1
|
Determining the impact of postoperative complications in neurosurgery based on simulated longitudinal smartphone app-based assessment. Acta Neurochir (Wien) 2022; 164:207-217. [PMID: 34420108 PMCID: PMC8761146 DOI: 10.1007/s00701-021-04967-0] [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: 05/29/2021] [Accepted: 08/07/2021] [Indexed: 11/25/2022]
Abstract
Background Complications after neurosurgical operations can have severe impact on patient well-being, which is poorly reflected by current grading systems. The objective of this work was to develop and conduct a feasibility study of a new smartphone application that allows for the longitudinal assessment of postoperative well-being and complications. Methods We developed a smartphone application “Post OP Tracker” according to requirements from clinical experience and tested it on simulated patients. Participants received regular notifications through the app, inquiring them about their well-being and complications that had to be answered according to their assigned scenarios. After a 12-week period, subjects answered a questionnaire about the app’s functionality, user-friendliness, and acceptability. Results A total of 13 participants (mean age 34.8, range 24–68 years, 4 (30.8%) female) volunteered in this feasibility study. Most of them had a professional background in either health care or software development. All participants downloaded, installed, and applied the app for an average of 12.9 weeks. On a scale of 1 (worst) to 4 (best), the app was rated on average 3.6 in overall satisfaction and 3.8 in acceptance. The design achieved a somewhat favorable score of 3.1. One participant (7.7%) reported major technical issues. The gathered patient data can be used to graphically display the simulated outcome and assess the impact of postoperative complications. Conclusions This study suggests the feasibility to longitudinally gather postoperative data on subjective well-being through a smartphone application. Among potential patients, our application indicated to be functional, user-friendly, and well accepted. Using this app-based approach, further studies will enable us to classify postoperative complications according to their impact on the patient’s well-being. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-021-04967-0.
Collapse
|
2
|
Andersen JA, Scoggins D, Michaud T, Wan N, Wen M, Su D. Racial Disparities in Diabetes Management Outcomes: Evidence from a Remote Patient Monitoring Program for Type 2 Diabetic Patients. Telemed J E Health 2020; 27:55-61. [PMID: 32302521 DOI: 10.1089/tmj.2019.0280] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction: Despite growing documentation of the efficacy of telemedicine in diabetes management, racial disparities in telemedicine-facilitated diabetes management remain underexplored. This study examined disparities in diabetes management outcomes between black and white patients with type 2 diabetes (T2D) in a remote monitoring program. Methods: The analysis sample included 914 white T2D patients and 365 black T2D patients in Nebraska who completed a 3-month remote patient monitoring and coaching after hospital discharge from 2014 to 2017. Ordinary least squares regression was estimated to examine racial differences in hemoglobin A1c (HbA1c), and logistic regression was used to determine the odds of HbA1c > 9% at the end of the program, controlling for demographics, baseline health conditions, and patient activation and engagement with the program. Results: The proportion of white patients with HbA1c > 9% was reduced from 16% at the baseline to 7% at program completion, and the corresponding reduction among black patients was from 30% to 18%. After adjusting for the effects of baseline HbA1c and other covariates, the average HbA1c among black patients at the end of the program was 0.23 points higher than that among white patients (p < 0.01), and the adjusted odds of black patients having HbA1c > 9% was 1.68 times that of white patients (95% confidence interval [1.07-2.63]). Discussion: The remote patient monitoring and coaching program reduced the absolute gap between black and white T2D patients. However, substantial racial disparities in HbA1c still remained at the end of the program and warranted further research.
