1
|
Hayden EM, Nentwich LM, Jung OS, Zheng H, White BA. Patient Perceptions of Emergency Department Observation Care at Home. Telemed J E Health 2024. [PMID: 38597956 DOI: 10.1089/tmj.2023.0705] [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: 04/11/2024] Open
Abstract
Introduction: The Virtual Observation Unit (VOU) utilizes telehealth and community paramedicine to provide observation-level care in patients' homes. Patients' experience of this novel program has not been reported. Methods: A phone-based patient experience survey was administered to the patients who were admitted to the VOU at an urban, academic Emergency Department in the Northeast United States. The survey asked about patient's perception of the program's quality of care (0 = worst care possible, 10 = best care possible). t Tests with a Bonferroni adjustment assessed for differences between patient demographic groups. Results: The survey response rate was 40% (124/307). Overall mean scores for perceived quality of care were very high (9.51 ± 1.19). There were no significant differences in patient's perception of quality of care between demographic cohorts of age, gender, race, or ethnicity. Conclusions: Patient experience with a novel VOU program was very positive and did not differ significantly by demographic cohort. Further research is warranted.
Collapse
Affiliation(s)
- Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren M Nentwich
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Olivia S Jung
- Department of Health Policy and Management, University of California-Los Angeles, Los Angeles, California, USA
| | - Hui Zheng
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Benjamin A White
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Markus DH, Colasanti CA, Kaplan DJ, Manjunath AK, Alaia MJ, Strauss EJ, Jazrawi LM, Campbell KA. High Rate of Patient Satisfaction with Either Telemedicine or Traditional Office-Based Follow-Up Visit After Arthroscopic Shoulder Surgery. Telemed J E Health 2024; 30:134-140. [PMID: 37318834 DOI: 10.1089/tmj.2022.0220] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Background: The purpose of this study was to determine if any differences exist in patient satisfaction with office-based visits versus telemedicine visits following arthroscopic shoulder surgery. Methods: Patients undergoing shoulder arthroscopy were prospectively enrolled for 1 year. Patient demographic and clinical data (including complication events) and second postoperative visit satisfaction data were recorded and analyzed for statistical significance. Results: Ninety-six (n = 96) patients met inclusion criteria. Fifty-four patients (56.3%) participated in a traditional in-person office visit, and 42 participated in a video visit (43.8%). No significant differences were found between office and video appointments in terms of overall care satisfaction (9.46 ± 0.9 vs. 9.55 ± 1.0, p = 0.67). Females were significantly less satisfied with their second postoperative visit compared with males (8.3 ± 2.3 vs. 9.3 ± 1.5, p = 0.035). Significantly more females would also have preferred a traditional in person office visit compared with males (91% vs. 67%, p = 0.009). Video appointment patients spent significantly more time with their surgeon than office visit patients (57.64 mean rank vs. 41.39 mean rank, p = 0.003). Discussion: Video visit patients required significantly less time overall for their visit and spent significantly more time with their surgeon, although did not demonstrate differences in satisfaction.
Collapse
Affiliation(s)
- Danielle H Markus
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Christopher A Colasanti
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Daniel J Kaplan
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Amit K Manjunath
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Michael J Alaia
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Eric J Strauss
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Laith M Jazrawi
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Kirk A Campbell
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| |
Collapse
|
3
|
Nagy P, Sax B, Kozák A, Merkely B, Osztheimer I, Jobbágy Á. Automatic non-invasive blood pressure measurement in left ventricular assist device patients with a photoplethysmography assisted device. Int J Artif Organs 2023; 46:274-279. [PMID: 37051689 DOI: 10.1177/03913988231168159] [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: 04/14/2023]
Abstract
INTRODUCTION Non-invasive measurement of blood pressure in patients with a left ventricular assist device (LVAD) is challenging due to the mechanical properties of these circulatory support devices. Keeping blood pressure in a target range is crucial to reduce the risk of LVAD complications. As current assessment methods require trained personnel resulting in infrequent monitoring, devices for home-based measurements are sorely needed. OBJECTIVES In this paper, we report a measurement method and a custom-made monitoring device based on photoplethysmography (PPG) enabling automated measurement of the mean arterial pressure (MAP) of patients with LVAD. METHODS The method and the device were tested on 21 adult patients with LVAD, and the estimated MAP values were compared to MAP values measured simultaneously by a human expert applying the commonly used Doppler-based method. RESULTS Results of the proposed method showed highly significant correlation with Doppler-based MAP values (R = 0.85 for inflation, p < 0.001; R = 0.96 for deflation, p<0.001). The mean difference of the proposed method to the Doppler-based MAP values was 1.48 ± 5.43 mmHg for inflation and -0.19 ± 2.71 mmHg for deflation. CONCLUSION The results demonstrate that the proposed method is a promising direction to achieve accurate, automated, non-invasive BP measurement, applicable in home health monitoring for patients with LVAD.
Collapse
Affiliation(s)
- Péter Nagy
- Department of Measurement and Information Systems, Faculty of Electrical Engineering and Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Balázs Sax
- Heart and Vascular Centre, Department of Cardiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Anna Kozák
- Heart and Vascular Centre, Department of Cardiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Centre, Department of Cardiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - István Osztheimer
- Heart and Vascular Centre, Department of Cardiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ákos Jobbágy
- Department of Measurement and Information Systems, Faculty of Electrical Engineering and Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| |
Collapse
|
4
|
Adamkiewicz D, Atri L, Berman L, Broughton R, Jones C, Maslesa A, Lyon M. Implementation of a Telemedicine Student Clinical Experience. Telemed J E Health 2023; 29:432-441. [PMID: 35852847 DOI: 10.1089/tmj.2022.0127] [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: 10/17/2022] Open
Abstract
Background: As part of a curricular change, an academic medical center implemented a medical student telemedicine clinical experience for first-year medical students in October 2020. This research is a process evaluation of the implementation of a preclerkship medical student telemedicine clinical experience. Methods: Patients with two or more chronic diseases were recruited from affiliated primary care practices. We monitored the recruitment and retainment of patients throughout the curriculum. We used surveys to evaluate patient, student, and primary care overall experience with the program. We tracked referrals to higher levels of care and assessed skills students' felt they practice with each encounter. We followed progression of notes through chart review as the year progressed. Results: Of the 408 patients contacted, 150 agreed to participate in this program (36%). Of 1,053 scheduled visits, 686 (65%) were successfully completed. Seventy-five percent of patients were seen two or more times. Nearly 70% of surveyed patients felt that the clinical experience enhanced their communication with their primary care provider, and nearly 90% stated that students were "somewhat" or "extremely" professional. The majority (97%) of students reported an "excellent" or "good" view of the medical student telemedicine clinical experience. Qualitative measures of student performance, such as note writing, showed improvement over the course of the curriculum. Conclusions: Our data suggest that patients, students, and primary care providers were widely accepting of the curriculum, patients were successfully recruited and retained, and students successfully practiced key clinical skills on a telemedicine platform.
