aimed to evaluate the feasibility of a hospital-community-family (HCF)–based telehealth program, which was designed to implement remote hierarchical management in patients with CHF. Methods This was a single-arm prospective study in which 70 patients with CHF participated in the HCF-based telehealth program for remote intervention for at least 4 months. The participants were recruited from the clinic and educated on the use of smart health tracking devices and mobile apps to collect and manually upload comprehensive data elements related to the risk of CHF self-care management. They were also instructed on how to use the remote platform and mobile app to send text messages, check notifications, and open video channels. The general practitioners viewed the index of each participant on the mobile app and provided primary care periodically, and cardiologists in the regional central hospital offered remote guidance, if necessary. The assessed outcomes included accomplishments of the program, usability and satisfaction, engagement with the intervention, and changes of heart failure–related health behaviors. Results As of February 2018, a total of 66 individuals, aged 40-79 years, completed the 4-month study. Throughout the study period, 294 electronic medical records were formed on the remote monitoring service platform. In addition, a total of 89 remote consultations and 196 remote ward rounds were conducted. Participants indicated that they were generally satisfied with the intervention for its ease of use and usefulness. More than 91% (21/23) of physicians believed the program was effective, and 87% (20/23) of physicians stated that their professional knowledge could always be refreshed and enhanced through a library hosted on the platform and remote consultation. More than 60% (40/66) of participants showed good adherence to the care plan in the study period, and 79% (52/66) of patients maintained a consistent pattern of reporting and viewing their data over the course of the 4-month follow-up period. The program showed a positive effect on self-management for patients (healthy diet: P=.046, more fruit and vegetable intake: P=.02, weight monitoring: P=.002, blood pressure: P<.001, correct time: P=.049, and daily dosages of medicine taken: P=.006). Conclusions The HCF-based telehealth program is feasible and provided researchers with evidence of remote hierarchical management for patients with CHF, which can enhance participants’ and their families’ access and motivation to engage in self-management. Further prospective studies with a larger sample size are necessary to confirm the program’s effectiveness.
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Affiliation(s)
- Xiaorong Guo
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Dalian Medical University, Dalian, Liaoning, China.,Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Xiang Gu
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Dalian Medical University, Dalian, Liaoning, China.,Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Jiang Jiang
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Dalian Medical University, Dalian, Liaoning, China.,Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Hongxiao Li
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Ruoyu Duan
- Dalian Medical University, Dalian, Liaoning, China.,Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Yi Zhang
- Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Lei Sun
- Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Zhengyu Bao
- Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Jianhua Shen
- Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Fukun Chen
- Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
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