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Casabona E, Riva-Rovedda F, Castello A, Sciarrotta D, Di Giulio P, Dimonte V. Factors Associated with Falls in Community-Dwelling Older Adults: A Subgroup Analysis from a Telemergency Service. Geriatrics (Basel) 2024; 9:69. [PMID: 38920425 PMCID: PMC11203033 DOI: 10.3390/geriatrics9030069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/06/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
According to the number of falls, fallers can be single (only one fall) or recurrent (two or more falls), with different risk profiles for loss of independence and frailty. The presence of risk factors in community-dwelling single- and recurrent fallers using a wearable fall-detection device, such as the Personal Emergency Response System (PERS), as part of a telemergency service, is still unknown. This article evaluates how using a PERS, within a telemergency service, helps identify risk profiles and assessment of any differences between non-fallers and fallers in community-dwelling older adults. A sub-group analysis was performed, dividing users into non-fallers (n = 226) and fallers (≥1 fall; n = 89); single-fallers (n = 66) and recurrent fallers (n = 23). Median age was higher in fallers (87.7 years vs. 86), whereas recurrent fallers were less independent, had fewer comorbidities, and had more low-extremity disabilities. The use of the PERS for medical problems (Adjusted OR = 0.31), excluding falls, support calls (Adjusted OR = 0.26), and service demands (Adjusted OR = 0.30), was significantly associated with a fall risk reduction. The findings suggest that the integration within a telemergency service may impact on fall-risk factors.
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Affiliation(s)
- Elena Casabona
- Department of Public Health and Pediatrics, University of Torino, 10100 Torino, Italy; (E.C.); (F.R.-R.); (A.C.); (V.D.)
| | - Federica Riva-Rovedda
- Department of Public Health and Pediatrics, University of Torino, 10100 Torino, Italy; (E.C.); (F.R.-R.); (A.C.); (V.D.)
| | - Angela Castello
- Department of Public Health and Pediatrics, University of Torino, 10100 Torino, Italy; (E.C.); (F.R.-R.); (A.C.); (V.D.)
| | | | - Paola Di Giulio
- Department of Public Health and Pediatrics, University of Torino, 10100 Torino, Italy; (E.C.); (F.R.-R.); (A.C.); (V.D.)
| | - Valerio Dimonte
- Department of Public Health and Pediatrics, University of Torino, 10100 Torino, Italy; (E.C.); (F.R.-R.); (A.C.); (V.D.)
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Wang T, Giunti G, Goossens R, Melles M. Timing, Indicators, and Approaches to Digital Patient Experience Evaluation: Umbrella Systematic Review. J Med Internet Res 2024; 26:e46308. [PMID: 38315545 PMCID: PMC10877490 DOI: 10.2196/46308] [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: 02/06/2023] [Revised: 06/05/2023] [Accepted: 11/29/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The increasing prevalence of DH applications has outpaced research and practice in digital health (DH) evaluations. Patient experience (PEx) was reported as one of the challenges facing the health system by the World Health Organization. To generate evidence on DH and promote the appropriate integration and use of technologies, a standard evaluation of PEx in DH is required. OBJECTIVE This study aims to systematically identify evaluation timing considerations (ie, when to measure), evaluation indicators (ie, what to measure), and evaluation approaches (ie, how to measure) with regard to digital PEx. The overall aim of this study is to generate an evaluation guide for further improving digital PEx evaluation. METHODS This is a 2-phase study parallel to our previous study. In phase 1, literature reviews related to PEx in DH were systematically searched from Scopus, PubMed, and Web of Science databases. Two independent raters conducted 2 rounds of paper screening, including title and abstract screening and full-text screening, and assessed the interrater reliability for 20% (round 1: 23/115 and round 2: 12/58) random samples using the Fleiss-Cohen coefficient (round 1: k1=0.88 and round 2: k2=0.80). When reaching interrater reliability (k>0.60), TW conducted the rest of the screening process, leaving any uncertainties for group discussions. Overall, 38% (45/119) of the articles were considered eligible for further thematic analysis. In phase 2, to check if there were any meaningful novel insights that would change our conclusions, we performed an updated literature search in which we collected 294 newly published reviews, of which 102 (34.7%) were identified as eligible articles. We considered them to have no important changes to our original results on the research objectives. Therefore, they were not integrated into the synthesis of this review and were used as supplementary materials. RESULTS Our review highlights 5 typical evaluation objectives that serve 5 stakeholder groups separately. We identified a set of key evaluation timing considerations and classified them into 3 categories: intervention maturity stages, timing of the evaluation, and timing of data collection. Information on evaluation indicators of digital PEx was identified and summarized into 3 categories (intervention outputs, patient outcomes, and health care system impact), 9 themes, and 22 subthemes. A set of evaluation theories, common study designs, data collection methods and instruments, and data analysis approaches was captured, which can be used or adapted to evaluate digital PEx. CONCLUSIONS Our findings enabled us to generate an evaluation guide to help DH intervention researchers, designers, developers, and program evaluators evaluate digital PEx. Finally, we propose 6 directions for encouraging further digital PEx evaluation research and practice to address the challenge of poor PEx.
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Affiliation(s)
- Tingting Wang
- Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Guido Giunti
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Clinical Medicine Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Richard Goossens
- Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Marijke Melles
- Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
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Bergschöld JM, Gunnes M, Eide AH, Lassemo E. Characteristics and Range of Reviews About Technologies for Aging in Place: Scoping Review of Reviews. JMIR Aging 2024; 7:e50286. [PMID: 38252472 PMCID: PMC10845034 DOI: 10.2196/50286] [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: 06/26/2023] [Revised: 09/25/2023] [Accepted: 10/30/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND It is a contemporary and global challenge that the increasing number of older people requiring care will surpass the available caregivers. Solutions are needed to help older people maintain their health, prevent disability, and delay or avoid dependency on others. Technology can enable older people to age in place while maintaining their dignity and quality of life. Literature reviews on this topic have become important tools for researchers, practitioners, policy makers, and decision makers who need to navigate and access the extensive available evidence. Due to the large number and diversity of existing reviews, there is a need for a review of reviews that provides an overview of the range and characteristics of the evidence on technology for aging in place. OBJECTIVE This study aimed to explore the characteristics and the range of evidence on technologies for aging in place by conducting a scoping review of reviews and presenting an evidence map that researchers, policy makers, and practitioners may use to identify gaps and reviews of interest. METHODS The review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Literature searches were conducted in Web of Science, PubMed, and Scopus using a search string that consisted of the terms "older people" and "technology for ageing in place," with alternate terms using Boolean operators and truncation, adapted to the rules for each database. RESULTS A total of 5447 studies were screened, with 344 studies included after full-text screening. The number of reviews on this topic has increased dramatically over time, and the literature is scattered across a variety of journals. Vocabularies and approaches used to describe technology, populations, and problems are highly heterogeneous. We have identified 3 principal ways that reviews have dealt with populations, 5 strategies that the reviews draw on to conceptualize technology, and 4 principal types of problems that they have dealt with. These may be understood as methods that can inform future reviews on this topic. The relationships among populations, technologies, and problems studied in the reviews are presented in an evidence map that includes pertinent gaps. CONCLUSIONS Redundancies and unexploited synergies between bodies of evidence on technology for aging in place are highly likely. These results can be used to decrease this risk if they are used to inform the design of future reviews on this topic. There is a need for an examination of the current state of the art in knowledge on technology for aging in place in low- and middle-income countries, especially in Africa.