Collapse
Affiliation(s)
- Daniel Adamkiewicz
- Center for Ultrasound Education, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Lavannya Atri
- Center for Ultrasound Education, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Lindsay Berman
- Center for Ultrasound Education, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Robert Broughton
- Department of Medicine and Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Cara Jones
- Center for Ultrasound Education, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Ana Maslesa
- Center for Ultrasound Education, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Matthew Lyon
- Department of Emergency Medicine, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| |
Collapse
|
5
|
Chan A, Cohen R, Robinson KM, Bhardwaj D, Gregson G, Jutai JW, Millar J, Ríos Rincón A, Roshan Fekr A. Evidence and User Considerations of Home Health Monitoring for Older Adults: Scoping Review. JMIR Aging 2022; 5:e40079. [PMID: 36441572 DOI: 10.2196/40079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/06/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Home health monitoring shows promise in improving health outcomes; however, navigating the literature remains challenging given the breadth of evidence. There is a need to summarize the effectiveness of monitoring across health domains and identify gaps in the literature. In addition, ethical and user-centered frameworks are important to maximize the acceptability of health monitoring technologies. OBJECTIVE This review aimed to summarize the clinical evidence on home-based health monitoring through a scoping review and outline ethical and user concerns and discuss the challenges of the current user-oriented conceptual frameworks. METHODS A total of 2 literature reviews were conducted. We conducted a scoping review of systematic reviews in Scopus, MEDLINE, Embase, and CINAHL in July 2021. We included reviews examining the effectiveness of home-based health monitoring in older adults. The exclusion criteria included reviews with no clinical outcomes and lack of monitoring interventions (mobile health, telephone, video interventions, virtual reality, and robots). We conducted a quality assessment using the Assessment of Multiple Systematic Reviews (AMSTAR-2). We organized the outcomes by disease and summarized the type of outcomes as positive, inconclusive, or negative. Second, we conducted a literature review including both systematic reviews and original articles to identify ethical concerns and user-centered frameworks for smart home technology. The search was halted after saturation of the basic themes presented. RESULTS The scoping review found 822 systematic reviews, of which 94 (11%) were included and of those, 23 (24%) were of medium or high quality. Of these 23 studies, monitoring for heart failure or chronic obstructive pulmonary disease reduced exacerbations (4/7, 57%) and hospitalizations (5/6, 83%); improved hemoglobin A1c (1/2, 50%); improved safety for older adults at home and detected changing cognitive status (2/3, 66%) reviews; and improved physical activity, motor control in stroke, and pain in arthritis in (3/3, 100%) rehabilitation studies. The second literature review on ethics and user-centered frameworks found 19 papers focused on ethical concerns, with privacy (12/19, 63%), autonomy (12/19, 63%), and control (10/19, 53%) being the most common. An additional 7 user-centered frameworks were studied. CONCLUSIONS Home health monitoring can improve health outcomes in heart failure, chronic obstructive pulmonary disease, and diabetes and increase physical activity, although review quality and consistency were limited. Long-term generalized monitoring has the least amount of evidence and requires further study. The concept of trade-offs between technology usefulness and acceptability is critical to consider, as older adults have a hierarchy of concerns. Implementing user-oriented frameworks can allow long-term and larger studies to be conducted to improve the evidence base for monitoring and increase the receptiveness of clinicians, policy makers, and end users.
Collapse
Affiliation(s)
- Andrew Chan
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Rachel Cohen
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Katherine-Marie Robinson
- School of Engineering Design and Teaching Innovation, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada.,Department of Philosophy, Faculty of Arts, University of Ottawa, Ottawa, ON, Canada
| | - Devvrat Bhardwaj
- Department of Electrical Engineering and Computer Science, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Geoffrey Gregson
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Jeffrey W Jutai
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,LIFE Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jason Millar
- School of Engineering Design and Teaching Innovation, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada.,Department of Philosophy, Faculty of Arts, University of Ottawa, Ottawa, ON, Canada
| | - Adriana Ríos Rincón
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Atena Roshan Fekr
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
6
|
Durojaiye OC, Jibril I, Kritsotakis EI. Effectiveness of telemedicine in outpatient parenteral antimicrobial therapy (Tele-OPAT): A systematic review. J Telemed Telecare 2022:1357633X221131842. [PMID: 36221964 DOI: 10.1177/1357633x221131842] [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: 11/15/2022]
Abstract
INTRODUCTION Telemedicine is increasingly used to deliver healthcare in many clinical specialities. However, the adoption of telemedicine in the delivery of outpatient parenteral antimicrobial therapy (OPAT) has been relatively slow and limited. This study aims to collate current evidence for telemedicine in OPAT regarding clinical efficacy, safety, acceptability and cost-effectiveness. METHODS We systematically searched the Cochrane Library, CINAHL, EMCARE, EMBASE and MEDLINE databases through 24 July 2022, for relevant studies published in English. Research articles and conference abstracts were included if they involved any form of telephone or video consultation in delivering parenteral antibiotics in the home or outpatient setting. Study findings were synthesised into three main themes: patient outcomes and safety, patient and provider satisfaction and cost-effectiveness. The mixed methods appraisal tool was used to review the methodological quality of the studies. PROSPERO CRD42022342874. RESULTS The literature search yielded 311 articles, of which 12 (five full-length articles and seven conference abstracts) reporting over 1245 telemedicine interventions were reviewed. The reported outcomes were heterogeneous. Telemedicine was cost-effective and associated with high patient satisfaction and comparable complication rates compared to conventional OPAT. Considering six comparative studies, rehospitalisation risk was lower for telemedicine than conventional OPAT (risk ratio, 0.58; 95% confidence interval, 0.38-0.88; I2 = 31%). DISCUSSION The results of this review demonstrate that telemedicine has a role in delivering safe and cost-effective OPAT care, especially for patients residing in remote and geographically isolated locations. Nevertheless, high-quality studies and publication of existing data and experiences are needed to further validate this model of care delivery.
