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Baird CE, Guiahi M, Chudnoff S, Loyo-Berrios N, Garcia S, Jung M, Gressler LE, Mao J, Hodshon B, Sedrakyan A, Andrews S, Colden K, Roberts J, Anderson A, Sewell C, Marinac-Dabic D. Building Blocks for the Long-acting and Permanent Contraceptives Coordinated Registry Network. BMJ Surg Interv Health Technologies 2022; 4:e000075. [PMID: 36393889 PMCID: PMC9660629 DOI: 10.1136/bmjsit-2020-000075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives A multistakeholder expert group under the Women’s Health Technology Coordinated Registry Network (WHT-CRN) was organized to develop the foundation for national infrastructure capturing the performance of long-acting and permanent contraceptives. The group, consisting of representatives from professional societies, the US Food and Drug Administration, academia, industry and the patient community, was assembled to discuss the role and feasibility of the CRN and to identify the core data elements needed to assess contraceptive medical product technologies. Design We applied a Delphi survey method approach to achieve consensus on a core minimum data set for the future CRN. A series of surveys were sent to the panel and answered by each expert anonymously and individually. Results from the surveys were collected, collated and analyzed by a study design team from Weill Cornell Medicine. After the first survey, questions for subsequent surveys were based on the analysis process and conference call discussions with group members. This process was repeated two times over a 6-month time period until consensus was achieved. Results Twenty-three experts participated in the Delphi process. Participation rates in the first and second round of the Delphi survey were 83% and 100%, respectively. The working group reached final consensus on 121 core data elements capturing reproductive/gynecological history, surgical history, general medical history, encounter information, long-acting/permanent contraceptive index procedures and follow-up, procedures performed in conjunction with the index procedure, product removal, medications, complications related to the long-acting and/or permanent contraceptive procedure, pregnancy and evaluation of safety and effectiveness outcomes. Conclusions The WHT-CRN expert group produced a consensus-based core set of data elements that allow the study of current and future contraceptives. These data elements influence patient and provider decisions about treatments and include important outcomes related to safety and effectiveness of these medical devices, which may benefit other women’s health stakeholders.
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Affiliation(s)
- Courtney E Baird
- Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Maryam Guiahi
- Department of Obstetrics and Gynecology, Division of Family Planning, University of Colorado—Anschutz Medical Campus, Aurora, Colorado, USA
| | - Scott Chudnoff
- Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, Connecticut, USA
| | - Nilsa Loyo-Berrios
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Stephanie Garcia
- Office of the National Coordinator for Health Information Technology, Washington, District of Columbia, USA
| | - Mary Jung
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Laura Elisabeth Gressler
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
- Department of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jialin Mao
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Beth Hodshon
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Art Sedrakyan
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Sharon Andrews
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Kelly Colden
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jason Roberts
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Abby Anderson
- Center for Drug Evaluation and Research (CDER), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Catherine Sewell
- Center for Drug Evaluation and Research (CDER), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
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Campbell Britton M, Petersen-Pickett J, Hodshon B, Chaudhry SI. Mapping the care transition from hospital to skilled nursing facility. J Eval Clin Pract 2020; 26:786-790. [PMID: 31309664 PMCID: PMC6962572 DOI: 10.1111/jep.13238] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/03/2019] [Accepted: 07/06/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE Care transitions between hospitals and skilled nursing facilities (SNFs) are often associated with breakdowns in communication that may place patients at risk for adverse events. Less is known about how to address these issues in the context of busy patient care settings. We used process mapping to examine hospital discharge and SNF admission processes to identify opportunities for improvement. METHODS A quality improvement (QI) team worked with frontline staff to create a process map illustrating the sequence of events involved with hospital discharge and SNF admission. The project was completed at an academic medical centre and two local SNFs in the north-eastern United States. Participants represented the care management, medicine, nursing, admissions, and physical therapy services. The data informed hospital QI interventions seeking to improve the quality and safety of hospital-SNF transfers and reduce unplanned hospital readmissions. RESULTS The final process map highlighted numerous activities that need to be coordinated between care teams, including the time-sensitive exchange of clinical and administrative information. Participants shared insights about how care teams reach critical decisions about patient disposition and post-acute care utilization. CONCLUSIONS Process mapping highlighted specific opportunities for improving communication between care teams. Participants advocated for earlier assessments of patients' functional status and support systems, including reliable at-home services. They also reasoned that improved communication would help patients and providers reach decisions together, coordinate work efforts, and better prepare for hospital discharge and SNF admission. This information can be used to improve patient care transitions between hospitals and SNFs.