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Affiliation(s)
| | - Mari Gunnes
- Department of Health, SINTEF Digital, Trondheim, Norway
| | - Arne H Eide
- Department of Health, SINTEF Digital, Oslo, Norway
| | - Eva Lassemo
- Department of Health, SINTEF Digital, Trondheim, Norway
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Khatri RB, Endalamaw A, Erku D, Wolka E, Nigatu F, Zewdie A, Assefa Y. Preparedness, impacts, and responses of public health emergencies towards health security: qualitative synthesis of evidence. Arch Public Health 2023; 81:208. [PMID: 38037151 PMCID: PMC10687930 DOI: 10.1186/s13690-023-01223-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/25/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Natural and human-made public health emergencies (PHEs), such as armed conflicts, floods, and disease outbreaks, influence health systems including interruption of delivery and utilization of health services, and increased health service needs. However, the intensity and types of impacts of these PHEs vary across countries due to several associated factors. This scoping review aimed to synthesise available evidence on PHEs, their preparedness, impacts, and responses. METHODS We conducted a scoping review of published evidence. Studies were identified using search terms related to two concepts: health security and primary health care. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines to select studies. We adapted the review framework of Arksey and O'Malley. Data were analyzed using a thematic analysis approach and explained under three stages of PHEs: preparedness, impacts, and responses. RESULTS A total of 64 studies were included in this review. Health systems of many low- and middle-income countries had inadequate preparedness to absorb the shocks of PHEs, limited surveillance, and monitoring of risks. Health systems have been overburdened with interrupted health services, increased need for health services, poor health resilience, and health inequities. Strategies of response to the impact of PHEs included integrated services such as public health and primary care, communication and partnership across sectors, use of digital tools, multisectoral coordination and actions, system approach to responses, multidisciplinary providers, and planning for resilient health systems. CONCLUSIONS Public health emergencies have high impacts in countries with weak health systems, inadequate preparedness, and inadequate surveillance mechanisms. Better health system preparedness is required to absorb the impact, respond to the consequences, and adapt for future PHEs. Some potential response strategies could be ensuring need-based health services, monitoring and surveillance of post-emergency outbreaks, and multisectoral actions to engage sectors to address the collateral impacts of PHEs. Mitigation strategies for future PHEs could include risk assessment, disaster preparedness, and setting digital alarm systems for monitoring and surveillance.
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Affiliation(s)
- Resham B Khatri
- Health Social Science and Development Research Institute, Kathmandu, Nepal.
- School of Public Health, University of Queensland, Brisbane, Australia.
| | - Aklilu Endalamaw
- School of Public Health, University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Eskinder Wolka
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Frehiwot Nigatu
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, University of Queensland, Brisbane, Australia
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Chang F, Östlund B, Kuoppamäki S. Domesticating Social Alarm Systems in Nursing Homes: Qualitative Study of Differences in the Perspectives of Assistant Nurses. J Med Internet Res 2023; 25:e44692. [PMID: 37145835 DOI: 10.2196/44692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/07/2023] [Accepted: 03/12/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND New social alarm solutions are viewed as a promising approach to alleviate the global challenge of an aging population and a shortage of care staff. However, the uptake of social alarm systems in nursing homes has proven both complex and difficult. Current studies have recognized the benefits of involving actors such as assistant nurses in advancing these implementations, but the dynamics by which implementations are created and shaped in their daily practices and relations have received less attention. OBJECTIVE Based on domestication theory, this paper aims to identify the differences in the perspectives of assistant nurses when integrating a social alarm system into daily practices. METHODS We interviewed assistant nurses (n=23) working in nursing homes to understand their perceptions and practices during the uptake of social alarm systems. RESULTS During the four domestication phases, assistant nurses were facing different challenges including (1) system conceptualization; (2) spatial employment of social alarm devices; (3) treatment of unexpected issues; and (4) evaluation of inconsistent competence in technology use. Our findings elaborate on how assistant nurses have distinct goals, focus on different facets, and developed diverse coping strategies to facilitate the system domestication in different phases. CONCLUSIONS Our findings reveal a divide among assistant nurses in terms of domesticating social alarm systems and stress the potential of learning from each other to facilitate the whole process. Further studies could focus on the role of collective practices during different domestication phases to enhance the understanding of technology implementation in the contexts of complex interactions within a group.
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Affiliation(s)
- Fangyuan Chang
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
- Department of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Britt Östlund
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Sanna Kuoppamäki
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
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Reid B, Davis LL, Gordon L. Capturing what and why in healthcare innovation. BMJ LEADER 2023:leader-2022-000642. [PMID: 37192109 DOI: 10.1136/leader-2022-000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 02/25/2023] [Indexed: 05/18/2023]
Abstract
Understandings of innovation usually encompass multiple overlapping aspects, putting innovation terminology at risk of vagueness and overuse. However, innovation concepts are expected to remain powerful and useful in healthcare beyond the pandemic and into the future, so clarity will be helpful for effective leadership. To disentangle and disambiguate meanings within innovation, we offer a framework that captures and simplifies foundational substance within innovation concepts. Our method is an overview review of innovation literature from the 5 years preceding COVID-19. 51 sources were sampled and analysed for explicit definitions of healthcare innovation. Drawing on broad themes suggested from previous reviews, and gathering specific themes emergent from this literary dataset, we focused on categorising the nature of innovations (the what) and reasons given for them (the why). We identified 4 categories of what (ideas, artefacts, practice/process and structure) and 10 categories of why (economic value, practical value, experience, resource use, equity/accessibility, sustainability, behaviour change, specific-problem solving, self-justifying renewal and improved health). These categories reflect contrasting priorities and values, but do not substantially interfere or occlude each other. They can freely be additively combined to create composite definitions. This conceptual scheme affords insight and clarity for creating precise meanings, and making critical sense of imprecision, around innovation. Improved communication and clear shared understandings around innovative intentions, policies and practices cannot but improve the chances of enhanced outcomes. The all-inclusive character of this scheme leaves space for considering the limits of innovation, and notwithstanding well-established critiques, provides a basis for clarity in ongoing usage.
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Affiliation(s)
- Benet Reid
- Management School, University of St Andrews, St Andrews, UK
| | | | - Lisi Gordon
- Centre for Medical Education, University of Dundee, Dundee, UK
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Wang T, Giunti G, Melles M, Goossens R. Digital Patient Experience: Umbrella Systematic Review. J Med Internet Res 2022; 24:e37952. [PMID: 35925651 PMCID: PMC9389377 DOI: 10.2196/37952] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The adoption and use of technology have significantly changed health care delivery. Patient experience has become a significant factor in the entire spectrum of patient-centered health care delivery. Digital health facilitates further improvement and empowerment of patient experiences. Therefore, the design of digital health is served by insights into the barriers to and facilitators of digital patient experience (PEx). OBJECTIVE This study aimed to systematically review the influencing factors and design considerations of PEx in digital health from the literature and generate design guidelines for further improvement of PEx in digital health. METHODS We performed an umbrella systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. We searched Scopus, PubMed, and Web of Science databases. Two rounds of small random sampling (20%) were independently reviewed by 2 reviewers who evaluated the eligibility of the articles against the selection criteria. Two-round interrater reliability was assessed using the Fleiss-Cohen coefficient (k1=0.88 and k2=0.80). Thematic analysis was applied to analyze the extracted data based on a small set of a priori categories. RESULTS The search yielded 173 records, of which 45 (26%) were selected for data analysis. Findings and conclusions showed a great diversity; most studies presented a set of themes (19/45, 42%) or descriptive information only (16/45, 36%). The digital PEx-related influencing factors were classified into 9 categories: patient capability, patient opportunity, patient motivation, intervention technology, intervention functionality, intervention interaction design, organizational environment, physical environment, and social environment. These can have three types of impacts: positive, negative, or double edged. We captured 4 design constructs (personalization, information, navigation, and visualization) and 3 design methods (human-centered or user-centered design, co-design or participatory design, and inclusive design) as design considerations. CONCLUSIONS We propose the following definition for digital PEx: "Digital patient experience is the sum of all interactions affected by a patient's behavioral determinants, framed by digital technologies, and shaped by organizational culture, that influence patient perceptions across the continuum of care channeling digital health." In this study, we constructed a design and evaluation framework that contains 4 phases-define design, define evaluation, design ideation, and design evaluation-and 9 design guidelines to help digital health designers and developers address digital PEx throughout the entire design process. Finally, our review suggests 6 directions for future digital PEx-related research.