Collapse
Affiliation(s)
- Oyewole Christopher Durojaiye
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, UK
- Department of Microbiology, Royal Derby Hospital, Derby, UK
| | - Ihsan Jibril
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, UK
| | - Evangelos I Kritsotakis
- Laboratory of Biostatistics, 37778School of Medicine, University of Crete, Heraklion, Greece
- School of Health and Related Research, Faculty of Medicine, Dentistry and Health, 7315University of Sheffield, Sheffield, UK
| |
Collapse
|
7
|
Rochmawati E, Kamilah F, Iskandar AC. Acceptance of e-health technology among older people: A qualitative study. Nurs Health Sci 2022; 24:437-446. [PMID: 35297152 DOI: 10.1111/nhs.12939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/15/2021] [Revised: 02/17/2022] [Accepted: 03/12/2022] [Indexed: 01/04/2023]
Abstract
E-health technology has been widely implemented in healthcare systems and has many benefits. However, available studies that focus on the acceptance and adoption of e-health technology, particularly among older people in primary care centers, are still limited. A qualitative approach was adopted in this study to explore the acceptability and adoption of health technology among older people who use primary health care. Semistructured interviews were conducted with 11 older people to gain in-depth insight into their perspectives on health technology. An inductive thematic analysis was conducted to gain insight from older people. Three main themes emerged: (1) "demand of care" refers a situation where participants realized that they had a health problem, sought ways to solve the health problem, and expected to be cared and monitored; (2) "resistance and openness" represent technology acceptance by older people; and (3) "preference for home health monitoring": We found older people preferred home health monitoring in terms of comfort and ease of use. The study has provided important new knowledge in relation to acceptance and preference for health technology that currently exists, particularly among older people in Indonesia.
Collapse
Affiliation(s)
- Erna Rochmawati
- School of Master in Nursing, Universitas of Muhammadiyah Yogyakarta, Bantul, Indonesia
| | - Farhah Kamilah
- School of Master in Nursing, Universitas of Muhammadiyah Yogyakarta, Bantul, Indonesia
| | - Ayuk Cucuk Iskandar
- School of Master in Nursing, Universitas of Muhammadiyah Yogyakarta, Bantul, Indonesia
| |
Collapse
|
8
|
Muller AE, Berg RC, Jardim PSJ, Johansen TB, Ormstad SS. Can Remote Patient Monitoring Be the New Standard in Primary Care of Chronic Diseases, Post-COVID-19? Telemed J E Health 2021; 28:942-969. [PMID: 34665645 DOI: 10.1089/tmj.2021.0399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/13/2023] Open
Abstract
Background: One lesson from the current COVID-19 pandemic is the need to optimize health care provision outside of traditional settings, and potentially over longer periods of time. An important strategy is remote patient monitoring (RPM), allowing patients to remain at home, while they transmit health data and receive follow-up services. Materials and Methods: We conducted an overview of the latest systematic reviews that had included randomized controlled trials with adult patients with chronic diseases. We summarized results and displayed these in forest plots, and used GRADE (Grading of Recommendations Assessment, Development, and Evaluation) to assess our certainty of the evidence. Results: We included 4 systematic reviews that together reported on 11 trials that met our definition of RPM, each including patients with diabetes and/or hypertension. RPM probably makes little to no difference on HbA1c levels. RPM probably leads to a slight reduction in systolic blood pressure, with questionable clinical meaningfulness. RPM probably has a small negative effect on the physical component of health-related quality of life, but the clinical significance of this reduction is uncertain. We have low confidence in the finding that RPM makes no difference to the remaining five primary outcomes. Conclusion: Most of our findings are consistent with reviews of other, broader definitions of RPM. The type of RPM examined in this review is as effective as standard treatment for patients with diabetes/hypertension. If this or other types of RPM are to be used for "long covid" patients or for other chronic disease groups post-pandemic, we need to understand why RPM may negatively affect quality of life.
Collapse
Affiliation(s)
- Ashley Elizabeth Muller
- Department of Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
| | - Rigmor C Berg
- Department of Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway.,Department of Community Medicine, The Arctic University of Norway, University of Tromsø, Tromsø, Norway
| | | | - Trine Bjerke Johansen
- Department of Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
| | - Sari Susanna Ormstad
- Department of Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
9
|
Ho K, Novak Lauscher H, Cordeiro J, Hawkins N, Scheuermeyer F, Mitton C, Wong H, McGavin C, Ross D, Apantaku G, Karim ME, Bhullar A, Abu-Laban R, Nixon S, Smith T. Testing the Feasibility of Sensor-Based Home Health Monitoring (TEC4Home) to Support the Convalescence of Patients With Heart Failure: Pre-Post Study. JMIR Form Res 2021; 5:e24509. [PMID: 34081015 PMCID: PMC8212633 DOI: 10.2196/24509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/18/2020] [Accepted: 03/16/2021] [Indexed: 01/29/2023] Open
Abstract
Background Patients with heart failure (HF) can be affected by disabling symptoms and low quality of life. Furthermore, they may frequently need to visit the emergency department or be hospitalized due to their condition deteriorating. Home telemonitoring can play a role in tracking symptoms, reducing hospital visits, and improving quality of life. Objective Our objective was to conduct a feasibility study of a home health monitoring (HHM) solution for patients with HF in British Columbia, Canada, to prepare for conducting a randomized controlled trial. Methods Patients with HF were recruited from 3 urban hospitals and provided with HHM technology for 60 days of monitoring postdischarge. Participants were asked to monitor their weight, blood pressure, and heart rate and to answer symptomology questions via Bluetooth sensors and a tablet computer each day. A monitoring nurse received this data and monitored the patient’s condition. In our evaluation, the primary outcome was the combination of unscheduled emergency department revisits of discharged participants or death within 90 days. Secondary outcomes included 90-day hospital readmissions, patient quality of life (as measured by Veterans Rand 12-Item Health Survey and Kansas City Cardiomyopathy Scale), self-efficacy (as measured by European Heart Failure Self-Care Behaviour Scale 9), end-user experience, and health system cost-effectiveness including cost reduction and hospital bed capacity. In this feasibility study, we also tested the recruitment strategy, clinical protocols, evaluation framework, and data collection methods. Results Seventy participants were enrolled into this trial. Participant engagement to monitoring was measured at 94% (N=70; ie, data submitted 56/60 days on average). Our evaluation framework allowed us to collect sound data, which also