Using information technology to improve the management of chronic disease

The Path to Sustainable Healthcare: Implementing Care Transition Teams to Mitigate Hospital Readmissions and Improve Patient Outcomes

Introduction Hospital readmissions within 30 days suggest care quality issues and increased mortality risks. They result from ineffective initial treatment, poor discharge planning, and inadequate post-acute care. These high readmission rates harm patient outcomes and financially strain healthcare institutions, inviting penalties and discouraging potential patients. Enhancing inpatient care, care transitions, and case management is crucial to lowering readmissions. Our research underscores the role of care transition teams in reducing readmissions and financial stress in hospitals. By consistently applying transition strategies and focusing on high-quality care, we can improve patient outcomes and ensure hospital success in the long run. Methods This two-phase study investigated readmission rates and risk factors in a community hospital from May 2017 to November 2022. Phase 1 determined a baseline readmission rate and identified individual risk factors using logistic regression. In phase 2, a care transition team addressed these factors by providing post-discharge patient support through phone calls and assessing social determinants of health (SDOH). Readmission data from the intervention period was compared to baseline data using statistical tests. Data, including demographics, medical conditions, and comorbidities, were collected via electronic medical records and the International Classification of Diseases (ICD-10 codes). The study focused on patients aged 20-80 with readmissions within 30 days. Exclusions were made to minimize confounding effects from unmeasured comorbidities and ensure an accurate representation of factors affecting readmissions. Results In the study's initial phase, 74,153 patients participated, with an 18% mean readmission rate. Women accounted for 46% of readmissions, and the white population had the highest rate (49%). The 40-59 age group showed a higher readmission rate than other age groups, and certain health factors were identified as risk factors for 30-day readmission. In the subsequent phase, a care transition team intervened with high-risk groups using an SDOH questionnaire. They contacted 432 patients, resulting in a reduced overall readmission rate of 9%. The 60-79 age group and the Hispanic population experienced higher readmission rates, and the previously identified health factors remained significant risk factors. Conclusion This study emphasizes the crucial role of care transition teams in reducing hospital readmission rates and easing the financial strain on healthcare institutions. By identifying and addressing individual risk factors, the care transition team effectively lowered the overall readmission rate from 18% to 9%. Continually implementing transition strategies and prioritizing high-quality care focused on minimizing readmissions are essential for improving patient outcomes and long-term hospital success. Healthcare providers should consider utilizing care transition teams and social determinants of health assessments to better understand and manage risk factors and tailor post-discharge support for patients at higher risk of readmission.

Investigating the role of health information technology in the control and management of Systemic Lupus Erythematosus (SLE): a systematic review

Background

Despite the use of health information technology (HIT) for controlling and managing lupus, its effectiveness has not been well studied. The objective of this study was to investigate the role of HIT in controlling and managing lupus.

Methods

We searched Scopus, PubMed, Web of Science, and Embase, using "self-management", "self-care" and "Systemic Lupus Erythematosus" keywords. Two researchers selected relevant papers and extracted data using a data collection form. Disagreements were resolved in consultation with the third and fourth researchers. After extraction, the data were analyzed.

Results

Totally, 23 papers met the inclusion criteria. About 75% of the studies used web and telephone-based technologies. Most services provided with health technologies were ‘Training’ and ‘consulting’. The ‘lifestyle" and ‘Consultation and education’ axes were the most widely used HIT services to control and manage lupus. While, ‘Better management and control of the disease’, ‘Increasing knowledge and awareness of people about lupus’ and ‘Improving behaviors and attitudes toward self-management and self-care’ were also the most important outcomes. ‘Collectiing patient data and information’, 'Providing education and consultation services to patients', 'Measuring patient-reported outcomes', and 'Increasing patients' knowledge and awareness of their disease' were the most important advantages of various technologies. 'Slow internet speed' and 'Challenges and problems related to appearance and usability' and 'Patient concerns about privacy and misuse of their data' were three disadvantages of technologies.

Conclusion

The findings showed that HIT can improve the management and control of lupus and facilitate self-efficacy, self-care, and self-management in patients. The axes and data elements identified in this study can be the basis for developing and implementing efficient HIT-based systems to improve, control, and manage lupus.

A look to the future: Pandemic-induced digital technologies in vascular surgery

Like many areas of medicine, vascular surgery has been transformed by the COVID-19 (coronavirus disease 2019) pandemic. Public health precautions to minimize disease transmission have led to reduced attendance at hospitals and clinics in elective and emergency settings; fewer face-to-face and hands-on clinical interactions; and increased reliance on telemedicine, virtual attendance, investigations, and digital therapeutics. However, a “silver lining” to the COVID-19 pandemic may be the mainstream acceptance and acceleration of telemedicine, remote monitoring, digital health technology, and three-dimensional technologies, such as three-dimensional printing and virtual reality, by connecting health care providers to patients in a safe, reliable, and timely manner, and supplanting face-to-face surgical simulation and training. This review explores the impact of these changes in the delivery of vascular surgical care.

The Effectiveness of Telenursing for Self-Management Education on Cardiometabolic Conditions: A Pilot Project on a Remote Island of Ōsakikamijima, Japan

Introduction:

Providing self-management education for residents with cardiometabolic conditions in remote islands is a challenge due to the shortage of primary care practitioners (PCPs), specialist physicians, and nurses. Therefore, we applied telenursing with lifestyle-related chronic diseases in remote island residents in Japan. This project aimed to improve the self-management behavior, cardiometabolic indicators, self-efficacy, and quality of life (QoL) of residents with cardiometabolic risks.

Methods:

We chose Ōsakikamijima Island, Hiroshima Prefecture, Japan, which is designated under the Remote Islands Development Act. The project was conducted from 2013 to 2014. The residents aged over 40 and under 75 years old, selected from the annual specific health check-up examination and from PCPs for screening cardiometabolic risks (urinary protein, glycohemoglobin A1c, systolic and diastolic blood pressure (BP), Low-density lipoprotein cholesterol, High-density lipoprotein cholesterol, and triglyceride) were included. The effectiveness of telenursing for self-management education was 6-month-long with a 6-month follow-up and evaluated by a single-group pre-and post-test design. Face-to-face health education was applied at the initial interview followed by telenursing (biweekly telephone calls till third-month, and a monthly telephone call during the fourth and fifth-month) by the trained nurses outside the island. To enhance participants’ self-monitoring health behavior changes, the nurses used motivational interviewing and behavior change techniques based on the transtheoretical model.