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Affiliation(s)
- Tingting Wang
- Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Guido Giunti
- Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
- Digital Health Design and Development, University of Oulu, Oulu, Finland
| | - Marijke Melles
- Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Richard Goossens
- Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
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Rostad HM, Stokke R. Integrating Welfare Technology in Long-term Care Services: Nationwide Cross-sectional Survey Study. J Med Internet Res 2021; 23:e22316. [PMID: 34398791 PMCID: PMC8406104 DOI: 10.2196/22316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/19/2020] [Accepted: 05/24/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Welfare technologies are often described as a solution to the increasing pressure on primary health care services. However, despite initiating welfare technology projects in the health care sector and different government incentives, research indicates that it is difficult to integrate welfare technology innovations in a complex and varying setting, such as long-term care. OBJECTIVE We aim to describe the types of welfare technology and the extent to which welfare technology is provided in long-term care (ie, nursing homes and home care services); examine whether the extent of welfare technology provision differs on the basis of municipal characteristics (ie, population size, centrality, the proportion of older inhabitants, and income); and identify how local governments (ie, municipalities) describe their efforts toward integrating welfare technologies in long-term care. METHODS Quantitative and qualitative data about welfare technology from a larger cross-sectional survey about the provision of long-term care services in Norwegian municipalities were combined with registry data. Representatives of 422 Norwegian municipalities were invited to participate in the survey. Frequencies were used to describe the distribution of the types and extent of welfare technologies, whereas the Fisher exact test and Kruskal-Wallis one-way analysis of variance were used to determine the association between the extent of welfare technology and municipal characteristics. Free-form text data were analyzed using thematic analysis. RESULTS A total of 277 municipalities were surveyed. Technology for safety was the most widespread type of welfare technology, whereas technology for social contact was the least prevalent. Two-thirds of the sample (183/277, 66.1%) in nursing home and (197/277, 71.1%) in home care services reported providing one or two different types of welfare technology. There was a statistically significant association between the extent of welfare technology and population size (in both nursing homes and home care services: P=.01), centrality (nursing homes: P=.01; home care services: P<.001), and municipal income (nursing homes: P=.02; home care services: P<.001). The extent of welfare technology was not associated with the proportion of older adults. The municipalities described being in a piloting phase and committing to future investment in welfare technology. Monetary resources were allocated, competency development among staff was initiated, and the municipalities were concerned about establishing collaborations within and between municipalities. Home care services seem to have a more person-centered approach in their efforts toward integrating welfare technologies, whereas nursing homes seem to have a more technology-centered approach. CONCLUSIONS Many municipalities provide welfare technologies; however, their extent is limited and varies according to municipal characteristics. Municipal practices still seem dominated by piloting, and welfare technologies are not fully integrated into long-term care services. Innovation with welfare technology appears top-down and is influenced by national policy but also reflects creating a window of opportunity through the organization of municipal efforts toward integrating welfare technology through, for example, collaborations and committing personnel and financial resources.
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Affiliation(s)
- Hanne Marie Rostad
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Randi Stokke
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
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Trento M, Franceschini M, Fornengo P, Tricarico L, Mazzeo A, Bertello S, Clerico A, Oleandri S, Chiesa M, Di Leva A, Charrier L, Cavallo F, Porta M. Ambient intelligence for long-term diabetes care (AmILCare). Qualitative analysis of patients' expectations and attitudes toward interactive technology. Endocrine 2021; 73:472-475. [PMID: 33768444 PMCID: PMC7993083 DOI: 10.1007/s12020-021-02694-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/11/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Marina Trento
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Marta Franceschini
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Fornengo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lucia Tricarico
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Aurora Mazzeo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | | | | | - Mario Chiesa
- Links Foundation, Polytechnic University of Turin, Turin, Italy
| | - Anna Di Leva
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorena Charrier
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Franco Cavallo
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Massimo Porta
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy
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10
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Digital ageing in Europe: a comparative analysis of Italian, Finnish and Swedish national policies on eHealth. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21000945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Ageing Europeans are today healthier than previous generations and often manage to live independently up to a high age. The proportion of people 80 years of age and older has increased significantly, and with high age the risk of multi-illness and dementia increases. Strong urbanisation processes have changed the demographic structure in rural areas, and young women and men have migrated towards the urban areas to study and work, while older persons have remained behind. This demographic challenge of increasing numbers of persons older than 80 years with care needs living in remote rural areas has become a major European social problem. In tackling this dilemma, many European countries have high expectations for eHealth, digitalisation and welfare technology. In this comparative study of policy debates in Italy, Finland and Sweden, we analyse how – between 2009 and 2019 – the issues of eHealth have been articulated in national and regional policies of the three countries with deep differences in terms of digitalisation and health systems, but with similar ageing populations. We identify in the documents three core topics – the role of technology, the rural issue and responsibility for care. These topics are treated in the documents with differences and similarities between the three countries. Beyond the differences and similarities, the documents reveal both a certain techno-enthusiasm about the role of eHealth in the life of the older adults as well as a limited understanding of the complexity (relationally as well as spatially) of the digital landscape of caring for older adults.
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Thilo FJ, Hahn S, Halfens RJ, Heckemann B, Schols JM. Facilitating the use of personal safety alerting device with older adults: The views, experiences and roles of relatives and health care professionals. Geriatr Nurs 2021; 42:935-942. [PMID: 34130125 DOI: 10.1016/j.gerinurse.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022]
Abstract
To explore relatives', community nurses' and general practitioners' perspectives and experiences in promoting Personal Safety Alerting Device (PSAD) use among community-dwelling older adults, we applied a qualitative study design. Altogether 15 focus groups and 11 semi-structured interviews were conducted. Data-analysis followed the Qualitative Analysis Guide of Leuven. PSAD use was considered to be complex. Relatives and health care professionals are involved in a negotiation process comprising three phases: A) waiting for a critical event in the older adult's everyday life; B) introducing the idea of a PSAD; C) deciding on and supporting PSAD use. In conclusion, the actors involved in PSAD use should be aware of the negotiation process, which is complex, dynamic, iterative and needs time. While nurses play a crucial role, they lack sufficient knowledge for comprehensive PSAD counselling. The negotiation process could serve as an example for other technologies in the context of aging in place.
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Affiliation(s)
- Friederike Js Thilo
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.
| | - Sabine Hahn
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
| | - Ruud Jg Halfens
- School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Birgit Heckemann
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Anaesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Jos Mga Schols
- School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands; School CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.
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12
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Stokke R, Melby L, Isaksen J, Obstfelder A, Andreassen H. A qualitative study of what care workers do to provide patient safety at home through telecare. BMC Health Serv Res 2021; 21:553. [PMID: 34090450 PMCID: PMC8180066 DOI: 10.1186/s12913-021-06556-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/17/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In health care, the work of keeping the patient safe and reducing the risk of harm is defined as safety work. In our digitised and technology-rich era, safety work usually involves a relationship between people and technologies. Telecare is one of the fastest-growing technology-domains in western health care systems. In the marketing of telecare, the expectation is that safety is implicit simply by the presence of technology in patients' homes. Whilst both researchers and health authorities are concerned with developing cost-benefit analyses and measuring effects, there is a lack of attention to the daily work needed to ensure that technologies contribute to patient safety. This paper aims to describe how patient safety in home care is addressed through and with telecare. We base our exploration on the social alarm, an established technology that care workers are expected to handle as an integrated part of their ordinary work. METHODS The study has a qualitative explorative design where we draw on empirical data from three case studies, involving five Norwegian municipalities that use social alarm systems in home care services. We analyse observations of practice and interviews with the actors involved, following King's outline of template analysis. RESULTS We identified three co-existing work processes that contributed to patient safety: "Aligning people and technologies"; "Being alert and staying calm"; and "Coordinating activities based on people and technology". Attention to these work processes exposes safety practices, and how safety is constructed in relational practices involving multiple people and technologies. CONCLUSIONS We conclude that the three work processes identified are essential if the safety alarm is to function for the end user's safety. The safety of home-dwelling patients is reliant on the person-technology interface. The efforts of care workers and their interface with technology are a central feature of creating safety in a patient's home, and in doing so, they utilise a repertoire of skills and knowledge.