showed encouraging trends: a 79% reduction of emergency department revisits post monitoring, an 87% reduction in hospital readmissions, and a 60% reduction in the median hospital length of stay (n=36). Cost of hospitalization for participants decreased by 71%, and emergency department visit costs decreased by 58% (n=30). Overall health system costs for our participants showed a 56% reduction post monitoring (n=30). HF-specific quality of life (Kansas City Cardiomyopathy Scale) scores showed a significant increase of 101% (n=35) post monitoring (P<.001). General quality of life (Veterans Rand 12-Item Health Survey) improved by 19% (n=35) on the mental component score (P<.001) and 19% (n=35) on the physical component score (P=.02). Self-efficacy improved by 6% (n=35). Interviews with participants revealed that they were satisfied overall with the monitoring program and its usability, and participants reported being more engaged, educated, and involved in their self-management. Conclusions Results from this small-sample feasibility study suggested that our HHM intervention can be beneficial in supporting patients post discharge. Additionally, key insights from the trial allowed us to refine our methods and procedures, such as shifting our recruitment methods to in-patient wards and increasing our scope of data collection. Although these findings are promising, a more rigorous trial design is required to test the true efficacy of the intervention. The results from this feasibility trial will inform our next step as we proceed with a randomized controlled trial across British Columbia. Trial Registration ClinicalTrials.gov NCT03439384; https://clinicaltrials.gov/ct2/show/NCT03439384
Collapse
Affiliation(s)
- Kendall Ho
- Digital Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Helen Novak Lauscher
- Digital Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Cordeiro
- Digital Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Craig Mitton
- Centre for Clinical Epidemiology & Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Hubert Wong
- Centre for Health Evaluation & Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Colleen McGavin
- BC Support for People & Patient-Oriented Research & Trials, Vancouver, BC, Canada
| | - Dianne Ross
- Vancouver General Hospital, Vancouver, BC, Canada
| | - Glory Apantaku
- Centre for Clinical Epidemiology & Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Mohammad Ehsan Karim
- Centre for Health Evaluation & Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Amrit Bhullar
- Digital Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Suzanne Nixon
- University of British Columbia, Vancouver, BC, Canada
| | | |
Collapse
|
10
|
Kodama R, Arora S, Anand S, Choudhary A, Weingarten J, Francesco N, Chiricolo G, Silber S, Mehta PH. Reengineering the Discharge Transition Process of COVID-19 Patients Using Telemedicine, Remote Patient Monitoring, and Around-the-Clock Remote Patient Monitoring from the Emergency Department and Inpatient Units. Telemed J E Health 2020; 27:1188-1193. [PMID: 33320031 DOI: 10.1089/tmj.2020.0459] [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] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: At the beginning of the COVID-19 pandemic, New York City quickly became the epicenter with hospitals at full capacity needing to care for patients. At New York Presbyterian Brooklyn Methodist Hospital, we needed to develop an innovative system of how to safely discharge the massive influx of patients. Inundation of patient care with limited manpower and resources forced us to align with a third-party vendor, around-the-clock alert, to make remote patient monitoring (RPM) possible. Each patient was prescribed a pulse oximeter and nurses were assigned to monitor vital signs, speak to patients, and escalate to physicians if required. Results: We enrolled 50 patients, of whom 13 were escalated resulting in 3 emergency room visits and 1 readmission. We had a high compliance rate with high patient satisfaction in postsurveys. Discussion: Our program was unique in that it utilized telemedicine for regular patient follow-up, along with RPM through a third-party vendor. Patients were able to be safely discharged home with close follow-up through regularly obtained vitals with access to a 24/7 hotline for any emergencies, possibly preventing readmissions. Limitations include a small sample size population. Conclusions: Our experience shows that in a short period despite lack of resources, telehealth and RPM's concurrent use with a third-party vendor could be successfully utilized for safe discharges with high patient satisfaction.
Collapse
Affiliation(s)
- Rich Kodama
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Sunny Arora
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Swati Anand
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Abu Choudhary
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Jeremy Weingarten
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Notar Francesco
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Gerardo Chiricolo
- Department of Emergency Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Steven Silber
- Department of Emergency Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Parag H Mehta
- Department of Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| |
Collapse
|
11
|
Kayser MZ, Valtin C, Greer M, Karow B, Fuge J, Gottlieb J. Video Consultation During the COVID-19 Pandemic: A Single Center's Experience with Lung Transplant Recipients. Telemed J E Health 2020; 27:807-815. [PMID: 33054671 DOI: 10.1089/tmj.2020.0170] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/24/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has disrupted health care systems worldwide. This is due to both to the reallocation of resources toward COVID-19 patients as well as concern for the risk of nosocomial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure. The interruption of routine care is especially problematic for patients with chronic conditions requiring regular follow-up, such as lung transplant (LTx) recipients. Introduction: New methods such as telemedicine are needed to bridge the gap in follow-up care caused by the pandemic. Materials and Methods: A retrospective analysis of video consultations (VCs) in comparison with on-site visits (OSVs) was performed during a 6-week period in an LTx center in Germany. VC included a structured work-up questionnaire and vital sign documentation. Results: During the 6-week study period, 75 VCs were performed for 53 patients and 75 OSVs by 51 patients occurred. By the end of our study period, 77% of physician-patient contacts occurred through VC. Physician-patient consultations were reduced by 47% compared with the equivalent time frame in 2019. In 62% of cases, VC resulted in a concrete clinical decision. One COVID-19 patient in home quarantine was admitted due to respiratory failure detected by VC. Patient satisfaction with VC was high. Discussion: Implementation of VC helped to reduce the need for OSV and thus the risk of SARS-CoV-2 exposure in our patient cohort. This technology can be adopted to provide care for a wide range of chronic illnesses. Conclusions: VC can preserve access to specialist care while reducing SARS-CoV-2 exposure for patients with chronic illnesses during the pandemic.