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Affiliation(s)
| | | | - Beth Hodshon
- Yale School of Medicine, New Haven, Connecticut, United States
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States
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Fekieta R, Rosenberg A, Hodshon B, Feder S, Chaudhry SI, Emerson BL. Organisational factors underpinning intra-hospital transfers: a guide for evaluating context in quality improvement. Health Syst (Basingstoke) 2020; 10:239-248. [PMID: 34745587 DOI: 10.1080/20476965.2020.1768807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
During intra-hospital transfers, multiple clinicians perform coordinated tasks that leave patients vulnerable to undesirable outcomes. Communication has been established as a challenge to care transitions, but less is known about the organisational complexities within which transfers take place. We performed a qualitative assessment that included various professions to capture a multi-faceted understanding of intra-hospital transfers. Ethnographic observations and semi-structured interviews were conducted with clinicians and staff from the Medical Intensive Care Unit, Emergency Department, and general medicine units at a large, urban, academic, tertiary medical centre. Results highlight the organisational factors that stakeholders view as important for successful transfers: the development, dissemination, and application of protocols; robustness of technology; degree of teamwork; hospital capacity; and the ways in which competing hospital priorities are managed. These factors broaden our understanding of the organisational context of intra-hospital transfers and informed the development of a practical guide that can be used prior to embarking on quality improvement efforts around transitions of care.
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Affiliation(s)
- Renee Fekieta
- Center for Healthcare Innovation, Redesign & Learning, Yale University School of Medicine, New Haven, CT, USA
| | | | - Beth Hodshon
- Center for Healthcare Innovation, Redesign & Learning, Yale University School of Medicine, New Haven, CT, USA
| | - Shelli Feder
- Yale University School of Nursing, New Haven, CT, USA
| | - Sarwat I Chaudhry
- Center for Healthcare Innovation, Redesign & Learning, Yale University School of Medicine, New Haven, CT, USA
| | - Beth L Emerson
- Center for Healthcare Innovation, Redesign & Learning, Yale University School of Medicine, New Haven, CT, USA
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Finn EB, Campbell Britton MJ, Rosenberg AP, Sather JE, Marcolini EG, Feder SL, Sheth KN, Matouk CC, Pham LTL, Ulrich AS, Parwani VL, Hodshon B, Venkatesh AK. A Qualitative Study of Risks Related to Interhospital Transfer of Patients with Nontraumatic Intracranial Hemorrhage. J Stroke Cerebrovasc Dis 2019; 28:1759-1766. [PMID: 30879712 DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/28/2018] [Indexed: 12/26/2022] Open
Abstract
GOAL Interhospital transfer (IHT) facilitates access to specialized neurocritical care but may also introduce unique risk. Our goal was to describe providers' perceptions of safety threats during IHT for patients with nontraumatic intracranial hemorrhage. MATERIALS AND METHODS We employed qualitative, semi-structured interviews at an academic medical center receiving critically-ill neurologic transfers, and 5 referring hospitals. Interviewees included physicians, nurses, and allied health professionals with experience caring for patients transferred between hospitals for nontraumatic intracranial hemorrhage. Interviews continued until data saturation was reached. Coding occurred concurrently with interviews. Analysis was inductive, using the constant comparative method. FINDINGS The predominant impediments to safe, high-quality neurocritical care transitions between hospitals are insufficient communication, gaps in clinical practice, and lack of IHT structure. Insufficient communication highlights the unique communication challenges specific to IHT, which overlay and compound known intrahospital communication barriers. Gaps in clinical practice revolve primarily around the provision of neurocritical care for this patient population, often subject to resource availability, by receiving hospital emergency medicine providers. Lack of structure outlines providers' questions that emerge when institutions fail to identify process channels, expectations, and accountability during complex neurocritical care transitions. CONCLUSIONS The predominant impediments to safe, high-quality neurocritical care transitions between hospitals are insufficient communication, gaps in clinical practice, and lack of IHT structure. These themes serve as fundamental targets for quality improvement initiatives. To our knowledge, this is the first description of challenges to quality and safety in high-risk neurocritical care transitions through clinicians' voices.