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Affiliation(s)
- Randi Stokke
- Centre for Care Research, NTNU Norwegian University of Science and Technology, P.O. Box 191, 2802, Gjøvik, Norway.
| | - Line Melby
- Centre for Care Research, NTNU Norwegian University of Science and Technology, P.O. Box 191, 2802, Gjøvik, Norway
| | - Jørn Isaksen
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Gudbrandsdalsvegen 350, 2624, Lillehammer, Norway
| | - Aud Obstfelder
- Centre for Care Research, NTNU Norwegian University of Science and Technology, P.O. Box 191, 2802, Gjøvik, Norway
| | - Hege Andreassen
- Centre for Care Research, NTNU Norwegian University of Science and Technology, P.O. Box 191, 2802, Gjøvik, Norway
- Centre for Women and Gender Research, UiT, The Arctic University of Norway, P.O Box 6050 Langnes, 9037, Tromsø, Norway
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13
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Frennert S. Gender blindness: On health and welfare technology, AI and gender equality in community care. Nurs Inq 2021; 28:e12419. [PMID: 33979011 DOI: 10.1111/nin.12419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/28/2022]
Abstract
Digital health and welfare technologies and artificial intelligence are proposed to revolutionise healthcare systems around the world by enabling new models of care. Digital health and welfare technologies enable remote monitoring and treatments, and artificial intelligence is proposed as a means of prediction instead of reaction to individuals' health and as an enabler of proactive care and rehabilitation. The digital transformation not only affects hospital and primary care but also how the community meets older people's needs. Community care is often provided by informal and formal care-givers, most of whom are women. Gender equality is at the heart of many national strategies, but do all genders have equal rights, responsibilities and opportunities when it comes to community care and its digital transformation? The digital transformation of community care is entangled with how care is provided to older people and the working conditions of community-care professionals. Current and, even more so, future community-care systems are and will be partly constituted by networks of technological artefacts. These health and welfare technological artefacts and the discourse surrounding them mediate and constitute social relations and community care. This article looks into how health and welfare technology and artificial intelligence-based devices and systems mediate and constitute gender relations in community care and presents an argument for reflexivity, embodiment, pluralism, participation and ecology as an alternative strategy to treating community care as one-size-fit-all and being blind to gender-related issues.
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Affiliation(s)
- Susanne Frennert
- Department of Computer Science and Media Technology, Internet of Things and People Research Center, Malmö University, Malmö, Sweden
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14
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Smith RW, Barnes I, Green J, Reeves GK, Beral V, Floud S. Social isolation and risk of heart disease and stroke: analysis of two large UK prospective studies. Lancet Public Health 2021; 6:e232-e239. [PMID: 33662329 PMCID: PMC7994247 DOI: 10.1016/s2468-2667(20)30291-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Social isolation has been associated with increased risk of coronary heart disease and stroke. However, it is unclear whether the associations differ between fatal and non-fatal events or by the type of isolation (living alone or having few social contacts). We aimed to examine these associations in two large UK prospective cohorts. METHODS Million Women Study and UK Biobank participants without previous coronary heart disease or stroke who provided data in median year 2010 (IQR 2009-2011) on social contacts were included in this prospective analysis. Participants were followed up to median year 2017 (2017-2017) by electronic linkage to national hospital and death records. Risk ratios (RRs) were calculated using Cox regression for first coronary heart disease and stroke event (overall, and separately for hospital admission as the first event and for death without an associated hospital admission as the first event) by three levels of social isolation (based on living alone, contact with family or friends, and group participation) adjusted for age, sex, study, region, deprivation, smoking, alcohol intake, body-mass index, physical activity, and self-rated health. FINDINGS 938 558 participants were included in our analyses (mean age 63 years [SD 9]): 481 946 participants from the Million Women Study (mean age 68 years [5]) and 456 612 participants (mean age 57 years [8]) from UK Biobank. During a mean follow-up period of 7 years (2), 42 402 first coronary heart disease events (of which 1834 were fatal without an associated hospital admission) and 19 999 first stroke events (of which 529 were fatal without an associated hospital admission) occurred. Little, if any, association was found between social isolation and hospital admission for a first coronary heart disease or stroke event (combined RR for both studies 1·01 [95% CI 0·98-1·04] for coronary heart disease and 1·13 [1·08-1·18] for stroke, when comparing the most isolated group with the least isolated group). However, the risk of death without an associated hospital admission was substantially higher in the most isolated group than the least isolated group for coronary heart disease (1·86 [1·63-2·12]) and stroke (1·91 [1·48-2·46]). For coronary heart disease or stroke death as the first event, RRs were substantially higher (test for heterogeneity, p=0·002) for participants living alone versus those not living alone (1·60 [1·46-1·75]) than for those with fewer versus more contact with family, friends, or groups (1·27 [1·16-1·38]). These findings did not differ greatly between studies, or by self-rated health. INTERPRETATION Social isolation seems to have little direct effect on the risk of developing a first coronary heart disease or stroke. By contrast, social isolation substantially increases the risk that the first such event is fatal before reaching hospital, particularly among people who live alone, perhaps because of the absence of immediate help in responding to an acute heart attack or stroke. FUNDING UK Medical Research Council, Cancer Research UK.
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Affiliation(s)
- Robert W Smith
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Upstream Lab, St Michael's Hospital, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Isobel Barnes
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jane Green
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gillian K Reeves
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Valerie Beral
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah Floud
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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Andrew NE, Wang Y, Teo K, Callisaya ML, Moran C, Snowdon DA, Ellmers S, Beare R, Richardson D, Srikanth V. Exploring patterns of personal alarm system use and impacts on outcomes. Australas J Ageing 2021; 40:252-260. [PMID: 33779038 DOI: 10.1111/ajag.12941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe the patterns of personal emergency response systems (PERS) use in a statewide cohort of older Australians. METHODS PERS data from clients enrolled in the Personal Alarm Victoria program between January 2014 and June 2017 were analysed. Alarm activation reasons were extracted, and a medical record audit was performed for a sub-cohort of patients admitted to a local hospital following an alarm event. Descriptive statistics were used. RESULTS There were 42,180 clients enrolled during the study (mean age 80 years, 80% female, 93% living alone). An ambulance attended 44% of the fall-related events and 81% of events coded as unwell. Activation reasons were distributed equally between a fall and feeling unwell, and a repeating pattern of activation reasons was observed. In our sub-cohort (n = 92), the majority of admissions (86%) followed an alarm activation coded as unwell. CONCLUSION We demonstrated recurring patterns associated with the reasons for alarm use.
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Affiliation(s)
- Nadine E Andrew
- Department of Medicine, Central Clinical School, Peninsula Clinical School, Monash University, Melbourne, Victoria, Australia.,Professorial Academic Unit, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
| | - Yun Wang
- Department of Medicine, Central Clinical School, Peninsula Clinical School, Monash University, Melbourne, Victoria, Australia.,Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ken Teo
- Professorial Academic Unit, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia.,Department of General Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Michele L Callisaya
- Department of Medicine, Central Clinical School, Peninsula Clinical School, Monash University, Melbourne, Victoria, Australia.,Professorial Academic Unit, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
| | - Christopher Moran
- Department of Medicine, Central Clinical School, Peninsula Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Aged Care and Rehabilitation, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia
| | - David A Snowdon
- Department of Medicine, Central Clinical School, Peninsula Clinical School, Monash University, Melbourne, Victoria, Australia.,Professorial Academic Unit, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
| | - Sonya Ellmers
- Department of Health and Human Services, State Government of Victoria, Melbourne, Victoria, Australia
| | - Richard Beare
- Department of Medicine, Central Clinical School, Peninsula Clinical School, Monash University, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Velandai Srikanth
- Department of Medicine, Central Clinical School, Peninsula Clinical School, Monash University, Melbourne, Victoria, Australia.,Professorial Academic Unit, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
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16
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Op den Buijs J, Pijl M, Landgraf A. Predictive Modeling of 30-Day Emergency Hospital Transport of German Patients Using a Personal Emergency Response: Retrospective Study and Comparison with the United States. JMIR Med Inform 2021; 9:e25121. [PMID: 33682679 PMCID: PMC7985802 DOI: 10.2196/25121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/08/2021] [Accepted: 02/07/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Predictive analytics based on data from remote monitoring of elderly via a personal emergency response system (PERS) in the United States can identify subscribers at high risk for emergency hospital transport. These risk predictions can subsequently be used to proactively target interventions and prevent avoidable, costly health care use. It is, however, unknown if PERS-based risk prediction with targeted interventions could also be applied in the German health care setting. OBJECTIVE The objectives were to develop and validate a predictive model of 30-day emergency hospital transport based on data from a German PERS provider and compare the model with our previously published predictive model developed on data from a US PERS provider. METHODS Retrospective data of 5805 subscribers to a German PERS service were used to develop and validate an extreme gradient boosting predictive model of 30-day hospital transport, including predictors derived from subscriber demographics, self-reported medical conditions, and a 2-year history of case data. Models were trained on 80% (4644/5805) of the data, and performance was evaluated on an independent test set of 20% (1161/5805). Results were compared with our previously published prediction model developed on a data set of PERS users in the United States. RESULTS German PERS subscribers were on average aged 83.6 years, with 64.0% (743/1161) females, with 65.4% (759/1161) reported 3 or more chronic conditions. A total of 1.4% (350/24,847) of subscribers had one or more emergency transports in 30 days in the test set, which was significantly lower compared with the US data set (2455/109,966, 2.2%). Performance of the predictive model of emergency hospital transport, as evaluated by area under the receiver operator characteristic curve (AUC), was 0.749 (95% CI 0.721-0.777), which was similar to the US prediction model (AUC=0.778 [95% CI 0.769-0.788]). The top 1% (12/1161) of predicted high-risk patients were 10.7 times more likely to experience an emergency hospital transport in 30 days than the overall German PERS population. This lift was comparable to a model lift of 11.9 obtained by the US predictive model. CONCLUSIONS Despite differences in emergency care use, PERS-based collected subscriber data can be used to predict use outcomes in different international settings. These predictive analytic tools can be used by health care organizations to extend population health management into the home by identifying and delivering timelier targeted interventions to high-risk patients. This could lead to overall improved patient experience, higher quality of care, and more efficient resource use.