Collapse
Affiliation(s)
- Jennifer A Andersen
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Dylan Scoggins
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tzeyu Michaud
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Department of Health Promotion, Social & Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Neng Wan
- Department of Geography and University of Utah, Salt Lake City, Utah, USA
| | - Ming Wen
- Department of Sociology, University of Utah, Salt Lake City, Utah, USA
| | - Dejun Su
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Department of Health Promotion, Social & Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
3
|
Rodriguez S, Hwang K, Wang J. Connecting Home-Based Self-Monitoring of Blood Pressure Data Into Electronic Health Records for Hypertension Care: A Qualitative Inquiry With Primary Care Providers. JMIR Form Res 2019; 3:e10388. [PMID: 31124468 PMCID: PMC6552440 DOI: 10.2196/10388] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/04/2018] [Accepted: 04/23/2019] [Indexed: 01/26/2023] Open
Abstract
Background There is a lack of research on how to best incorporate home-based self-measured blood pressure (SMBP) measurements, combined with other patient-generated health data (PGHD), into electronic health record (EHR) systems in a way that promotes primary care workflow without burdening the primary care team with irrelevant or superfluous data. Objective The purpose of this study was to explore the perspectives of primary care providers in utilizing SMBP measurements and integrating SMBP data into the clinical workflow for the management of hypertension in the primary care setting. Methods A total of 13 primary care physicians were interviewed in total; 5 in individual interviews and 8 in a focus group. The interview questions were centered on (1) the value of SMBP in hypertension care, (2) needs of viewing SMBP and desired visual display, (3) desired alert algorithm and critical values, (4) needs for other PGHD, and (5) workflow of primary care team in utilizing SMBP. The interviews were audiotaped and transcribed verbatim, and a thematic analysis was performed to extract overarching themes. Results The primary care experience of the 13 providers ranged from 5 to 35 years. The following themes emerged from the individual and focus group interviews: (1) ways to utilize SMBP measurements in primary care, (2) preferred visual display of SMBP, (3) patient condition determines preferred scheduling of patient SMBP measurements and provider’s preferred frequency of viewing SMBP data, (4) effect of patient condition on alert parameters, (5) location to receive critical value alerts, (6) primary recipient of critical value alerts, and (7) the need of additional PGHD (eg, emotional stressors, food diary, and medication adherence) to provide context of SMBP values. Conclusions The perspectives of primary care providers need to be incorporated into the design of a built-in interface in the EHR to incorporate SMBP and other PGHD. Future usability evaluation should be conducted with mock-up interfaces to solicit opinions on the optimal alert frequency and mechanism to best fit the workflow in the primary care setting. Future studies should examine how the utilization of a built-in interface that fully integrates SMBP measurements and PGHD into EHR systems can support patient self-management and thus, improve patient outcomes.
Collapse
Affiliation(s)
- Sarah Rodriguez
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Kevin Hwang
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jing Wang
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| |
Collapse
|
4
|
Scheper H, Derogee R, Mahdad R, van der Wal RJP, Nelissen RGHH, Visser LG, de Boer MGJ. A mobile app for postoperative wound care after arthroplasty: Ease of use and perceived usefulness. Int J Med Inform 2019; 129:75-80. [PMID: 31445292 DOI: 10.1016/j.ijmedinf.2019.05.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/19/2018] [Accepted: 05/11/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Early postoperative discharge after joint arthroplasty may lead to decreased wound monitoring. A mobile woundcare app with an integrated algorithm to detect complications may lead to improved monitoring and earlier treatment of complications. In this study, the ease of use and perceived usefulness of such a mobile app was investigated. OBJECTIVE Primary objective was to investigate the ease of use and perceived usefulness of using a woundcare app. Secondary objectives were the number of alerts created, the amount of days the app was actually used and patient-reported wound infection. METHODS Patients that received a joint arthroplasty were enrolled in a prospective cohort study. During 30 postoperative days, patients scored their surgical wound by daily answering of questions in the app. An inbuilt algorithm advised patients to contact their treating physician if needed. On day 15 and day 30, additional questionnaires in the app investigated ease of use and perceived usefulness. RESULTS Sixty-nine patients were included. Median age was 68 years. Forty-one patients (59.4%) used the app until day 30. Mean grade for ease of use (on a Likert-scale of 1-5) were 4.2 on day 15 and 4.2 on day 30; grades for perceived usefulness were 4.1 on day 15 and 4.0 on day 30. Out of 1317 days of app use, an alert was sent to patients on 29 days (2.2%). Concordance between patient-reported outcome and physician-reported outcome was 80%. CONCLUSIONS Introduction of a woundcare app with an alert communication on possible wound problems resulted in a high perceived usefulness and ease of use. Future studies will focus on validation of the algorithm and the association between postoperative wound leakage and the incidence of prosthetic joint infection.