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Affiliation(s)
| | | | | | | | | | - Shelli L Feder
- National Clinical Scholars Program, Yale School of Medicine/Department of Veterans Affairs, New Haven, Connecticut
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Jayaram NM, Khariton Y, Krumholz HM, Chaudhry SI, Mattera J, Tang F, Herrin J, Hodshon B, Spertus JA. Impact of Telemonitoring on Health Status. Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.117.004148. [PMID: 29237746 DOI: 10.1161/circoutcomes.117.004148] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/08/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Although noninvasive telemonitoring in patients with heart failure does not reduce mortality or hospitalizations, less is known about its effect on health status. This study reports the results of a randomized clinical trial of telemonitoring on health status in patients with heart failure. METHODS AND RESULTS Among 1521 patients with recent heart failure hospitalization randomized in the Tele-HF trial (Telemonitoring to Improve Heart Failure Outcomes), 756 received telephonic monitoring and 765 usual care. Disease-specific health status was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) within 2 weeks of discharge and at 3 and 6 months. Repeated measures linear regression models were used to assess differences in KCCQ scores between patients assigned to telemonitoring and usual care over 6 months. The baseline characteristics of the 2 treatment arms were similar (mean age, 61 years; 43% female and 39% black). Over the 6-month follow-up period, there was a statistically significant, but clinically small, difference between the 2 groups in their KCCQ overall summary and subscale scores. The average KCCQ overall summary score for those receiving telemonitoring was 2.5 points (95% confidence interval, 0.38-4.67; P=0.02) higher than usual care, driven primarily by improvements in symptoms (3.5 points; 95% confidence interval, 1.18-5.82; P=0.003) and social function (3.1 points; 95% confidence interval, 0.30-6.00; P=0.03). CONCLUSIONS Telemonitoring results in statistically significant, but clinically small, improvements in health status when compared with usual care. Given that the KCCQ was a secondary outcome, the benefits should be confirmed in future studies. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00303212.
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Affiliation(s)
- Natalie M Jayaram
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.)
| | - Yevgeniy Khariton
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.)
| | - Harlan M Krumholz
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.)
| | - Sarwat I Chaudhry
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.)
| | - Jennifer Mattera
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.)
| | - Fengming Tang
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.)
| | - Jeph Herrin
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.)
| | - Beth Hodshon
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.)
| | - John A Spertus
- From the Department of Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (Y.K., F.T., J.A.S.); Department of Cardiology and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT (H.M.K., S.I.C., J.H., B.H.); Yale New Haven Hospital Center for Outcomes Research and Evaluation, CT (H.M.K., J.M., B.H.); Yale University School of Public Health, New Haven, CT (J.M.); and Health Research and Educational Trust, Chicago, IL (J.H.).
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Rosenberg A, Britton MC, Feder S, Minges K, Hodshon B, Chaudhry SI, Jenq GY, Emerson BL. A taxonomy and cultural analysis of intra-hospital patient transfers. Res Nurs Health 2018; 41:10.1002/nur.21875. [PMID: 29722043 PMCID: PMC8459627 DOI: 10.1002/nur.21875] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 03/11/2018] [Indexed: 01/21/2023]
Abstract
Existing research on intra-hospital patient transitions focuses chiefly on handoffs, or exchanges of information, between clinicians. Less is known about patient transfers within hospitals, which include but extend beyond the exchange of information. Using participant observations and interviews at a 1,541-bed, academic, tertiary medical center, we explored the ways in which staff define and understand patient transfers between units. We conducted observations of staff (n = 16) working in four hospital departments and interviewed staff (n = 29) involved in transfers to general medicine floors from either the Emergency Department or the Medical Intensive Care Unit between February and September 2015. The collected data allowed us to understand transfers in the context of several hospital cultural microsystems. Decisions were made through the lens of the specific unit identity to which staff felt they belonged; staff actively strategized to manage workload; and empty beds were treated as a scarce commodity. Staff concepts informed the development of a taxonomy of intra-hospital transfers that includes five categories of activity: disposition, or determining the right floor and bed for the patient; notification to sending and receiving staff of patient assignment, departure and arrival; preparation to send and receive the patient; communication between sending and receiving units; and coordination to ensure that transfer components occur in a timely and seamless manner. This taxonomy widens the study of intra-hospital patient transfers from a communication activity to a complex cultural phenomenon with several categories of activity and views them as part of multidimensional hospital culture, as constructed and understood by staff.