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17
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Stokke R, Furnes M, Vifladt A, Ringsby Odberg K. Pasientsikkerhet og velferdsteknologi – parhester i utakt. TIDSSKRIFT FOR OMSORGSFORSKNING 2020. [DOI: 10.18261/issn.2387-5984-2020-02-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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18
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Thilo FJS, Schols JMGA, Halfens RJG, Linhart M, Hahn S. Deciding about the use of a Personal Safety Alerting Device-The need for a legitimation process: A qualitative study. J Adv Nurs 2020; 77:331-342. [PMID: 33048381 PMCID: PMC7756415 DOI: 10.1111/jan.14566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/26/2020] [Accepted: 09/07/2020] [Indexed: 01/23/2023]
Abstract
Aims To explore reasons, thoughts, motives, and influencing factors regarding the use or non‐use of Personal Safety Alerting Devices (PSADs) in the daily lives of community‐dwelling older persons. Design A qualitative descriptive study design was used. Methods Six focus groups were conducted with a total of 32 older persons between February–August 2016. Data analysis followed the Qualitative Analysis Guide of Leuven. Results The participants described the use or non‐use of PSADs as a decision resulting from a “legitimation process”. This process implies that a person needs to perceive the necessity for a PSAD and then determine the right moment at which to start using it. During this process, each person weighs her or his “ageing self” and “perception of technology” then decides whether to start using a device or to delay its use. “Critical events” initiate this process, compelling the person to consider their own safety and their possible need for assistance. Conclusion The legitimation process suggests that the initiation of PSAD use represents a turning point in life. Using a PSAD is not simply a matter of obtaining one. It is a complex decision‐making process establishing legitimation for its use, which is interwoven with one's individual ageing, self‐perception, and the meaning attributed to the device. Impact Older persons need to be supported; in particular, they require time to go through the legitimation process for PSAD use. Nurses can empower them in this process, such that they perceive using a PSAD as a means to restore their frailty balance and feel enabled to (re)gain control over their own life and thus to preserve their independence.
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Affiliation(s)
- Friederike J S Thilo
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Jos M G A Schols
- School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.,School CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Ruud J G Halfens
- School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Monika Linhart
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Sabine Hahn
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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19
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Chang F, Eriksson A, Östlund B. Discrepancies between Expected and Actual Implementation: The Process Evaluation of PERS Integration in Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4245. [PMID: 32545871 PMCID: PMC7344572 DOI: 10.3390/ijerph17124245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022]
Abstract
Recent studies prove that when implementing new technology technology-driven and one-size-fits-all approaches are problematic. This study focuses on the process of implementing personal emergency response system (PERS) at nursing homes. The aim is to understand why the implementation of PERS has not met initial expectations. Multiple methods were used in two Swedish nursing homes, including document analysis, questionnaires (n = 42), participant observation (67 h), and individual interviews (n = 12). A logic model was used to ascertain the discrepancies that emerged between expected and actual implementation, and the domestication theory was used to discuss the underlying meanings of the discrepancies. The discrepancies primarily focused on staff competence, system readiness, work routines, and implementation duration. Corresponding reasons were largely relevant to management issues regarding training, the procurement systems, individual and collective responsibilities as well as invisible work. The uptake of technology in daily practice is far more nuanced than a technology implementation plan might imply. We point out the importance of preparing for implementation, adjusting to new practices, and leaving space and time for facilitating implementation. The findings will be of use to implementers, service providers, and organizational managers to evaluate various measures in the implementation process, enabling them to perform technology implementation faster and more efficiently.
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Affiliation(s)
- Fangyuan Chang
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, SE-142 58 Stockholm, Sweden; (A.E.); (B.Ö.)
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20
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Commercial ICT Smart Solutions for the Elderly: State of the Art and Future Challenges in the Smart Furniture Sector. ELECTRONICS 2020. [DOI: 10.3390/electronics9010149] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Within a ubiquitous environment, home and office furniture can be maximally utilized to provide ease, especially if the items are designed based on smart technology. For this reason, the acceptance of smart furniture has soared over the years. Given the vast influence of the Internet of Things (IoT) and Industry 4.0 on technological advancement in furniture design, it is imperative to examine information and communication technology (ICT) solutions for the elderly in the context of smart furniture design and implementation. This article presents a review of the state-of-the-art literature in smart solutions for the elderly based on publications under ICT smart solutions for these elderly, along with smart furniture options and manufacturer activities in terms of fixing market prices for these furniture materials. Furthermore, patenting rights on some existing smart furniture designs for the elderly, given the current trends in worldwide acceptance, are examined. Moreover, this article also highlights opportunities introduced by IoT-based solutions for the elderly as current trends in research and their effects on human life. Some smart product examples from different enterprises are also presented. New, innovative and active designs must be developed, focusing upon human healthcare, and in turn providing greater comfort and convenience for elderly people. To fulfil these requirements, the also selected technical aspects of new Smart Furniture solutions in connection to the cost of these solutions are discussed. Simultaneously, Smart Furniture solutions need to be flexible, low-cost, easy to buy and install without expert knowledge, and widely available on the market.
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21
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Stokke R, Hellesø R, Sogstad M. Hvorfor er det så vanskelig å integrere velferdsteknologii omsorgstjenesten? TIDSSKRIFT FOR OMSORGSFORSKNING 2019. [DOI: 10.18261/issn.2387-5984-2019-03-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Ragnhild Hellesø
- Senter for omsorgsforskning, øst, NTNU i Gjøvik
- Avdeling for sykepleievitenskap, Institutt for helse og samfunn, Universitetet i Oslo
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22
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Abstract
PURPOSE An ageing population presents a challenge for municipal eldercare in Sweden due to difficulties recruiting staff and there being a strained economy. A strategy involving welfare technology is presented as one such solution. An important group to carry out this strategy involves those who work with welfare technology in municipal eldercare. In this paper we describe their perception of welfare technology, and the challenges and opportunities they perceive in utilizing it. METHODS A self-administered online questionnaire was distributed to all Swedish municipalities and answered by 393 respondents. Analyses show that the respondents were representative of the different professions who work with welfare technology within municipal eldercare. RESULTS Welfare technology was perceived as being more reliable and safer than humans with regards to supervisions and reminders. The respondents acknowledged factors that slowed down the implementation of welfare technology in municipal eldercare organizations, such as resistance to change, lack of finances, lack of supporting evidence, lack of infrastructure, high staff turnover, difficulties with procurement and uncertainties about responsibility and laws. CONCLUSIONS We found that the people who work with and make decisions about welfare technology in municipal eldercare organizations were generally very positive about the deployment and use of such technology, but there appear to be problems within municipal eldercare organizations to realize this vision. The lack of structured implementation processes and coherent evaluation models indicates inequality of the access to welfare technology and, as a result, even though Swedish eldercare is publicly funded, the availability of welfare technologies and their usage differ between municipalities.IMPLICATIONS FOR REHABILITATIONThe research findings show that implementing welfare technologies in municipal eldercare must include transformed working processes and long-term strategies or they may lead to conflicts of priorities or unstructured implementation processes.Structured implementation processes and coherent evaluation models are needed for equality of access and availability of welfare technologies in municipal eldercare.High staff turnover negatively affects the deployment of welfare technology and the root cause of high staff turnover needs to be addressed.