Results:

A total of 130 residents, 42 agreed to participate, 41 finished the 6-month program, and 33 completed the 12-month follow-up. Most of their behavior changes like self-management behaviors, cardiometabolic indicators, and self-efficacy at 6-month were improved significantly except QoL. Among the 12-month study periods, self-management behaviors, body mass index, systolic BP, diastolic BP, and self-efficacy (sense of control), (all P < .05) showed significant improvement.

Conclusion:

This study results indicated that telenursing might be effective to improve the lifestyles-related behaviors in chronic diseases on the remote island of Ōsakikamijima, Japan.

Design of a Kitchen-Monitoring and Decision-Making System to Support AAL Applications

Numerous researchers are working on Ambient Assisted Living systems to enable more comfortable and safer living for senior people in their homes. Due to modern lifestyles and an aging population, this has become a very important issue. According to the available literature, it is obvious that the kitchen is one of the most important and most dangerous rooms in the home. However, there is still evident lack of monitoring systems suitable for specific kitchen activities. In this paper, we propose a monitoring system capable of identifying activities related to the cooking process, and a decision-making system capable of identifying some unwanted and possibly critical conditions. The proposed systems are designed to satisfy the requirements of the modern Ambient Assisted Living systems dedicated to older adults. The proposed monitoring system consists of ultrasound, temperature, and humidity sensors. The acquired results from these sensors are the inputs for the decision-making system, which generate warnings or alarms intended for the senior users and/or formal or informal caregivers. This system is designed to improve home safety related to kitchen activities, as well as to provide information about the lifestyle and daily activities of senior users. Experimental validation of the proposed system confirms its functionality and accurate design approach.

The use of health information technology in renal transplantation: A systematic review

Renal transplantation is a complex, multi-disciplinary and cross-center service. Clinical pathways naturally traverse specialty and organizational boundaries as patients transition from chronic kidney disease to renal failure and ultimately transplantation. Health information technology (IT) has the potential to support transplant care by improving access to data, information sharing and communication. This novel review aimed to identify and characterize health IT solutions in renal transplantation, and where possible evaluate any intended benefits. A systematic literature review was conducted of studies covering any part of the clinical pathway, with end-users being clinical staff or patients. Interventions were characterized and evaluated for achieved benefits using the World Health Organization (WHO) Classification of Digital Health Interventions and the mixed methods assessment tool (MMAT) was used to determine the quality of experimental studies. Of 4498 articles, 12 descriptive and 6 experimental studies met the inclusion criteria. Median MMAT percentage score of experimental studies was 64 (i.q.r. 57 to 74.8). The most frequent functionality of technology involved overcoming communication roadblocks and improving access to data. Intended benefits included improving information management and supporting workflow, however only one study reported evaluated results. Six patient-facing applications that primarily addressed adherence-to-treatment were identified, five of which were evaluated for intended benefits, showing overall positive results. Overall, despite transplantation being well suited to health IT interventions, this review demonstrates a scarcity of literature in this field. A small number of clinician- and patient-facing IT solutions have been reported, albeit mostly in non-experimental studies. Due to this lack of formal evaluation, the effectiveness of solutions remains unclear. High-quality evaluative studies are required to develop effective IT solutions that improve clinical care.

Silicon Nanofluidic Membrane for Electrostatic Control of Drugs and Analytes Elution

Individualized long-term management of chronic pathologies remains an elusive goal despite recent progress in drug formulation and implantable devices. The lack of advanced systems for therapeutic administration that can be controlled and tailored based on patient needs precludes optimal management of pathologies, such as diabetes, hypertension, rheumatoid arthritis. Several triggered systems for drug delivery have been demonstrated. However, they mostly rely on continuous external stimuli, which hinder their application for long-term treatments. In this work, we investigated a silicon nanofluidic technology that incorporates a gate electrode and examined its ability to achieve reproducible control of drug release. Silicon carbide (SiC) was used to coat the membrane surface, including nanochannels, ensuring biocompatibility and chemical inertness for long-term stability for in vivo deployment. With the application of a small voltage (≤ 3 V DC) to the buried polysilicon electrode, we showed in vitro repeatable modulation of membrane permeability of two model analytes-methotrexate and quantum dots. Methotrexate is a first-line therapeutic approach for rheumatoid arthritis; quantum dots represent multi-functional nanoparticles with broad applicability from bio-labeling to targeted drug delivery. Importantly, SiC coating demonstrated optimal properties as a gate dielectric, which rendered our membrane relevant for multiple applications beyond drug delivery, such as lab on a chip and micro total analysis systems (µTAS).

Emotion sharing in remote patient monitoring of patients with chronic kidney disease

OBJECTIVE

To investigate the relationship between emotion sharing and technically troubled dialysis (TTD) in a remote patient monitoring (RPM) setting.

MATERIALS AND METHODS

A custom software system was developed for home hemodialysis patients to use in an RPM setting, with focus on emoticon sharing and sentiment analysis of patients' text data. We analyzed the outcome of emoticon and sentiment against TTD. Logistic regression was used to assess the relationship between patients' emotions (emoticon and sentiment) and TTD.

RESULTS

Usage data were collected from January 1, 2015 to June 1, 2018 from 156 patients that actively used the app system, with a total of 31 159 dialysis sessions recorded. Overall, 122 patients (78%) made use of the emoticon feature while 146 patients (94%) wrote at least 1 or more session notes for sentiment analysis. In total, 4087 (13%) sessions were classified as TTD. In the multivariate model, when compared to sessions with self-reported very happy emoticons, those with sad emoticons showed significantly higher associations to TTD (aOR 4.97; 95% CI 4.13-5.99; P = < .001). Similarly, negative sentiments also revealed significant associations to TTD (aOR 1.56; 95% CI 1.22-2; P = .003) when compared to positive sentiments.

DISCUSSION

The distribution of emoticons varied greatly when compared to sentiment analysis outcomes due to the differences in the design features. The emoticon feature was generally easier to understand and quicker to input while the sentiment analysis required patients to manually input their personal thoughts.

CONCLUSION

Patients on home hemodialysis actively expressed their emotions during RPM. Negative emotions were found to have significant associations with TTD. The use of emoticons and sentimental analysis may be used as a predictive indicator for prolonged TTD.