Collapse
Affiliation(s)
- Moritz Z Kayser
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Christina Valtin
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Bernd Karow
- Department for Hospital Innovation and Quality Management, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
| |
Collapse
|
12
|
Wong JA, Dang LT, Phan NT, Le TK, Vu NC, Vu TD, James S, Katona P, Katona L, Rosen J, Wong FY, Nguyen CK. Effectiveness of an Automated Error Checking and Feedback System to Improve Text Message Reporting for Disease Surveillance in Viet Nam. Telemed J E Health 2020; 27:448-453. [PMID: 32673154 DOI: 10.1089/tmj.2020.0065] [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: 11/13/2022] Open
Abstract
Purpose: Viet Nam currently relies on a manual paper-based system to track and monitor 28 major infectious diseases. This inefficient system takes 2 or more months to complete. Method: We designed and pilot tested the use of text messaging to report certain infectious disease symptoms in rural areas of northern Viet Nam. The project was divided into three 6-month phases carried out in two provinces. The current analysis focuses on the implementation of a two-way feedback system between Phases II and III, which aims at (1) evaluating whether this system improves efficiency by determining the number of correctly (vs. incorrectly) formatted text messages; (2) assessing this system's influence on accuracy by comparing text messages with their respective official paper-based documented forms; and (3) determining whether the amount of information required to report through text messages influences the efficiency and accuracy of the text messages. Results: Between Phases II and III, results revealed a significant improvement in correctly formatted texts in comparison to incorrectly formatted texts. As the number of fields required to report increased, the number of correctly formatted texts (efficiency) as well as the number of matched text messages (accuracy) decreased. Conclusion: Our research demonstrates that an automated error bidirectional feedback system can significantly improve both the efficiency and accuracy of a Short Message Service-based method for disease surveillance. Also, our data may suggest that two-way communication has better engaged health care staff to follow reporting protocols as well as to maintain accuracy from their clinic's own data.
Collapse
Affiliation(s)
| | - Linh Thuy Dang
- Institute of Population, Health and Development, Hanoi, Vietnam
| | - Ngoc Tran Phan
- Institute of Population, Health and Development, Hanoi, Vietnam
| | - Thuy Kim Le
- Dartmouth College, Hanover, New Hampshire, USA
| | - Nguyen Cong Vu
- Institute of Population, Health and Development, Hanoi, Vietnam
| | - Thiem Dinh Vu
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Peter Katona
- University of California, Los Angeles, Los Angeles, California, USA
| | - Lindsay Katona
- Santa Barbara Cottage Hospital, Santa Barbara, California, USA
| | | | - Frank Y Wong
- Florida State University, Tallahassee, Florida, USA.,University of Hawaii at Mānoa, Honolulu, Hawaii, USA
| | | |
Collapse
|
13
|
Affiliation(s)
- Dylan A Mordaunt
- Office for the Chief Medical Information Officer, Digital Health, SA Health, Adelaide, Australia.,School of Medicine, The University of Adelaide, Adelaide, Australia
| |
Collapse
|
14
|
Abstract
Telemedicine could be a key to control the world-wide disruptive and spreading novel coronavirus disease (COVID-19) pandemic. The COVID-19 virus directly targets the lungs, leading to pneumonia-like symptoms and shortness of breath with life-threatening consequences. Despite the fact that self-quarantine and social distancing are indispensable during the pandemic, the procedure for testing COVID-19 contraction is conventionally available through nasal swabs, saliva test kits, and blood work at healthcare settings. Therefore, devising personalized self-testing kits for COVID-19 virus and other similar viruses is heavily admired. Many e-health initiatives have been made possible by the advent of smartphones with embedded software, hardware, high-performance computing, and connectivity capabilities. A careful review of breathing sounds and their implications in identifying breathing complications suggests that the breathing sounds of COVID-19 contracted users may reveal certain acoustic signal patterns, which is worth investigating. To this end, acquiring respiratory data solely from breathing sounds fed to the smartphone's microphone strikes as a very appealing resolution. The acquired breathing sounds can be analyzed using advanced signal processing and analysis in tandem with new deep/machine learning and pattern recognition techniques to separate the breathing phases, estimate the lung volume, oxygenation, and to further classify the breathing data input into healthy or unhealthy cases. The ideas presented have the potential to be deployed as self-test breathing monitoring apps for the ongoing global COVID-19 pandemic, where users can check their breathing sound pattern frequently through the app.
Collapse
Affiliation(s)
- Miad Faezipour
- Department of Computer Science & Engineering and University of Bridgeport, Bridgeport, Connecticut, USA.,Department of Biomedical Engineering, University of Bridgeport, Bridgeport, Connecticut, USA
| | - Abdelshakour Abuzneid
- Department of Computer Science & Engineering and University of Bridgeport, Bridgeport, Connecticut, USA
| |
Collapse
|
15
|
López Seguí F, Batlle Boada A, García García JJ, López Ulldemolins A, Achotegui Del Arco A, Adroher Mas C, García Cuyàs F. Families' Degree of Satisfaction With Pediatric Telehomecare: Interventional Prospective Pilot Study in Catalonia. JMIR Pediatr Parent 2020; 3:e17517. [PMID: 32213471 PMCID: PMC7146252 DOI: 10.2196/17517] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/30/2020] [Accepted: 02/10/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric home hospitalization improves the quality of life of children and their families, involving them in their children's care, while favoring the work-life balance of the family. In this context, technology guarantees accessibility to assistance, which provides security to users. From the perspective of the health care system, this could lower the demand for hospital services and reduce hospitalization costs. OBJECTIVE This study aimed to assess families' degree of satisfaction and acceptability of pediatric telehomecare and explore the clinical characteristics of children benefiting from the program. METHODS A total of 95 children and their families participated in the home-hospitalization pilot program operated by Sant Joan de Déu Hospital in Barcelona, Spain. Families were visited once a day and patients were monitored using a kit consisting of a scale, a thermometer, a pulse oximeter, and a blood pressure monitor. Data on parental experience, satisfaction, safety, and preference for care was collected by means of a questionnaire. Data about the children's characteristics were collected from medical records. Descriptive and comparative statistics were used to analyze the data. RESULTS A total of 65 survey respondents expressed very high levels of satisfaction. Families reported their experiences as being very positive, preferring home hospitalization in 94% (61/65) of cases, and gave high scores regarding the use of telemonitoring devices. The program did not record any readmissions after 72 hours and reported a very low number of adverse incidents. The user profile was very heterogeneous, highlighting a large number of respiratory patients and patients with infections that required endovenous antibiotic therapy. CONCLUSIONS Pediatric home hospitalization through telemonitoring is a feasible and desirable alternative to traditional hospitalization, both from the perspective of families and the hospital. The results of this analysis showed a very high degree of satisfaction with the care received and that the home-based telemonitoring system resulted in few adverse incidents.