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Affiliation(s)
- Susanne Frennert
- School of Chemistry, Biotechnology, and Health, KTH, Stockholm, Sweden
| | - Katarina Baudin
- School of Health Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
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23
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Frennert S. Hitting a moving target: digital transformation and welfare technology in Swedish municipal eldercare. Disabil Rehabil Assist Technol 2019; 16:103-111. [PMID: 31348681 DOI: 10.1080/17483107.2019.1642393] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION This article contributes to the discussion on digital transformation and welfare technology in municipal eldercare. The aim of welfare technology solutions is to exceed the current welfare system and to meet the challenges of an ageing population through technological innovations and applications that help people to better cope with health issues and strengthen their participation, activity and independence regarding their own healthcare. METHODS First, this article outlines a number of different perspectives on technological and social change. Against this backdrop, this article portrays the challenges faced by Swedish municipal eldercare organizations due to the moving targets of digital transformation and the development of welfare technologies. CONCLUSION In this context, eldercare organizations are at risk of becoming victims of the fast pace at which technology develops and the rhetoric of technological determinism; they may try to pursue the latest technological innovation at the expense of their stakeholders' needs. The implementation and deployment of welfare technology become a real-world social experiment. Without proper tools for evaluation, welfare technology might be implemented and deployed as an end in itself, instead of as means for better ageing or improved eldercare. This article concludes by framing a set of questions to help increase the understanding of welfare technology implementation and deployment in order to mitigate risks and improve outcomes. IMPLICATIONS FOR REHABILITATION Analysis of different perspectives regarding technological and social change. Identification of the challenges faced by municipal eldercare organizations due to digital transformation. Presentation of evaluation questions to increase the understanding of welfare technology implementation and deployment in order to mitigate risks and improve outcomes.
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Affiliation(s)
- Susanne Frennert
- Department of Technology in Health Care, School of Chemistry, Biotechnology, and Health, KTH Royal Institute of Technology, Stockholm, Sweden
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Vacher M, Aman F, Rossato S, Portet F, Lecouteux B. Making Emergency Calls More Accessible to Older Adults Through a Hands-free Speech Interface in the House. ACM TRANSACTIONS ON ACCESSIBLE COMPUTING 2019. [DOI: 10.1145/3310132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Wearable personable emergency response (PER) systems are the mainstream solution for allowing frail and isolated individuals to call for help in an emergency. However, these devices are not well adapted to all users and are often not worn all the time, meaning they are not available when needed. This article presents a Voice User Interface system for emergency-call recognition. The interface is designed to permit hands-free interaction using natural language. Crucially, this allows a call for help to be registered without necessitating physical proximity to the system. The system is based on an ASR engine and is tested on a corpus collected to simulate realistic situations. The corpus contains French speech from 4 older adults and 13 younger people wearing an old-age simulator to hamper their mobility, vision, and hearing. On-line evaluation of the preliminary system showed an emergency-call error rate of 27%. Subsequent off-line experimentation improved the results (call error rate 24%), demonstrating that emergency-call recognition in the home is achievable. Another contribution of this work is the corpus, which is made available for research with the hope that it will facilitate related research and quicker development of robust methods for automatic emergency-call recognition in the home.
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Affiliation(s)
- Michel Vacher
- Univ. Grenoble Alpes, CNRS, Grenoble INP, LIG, F-38000 Grenoble, France
| | - Frédéric Aman
- Univ. Grenoble Alpes, CNRS, Grenoble INP, LIG, F-38000 Grenoble, France
| | - Solange Rossato
- Univ. Grenoble Alpes, CNRS, Grenoble INP, LIG, F-38000 Grenoble, France
| | - François Portet
- Univ. Grenoble Alpes, CNRS, Grenoble INP, LIG, F-38000 Grenoble, France
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Offermann-van Heek J, Ziefle M. Nothing Else Matters! Trade-Offs Between Perceived Benefits and Barriers of AAL Technology Usage. Front Public Health 2019; 7:134. [PMID: 31245342 PMCID: PMC6581733 DOI: 10.3389/fpubh.2019.00134] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/13/2019] [Indexed: 01/27/2023] Open
Abstract
Ambient assisted living (AAL) technologies present one approach to counter the challenges of demographic change in terms of an aging population, rising care needs, and lacking care personnel by supporting (older) people in need of care and enabling a longer and more independent staying at own home. Although the number of studies focusing on AAL users' acceptance and perception has increased in the last years, trade-off decisions-the weighing of perceived benefits and barriers of technology usage-have not been studied so far. Nevertheless, this is of high relevance: A realistic evaluation of adoption behaviors in different stakeholders (patients, care personnel) requires an understanding of exactly the weighing process of benefits against the barriers in line with the decision of the final willingness to use AAL technology. The current study applied a conjoint analysis approach and investigates people's decision behavior to use an AAL system for a family member in need of care. Study participants (n = 140) had to decide between realistic care scenarios consisting of different options of two benefits (increase in safety, relief of caring burden of relatives) and two barriers (access to personal data and data handling) of technology usage. Results revealed data access and privacy to be most relevant for the decision to use AAL technology at home. However, care experience essentially influenced the decision patterns. For the care experienced group, data access should be limited to most trusted persons and close relatives, rather than to medical professionals. The most important reasons to use AAL are the emotional relief and the felt safety for the person in care. For care novices, in contrast, data access should be in the exclusive responsibility of medical professionals. The reasons that militate in favor of using AAL technology are the increase in process efficiency and medical safety. The results are useful to develop user-tailored technology concepts and derive user-specific communication guidelines within and across clinical and home care contexts.
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‘That's for old so and so's!’: does identity influence older adults’ technology adoption decisions? AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x19000230] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe role of identity in older adults’ decision-making about assistive technology adoption has been suggested but not fully explored. This scoping review was conducted to understand better how older adults’ self-image and their desire to maintain this influence their decision-making processes regarding assistive technology adoption. Using the five-stage scoping review framework by Arksey and O'Malley, a total of 416 search combinations were run across nine databases, resulting in a final yield of 49 articles. From these 49 articles, five themes emerged: (a) resisting the negative reality of an ageing and/or disabled identity; (b) independence and control are key; (c) the aesthetic dimension of usability; (d) assistive technology as a last resort; and (e) privacy versus pragmatics. The findings highlight the importance of older adults’ desire to portray an identity consistent with independence, self-reliance and competence, and how this desire directly impacts their assistive technology decision-making adoption patterns. These findings aim to support the adoption of assistive technologies by older adults to facilitate engagement in meaningful activities, enable social participation within the community, and promote health and wellbeing in later life.
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Op den Buijs J, Simons M, Golas S, Fischer N, Felsted J, Schertzer L, Agboola S, Kvedar J, Jethwani K. Predictive Modeling of 30-Day Emergency Hospital Transport of Patients Using a Personal Emergency Response System: Prognostic Retrospective Study. JMIR Med Inform 2018; 6:e49. [PMID: 30482741 PMCID: PMC6290270 DOI: 10.2196/medinform.9907] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 07/20/2018] [Accepted: 08/07/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Telehealth programs have been successful in reducing 30-day readmissions and emergency department visits. However, such programs often focus on the costliest patients with multiple morbidities and last for only 30 to 60 days postdischarge. Inexpensive monitoring of elderly patients via a personal emergency response system (PERS) to identify those at high risk for emergency hospital transport could be used to target interventions and prevent avoidable use of costly readmissions and emergency department visits after 30 to 60 days of telehealth use. OBJECTIVE The objectives of this study were to (1) develop and validate a predictive model of 30-day emergency hospital transport based on PERS data; and (2) compare the model's predictions with clinical outcomes derived from the electronic health record (EHR). METHODS We used deidentified medical alert pattern data from 290,434 subscribers to a PERS service to build a gradient tree boosting-based predictive model of 30-day hospital transport, which included predictors derived from subscriber demographics, self-reported medical conditions, caregiver network information, and up to 2 years of retrospective PERS medical alert data. We evaluated the model's performance on an independent validation cohort (n=289,426). We linked EHR and PERS records for 1815 patients from a home health care program to compare PERS-based risk scores with rates of emergency encounters as recorded in the EHR. RESULTS In the validation cohort, 2.22% (6411/289,426) of patients had 1 or more emergency transports in 30 days. The performance of the predictive model of emergency hospital transport, as evaluated by the area under the receiver operating characteristic curve, was 0.779 (95% CI 0.774-0.785). Among the top 1% of predicted high-risk patients, 25.5% had 1 or more emergency hospital transports in the next 30 days. Comparison with clinical outcomes from the EHR showed 3.9 times more emergency encounters among predicted high-risk patients than low-risk patients in the year following the prediction date. CONCLUSIONS Patient data collected remotely via PERS can be used to reliably predict 30-day emergency hospital transport. Clinical observations from the EHR showed that predicted high-risk patients had nearly four times higher rates of emergency encounters than did low-risk patients. Health care providers could benefit from our validated predictive model by targeting timely preventive interventions to high-risk patients. This could lead to overall improved patient experience, higher quality of care, and more efficient resource utilization.