Collapse
Affiliation(s)
- H Scheper
- Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, the Netherlands.
| | - R Derogee
- Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, the Netherlands
| | - R Mahdad
- Department of Orthopaedic Surgery, Alrijne Hospital, Leiderdorp, the Netherlands
| | - R J P van der Wal
- Department of Orthopaedics, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, the Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, the Netherlands
| | - L G Visser
- Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, the Netherlands
| | - M G J de Boer
- Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, the Netherlands
| |
Collapse
|
5
|
Reaching the Latino Population: a Brief Conceptual Discussion on the Use of Telehealth to Address Healthcare Disparities for the Large and Growing Population. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s41347-019-00088-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
6
|
Su D, Michaud TL, Estabrooks P, Schwab RJ, Eiland LA, Hansen G, DeVany M, Zhang D, Li Y, Pagán JA, Siahpush M. Diabetes Management Through Remote Patient Monitoring: The Importance of Patient Activation and Engagement with the Technology. Telemed J E Health 2018; 25:952-959. [PMID: 30372366 DOI: 10.1089/tmj.2018.0205] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The documented efficacy and promise of telemedicine in diabetes management does not necessarily mean that it can be easily translated into clinical practice. An important barrier concerns patient activation and engagement with telemedicine technology. Objective: To assess the importance of patient activation and engagement with remote patient monitoring technology in diabetes management among patients with type 2 diabetes. Methods: Ordinary least squares and logistic regression analyses were used to examine how patient activation and engagement with remote patient monitoring technology were related to changes in hemoglobin A1c (HbA1c) for 1,354 patients with type 2 diabetes monitored remotely for 3 months between 2015 and 2017. Results: Patients with more frequent and regular participation in remote monitoring had lower HbA1c levels at the end of the program. Compared to patients who uploaded their biometric data every 2 days or less frequently, patients who maintained an average frequency of one upload per day were less likely to have a postmonitoring HbA1c > 9% after adjusting for selected covariates on baseline demographics and health conditions. Conclusions: Higher levels of patient activation and engagement with remote patient monitoring technology were associated with better glycemic control outcomes. Developing targeted interventions for different groups of patients to promote their activation and engagement levels would be important to improve the effectiveness of remote patient monitoring in diabetes management.
Collapse
Affiliation(s)
- Dejun Su
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.,Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Tzeyu L Michaud
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.,Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Paul Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Robert J Schwab
- Divisions of General Internal Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Leslie A Eiland
- Divisions of Diabetes, Endocrine and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Geri Hansen
- TeleHealth Program, Nebraska Medicine, Omaha, Nebraska
| | - Mary DeVany
- TeleHealth Program, Nebraska Medicine, Omaha, Nebraska
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Yan Li
- Center for Health Innovation, The New York Academy of Medicine, New York, New York
| | - José A Pagán
- Center for Health Innovation, The New York Academy of Medicine, New York, New York.,Department of Public Health Policy and Management, College of Global Public Health, New York University, New York, New York.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mohammad Siahpush
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| |
Collapse
|
7
|
Validation of the A&D BP UA-1200BLE device for home blood pressure measurement according to the ISO 81060-2: 2013 standard. Blood Press Monit 2018; 23:312-314. [PMID: 30199378 DOI: 10.1097/mbp.0000000000000347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to validate the UA-1200BLE device using the ISO 81060-2:2013 standard. MATERIALS AND METHODS Individuals aged more than 12 years were recruited from among the outpatients and volunteers of Jichi Medical University (Tochigi, Japan). Eighty-five patients were included in the final analyses. Validation was performed using the same-arm sequence protocol as per the ISO 81060-2:2013 standard. RESULTS The device performed well against the standard; the mean and SD values for the differences between device and observed systolic and diastolic blood pressure values fulfilled both criterion 1 and criterion 2 of the standard (criterion 1: -2.62±6.89 and -0.90±6.63 mmHg, respectively; criterion 2: -2.65±5.36 and -0.91±6.12 mmHg, respectively). The Bland-Altman plots did not show any systematic variation in the error. CONCLUSION The UA-1200BLE device had a high level of accuracy and fulfilled all ISO 81060-2:2013 standard requirements in adults with a wide range of arm circumference measurements. It is therefore suitable as a wireless blood pressure monitoring tool in patients with hypertension.