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Affiliation(s)
| | | | | | - Karl Minges
- Yale School of Medicine, New Haven, Connecticut
| | | | | | - Grace Y. Jenq
- University of Michigan Health System, Ann Arbor, Michigan
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Krumholz HM, Chaudhry SI, Spertus JA, Mattera JA, Hodshon B, Herrin J. Do Non-Clinical Factors Improve Prediction of Readmission Risk?: Results From the Tele-HF Study. JACC Heart Fail 2015; 4:12-20. [PMID: 26656140 DOI: 10.1016/j.jchf.2015.07.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to determine whether a model that included self-reported socioeconomic, health status, and psychosocial characteristics obtained from patients recently discharged from hospitalizations for heart failure substantially improved 30-day readmission risk prediction compared with a model that incorporated only clinical and demographic factors. BACKGROUND Existing readmission risk models have poor discrimination and it is unknown whether they would be markedly improved by the inclusion of patient-reported information. METHODS As part of the Tele-HF (Telemonitoring to Improve Heart Failure Outcomes) trial, we conducted medical record abstraction and telephone interviews in a sample of 1,004 patients recently hospitalized for heart failure to obtain clinical, functional, and psychosocial information within 2 weeks of discharge. Candidate risk factors included 110 variables divided into 2 groups: demographic and clinical variables generally available from the medical record; and socioeconomic, health status, adherence, and psychosocial variables from patient interview. RESULTS The 30-day readmission rate was 17.1%. Using the 3-level risk score derived from the restricted medical record variables, patients with a score of 0 (no risk factors) had a readmission rate of 10.9% (95% confidence interval [CI]: 8.2% to 14.2%), and patients with a score of 2 (all risk factors) had a readmission rate of 32.1% (95% CI: 22.4% to 43.2%), a C-statistic of 0.62. Using the 5-level risk score derived from all variables, patients with a score of 0 (no risk factors) had a readmission rate of 9.6% (95% CI: 6.1% to 14.2%), and patients with a score of 4 (all risk factors) had a readmission rate of 55.0% (95% CI: 31.5% to 76.9%), a C-statistic of 0.65. CONCLUSIONS Self-reported socioeconomic, health status, adherence, and psychosocial variables are not dominant factors in predicting readmission risk for patients with heart failure. Patient-reported information improved model discrimination and extended the predicted ranges of readmission rates, but the model performance remained poor. (Telemonitoring to Improve Heart Failure Outcomes [Tele-HF]; NCT00303212).
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Affiliation(s)
- Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - John A Spertus
- Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Jennifer A Mattera
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Beth Hodshon
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Health Research and Educational Trust, Chicago, Illinois
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Ross JS, Blount KL, Ritchie JD, Hodshon B, Krumholz HM. Post-market clinical research conducted by medical device manufacturers: a cross-sectional survey. Med Devices (Auckl) 2015; 8:241-9. [PMID: 26060416 PMCID: PMC4454210 DOI: 10.2147/mder.s82964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In the US, once a medical device is made available for use, several requirements have been established by the US Food and Drug Administration (FDA) to ensure ongoing post-market surveillance of device safety and effectiveness. Our objective was to determine how commonly medical device manufacturers initiate post-market clinical studies or augment FDA post-market surveillance requirements for higher-risk devices that are most often approved via the FDA’s pre-market approval (PMA) pathway. Methods and results We conducted a cross-sectional survey of 47 manufacturers with operations in California, Minnesota, and Massachusetts who market devices approved via the PMA pathway. Among 22 respondents (response rate =47%), nearly all self-reported conducting post-market clinical research studies, commonly between 1 and 5; only 1 respondent reported never conducting post-market clinical research studies. While manufacturers most often engaged in these studies to satisfy FDA requirements, other reasons were reported, including performance monitoring and surveillance and market acceptance initiatives. Risks of conducting and not conducting post-market clinical research studies were described through open-ended response to questions. Conclusion Medical device manufacturers commonly initiate post-market clinical studies at the request of the FDA. Clinical data from these studies should be integrated into national post-market surveillance initiatives.