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Affiliation(s)
| | | | - Sara Golas
- Partners HealthCare Pivot Labs, Partners HealthCare, Boston, MA, United States
| | - Nils Fischer
- Partners HealthCare Pivot Labs, Partners HealthCare, Boston, MA, United States
| | - Jennifer Felsted
- Partners HealthCare Pivot Labs, Partners HealthCare, Boston, MA, United States.,Department of Dermatology, Harvard Medical School, Boston, MA, United States
| | | | - Stephen Agboola
- Partners HealthCare Pivot Labs, Partners HealthCare, Boston, MA, United States.,Department of Dermatology, Harvard Medical School, Boston, MA, United States.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, United States
| | - Joseph Kvedar
- Department of Dermatology, Harvard Medical School, Boston, MA, United States.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, United States.,Partners Connected Health, Partners HealthCare, Boston, MA, United States
| | - Kamal Jethwani
- Partners HealthCare Pivot Labs, Partners HealthCare, Boston, MA, United States.,Department of Dermatology, Harvard Medical School, Boston, MA, United States.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, United States
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Ayton D, Morello R, Natora A, Yallop S, Barker A, Soh SE. Perceptions of falls and falls prevention interventions among Personal Alert Victoria clients. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:970-978. [PMID: 30027667 DOI: 10.1111/hsc.12626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 06/19/2018] [Accepted: 06/25/2018] [Indexed: 06/08/2023]
Abstract
This paper explores the perceptions and experiences of falls among Personal Alert Victoria (PAV) clients and identifies barriers and enablers to engagement in falls prevention interventions. Data were collected via semistructured telephone interviews (n = 12) and a client survey with open-ended and closed-ended questions (n = 46). Descriptive statistics and thematic analysis was guided by the COM-B model (capability, opportunity, and motivation) for behaviour change. The interview and survey explored experiences of falls, falls risk factors, access and participation in falls prevention interventions, access to health and support services, and experiences using the PAV service. Capability barriers identified included poor health, lack of time, low health literacy, and perceived high intensity of exercise classes. Opportunity barriers were lack of transport, high cost, and long waiting times for falls prevention interventions. Motivation barriers were the belief that falls are inevitable and a perceived lack of relevance of falls prevention interventions. Enablers identified were a focus on broader health and well-being benefits (capability), hospitalisations or rehabilitation that incorporates falls prevention in recovery (opportunity), and raising awareness of falls risk (motivation). Findings suggest that further research is required to inform the tailoring of positive health messages to improve the uptake of falls prevention interventions by PAV clients.
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Affiliation(s)
- Darshini Ayton
- Department of Epidemiology and Preventive Medicine, Monash University, Vic., Australia
| | - Renata Morello
- Department of Epidemiology and Preventive Medicine, Monash University, Vic., Australia
| | - Aleksandra Natora
- Victorian Department of Health and Human Services, Victoria, Australia
| | - Sarah Yallop
- Victorian Department of Health and Human Services, Victoria, Australia
| | - Anna Barker
- Department of Epidemiology and Preventive Medicine, Monash University, Vic., Australia
| | - Sze-Ee Soh
- Department of Epidemiology and Preventive Medicine, Monash University, Vic., Australia
- Department of Health and Human Services, Vic., Australia
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Stokke R. Older People Negotiating Independence and Safety in Everyday Life Using Technology: Qualitative Study. J Med Internet Res 2018; 20:e10054. [PMID: 30341049 PMCID: PMC6234346 DOI: 10.2196/10054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/28/2018] [Accepted: 07/17/2018] [Indexed: 11/18/2022] Open
Abstract
Background Due to demographic changes with an aging population, there is a demand for technology innovations in care services. However, technology innovations have proven difficult to implement in regular use. To understand the complexity of technology innovations in care practices, we need a knowledge base of the complex and diverse experiences of people interacting with established technologies. Objective This paper addresses the research gap in relation to understanding the microcontext of co-production of care involving established technologies integrated into care practices. The paper also aims to provide a framework for exploring what really happens when different actors use technology in care practices. Methods Participant observations and 22 interviews with actors using social alarms were conducted employing the critical incident technique. A stepwise deductive-inductive analysis was then performed. Results The results reveal how co-production of care assumes different meanings according to how actors use the technology. The results also show how technology innovation changes the dynamics between the actors and rearranges care practices. Independent and safe living is co-produced through performing bricolages and optimizing practice. Additionally, this opens up for unexpected results and bricolages as an integrated part of technology innovations. Conclusions This study illustrates how care services are always co-produced between the actors involved. By using aspects from science and technology studies, this paper provides a framework for exploring technology in use in care practices. The framework provides tools to unpack and articulate the process of co-producing services.
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Affiliation(s)
- Randi Stokke
- Department of Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
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Cohen AB, Mathews SC. The Digital Outcome Measure. Digit Biomark 2018; 2:94-105. [PMID: 32095761 PMCID: PMC7015352 DOI: 10.1159/000492396] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/23/2018] [Indexed: 01/04/2023] Open
Abstract
Improving clinical outcomes remains the gold standard in advancing healthcare. Focusing on outcomes holds the potential to unite all clinical stakeholders including payers, industry, providers, and patients. Yet, the dominant ways in which outcomes are captured, provider-collected or patient-reported, have significant limitations. The emerging field of biosensors and wearables, which aims to capture many types of health data, holds promise to specifically capture outcomes while complementing existing outcome collection methods. A digital outcome measure, unlike a traditional provider-collected or patient-reported outcome measure, depends less on active patient or provider participation. Thus, digital outcome measures may be more amenable to standardization as well as greater collection consistency, frequency, and accuracy.
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Affiliation(s)
- Adam B. Cohen
- The Johns Hopkins University Applied Physics Lab, Health Technologies, National Health Mission Area, Laurel, Maryland, USA
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Simon C. Mathews
- Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland, USA
- Division of Gastroenterology, Department of Internal Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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Thilo FJS, Hahn S, Halfens RJG, Schols JMGA. Usability of a wearable fall detection prototype from the perspective of older people-A real field testing approach. J Clin Nurs 2018; 28:310-320. [PMID: 29964344 DOI: 10.1111/jocn.14599] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES Community-dwelling older people were involved in the testing of a fall detection device to improve its utilisation and acceptance in everyday life. BACKGROUND The usability of alerting devices remains unsatisfactory, as they are scarcely utilised by older people, despite wide recognition of the importance of rapid assistance after a fall. Moreover, the time a person remains on the floor negatively impacts the severity of fall consequences. However, it is unclear how to increase alerting device utilisation in everyday life. Therefore, older people were involved in this research to consider their perspective during prototype development. DESIGN A qualitative focus group study was conducted, following a real field testing approach, underpinned by the theoretical framework "Medical Device Technology Development Process." METHODS Fifteen community-dwelling older people tested the prototype in daily living over a period of nine days. Different means of involvement were exploited such as "user seminars" or "discussion with users." On day 9, data were collected using focus groups and analysed with qualitative content analysis. RESULTS The participants' perspectives yielded positive aspects of the prototype along with aspects requiring improvement. They indicated that technical requirements are essential. They also revealed that a minimal change in daily routines, support for physical activity and independent living and the inclusion of trusted contact persons could lead to wider use of the alerting device. CONCLUSIONS Involving users is crucial in gaining a deeper understanding of aspects influencing utilisation of an alerting device. The study revealed that usability is influenced both by technical requirements as well as habits and personal preferences. This finding is vital, as habits and personal preferences can only be identified through the involvement of target users. RELEVANCE TO CLINICAL PRACTICE The study provides key insights for health practitioners interested in promoting the use of an alerting device in community-dwelling older people.