Collapse
|
8
|
Chen J, Lin Y, Shen B. Informatics for Precision Medicine and Healthcare. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1005:1-20. [PMID: 28916926 DOI: 10.1007/978-981-10-5717-5_1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The past decade has witnessed great advances in biomedical informatics. Biomedical informatics is an emerging field of healthcare that aims to translate the laboratory observation into clinical practice. Smart healthcare has also developed rapidly with ubiquitous sensor and communication technologies. It is able to capture the online patient-centric phenotypic variables, thus providing a rich information base for translational biomedical informatics. Biomedical informatics and smart healthcare represent two interrelated disciplines. On one hand, biomedical informatics translates the bench discoveries into bedside, and, on the other hand, it is reciprocally informed by clinical data generated from smart healthcare. In this chapter, we will introduce the major strategies and challenges in the application of biomedical informatics technology in precision medicine and healthcare. We highlight how the informatics technology will promote the precision medicine and therefore promise the improvement of healthcare.
Collapse
Affiliation(s)
- Jiajia Chen
- School of Chemistry, Biology and Materials Engineering, Suzhou University of Science and Technology, No.1 Kerui road, Suzhou, Jiangsu, 215011, China
| | - Yuxin Lin
- Center for Systems Biology, Soochow University, No.1 Shizi Street, Suzhou, Jiangsu, 215006, China
| | - Bairong Shen
- Center for Systems Biology, Soochow University, No.1 Shizi Street, Suzhou, Jiangsu, 215006, China. .,Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, 215163, China. .,Medical College of Guizhou University, Guiyang, 550025, China.
| |
Collapse
|
9
|
Boatin AA, Wylie BJ, Goldfarb I, Azevedo R, Pittel E, Ng C, Haberer JE. Wireless Vital Sign Monitoring in Pregnant Women: A Functionality and Acceptability Study. Telemed J E Health 2016; 22:564-71. [PMID: 27172448 DOI: 10.1089/tmj.2015.0173] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To test the functionality and acceptability of a wireless vital sign monitor in an inpatient obstetric unit. MATERIALS AND METHODS Pregnant women at a U.S. tertiary-care hospital wore a wireless vital sign sensor that captures heart rate, respiratory rate, and temperature. Measurements were compared with vital signs obtained by standard devices. We defined continuous capture of vital signs for 30 min with wireless data transfer to a central monitor as functional success. Acceptability was assessed per the pregnant women and nurses observing the device. Bland-Altman plots were constructed to assess agreement between the wireless sensor and standard measurements. RESULTS Thirty of 32 enrolled pregnant women had successful monitoring; 2 cases were stopped early for non-study-related reasons. Comparing wireless sensor and standard measurements, the mean difference (limits of agreement) values at the 25th and 75th percentiles were 1.6 (±13.2) and 4.2 (±18.6) heartbeats/min, 4.2 (±6.1) and 0.7 (±5.4) respirations/min, and 0.02°C (±1.5) and 0.5°C (±1.8), respectively. Most pregnant women found the device comfortable, likeable, and useful (78%, 81%, and 97%, respectively); 80% of nurses found the monitor easy to use, and 84% would recommend it to a patient. CONCLUSIONS We successfully obtained maternal vital signs using a simple wireless monitor with high acceptability. Well-validated monitors of this nature could significantly alleviate the human resource burden of monitoring during labor and confer greatly desired mobility to laboring pregnant women, although incorporation of blood pressure monitoring will be critical.