Using Telehealth to Remediate Rural Mental Health and Healthcare Disparities

"Deaths of despair", deaths due to drugs, alcohol, and suicide, occur at higher rates in rural communities. The incidence of such deaths highlights underlying access and treatment disparities which result in poorer outcomes. Telehealth is a viable option for addressing rural mental healthcare needs as it enables more effective care management, provides expanded access to services, and fosters integrating primary and mental healthcare services. Implementing telemental health will involve overcoming coverage and reimbursement, licensure, broadband access and adequacy, and privacy and security barriers and advancing select policy changes. Telehealth diffusion will require changes in professional training and care delivery models.

Personalised telehealth intervention for chronic disease management: A pilot randomised controlled trial

INTRODUCTION

The aim of this study was to assess the impact of home-based telehealth monitoring on health outcomes, quality of life and costs over 12 months for patients with diabetes and/or chronic obstructive pulmonary disease (COPD) who were identified as being at high risk of readmission to hospital.

METHODS

This pilot study was a randomised controlled trial combined with an economic analysis to examine the outcomes of standard care versus home-based telehealth for people with diabetes and/or COPD who were at risk of hospital readmission within one year. The primary outcomes were (i) hospital admission and length of stay (LOS); and (ii) health-related quality of life (HRQOL); and the secondary outcomes were (i) health-related clinical outcomes; (ii) anxiety and depression scores; and (iii) health literacy. The costs of the intervention and hospitalisations were included.

RESULTS

A total of 86 and 85 participants were randomised to the intervention and control groups respectively. The difference between groups in hospital LOS was -3.89 (95% confidence interval (CI): -9.40, 1.62) days, and for HRQOL, 0.09 (95% CI: 0.05, 0.14) in favour of the telehealth monitoring group. There was a saving of AUD$6553 (95% CI: -12145, -961) in the cost of hospitalisation over 12 months, which offset the increased cost of tele-monitoring. The intervention group showed an improvement in anxiety, depression and health literacy at 12 months, and in the diabetes group, a reduction in microalbuminuria.

DISCUSSION

The telehealth monitoring intervention improved patient's health outcomes and quality of life at no additional cost.

Quality of Care in Rheumatoid Disease from the Clinician Perspective: A Modified Delphi Panel Approach

INTRODUCTION

To establish clinical consensus on important and relevant quality-of-care (QoC) attributes in rheumatic disease (RD) treatment that may improve treatment outcomes and guide best practices.

METHODS

Twenty-three QoC attributes were identified in a literature review. Fifteen European-based clinicians were selected based on their contributions to RD guidelines, publications, and patient care. A three-round (an interview round and two web-based rounds) modified Delphi panel was conducted to reach consensus and finalize a QoC attribute list.

RESULTS

In round 1 (clinician interviews), clinicians reported 52 unique QoC attributes across 14 themes, with the greatest number of attributes reported in the "treatment goals" (n = 7) and "remote monitoring" (n = 7) themes. During rounds 2 and 3, the critically important QoC attributes most frequently reported were access to care/treatment (n = 14, 93.3%), safety of treatment (round 2 n = 14, 93.3%, round 3 n = 13, 86.7%), and access to clinicians and specialists (round 2: n = 13, 86.7%, round 3: n = 14, 93.3%). The final list contained 53 QoC attributes.

CONCLUSION

The study demonstrates consensus across several themes of QoC. Quality of care is a complex, multidimensional, and fluid concept that can be improved by ensuring patients have access to care, open communication between patients and clinicians, and the use of novel strategies, such as remote monitoring. Utilization of the attribute list can potentially improve the lives of patients, provide clinicians with tools to provide greater QoC, and improve the healthcare system as a whole.

FUNDING

Merck & Co., Inc.

An Indoor Positioning System Based on Wearables for Ambient-Assisted Living

The urban population is growing at such a rate that by 2050 it is estimated that 84% of the world’s population will live in cities, with flats being the most common living place. Moreover, WiFi technology is present in most developed country urban areas, with a quick growth in developing countries. New Ambient-Assisted Living applications will be developed in the near future having user positioning as ground technology: elderly tele-care, energy consumption, security and the like are strongly based on indoor positioning information. We present an indoor positioning system for wearable devices based on WiFi fingerprinting. Smart-watch wearable devices are used to acquire the WiFi strength signals of the surrounding Wireless Access Points used to build an ensemble of Machine Learning classification algorithms. Once built, the ensemble algorithm is used to locate a user based on the WiFi strength signals provided by the wearable device. Experimental results for five different urban flats are reported, showing that the system is robust and reliable enough for locating a user at room level into his/her home. Another interesting characteristic of the presented system is that it does not require deployment of any infrastructure, and it is unobtrusive, the only device required for it to work is a smart-watch.

Telehealth methods to deliver dietary interventions in adults with chronic disease: a systematic review and meta-analysis

BACKGROUND

The long-term management of chronic disease requires the adoption of complex dietary recommendations, which can be facilitated by regular coaching to support behavioral changes. Telehealth interventions can overcome patient-centered barriers to accessing face-to-face programs and provide feasible delivery methods, accessible regardless of geographic location.

OBJECTIVE

This systematic review assessed the effectiveness of telehealth dietary interventions at facilitating dietary change in chronic disease.

DESIGN

A structured systematic search was conducted for all randomized controlled trials evaluating multifactorial dietary interventions in adults with chronic disease that provided diet education in an intervention longer than 4 wk. Meta-analyses that used the random-effects model were performed on diet quality, dietary adherence, fruit and vegetables, sodium intake, energy, and dietary fat intake.

RESULTS

A total of 25 studies were included, involving 7384 participants. The telehealth dietary intervention was effective at improving diet quality [standardized mean difference (SMD): 0.22 (95% CI: 0.09, 0.34), P = 0.0007], fruit and vegetable intake [mean difference (MD) 1.04 servings/d (95% CI: 0.46, 1.62 servings/d), P = 0.0004], and dietary sodium intake [SMD: -0.39 (-0.58, -0.20), P = 0.0001]. Single nutrients (total fat and energy consumption) were not improved by telehealth intervention; however, after a telehealth intervention, important clinical outcomes were improved, such as systolic blood pressure [MD: -2.97 mm Hg (95% CI: -5.72, -0.22 mm Hg), P = 0.05], total cholesterol [MD: -0.08 mmol/L (95% CI: -0.16, -0.00 mmol/L), P = 0.04], triglycerides [MD: -0.10 mmol/L (95% CI: -0.19, -0.01 mmol/L), P = 0.04], weight [MD: -0.80 kg (95% CI: -1.61, 0 kg), P = 0.05], and waist circumference [MD: -2.08 cm (95% CI: -3.97, -0.20 cm), P = 0.03].