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Affiliation(s)
- Joseph S Ross
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Katrina L Blount
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Jessica D Ritchie
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Beth Hodshon
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
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Al-Damluji MS, Dzara K, Hodshon B, Punnanithinont N, Krumholz HM, Chaudhry SI, Horwitz LI. Hospital variation in quality of discharge summaries for patients hospitalized with heart failure exacerbation. Circ Cardiovasc Qual Outcomes 2015; 8:77-86. [PMID: 25587091 DOI: 10.1161/circoutcomes.114.001227] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Single-site studies have demonstrated inadequate quality of discharge summaries in timeliness, transmission, and content, potentially contributing to adverse outcomes. However, degree of hospital-level variation in discharge summary quality for patients hospitalized with heart failure (HF) is uncertain. METHODS AND RESULTS We analyzed discharge summaries of patients enrolled in the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) study. We assessed hospital-level performance on timeliness (fraction of summaries completed on the day of discharge), documented transmission to the follow-up physician, and content (presence of components suggested by the Transitions of Care Consensus Conference). We obtained 1501 discharge summaries from 1640 (91.5%) patients discharged alive from 46 hospitals. Among hospitals contributing ≥ 10 summaries, the median hospital dictated 69.2% of discharge summaries on the day of discharge (range, 0.0%-98.0%; P<0.001); documented transmission of 33.3% of summaries to the follow-up physician (range, 0.0%-75.7%; P<0.001); and included 3.6 of 7 Transitions of Care Consensus Conference elements (range, 2.9-4.5; P<0.001). Hospital course was typically included (97.2%), but summaries were less likely to include discharge condition (30.7%), discharge volume status (16.0%), or discharge weight (15.7%). No discharge summary included all 7 Transitions of Care Consensus Conference-endorsed content elements, was dictated on the day of discharge, and was sent to a follow-up physician. CONCLUSIONS Even at the highest performing hospital, discharge summary quality is insufficient in terms of timeliness, transmission, and content. Improvements in all aspects of discharge summary quality are necessary to enable the discharge summary to serve as an effective transitional care tool.
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Affiliation(s)
- Mohammed Salim Al-Damluji
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); and Division of Healthcare Delivery Science, Department of Population Health and Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine (L.I.H.)
| | - Kristina Dzara
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); and Division of Healthcare Delivery Science, Department of Population Health and Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine (L.I.H.)
| | - Beth Hodshon
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); and Division of Healthcare Delivery Science, Department of Population Health and Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine (L.I.H.)
| | - Natdanai Punnanithinont
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); and Division of Healthcare Delivery Science, Department of Population Health and Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine (L.I.H.)
| | - Harlan M Krumholz
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); and Division of Healthcare Delivery Science, Department of Population Health and Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine (L.I.H.)
| | - Sarwat I Chaudhry
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); and Division of Healthcare Delivery Science, Department of Population Health and Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine (L.I.H.)
| | - Leora I Horwitz
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); and Division of Healthcare Delivery Science, Department of Population Health and Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine (L.I.H.).