Collapse
Affiliation(s)
- Adeline Adwoa Boatin
- 1 Department of Obstetrics and Gynecology, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts
| | - Blair Johnson Wylie
- 2 Division of Maternal Fetal Medicine, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts
| | - Ilona Goldfarb
- 2 Division of Maternal Fetal Medicine, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts
| | - Robin Azevedo
- 3 Department of Nursing, Massachusetts General Hospital , Boston, Massachusetts
| | - Elena Pittel
- 3 Department of Nursing, Massachusetts General Hospital , Boston, Massachusetts
| | - Courtney Ng
- 4 Harvard School of Public Health , Boston, Massachusetts
| | - Jessica Elizabeth Haberer
- 5 Massachusetts General Hospital Center for Global Health, Harvard Medical School , Boston, Massachusetts
| |
Collapse
|
10
|
Pavliscsak H, Little JR, Poropatich RK, McVeigh FL, Tong J, Tillman JS, Smith CH, Fonda SJ. Assessment of patient engagement with a mobile application among service members in transition. J Am Med Inform Assoc 2015; 23:110-8. [PMID: 26363048 DOI: 10.1093/jamia/ocv121] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/03/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This article examines engagement with a mobile application ("mCare") for wounded Service Members rehabilitating in their communities. Many had behavioral health problems, Traumatic Brain Injury (TBI), and/or post-traumatic stress disorder (PTS). The article also examines associations between Service Members' background characteristics and their engagement with mCare. MATERIALS AND METHODS This analysis included participants who received mCare (n = 95) in a randomized controlled trial. mCare participants received status questionnaires daily for up to 36 weeks. Participant engagement encompasses exposure to mCare, percentage of questionnaires responded to, and response time. Participants were grouped by health status-that is, presence/absence of behavioral health problems, PTS, and/or TBI. Histograms and regression analyses examined engagement by participants' health status and background characteristics. RESULTS Exposure to mCare did not differ by health status. Participants usually responded to ≥60% of the questionnaires weekly, generally in ≤10 h; however, participants with behavioral health problems had several weeks with <50% response and the longest response times. Total questionnaires responded to and response time did not differ statistically by health status. Older age and higher General Well-Being Schedule scores were associated with greater and faster response. DISCUSSION The sustained response to the questionnaires suggests engagement. Overall level of response surpassed trends reported for American's usage of mobile applications. With a few exceptions, Service Members engaged with mCare irrespective of health status. CONCLUSION Mobile health has the potential to increase the quantity and quality of patient-provider communications in a community-based, rehabilitation care setting, above that of standard care.
Collapse
Affiliation(s)
- Holly Pavliscsak
- mHealth Research Project Manager, The Geneva Foundation, Assigned to the Mobile Health Care Innovation Center (MHIC), Telemedicine and Advanced Technology Research Center (TATRC), United States Army Medical Research and Materiel Command (USAMRMC), Fort Gordon, GA 30905,
| | - Jeanette R Little
- Laboratory Lead, Mobile Health Innovation Center, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Materiel Command, Fort Gordon, GA, USA,
| | - Ronald K Poropatich
- Executive Director, Center for Military Medicine Research, University of Pittsburgh, Pittsburgh, PA, USA,
| | - Francis L McVeigh
- Chief Scientist, Advanced Technology and Innovation Laboratory, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Materiel Command, Fort Detrick, MD, UA,