Collapse
Affiliation(s)
- Francesc López Seguí
- TIC Salut Social, Ministry of Health, Barcelona, Spain.,Centre for Research in Health and Economics, Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | | | | | | | | | | | | |
Collapse
|
16
|
Alencar M, Johnson K, Gray V, Mullur R, Gutierrez E, Dionico P. Telehealth-Based Health Coaching Increases m-Health Device Adherence and Rate of Weight Loss in Obese Participants. Telemed J E Health 2020; 26:365-368. [PMID: 30994410 PMCID: PMC7071022 DOI: 10.1089/tmj.2019.0017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/23/2019] [Accepted: 02/26/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Healthy rate of weight loss (RWL) is defined as 1-2 lb of body weight loss per week. Objective: The objective of this study is to investigate changes in adherence to remote monitoring devices and RWL per week in response to a fully online, 12-week, medically monitored, weight management program incorporating weekly video-based health coaching (intervention group [INT]) versus self-guided (control group [CON]). Methods: Twenty-five obese participants (12 males, 13 females) were randomly assigned to either an INT (n = 13, 106.8 ± 25.46 kg, body mass index [BMI] = 35.19 ± 3.91 kg/m2) or CON group (n = 12, 99.8 ± 19.14 kg, BMI = 34.86 ± 4.43 kg/m2). Program related content was derived from inHealth Medical Services, Inc., Telehealth Enabled Approach to Multidisciplinary care (TEAM™) curriculum. All participants were given two wireless devices (Activity Pop and Body Scale; Withings®, Cambridge, MA) that connected them directly with the research team. The INT group connected via telehealth videoconferencing weekly for health coaching with the registered dietitian and monthly for medical monitoring with the physician, while the CON group did not. Both groups connected with the physician and registered dietitian at baseline to establish clinical goals and at the end to review progress. To analyze the data, independent samples t-tests and χ2 tests were performed via SPSS v24 with data displayed as average ± SD; significance set to p < 0.05. Results: The INT group had increased device adherence when compared with CON (92% ± 10% vs. 75% ± 15% scale [p < 0.05]) and (80% ± 14% vs. 49% ± 15% tracker [p < 0.05]). Furthermore, RWL per week was greater in the INT when compared with CON; -0.74 ± 1.8 kg versus 0.18 ± 1.8 kg per week, respectively (p < 0.05). Conclusions: Weekly health coaching via telehealth can be an effective tool to increase remote device adherence and may help to induce a healthy RWL.
Collapse
Affiliation(s)
- Michelle Alencar
- Department of Kinesiology, California State University, Long Beach, Long Beach, California
- inHealth Medical Services, Inc., Los Angeles, California
| | - Kelly Johnson
- Department of Kinesiology, Coastal Carolina University, Conway, South Carolina
| | - Virginia Gray
- Department of Family and Consumer Sciences, Nutrition and Dietetics, California State University, Long Beach, Long Beach, California
| | - Rashmi Mullur
- Division of Endocrinology, Diabetes, and Metabolism, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Elizabeth Gutierrez
- Department of Family and Consumer Sciences, Nutrition and Dietetics, California State University, Long Beach, Long Beach, California
| | - Patricia Dionico
- Department of Kinesiology, California State University, Long Beach, Long Beach, California
| |
Collapse
|
17
|
Abstract
Introduction: A variety of team-based telehealth interventions have recently been developed and piloted in a number of practice settings. Despite the variety of intervention designs, clinical inertia (CI) continues to be problematic for therapeutic intensification and subsequent disease control. Commentary: Based on recent literature, pharmacists have the ability to mitigate a number of factors contributing to CI. Considering CI continues to limit overall effectiveness of team-based telehealth interventions, involving pharmacists more intentionally in these interventions would provide benefit to therapeutic intensification and therapeutic outcomes.
Collapse
Affiliation(s)
- Logan T Murry
- The University of Iowa College of Pharmacy, Iowa City, Iowa, USA
| | - Korey Kennelty
- The University of Iowa College of Pharmacy, Iowa City, Iowa, USA
| |
Collapse
|
18
|
Abstract
Introduction: Remote patient monitoring or telemonitoring aims at improving patient care through digitally transmitted health-related data. That allows early detection of disease decompensation and intervention, patient education and improves patient-physician relationship. Despite its relevance, there are no comprehensive reviews evaluating the variables discussed by clinical studies on telemonitoring. Methods: A systematic literature search of PubMed was performed to identify studies about telemonitoring published between 2000 and 2018. These had to be case reports with >5 cases, comparative or clinical studies/trials. The following variables were evaluated: year of publication, author's country, discussed topic, objective of study, follow-up time, number of telemonitoring patients, primary outcome, use of teleconsultation and tele-education, presence of a control group, effectiveness of telemonitoring, telemonitoring strategies, and level of evidence. Results: After screening 947 records, 272 articles were included. The review showed a growing number of publications over the years, with 43.0% being published between 2015 and 2018, providing generally positive results (76.8%). The United States was responsible for 38.2% of articles. Cardiovascular disease was the topic of 47.8% of studies, whereas surgical pathologies and postoperative care represented only 2.6%. Wireless devices or smartphone apps were the most popular strategy (75.7%), with 17.6% of studies employing tele-education and 24.6% employing teleconsultation measures. Most publications were OCEBM Level of Evidence 2 (73.5%). Conclusion: Telemonitoring appears to maximize patient care and effectiveness of treatment. The number of publications illustrates the growing interest in the matter. Telemonitoring has yet to be evaluated in the setting of postoperative care and surgical pathologies.
Collapse
Affiliation(s)
| | - Carolina Matté Dagostini
- Cell Therapy Laboratory (LATEC), and University of Caxias do Sul (UCS), Caxias do Sul, Rio Grande do Sul, Brazil
| | - Yan de Assunção Bicca
- Cell Therapy Laboratory (LATEC), and University of Caxias do Sul (UCS), Caxias do Sul, Rio Grande do Sul, Brazil
| | - Vincenzo Fin Falavigna
- Cell Therapy Laboratory (LATEC), and University of Caxias do Sul (UCS), Caxias do Sul, Rio Grande do Sul, Brazil
| | - Asdrubal Falavigna
- Health Sciences Postgraduate Program, University of Caxias do Sul (UCS), Caxias do Sul, Rio Grande do Sul, Brazil
| |
Collapse
|
19
|
Abstract
Introduction: Parkinson's disease affects over 10 million people globally, and ∼20% of patients with Parkinson's disease have not been diagnosed as such. The clinical diagnosis is costly: there are no specific tests or biomarkers and it can take days to diagnose as it relies on a holistic evaluation of the individual's symptoms. Existing research either predicts a Unified Parkinson Disease Rating Scale rating, uses other key Parkinsonian features such as tapping, gait, and tremor to diagnose an individual, or focuses on different audio features. Methods: In this article, we present a classification approach implemented as an iOS App to detect whether an individual has Parkinson's using 10-s audio clips of the individual saying "aaah" into a smartphone. Results: The 1,000 voice samples analyzed were obtained from the mPower (mobile Parkinson Disease) study, which collected 65,022 voice samples from 5,826 unique participants. Conclusions: The experimental results comparing 12 different methods indicate that our approach achieves 99.0% accuracy in under a second, which significantly outperforms both prior diagnosis methods in the accuracy achieved and the efficiency of clinical diagnoses.