CONCLUSIONS

Telehealth-delivered dietary interventions targeting whole foods and/or dietary patterns can improve diet quality, fruit and vegetable intake, and dietary sodium intake. When applicable, they should be incorporated into health care services for people with chronic conditions. This review was registered at http://www.crd.york.ac.uk/PROSPERO/ as CRD42015026398.

Internet-Based Resources for Disease Self-Care Among Middle-Aged and Older Women with Chronic Conditions

OBJECTIVE

This two-part study analyzed data collected from middle-aged (age 44-64) and older women (age 65+) with one or more chronic conditions who completed the National Council on Aging Chronic Care Survey.

MATERIALS AND METHODS

Part One analyzed data from 418 women to describe sociodemographics, disease types, and healthcare utilization associated with Internet use among middle-aged and older women with 1 or more chronic diseases. Part Two analyzed data from the 251 Internet-using women to identify the online self-care resources they are using (format, host organization) and for what purposes.

RESULTS

Approximately 31% of participants were age 65 years or older, 30% reported having three or more chronic condition types, and 65% reported using the Internet. A significantly larger proportion of older women reported multiple chronic conditions, and a significantly fewer number of older women reported using the Internet. A significantly smaller proportion of Internet users were non-Hispanic white, more educated, and employed. A significantly larger proportion of non-Internet users reported needing help learning what to do to manage their health conditions and needing help learning how to care for their health conditions. Among only Internet-using women, 18.7% participated in online discussions/chatrooms/listserv and 45.2% read about the experiences of others with chronic diseases. Interest in websites and online courses varied.

CONCLUSION

Understanding Internet use among women with chronic conditions can inform targeted efforts to increase Internet availability, educate potential users about the benefits of online resources, and effectively tailor Internet-based materials to self-care needs.

Telehealth methods to deliver multifactorial dietary interventions in adults with chronic disease: a systematic review protocol

BACKGROUND

The long-term management of chronic diseases requires adoption of complex dietary recommendations, which can be facilitated by regular coaching to support sustained behaviour change. Telehealth interventions can overcome patient-centred barriers to accessing face-to-face programs and provide feasible delivery methods, ubiquitous and accessible regardless of geographic location. The protocol for this systematic review explains the methods that will be utilised to answer the review question of whether telehealth interventions are effective at promoting change in dietary intake and improving diet quality in people with chronic disease.

METHODS/DESIGN

A structured search of Medline, EMBASE, CINAHL, and PsychINFO, from their inception, will be conducted. We will consider randomised controlled trials which evaluate complex dietary interventions in adults with chronic disease. Studies must provide diet education in an intervention longer than 4 weeks in duration, and at least half of the intervention contact must be delivered via telehealth. Comparisons will be made against usual care or a non-telehealth intervention. The primary outcome of interest is dietary change with secondary outcomes relating to clinical markers pre-specified in the methodology. The process for selecting studies, extracting data, and resolving conflicts will follow a set protocol. Two authors will independently appraise the studies and extract the data, using specified methods. Meta-analyses will be conducted where appropriate, with parameters for determining statistical heterogeneity pre-specified. The GRADE tool will be used for determining the quality of evidence for analysed outcomes.

DISCUSSION

To date, there has been a considerable variability in the strategies used to deliver dietary education, and the overall effectiveness of telehealth dietary interventions for facilitating dietary change has not been reviewed systematically in adults with chronic disease. A systematic synthesis of telehealth strategies will inform the development of evidence-based telehealth programs that can be tailored to deliver dietary interventions specific to chronic disease conditions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015026398.

Applying a novel combination of techniques to develop a predictive model for diabetes complications

Among the many related issues of diabetes management, its complications constitute the main part of the heavy burden of this disease. The aim of this paper is to develop a risk advisor model to predict the chances of diabetes complications according to the changes in risk factors. As the starting point, an inclusive list of (k) diabetes complications and (n) their correlated predisposing factors are derived from the existing endocrinology text books. A type of data meta-analysis has been done to extract and combine the numeric value of the relationships between these two. The whole n (risk factors) - k (complications) model was broken down into k different (n-1) relationships and these (n-1) dependencies were broken into n (1-1) models. Applying regression analysis (seven patterns) and artificial neural networks (ANN), we created models to show the (1-1) correspondence between factors and complications. Then all 1-1 models related to an individual complication were integrated using the naïve Bayes theorem. Finally, a Bayesian belief network was developed to show the influence of all risk factors and complications on each other. We assessed the predictive power of the 1-1 models by R2, F-ratio and adjusted R2 equations; sensitivity, specificity and positive predictive value were calculated to evaluate the final model using real patient data. The results suggest that the best fitted regression models outperform the predictive ability of an ANN model, as well as six other regression patterns for all 1-1 models.

Development and evaluation of an E-health system to care for patients with bladder pain syndrome/interstitial cystitis

OBJECTIVES

Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic disease that highly degrades the quality of life for patients. In the present study, Internet intervention was used to care for bladder pain syndrome/interstitial cystitis patients to alleviate their pain and bothering symptoms.

METHODS

Healthcare education was carried out through the Internet by asking the patients, who were randomly divided into study (40 patients) and control (40 patients) groups, to check possible sensitive foods, habits, and behaviors weekly to remind and consolidate important rules for promoting quality of life. The symptom flares consultation through short message service with the Internet used to elevate healthcare efficiency was undertaken. Questionnaires, including Short Form 36 health survey, O'Leary-Sant symptom and problem indices, as well as visual analog scales pain and urgency scales, were used to evaluate quality of life and disease severity improvements before and after information and communication technology intervention. The outcome was evaluated at week 8.

RESULTS

The quality of life of both the control and study groups was significantly improved. The quality of life and visual analog scales for the patients in the study group with information and communication technology intervention showed a much greater improvement compared with the patients in the control group (P < 0.05).

CONCLUSIONS

The E-health system was shown to be effective in improving quality of life of bladder pain syndrome/interstitial cystitis patients through intervention of Internet healthcare education and short message service for the consolidation of healthy behavior and lifestyle in the 8-week follow up.