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Affiliation(s)
- Friederike J S Thilo
- Applied Research & Development in Nursing, Health Division, Bern University of Applied Sciences, Bern, Switzerland.,School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Sabine Hahn
- Applied Research & Development in Nursing, Health Division, Bern University of Applied Sciences, Bern, Switzerland
| | - Ruud J G Halfens
- School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Jos M G A Schols
- School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.,School CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
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Wang C, Lu W, Redmond SJ, Stevens MC, Lord SR, Lovell NH. A Low-Power Fall Detector Balancing Sensitivity and False Alarm Rate. IEEE J Biomed Health Inform 2017; 22:1929-1937. [PMID: 29990072 DOI: 10.1109/jbhi.2017.2778271] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Falls in older people are a major challenge to public health. A wearable fall detector can detect falls automatically based on kinematic information of the human body, allowing help to arrive sooner. To date, most studies have focused on the accuracy of an offline algorithm to distinguish real-world or simulated falls from activities of daily living, while neglecting the false alarm rate and battery life of a real device. To address these two important metrics, which significantly influence user compliance, this paper proposes a low-power fall detector using triaxial accelerometry and barometric pressure sensing. This fall detector minimizes power consumption using both hardware- and firmware-based techniques. Additionally, the fall detection algorithm used in this device is optimized to achieve a balance between sensitivity and false alarm rate, while minimizing the power consumption due to algorithm execution. The fall detector achieved a high sensitivity (91%) with a low false alarm rate (0.1149 alarms per hour), and a commercially-viable battery life (1125 days).
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Stokke R. "Maybe we should talk about it anyway": a qualitative study of understanding expectations and use of an established technology innovation in caring practices. BMC Health Serv Res 2017; 17:657. [PMID: 28915809 PMCID: PMC5602870 DOI: 10.1186/s12913-017-2587-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/01/2017] [Indexed: 11/21/2022] Open
Abstract
Background Technological innovations are strongly promoted to meet the demands posed by increased pressure on home care services and to assist ageing in place in western societies. Although heavily advocated as plug and play solutions, technologies have proven difficult and unpredictable when integrated into home care services. We need greater insight into what happens when technologies are integrated into caring practices. All technologies come with expectations as to their function. This study explores how actors who are involved with the social alarm, which is an established technology innovation, relate to, perceive and articulate these expectations of the technology in everyday living. Methods The article presents results from a two-case study, using a triangulation of qualitative methods in order to gain an in-depth understanding of technology in use in home care services through “thick descriptions”. The study was conducted in Norway and data were analysed using a stepwise deductive-inductive analysis. Results The empirical findings demonstrate that expectations regarding the social alarm, even though it represents a simple and well-established technology, are complex and multidimensional. The notion of script and domestication provided relevant tools for exploring these expectations and for understanding how actors interpret and adapt their practices of using the technology. This enabled a more comprehensive understanding of how technology opens up for different interpretations and puts values in play. Conclusions This article suggests exploring technology in use as scripted in multidimensional script, and offers a frame for doing so. It also reveals how technology scripts and articulation prove important for understanding the complex reality when integrated into home care practices, thus identifying how using the technology leads to the taming and unleashing of both technology and actors. The study offers an increased understanding of how and why technology is unpredictable and works differently in different contexts. Moreover, it stresses the importance of avoiding expectations of plug-and-play in a reality of complex interactions between different actors.
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Affiliation(s)
- Randi Stokke
- NTNU Norwegian University of Science and Technology, Centre for Care Research, P.O. Box 191, 2802, Gjøvik, Norway. .,Inland Norway University of Applied Sciences - INN University, The Centre for Innovation in Services, P.O. Box 400, 2418, Elverum, Norway.
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Haried P, Claybaugh C, Dai H. Evaluation of health information systems research in information systems research: A meta-analysis. Health Informatics J 2017; 25:186-202. [DOI: 10.1177/1460458217704259] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Given the importance of the health-care industry and the promise of health information systems, researchers are encouraged to build on the shoulders of giants as the saying goes. The health information systems field has a unique opportunity to learn from and extend the work that has already been done by the highly correlated information systems field. As a result, this research article presents a past, present and future meta-analysis of health information systems research in information systems journals over the 2000–2015 time period. Our analysis reviewed 126 articles on a variety of topics related to health information systems research published in the “Senior Scholars” list of the top eight ranked information systems academic journals. Across the selected information systems academic journals, our findings compare research methodologies applied, health information systems topic areas investigated and research trends. Interesting results emerge in the range and evolution of health information systems research and opportunities for health information systems researchers and practitioners to consider moving forward.
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Affiliation(s)
| | | | - Hua Dai
- California State University Channel Islands, USA
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35
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Agboola S, Golas S, Fischer N, Nikolova-Simons M, Op den Buijs J, Schertzer L, Kvedar J, Jethwani K. Healthcare utilization in older patients using personal emergency response systems: an analysis of electronic health records and medical alert data : Brief Description: A Longitudinal Retrospective Analyses of healthcare utilization rates in older patients using Personal Emergency Response Systems from 2011 to 2015. BMC Health Serv Res 2017; 17:282. [PMID: 28420358 PMCID: PMC5395921 DOI: 10.1186/s12913-017-2196-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Personal Emergency Response Systems (PERS) are traditionally used as fall alert systems for older adults, a population that contributes an overwhelming proportion of healthcare costs in the United States. Previous studies focused mainly on qualitative evaluations of PERS without a longitudinal quantitative evaluation of healthcare utilization in users. To address this gap and better understand the needs of older patients on PERS, we analyzed longitudinal healthcare utilization trends in patients using PERS through the home care management service of a large healthcare organization. METHODS Retrospective, longitudinal analyses of healthcare and PERS utilization records of older patients over a 5-years period from 2011-2015. The primary outcome was to characterize the healthcare utilization of PERS patients. This outcome was assessed by 30-, 90-, and 180-day readmission rates, frequency of principal admitting diagnoses, and prevalence of conditions leading to potentially avoidable admissions based on Centers for Medicare and Medicaid Services classification criteria. RESULTS The overall 30-day readmission rate was 14.2%, 90-days readmission rate was 34.4%, and 180-days readmission rate was 42.2%. While 30-day readmission rates did not increase significantly (p = 0.16) over the study period, 90-days (p = 0.03) and 180-days (p = 0.04) readmission rates did increase significantly. The top 5 most frequent principal diagnoses for inpatient admissions included congestive heart failure (5.7%), chronic obstructive pulmonary disease (4.6%), dysrhythmias (4.3%), septicemia (4.1%), and pneumonia (4.1%). Additionally, 21% of all admissions were due to conditions leading to potentially avoidable admissions in either institutional or non-institutional settings (16% in institutional settings only). CONCLUSIONS Chronic medical conditions account for the majority of healthcare utilization in older patients using PERS. Results suggest that PERS data combined with electronic medical records data can provide useful insights that can be used to improve health outcomes in older patients.
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Affiliation(s)
- Stephen Agboola
- Partners Connected Health, Partner Healthcare, 25 New Chardon St., Suite 300, Boston, MA, 02114, USA. .,Massachusetts General Hospital, Boston, USA. .,Harvard Medical School, Boston, USA.
| | - Sara Golas
- Partners Connected Health, Partner Healthcare, 25 New Chardon St., Suite 300, Boston, MA, 02114, USA.,Massachusetts General Hospital, Boston, USA
| | - Nils Fischer
- Partners Connected Health, Partner Healthcare, 25 New Chardon St., Suite 300, Boston, MA, 02114, USA.,Massachusetts General Hospital, Boston, USA
| | | | | | | | - Joseph Kvedar
- Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Kamal Jethwani
- Partners Connected Health, Partner Healthcare, 25 New Chardon St., Suite 300, Boston, MA, 02114, USA.,Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, USA
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