| | - James Tong
- Engagement Manager, IMS Health, Government Solutions, Washington, DC, USA,
| | - Johnie S Tillman
- Former, PI, COL (Ret) Army, currently Director of Integrated Disability Evaluation System, Fort Gordon, GA USA,
| | - Challis H Smith
- Former, Principal Investigator, COL (Ret) Army, currently, Case Management Coordinator, Quality Management and Development, Virginia Department of Behavioral Health and Developmental Services, Richmond, VA,
| | - Stephanie Jo Fonda
- Principal Investigator and Senior Scientist, Geneva Research Foundation, Located at Walter Reed National Military Medical Center, Endocrinology Department, Bethesda, MD, USA,
| |
Collapse
|
11
|
Agboola S, Jethwani K, Khateeb K, Moore S, Kvedar J. Heart failure remote monitoring: evidence from the retrospective evaluation of a real-world remote monitoring program. J Med Internet Res 2015; 17:e101. [PMID: 25903278 PMCID: PMC4422937 DOI: 10.2196/jmir.4417] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/08/2015] [Accepted: 04/09/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Given the magnitude of increasing heart failure mortality, multidisciplinary approaches, in the form of disease management programs and other integrative models of care, are recommended to optimize treatment outcomes. Remote monitoring, either as structured telephone support or telemonitoring or a combination of both, is fast becoming an integral part of many disease management programs. However, studies reporting on the evaluation of real-world heart failure remote monitoring programs are scarce. OBJECTIVE This study aims to evaluate the effect of a heart failure telemonitoring program, Connected Cardiac Care Program (CCCP), on hospitalization and mortality in a retrospective database review of medical records of patients with heart failure receiving care at the Massachusetts General Hospital. METHODS Patients enrolled in the CCCP heart failure monitoring program at the Massachusetts General Hospital were matched 1:1 with usual care patients. Control patients received care from similar clinical settings as CCCP patients and were identified from a large clinical data registry. The primary endpoint was all-cause mortality and hospitalizations assessed during the 4-month program duration. Secondary outcomes included hospitalization and mortality rates (obtained by following up on patients over an additional 8 months after program completion for a total duration of 1 year), risk for multiple hospitalizations and length of stay. The Cox proportional hazard model, stratified on the matched pairs, was used to assess primary outcomes. RESULTS A total of 348 patients were included in the time-to-event analyses. The baseline rates of hospitalizations prior to program enrollment did not differ significantly by group. Compared with controls, hospitalization rates decreased within the first 30 days of program enrollment: hazard ratio (HR)=0.52, 95% CI 0.31-0.86, P=.01). The differential effect on hospitalization rates remained consistent until the end of the 4-month program (HR=0.74, 95% CI 0.54-1.02, P=.06). The program was also associated with lower mortality rates at the end of the 4-month program: relative risk (RR)=0.33, 95% 0.11-0.97, P=.04). Additional 8-months follow-up following program completion did not show residual beneficial effects of the CCCP program on mortality (HR=0.64, 95% 0.34-1.21, P=.17) or hospitalizations (HR=1.12, 95% 0.90-1.41, P=.31). CONCLUSIONS CCCP was associated with significantly lower hospitalization rates up to 90 days and significantly lower mortality rates over 120 days of the program. However, these effects did not persist beyond the 120-day program duration.
Collapse
Affiliation(s)
- Stephen Agboola
- Partners Healthcare Center for Connected Health, Connected Health Innovation, Boston, MA, United States.