Collapse
Affiliation(s)
| | - Wenyao Xu
- Department of Computer Science and Engineering, State University of New York at Buffalo, Buffalo, New York
| |
Collapse
|
20
|
Echarri A, Vera I, Ollero V, Arajol C, Riestra S, Robledo P, Calvo M, Gallego F, Ceballos D, Castro B, Aguas M, García-López S, Marín-Jiménez I, Chaparro M, Mesonero P, Guerra I, Guardiola J, Nos P, Muñiz J. The Harvey-Bradshaw Index Adapted to a Mobile Application Compared with In-Clinic Assessment: The MediCrohn Study. Telemed J E Health 2019; 26:80-88. [PMID: 30848700 PMCID: PMC6948001 DOI: 10.1089/tmj.2018.0264] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 12/26/2022] Open
Abstract
Objectives: Mobile apps are useful tools in e-health and self-management strategies in disease monitoring. We evaluated the Harvey–Bradshaw index (HBI) mobile app self-administered by the patient to see if its results agreed with HBI in-clinic assessed by a physician. Methods: Patients were enrolled in a 4-month prospective study with clinical assessments at months 1 and 4. Patients completed mobile app HBI and within 48 h, HBI was performed by a physician (gold standard). HBI scores characterized Crohn's disease (CD) as remission <5 or active ≥5. We determined agreement per item and total HBI score and intraclass correlation coefficients (ICCs). Bland–Altman plot was performed. HBI changes in disease activity from month 1 to month 4 were determined. Results: A total of 219 patients were enrolled. All scheduled assessments (385 pairs of the HBI questionnaire) showed a high percentage of agreement for remission/activity (92.4%, κ = 0.796), positive predictive value (PPV) for remission of 98.2%, and negative predictive value of 76.7%. High agreement was also found at month 1 (93.15%, κ = 0.82) and month 4 (91.5%, κ = 0.75). Bland–Altman plot was more uniform when the HBI mean values were <5 (remission). ICC values were 0.82, 0.897, and 0.879 in all scheduled assessments, 1 and 4 months, respectively. Conclusions: We found a high percentage of agreement between patients' self-administered mobile app HBI and in-clinic physician assessment to detect CD activity with a remarkably high PPV for remission. The mobile app HBI might allow a strict control of inflammation by remote monitoring and flexible follow-up of CD patients. Reduction of sanitary costs could be possible.
Collapse
Affiliation(s)
- Ana Echarri
- Gastroenterology Department, University Hospital, Ferrol, Spain
| | - Isabel Vera
- Gastroenterology Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Virginia Ollero
- Gastroenterology Department, University Hospital, Ferrol, Spain
| | - Claudia Arajol
- Gastroenterology Department, Bellvitge University Hospital; IDIBELL Barcelona University, Barcelona, Spain
| | - Sabino Riestra
- Gastroenterology Department, Central University Hospital, Oviedo, Spain
| | - Pilar Robledo
- Gastroenterology Department, San Pedro de Alacantara University Hospital, Cáceres, Spain
| | - Marta Calvo
- Gastroenterology Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Franscisco Gallego
- Gastroenterology Department, Poniente University Hospital, Almeria, Spain
| | - Daniel Ceballos
- Gastroenterology Department, Dr. Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | - Beatriz Castro
- Gastroenterology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Mariam Aguas
- Gastroenterology Department, La Fe University Hospital, Valencia, Spain
| | | | | | - María Chaparro
- Gastroenterology Department, Instituto de Investigación Sanitaria Princesa and CIBERehd, La Princesa University Hospital, Madrid, Spain
| | - Paco Mesonero
- Gastroenterology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Iván Guerra
- Gastroenterology Department, Fuenlabrada University Hospital, Madrid, Spain
| | - Jordi Guardiola
- Gastroenterology Department, Bellvitge University Hospital; IDIBELL Barcelona University, Barcelona, Spain
| | - Pilar Nos
- Gastroenterology Department, La Fe University Hospital, Valencia, Spain
| | - Javier Muñiz
- Instituto Universitario de Ciencias de La Salud e INIBIC, La Coruña University, La Coruña, Spain
| |
Collapse
|
21
|
Walia S, Wolfe D, Keast D, Ho C, Ethans K, Worley S, O'Connell C, Hill D. Facilitators and Barriers for Implementing an Internet Clinic for the Treatment of Pressure Injuries. Telemed J E Health 2019; 25:1237-1243. [PMID: 30707656 DOI: 10.1089/tmj.2018.0196] [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] [Indexed: 11/13/2022] Open
Abstract
Background: Pressure injuries (PIs) represent a frequent, often preventable, secondary complication of spinal cord injury (SCI) with serious consequences to health, societal participation, and quality of life. Specialized knowledge and service delivery related to treatment and prevention are typically located within major health centers. Introduction: For persons with SCI living at home, it can be challenging to access specialized PI care. A telehealth approach could help mitigate this challenge. This multisite pilot investigation assessed the feasibility of integrating information technologies within the management of PIs. Materials and Methods: Each study site formed a specialized interdisciplinary care team that identified components of their standard clinical care pathway and examined how they could be integrated with study technologies. A monitoring system was utilized to enable patients and caregivers to exchange clinical information with the care team. Results: Clinician and patient focus groups were completed to identify facilitators and barriers for long-term implementation. Findings demonstrate that this method of service delivery is feasible but requires further development. Discussion: This model of care requires refinement to address technological, regulatory, and clinician acceptance barriers; however, increased access to these services has the potential for improving PI healing or prevention rates in comparison with those not able to access specialized services. Conclusions: This project demonstrates that PI treatment services can be delivered effectively through the internet. Future trials can investigate efficacy and cost-effectiveness of this model of care to inform sustained implementation.