Examining the relationships between resources and online health information seeking among patients with chronic diseases and healthy people

The Internet is increasingly used as an important source of health and medical-related information for people with chronic diseases. It is recognized that online health information seeking (OHIS) is influenced by individuals' multi-dimensional factors, such as demographics, socio-economic factors, perceptions of the Internet, and health conditions. This study applies the conservation of resource theory to examine relationships between various multi-dimensional factors, daily challenges, and OHIS depending on individuals' health conditions. The data used in this study was taken from the U.S. Health Tracking Survey (2012). In this study, Internet users aged 18 and older were classified into patients (N = 518) and healthy people (N = 677) based on their health status related to chronic diseases. Multiple regression analysis was used to examine the relationships between multi-dimensional factors (resources), self-rated health, and OHIS. Patients' various resources (e.g., age, income, education, having a smartphone, and health tracking) significantly predicted their self-rated health and OHIS; in addition, self-rated health significantly mediated the relationships between focal resources and OHIS. However, the mediating effects of self-rated health were not found in healthy people.

The SMART personalised self-management system for congestive heart failure: results of a realist evaluation

BACKGROUND

Technology has the potential to provide support for self-management to people with congestive heart failure (CHF). This paper describes the results of a realist evaluation of the SMART Personalised Self-Management System (PSMS) for CHF.

METHODS

The PSMS was used, at home, by seven people with CHF. Data describing system usage and usability as well as questionnaire and interview data were evaluated in terms of the context, mechanism and outcome hypotheses (CMOs) integral to realist evaluation.

RESULTS

The CHF PSMS improved heart failure related knowledge in those with low levels of knowledge at baseline, through providing information and quizzes. Furthermore, participants perceived the self-regulatory aspects of the CHF PSMS as being useful in encouraging daily walking. The CMOs were revised to describe the context of use, and how this influences both the mechanisms and the outcomes.

CONCLUSIONS

Participants with CHF engaged with the PSMS despite some technological problems. Some positive effects on knowledge were observed as well as the potential to assist with changing physical activity behaviour. Knowledge of CHF and physical activity behaviour change are important self-management targets for CHF, and this study provides evidence to direct the further development of a technology to support these targets.

Monitoring technology for the elderly patient

In view of the current demographic change in the aging population and its impact on changing the health system towards community care, this review focuses on monitoring technology for elderly patients. In particular, the focus is on wearable monitoring technology and its integration into telehealth systems. In review of the available commercial wearable monitoring technologies, their form factor, sensing methods and application for the purpose of monitoring elderly patients for ongoing care are discussed. At the same time, advances in research regarding how to overcome the limitations of commercial wearable monitoring devices are reviewed. Issues of usability, functionality, human interaction and social factors, and ethical considerations in the application of wearable monitoring and telehealth technologies for elderly patients are outlined. Some of the initiatives taken to address these issues are also discussed and some suggestions are made. Finally, the review looks at the anticipated benefits of the application of wearable monitoring and telehealth technologies from an elderly patient, clinician or carer and healthcare system point of view. Expert opinion of what strategies need to be used to enhance the use and uptake of these technologies and what future directions are anticipated are expressed. In conclusion, available wearable monitoring technologies and its integration into teleheath systems are currently limited for application on elderly patients. There are many issues of standardization, design and ethical considerations that need to be addressed before advances can be made with these technologies so that these patients can be remotely monitored and provided with a better quality of care.

The reliability and validity of the Chinese version of the Short-form Chronic Disease Self-Efficacy Scales for older adults

AIMS AND OBJECTIVES

To examine the reliability and validity of the Chinese version of the Short-form Chronic Disease Self Efficacy Scales.

BACKGROUND

The prevalence of chronic disease is accelerating globally, advancing across every region and pervading all socioeconomic classes. Among the interventions, self-management programmes focusing on increasing self-efficacy have demonstrated significant patient outcomes, including the improvement of quality of life and functional status. The Chronic Disease Self-Efficacy Scales (CDSES) system developed by Lorig in 1996 has been widely used by healthcare professionals from different disciplines to measure self-efficacy for chronic disease patients due to their tested psychometric properties. The Short-form of the scales system is used today, as it takes substantially less time to administer.

DESIGN

This study used psychometric testing to establish the validity and reliability of the Short-form Chronic Disease Self-Efficacy Scales (CDSES).

METHODS

A convenience sample of 163 older patients with chronic diseases were recruited. The Chinese version of the CDSES, short-form CDSES, SF-36 and self-rated health were used to test for construct validity, concurrent validity, convergent validity and internal consistency.

RESULTS

Short-form CDSES had a single-factor structure with high internal consistency (0·96) and demonstrated no floor or ceiling effects. High intraclass correlation, 0·98, was demonstrated in test-retest. Correlations with the domain scores of the CDSES were found to be r = 0·97 and 0·98. The scale also demonstrated significant moderate correlations with SF-36 and self-rated health.

CONCLUSION

The Chinese version of the Short-form CDSES has shown statistically acceptable levels of reliability and validity for assessing self-efficacy in older patients with chronic diseases.

RELEVANCE TO CLINICAL PRACTICE

The scale is particularly valuable for use among older patients with chronic illness. The questionnaire can be used to assess nursing interventions focusing on increasing patients' self-efficacy or routine patient screening in carrying out daily activities.

Education of patients with chronic kidney disease at the interface of primary care providers and nephrologists

Patient education is promoted as an integral part of effective kidney disease management. Programs and tools are available for providers and patients to support patient CKD education in primary care and nephrology. Challenges to providing patient education across practice settings include patients' lack of awareness of CKD as a medical entity, physician perceptions of their own lack of skill and ability to educate patients, differences in how primary care and nephrology physicians perceive collaborative care, and shortage of staff and time to support educational efforts. In addition, there is little research available to guide evidence-based practices for implementing early patient CKD education interventions across medical disciplines. Development and testing of patient education programs using early CKD multidisciplinary care, educational websites, and phone-based applications are all areas of growing research. More work is needed to provide evidence and support that physicians and other health professionals need to ensure a seamless patient education experience across the continuum of care.

Innovative health care delivery system--a questionnaire survey to evaluate the influence of behavioral factors on individuals' acceptance of telecare

The purpose of this research is to explore people's intention to use telecare and evaluate the degree of influence that behavioral factors on individuals' acceptance of telecare. The subjects are residents of Taiwan. The Structural Equation Modeling (SEM) technique was used to analyze the forecasting model applied to telecare. The results show that this model has good explanatory power for the behavioral intentions of using telecare. Among factors influencing the behavioral intentions of using telecare, the strongest factor is attitude, followed by the perceived usefulness, the perceived ease of use, subjective norms, and personal innovativeness, respectively. The findings of this study may serve as a reference to future studies.