| | | | | | | | | |
Collapse
|
12
|
Agboola SO, Ju W, Elfiky A, Kvedar JC, Jethwani K. The effect of technology-based interventions on pain, depression, and quality of life in patients with cancer: a systematic review of randomized controlled trials. J Med Internet Res 2015; 17:e65. [PMID: 25793945 PMCID: PMC4381812 DOI: 10.2196/jmir.4009] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/18/2015] [Accepted: 02/18/2015] [Indexed: 02/06/2023] Open
Abstract
Background The burden of cancer is increasing; projections over the next 2 decades suggest that the annual cases of cancer will rise from 14 million in 2012 to 22 million. However, cancer patients in the 21st century are living longer due to the availability of novel therapeutic regimens, which has prompted a growing focus on maintaining patients’ health-related quality of life. Telehealth is increasingly being used to connect with patients outside of traditional clinical settings, and early work has shown its importance in improving quality of life and other clinical outcomes in cancer care. Objective The aim of this study was to systematically assess the literature for the effect of supportive telehealth interventions on pain, depression, and quality of life in cancer patients via a systematic review of clinical trials. Methods We searched PubMed, EMBASE, Google Scholar, CINAHL, and PsycINFO in July 2013 and updated the literature search again in January 2015 for prospective randomized trials evaluating the effect of telehealth interventions in cancer care with pain, depression, and quality of life as main outcomes. Two of the authors independently reviewed and extracted data from eligible randomized controlled trials, based on pre-determined selection criteria. Methodological quality of studies was assessed by the Cochrane Collaboration risk of bias tool. Results Of the 4929 articles retrieved from databases and relevant bibliographies, a total of 20 RCTs were included in the final review. The studies were largely heterogeneous in the type and duration of the intervention as well as in outcome assessments. A majority of the studies were telephone-based interventions that remotely connected patients with their health care provider or health coach. The intervention times ranged from 1 week to 12 months. In general, most of the studies had low risk of bias across the domains of the Cochrane Collaboration risk of bias tool, but most of the studies had insufficient information about the allocation concealment domain. Two of the three studies focused on pain control reported significant effects of the intervention; four of the nine studies focus on depression reported significant effects, while only the studies that were focused on quality of life reported significant effects. Conclusions This systematic review demonstrates the potential of telehealth interventions in improving outcomes in cancer care. However, more high-quality large-sized trials are needed to demonstrate cogent evidence of its effectiveness.
Collapse
Affiliation(s)
- Stephen O Agboola
- Partners Healthcare Center for Connected Health, Boston, MA, United States.
| | | | | | | | | |
Collapse
|
13
|
Agboola S, Hale TM, Masters C, Kvedar J, Jethwani K. "Real-world" practical evaluation strategies: a review of telehealth evaluation. JMIR Res Protoc 2014; 3:e75. [PMID: 25524892 PMCID: PMC4275475 DOI: 10.2196/resprot.3459] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 08/25/2014] [Accepted: 11/03/2014] [Indexed: 12/12/2022] Open
Abstract
Background Currently, the increasing interest in telehealth and significant technological breakthroughs of the past decade create favorable conditions for the widespread adoption of telehealth services. Therefore, expectations are high that telehealth can help alleviate prevailing challenges in health care delivery. However, in order to translate current research to policy and facilitate adoption by patients and health care providers, there is need for compelling evidence of the effectiveness of telehealth interventions. Such evidence is gathered from rigorously designed research studies, which may not always be practical in many real-world settings. Objective Our aim was to summarize current telehealth evaluation strategies and challenges and to outline practical approaches to conduct evaluation in real-world settings using one of our previously reported telehealth initiatives, the Diabetes Connect program, as a case study. Methods We reviewed commonly used current evaluation frameworks and strategies, as well as best practices based on successful evaluative efforts to date to address commonly encountered challenges in telehealth evaluation. These challenges in telehealth evaluation and commonly used frameworks are described relevant to the evaluation of Diabetes Connect, a 12-month Web-based blood glucose monitoring program. Results Designers of telehealth evaluation frameworks must give careful consideration to the elements of planning, implementation, and impact assessment of interventions. Evaluating performance at each of these phases is critical to the overall success of an intervention. Although impact assessment occurs at the end of a program, our review shows that it should begin at the point of problem definition. Critical to the success of an evaluative strategy is early planning that involves all stakeholders to identify the overall goals of the program and key measures of success at each phase of the program life cycle. This strategy should enable selection of an appropriate evaluation strategy and measures to aid in the ongoing development and implementation of telehealth and provide better evidence of program impact. Conclusions We recommend a pragmatic, multi-method, multi-phase approach to telehealth evaluation that is flexible and can be adapted to the characteristics and challenges unique to each telehealth program.
Collapse
Affiliation(s)
- Stephen Agboola
- Partners Healthcare Center for Connected Health, Boston, MA, United States.
| | | | | | | | | |
Collapse
|