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Salim Al-Damluji M, Dzara K, Hodshon B, Punnanithinont N, Krumholz HM, Chaudhry SI, Horwitz LI. Association of discharge summary quality with readmission risk for patients hospitalized with heart failure exacerbation. Circ Cardiovasc Qual Outcomes 2015; 8:109-11. [PMID: 25587092 DOI: 10.1161/circoutcomes.114.001476] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mohammed Salim Al-Damluji
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); Division of Healthcare Delivery Science, Department of Population Health (L.I.H.) and Division of General Internal Medicine and Clinical Innovation (L.I.H.), Department of Medicine, New York University School of Medicine
| | - Kristina Dzara
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); Division of Healthcare Delivery Science, Department of Population Health (L.I.H.) and Division of General Internal Medicine and Clinical Innovation (L.I.H.), Department of Medicine, New York University School of Medicine
| | - Beth Hodshon
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); Division of Healthcare Delivery Science, Department of Population Health (L.I.H.) and Division of General Internal Medicine and Clinical Innovation (L.I.H.), Department of Medicine, New York University School of Medicine
| | - Natdanai Punnanithinont
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); Division of Healthcare Delivery Science, Department of Population Health (L.I.H.) and Division of General Internal Medicine and Clinical Innovation (L.I.H.), Department of Medicine, New York University School of Medicine
| | - Harlan M Krumholz
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); Division of Healthcare Delivery Science, Department of Population Health (L.I.H.) and Division of General Internal Medicine and Clinical Innovation (L.I.H.), Department of Medicine, New York University School of Medicine
| | - Sarwat I Chaudhry
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); Division of Healthcare Delivery Science, Department of Population Health (L.I.H.) and Division of General Internal Medicine and Clinical Innovation (L.I.H.), Department of Medicine, New York University School of Medicine
| | - Leora I Horwitz
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); Division of Healthcare Delivery Science, Department of Population Health (L.I.H.) and Division of General Internal Medicine and Clinical Innovation (L.I.H.), Department of Medicine, New York University School of Medicine.
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Krumholz HM, Gross CP, Blount KL, Ritchie JD, Hodshon B, Lehman R, Ross JS. Sea change in open science and data sharing: leadership by industry. Circ Cardiovasc Qual Outcomes 2014; 7:499-504. [PMID: 24891590 PMCID: PMC4146622 DOI: 10.1161/circoutcomes.114.001166] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Krumholz HM, Ross JS, Gross CP, Emanuel EJ, Hodshon B, Ritchie JD, Low JB, Lehman R. A historic moment for open science: the Yale University Open Data Access project and medtronic. Ann Intern Med 2013; 158:910-1. [PMID: 23778908 PMCID: PMC5459387 DOI: 10.7326/0003-4819-158-12-201306180-00009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Mattera JA, Chaudhry S, Lin Z, Curry L, Hodshon B, Herrin J, Merry B, Krumholz HM. Abstract P25: Factors Associated with Patients' Adoption and Adherence to a Heart Failure Telemonitoring System. Circ Cardiovasc Qual Outcomes 2011. [DOI: 10.1161/circoutcomes.4.suppl_2.ap25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Despite numerous studies of telemonitoring (TM), the use of technology to monitor patients remotely, information about patients' adoption and adherence to using such technologies is scarce. The objective of this study was to determine the patient characteristics associated with: 1) initiating use of TM and 2) adherence to using daily TM over 6 months.
Methods:
We evaluated all 826 patients enrolled in the TM arm of the Tele-HF multicenter RCT. TM consisted of a telephone-based interactive voice response system whereby patients reported symptoms and weight daily for 6 months. The adherence rate was calculated as the # of weeks the patient used the TM system at least 3 days/week over 6-month study period. Multivariable hierarchical regression was used to identify factors independently associated with initiation of and adherence to TM.
Results:
The mean ± SD age of patients was 61.1 ± 15.3 years (range 19-90), 44% were women, and 50% were of minority race. Overall, 14% (119/ 826) never initiated use of TM. In the multivariable analysis, younger patients (age < 65) and patients with higher satisfaction with care were more likely to initiate TM (p-values ≤ .03) (Figure). Among the 707 patients who initiated TM, adherence averaged 90% in week 1 and 55% in week 26. Younger patients and those with lower health literacy had lower rates of adherence to using TM over 6 months (p-values ≤ .004).
Conclusion:
Age, satisfaction with care and health literacy were associated with utilization of a TM system for the management of HF. Understanding more about how patient nonclinical factors impact use of new technologies such as TM, may improve the design and effectiveness of TM strategies.
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