To use or not to use--practitioners' perceptions of an open web portal for young patients with diabetes

BACKGROUND

Health care professionals' attitudes can be a significant factor in their acceptance and efficient use of information technology, so they need to have more knowledge about this resource to enhance their participation.

OBJECTIVE

We explored practitioners' perceptions of using an open-access interactive Web portal tailored to young diabetes type 1 patients and their guardians or significant others. The portal offered discussion forums, blog tools, self-care and treatment information, research updates, and news from local practitioners.

METHODS

Eighteen professionals who were on pediatric diabetes care teams each wrote an essay on their experience using the portal. For their essays, they were asked to describe two situations, focusing on positive and negative user experiences. The essays were analyzed using qualitative content analysis.

RESULTS

Based on our analysis of the respondents essays, we identified three categories that describe perceptions of the Web portal. The first category - to use or not to use - included the different perspectives of the practioners; those who questioned the benefits of using the Web portal or showed some resistance to using it. The frequency of use among the practitioners varied greatly. Some practitioners never used it, while others used it on a daily basis and regularly promoted it to their patients. Some respondents in this category reflected on the benefits of contributing actively to online dialogues. In the second category - information center for everyone - practitioners embraced the site as a resource for scientifically sound information and advice. As part of their practice, and as a complement to traditional care, practitioners in this category described sending information through the portal to patients and their significant others. Practitioners felt safe recommending the site because they knew that the information provided was generated by other practitioners. They also assumed that their patients benefited from actively using the Web portal at home: peers brought the site to life by exchanging experiences through the discussion forums. In the third category - developing our practice - practitioners reflected upon the types of information that should be given to patients and how to give it (ie, during in-person appointments or through the Web portal). They perceived meeting with various professionals at other hospitals to update information on the portal and develop content policies as constructive teamwork. Practitioners expressed interest in reading patients' dialogues online to learn more about their views. They also thought about how they could use the portal to adapt more to patients' needs (eg, creating functions so patients could chat with the diabetes nurses and doctors).

CONCLUSIONS

Practitioners expressed positive perceptions toward a tailored open Web portal. They suggested that future benefits could be derived from systems that integrate factual information and online dialogues between practitioners and patients (ie, exchanging information for everyone's benefit).

A declaration of healthy dependence: the case of home care

Aging populations have become a major concern in the developed world and are expected to require novel care strategies. Public policies, health-care regimes and technology developers alike stress the need for a more individualized care to meet the increased demand for care services in response to demographic change. Increasingly, care services are offered to individuals with diseases and or disabilities in their homes by means of Personalized Health-Monitoring (PHM) technologies. PHM-based home care is typically portrayed as the key to a cost-effective future care that better can accommodate the needs of an aging population and promote care recipients' independence. In light of the emerging technology-based home care, this article sets forth to investigate the significance and implications of a strong emphasis on independence in relation to this novel care form. Notions of independence as used by care planners, care providers and technology developers are examined in relation to ICT-based home care and the reasonableness of independence as an aim for future health-care is critically discussed. In conclusion, the need for a shift from a strong emphasis on independence to a right to healthy dependence is advocated.

Electrocardiogram signal quality measures for unsupervised telehealth environments

The use of telehealth paradigms for the remote management of patients suffering from chronic conditions has become more commonplace with the advancement of Internet connectivity and enterprise software systems. To facilitate clinicians in managing large numbers of telehealth patients, and in digesting the vast array of data returned from the remote monitoring environment, decision support systems in various guises are often utilized. The success of decision support systems in interpreting patient conditions from physiological data is dependent largely on the quality of these recorded data. This paper outlines an algorithm to determine the quality of single-lead electrocardiogram (ECG) recordings obtained from telehealth patients. Three hundred short ECG recordings were manually annotated to identify movement artifact, QRS locations and signal quality (discrete quality levels) by a panel of three experts, who then reconciled the annotation as a group to resolve any discrepancies. After applying a published algorithm to remove gross movement artifact, the proposed method was then applied to estimate the remaining ECG signal quality, using a Parzen window supervised statistical classifier model. The three-class classifier model, using a number of time-domain features and evaluated using cross validation, gave an accuracy in classifying signal quality of 78.7% (κ = 0.67) when using fully automated preprocessing algorithms to remove gross motion artifact and detect QRS locations. This is a similar level of accuracy to the reported human inter-scorer agreement when generating the gold standard annotation (accuracy = 70-89.3%, κ = 0.54-0.84). These results indicate that the assessment of the quality of single-lead ECG recordings, acquired in unsupervised telehealth environments, is entirely feasible and may help to promote the acceptance and utility of future decision support systems for remotely managing chronic disease conditions.

Older People's Quality of Life and Role of Home-Based Technology

BACKGROUND

Household devices may have a positive impact on daily lives by reducing the burden of several tasks and enriching social interaction. There are varieties of assistive devices such as alarms, sensors, detectors, and life style monitoring devices, which can help in compensating for the activity limitations caused by impairments. This study aimed to review the contribution that residential technology devices can make to older people's lives.

METHODS

An open-ended literature review following the guidance of the Centre for Review and Dissemination was conducted to establish the current understanding of the topics by using clear and appropriate criteria to select or reject studies. The studies entered into the review were limited by language, topic, and date of publication.

RESULTS

The research literature indicated that residential facilities which appropriately are designed and supplied can have many benefits for older people such as increasing in-dependence, maximising physical and mental health, and improving their quality of life.

CONCLUSION

Although most of the literature has explored the positive effects of technology devices on older adults' social networks, independence, psychological well-being, and social status, the possibilities of negative consequences have been neglected.

KEYWORDS

Quality of life, Older people, Residential technology, Computer-mediated communication.

Educating patients about warfarin therapy using information technology: A survey on healthcare professionals' perspectives

OBJECTIVE

To explore healthcare professionals' views about the benefits and challenges of using information technology (IT) resources for educating patients about their warfarin therapy.

METHODS

A cross-sectional survey of both community and hospital-based healthcare professionals (e.g., doctors, pharmacists and nurses) involved using a purpose-designed questionnaire. The questionnaires were distributed using a multi-modal approach to maximise response rates.

RESULTS

Of the total 300 questionnaires distributed, 109 completed surveys were received (43.3% response rate). Over half (53.2%) of the healthcare participants were aged between 40-59 years, the majority (59.5%) of whom were female. Fifty nine (54.1%) participants reported having had no access to warfarin-specific IT-based patient education resources, and a further 19 (38.0%) of the participants who had IT-access reported that they never used such resources. According to the healthcare participants, the main challenges associated with educating their patients about warfarin therapy included: patient-related factors, such as older age, language barriers, cognitive impairments and/or ethnic backgrounds or healthcare professional factors, such as time constraints. The healthcare professionals reported that there were several aspects about warfarin therapy which they found difficult to educate their patients about which is why they identified computers and interactive touch screen kiosks as preferred IT devices to deliver warfarin education resources in general practices, hospital-based clinics and community pharmacies. At the same time, the healthcare professionals also identified a number of facilitators (e.g., to reinforce warfarin education, to offer reliable and easily comprehensible information) and barriers (e.g., time and costs of using IT resources, difficulty in operating the resources) that could impact on the effective implementation of these devices in educating patients about their warfarin therapy.

CONCLUSIONS

The findings of the study suggest that there is a need for improving healthcare professionals' use of, and access to IT-based warfarin education resources for patients. The study findings also suggest addressing the concerns raised by the healthcare professionals when implementing such IT resources successfully to help educate patients about their warfarin therapy.

Wireless technology in disease management and medicine

Healthcare information, and to some extent patient management, is progressing toward a wireless digital future. This change is driven partly by a desire to improve the current state of medicine using new technologies, partly by supply-and-demand economics, and partly by the utility of wireless devices. Wired technology can be cumbersome for patient monitoring and can restrict the behavior of the monitored patients, introducing bias or artifacts. However, wireless technologies, while mitigating some of these issues, have introduced new problems such as data dropout and "information overload" for the clinical team. This review provides an overview of current wireless technology used for patient monitoring and disease management. We identify some of the major related issues and describe some existing and possible solutions. In particular, we discuss the rapidly evolving fields of telemedicine and mHealth in the context of increasingly resource-constrained healthcare systems.

A meta-analysis of interventions to reduce loneliness

Social and demographic trends are placing an increasing number of adults at risk for loneliness, an established risk factor for physical and mental illness. The growing costs of loneliness have led to a number of loneliness reduction interventions. Qualitative reviews have identified four primary intervention strategies: (a) improving social skills, (b) enhancing social support, (c) increasing opportunities for social contact, and (d) addressing maladaptive social cognition. An integrative meta-analysis of loneliness reduction interventions was conducted to quantify the effects of each strategy and to examine the potential role of moderator variables. Results revealed that single-group pre-post and nonrandomized comparison studies yielded larger mean effect sizes relative to randomized comparison studies. Among studies that used the latter design, the most successful interventions addressed maladaptive social cognition. This is consistent with current theories regarding loneliness and its etiology. Theoretical and methodological issues associated with designing new loneliness reduction interventions are discussed.

Critical incidents and important information in the care processes of patients with cardiac symptoms

AIM

To describe important information in the care processes of patients with cardiac symptoms.

BACKGROUND

Process-based work-flow models are increasingly being used in healthcare. At the same time, developments in information systems offer the possibility of supporting improvements in process and information management in healthcare. To better utilize these possibilities we need to understand more about important information content and flow during treatment processes.

METHOD

A qualitative approach involving the critical incident technique was used. Critical incidents were collected using a semi-structured questionnaire (50 respondents) and interviews (n=10).

RESULTS

Three incident categories of important information were identified: (1) process-related incidents, (2) managerial incidents and (3) clinical incidents. Process-related incidents focused on agreed-care practices and the importance of the care environment. Managerial incidents focused on human and material resources. Clinical incidents focused on medical and nursing care and the importance of patient education.

CONCLUSIONS

Information content, information flow and the timing of such information should be modelled further in order to improve the management of care processes.

IMPLICATIONS FOR NURSING MANAGEMENT

Increasing knowledge about essential points of information as part of nursing management is important.

Telehealth technologies for managing chronic disease - experiences from Australia and the UK

In developed countries, chronic disease now accounts for more than 75% of health care expenditure and nearly an equivalent percentage of disease-related deaths [1]. The burden of chronic disease (often, but not exclusively, associated with ageing) includes congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), hypertension and diabetes. Over the past several decades there has been an epidemiological shift in disease burden from acute to chronic diseases that has rendered acute care models of health service delivery inadequate to address population health needs.

A new multidisciplinary home care telemedicine system to monitor stable chronic human immunodeficiency virus-infected patients: a randomized study

Background

Antiretroviral therapy has changed the natural history of human immunodeficiency virus (HIV) infection in developed countries, where it has become a chronic disease. This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals.

Methodology

We developed a new internet-based home care model covering the entire management of chronic HIV-infected patients. This was called Virtual Hospital. We report the results of a prospective randomised study performed over two years, comparing standard care received by HIV-infected patients with Virtual Hospital care. HIV-infected patients with access to a computer and broadband were randomised to be monitored either through Virtual Hospital (Arm I) or through standard care at the day hospital (Arm II). After one year of follow up, patients switched their care to the other arm. Virtual Hospital offered four main services: Virtual Consultations, Telepharmacy, Virtual Library and Virtual Community. A technical and clinical evaluation of Virtual Hospital was carried out.

Findings

Of the 83 randomised patients, 42 were monitored during the first year through Virtual Hospital (Arm I) and 41 through standard care (Arm II). Baseline characteristics of patients were similar in the two arms. The level of technical satisfaction with the virtual system was high: 85% of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system. Neither clinical parameters [level of CD4+ T lymphocytes, proportion of patients with an undetectable level of viral load (p = 0.21) and compliance levels >90% (p = 0.58)] nor the evaluation of quality of life or psychological questionnaires changed significantly between the two types of care.

Conclusions

Virtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients. Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection.

Trial Registration

Clinical-Trials.gov: NCT01117675.

Improving the management of chronic diseases using web-based technologies: an application in hemophilia care

Modern methods of information and communication that use web technologies provide an opportunity to facilitate closer communication between patients and healthcare providers, allowing a joint management of chronic diseases. This paper describes a web-based technological solution to support the management of inherited bleeding disorders integrating, diffusing and archiving large sets of data relating to the clinical practice of hemophilia care, more specifically the clinical practice at the Hematology Service of Coimbra Hospital Center (a Hemophilia Treatment Center located in Portugal).

Measuring Patients’ Perceptions and Social Influence on Home Telecare Management System Acceptance

Successful implementation of a Home Telecare Management System (HTMS) requires acceptance by the users, especially when technical innovation is applied to manage chronic healthcare in elderly patients, who are unaccustomed to using modern technology. Based on the Technology Acceptance Model (TAM) and Social Influence Theory (SIT), a Home Telecare Management System (HTMS) Acceptance Model is proposed and tested to improve the understanding of patients’ acceptance of HTMS and the impact of social influence on patients’ attitude and behavioral intentions in using HTMS. Via empirical research and analysis of 221 patients’ questionnaires, the partial least squares (PLS) technique indicates that most of the model’s hypotheses are significant. Implications for both theory and practice are also provided.

Effect of ECG quality measures on piecewise-linear trend detection for telehealth decision support systems

Fledgling clinical decision support systems (DSSs) are being designed on the false assumption that consistent, good-quality signals are created in the unsupervised telehealth environment, but it has in fact been shown that signal quality is often very poor. Hence, it is important to investigate the detrimental impact of failing to recognize erroneous clinical parameter values. This study combines previous work in this area, related to artifact detection in electrocardiogram (ECG) signals, and piecewise-linear trend detection in longitudinal heart rate parameter records, to investigate the impact of choosing to ignore ECG signal quality prior to trend detection in the heart rate (HR) records. Using an artifact detection algorithm to improve the HR estimates from the ECG signals, when compared to reference HR values derived from human annotated 2453 ECGs from nine patients, resulted in a decrease in the estimation bias from 2.54 BPM (beat per minute) to 0.70 BPM and a decrease in the standard error from 0.47 BPM to 0.17 BPM. The application of the same artifact detection also results in a significant improvement in trend fitting, when compared to a fitting of the reference HR values, by reducing the mean RMSE value of the error in the trend fit from 2.14 BPM to 0.78 BPM and standard error from 0.49 BPM to 0.10 BPM. As trend detection will be a component of future telehealth decision support systems, signal quality measures for unsupervised measurements are of paramount importance.

Smart homes - current features and future perspectives

In an ageing world, maintaining good health and independence for as long as possible is essential. Instead of hospitalization or institutionalization, the elderly and disabled can be assisted in their own environment 24h a day with numerous 'smart' devices. The concept of the smart home is a promising and cost-effective way of improving home care for the elderly and the disabled in a non-obtrusive way, allowing greater independence, maintaining good health and preventing social isolation. Smart homes are equipped with sensors, actuators, and/or biomedical monitors. The devices operate in a network connected to a remote centre for data collection and processing. The remote centre diagnoses the ongoing situation and initiates assistance procedures as required. The technology can be extended to wearable and in vivo implantable devices to monitor people 24h a day both inside and outside the house. This review describes a selection of projects in developed countries on smart homes examining the various technologies available. Advantages and disadvantages, as well as the impact on modern society, are discussed. Finally, future perspectives on smart homes as part of a home-based health care network are presented.

Randomized controlled trial of supervised patient self-testing of warfarin therapy using an internet-based expert system

BACKGROUND

Increased frequency of prothrombin time testing, facilitated by patient self-testing (PST) of the International Normalized Ratio (INR) can improve the clinical outcomes of oral anticoagulation therapy (OAT). However, oversight of this type of management is often difficult and time-consuming for healthcare professionals. This study reports the first randomized controlled trial of an automated direct-to-patient expert system, enabling remote and effective management of patients on OAT.

METHODS

A prospective, randomized controlled cross-over study was performed to test the hypothesis that supervised PST using an internet-based, direct-to-patient expert system could provide improved anticoagulation control as compared with that provided by an anticoagulation management service (AMS). During the 6 months of supervised PST, patients measured their INR at home using a portable meter and entered this result, along with other information, onto the internet web page. Patients received instant feedback from the system as to what dose to take and when the next test was due. During the routine care arm, patients attended the AMS at least every 4-6 weeks and were dosed by the anticoagulation pharmacist or physician. The primary outcome variable was the difference in the time in therapeutic range (TTR) between both arms.

RESULTS

One hundred and sixty-two patients were enrolled (male 61.6%, mean age 58.7 years), and 132 patients (81.5%) completed both arms. TTR was significantly higher during PST management than during AMS management (median TTR 74% vs 58.6%; z=5.67, P < 0.001).

CONCLUSIONS

The use of an internet-based, direct-to-patient expert system for the management of PST improves the control of OAT as compared with AMS management.

Application of biomedical informatics to chronic pediatric diseases: a systematic review

Background

Chronic diseases affect millions of children worldwide leading to substantial disease burden to the children and their families as well as escalating health care costs. The increasing trend in the prevalence of complex pediatric chronic diseases requires innovative and optimal delivery of care. Biomedical informatics applications play an important role in improving health outcomes while being cost-effective. However, their utility in pediatric chronic diseases has not been studied in a comprehensive and systematic way. The objective of this study was to conduct a systematic review of the effects of biomedical informatics applications in pediatric chronic diseases.

Methods

A comprehensive literature search was conducted using MEDLINE, the Cochrane Library and EMBASE databases from inception of each database to September 2008. We included studies of any methodological type and any language that applied biomedical informatics to chronic conditions in children and adolescents 18 years of age or younger. Two independent reviewers carried out study selection and data extraction. Quality assessment was performed using a study design evaluation instrument to appraise the strength of the studies and their methodological adequacy. Because of heterogeneity in the conditions and outcomes we studied, a formal meta-analysis was not performed.

Results

Based on our search strategy, 655 titles and abstracts were reviewed. From this set we identified 27 relevant articles that met our inclusion criteria. The results from these studies indicated that biomedical informatics applications have favourable clinical and patient outcomes including, but not limited to, reduced number of emergency room visits, improved knowledge on disease management, and enhanced satisfaction. Seventy percent of reviewed papers were published after year 2000, 89% of users were patients and 11% were either providers or caregivers. The majority (96%) of the selected studies reported improved outcomes.

Conclusion

Published studies suggested positive impacts of informatics predominantly in pediatric asthma. As electronic tools become more widely adopted, there will be opportunities to improve patient care in a wide range of chronic illnesses through informatics solutions.

A means to an end: a web-based client management system in palliative care

Home-based palliative care (hospice) services require comprehensive and fully integrated information systems to develop and manage the various aspects of their business, incorporating client data and management information. These systems assist in maintaining the quality of client care as well as improved management efficiencies. This article reports on a large not-for-profit home-based palliative care service in Australia, which embarked on a project to develop an electronic data management system specifically designed to meet the needs of the palliative care sector. This web-based client information management system represents a joint venture between the organization and a commercial company and has been a very successful project.