Collapse
Affiliation(s)
- Saagar Walia
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada
| | - Dalton Wolfe
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada.,University of Western Ontario, London, Ontario, Canada
| | - David Keast
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada
| | - Chester Ho
- Alberta Health Services, Alberta, Canada.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Karen Ethans
- Spinal Cord Rehabilitation Program, Winnipeg Health Sciences Centre, Winnipeg, Manitoba, Canada.,Department of Internal Medicine's Section of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott Worley
- Stan Cassidy Centre for Rehabilitation, Fredericton, New Brunswick, Canada.,Division of Physical Medicine & Rehabilitation, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Colleen O'Connell
- Stan Cassidy Centre for Rehabilitation, Fredericton, New Brunswick, Canada.,Division of Physical Medicine & Rehabilitation, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Faculty of Kinesiology, University of New Brunswick, New Brunswick, Canada
| | - Denise Hill
- Alberta Health Services, Alberta, Canada.,Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
22
|
Abstract
Background: Children with medical complexity (CMC) are high utilizers of health care services. Telehealth encounters may provide a means to improve care outcomes for this population. Objective: To evaluate the feasibility, usability, and impact of an in-home telehealth device in the care of CMC. Methods: This single-center feasibility study employed a nonblinded randomized clinical trial design. English-speaking caregivers of children within a pediatric complex care program with home Wi-Fi were eligible for participation. Participants were randomized 1.5:1 with stratification based on tracheostomy status to a control group that received usual care or an intervention group that received a telehealth device for in-home use. Patients were followed up for 4 months. The primary outcome was successful device connectivity and data transmission. Data included clinician encounter device usability; caregiver satisfaction; and encounter type, purpose, and cost. Descriptive statistics, negative binomial regression, and Kaplan–Meier plot were used for analysis. Results: Twenty-four patients were enrolled (9 controls, 15 in the intervention group) in September 2016. The telehealth device was attempted in 73 encounters. Device connectivity was successful 96% of the time. Image and sound quality were acceptable in 98% of visits. Caregivers expressed their overall satisfaction with the device. The hospitalization rate was lower in the intervention group (0.77 vs. 1.14 intensive care unit days/patient-months), resulting in $9,425/USD per patient savings compared with the control group. Conclusion: Despite small sample size and short observation period, this study demonstrated that use of an in-home telehealth device is feasible, well received by caregivers, and can result in decreased hospitalizations when compared with usual care.
Collapse
|
23
|
Liu J, Wong WT, Zwetsloot IM, Hsu YC, Tsui KL. Preliminary Agreement on Tracking Sleep Between a Wrist-Worn Device Fitbit Alta and Consensus Sleep Diary. Telemed J E Health 2019; 25:1189-1197. [PMID: 30601109 DOI: 10.1089/tmj.2018.0202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Sleep is related to various kinds of health outcomes. Many studies traditionally collect data on sleep using questionnaires or sleep diaries. An increasing popular alternative is a wrist-worn device. The accuracy of these devices is uncertain, and assessment of this accuracy is important. Introduction: The purpose of this study is to compare consensus sleep diary (CSD) and an actigraphy-based wrist-worn device (Fitbit Alta™ [Fitbit, San Francisco, CA]) measurements of total sleep time (TST), sleep onset latency, wake time after sleep onset, number of awakenings, and sleep efficiency. Materials and Methods: Ten healthy young adults (50% female, 100% Asian) in the age range between 20 to 24 years old wore a Fitbit Alta around their nondominated hand during seven consecutive nights. The participants also filled in a CSD every day. Results: On average, the wrist-worn device (Fitbit Alta) recorded a TST per night of 437.15 min, which is 5.46 min shorter on average than the CSD recorded (442.61 min). Bland-Altman plots indicate that there is large variance in the sleep recorded between Fitbit™ (Fitbit, San Francisco, CA) and CSD. For example, Fitbit recorded 2.15 more awakenings per night than CSD, which is equal to 13.09 min on average longer wake time after sleep onset. Conclusion: Fitbit and CSD show significant differences in recording sleep. We find that for most sleep metrics, the level of disagreement is small enough for the devices to be interchangeably used except for recording wakes during the night.
Collapse
Affiliation(s)
- Jiaxing Liu
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon, Hong Kong
| | - Wing To Wong
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon, Hong Kong
| | - Inez Maria Zwetsloot
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon, Hong Kong
| | - Yu Cheng Hsu
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon, Hong Kong
| | - Kwok Leung Tsui
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon, Hong Kong
| |
Collapse
|
24
|
Li CZ, Borycki EM. Smart Homes for Healthcare. Stud Health Technol Inform 2019; 257:283-287. [PMID: 30741210] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Smart Homes may improve the care received by the elderly and those with disabilities that prevent them from conveniently accessing care from providers. This paper examines the structures and mechanisms of Smart Homes, explores the advantages and disadvantages for patients receiving care from the comfort of their own homes and describes a model that can be used to view the needs of patients involving Smart Home technologies.
Collapse
Affiliation(s)
- Cindy Zhirui Li
- University of Victoria, School of Health Information Science, Victoria, Canada
| | - Elizabeth M Borycki
- University of Victoria, School of Health Information Science, Victoria, Canada
| |
Collapse
|
25
|
Pekmezaris R, Nouryan CN, Schwartz R, Castillo S, Makaryus AN, Ahern D, Akerman MB, Lesser ML, Bauer L, Murray L, Pecinka K, Zeltser R, Zhang M, DiMarzio P. A Randomized Controlled Trial Comparing Telehealth Self-Management to Standard Outpatient Management in Underserved Black and Hispanic Patients Living with Heart Failure. Telemed J E Health 2018; 25:917-925. [PMID: 30418101 PMCID: PMC6784489 DOI: 10.1089/tmj.2018.0219] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 12/19/2022] Open
Abstract
Background: Although the American Heart Association promotes telehealth models to improve care access, there is limited literature on its use in underserved populations. This study is the first to compare utilization and quality of life (QoL) for underserved black and Hispanic heart failure (HF) patients assigned to telehealth self-monitoring (TSM) or comprehensive outpatient management (COM) over 90 days. Methods: This randomized controlled trial enrolled 104 patients. Outcomes included emergency department (ED) visits, hospitalizations, QoL, depression, and anxiety. Binary outcomes for utilization were analyzed using chi-square or Fisher's exact test. Poisson or negative binomial regression, repeated-measures analysis of variance, or generalized estimating equations were also used as appropriate. Results: Of 104 patients, 31% were Hispanic, 69% black, 41% women, and 72% reported incomes of <$10,000/year. Groups did not differ regarding binary ED visits (relative risk [RR] = 1.37, confidence interval [CI] = 0.83–2.27), hospitalization (RR = 0.92, CI = 0.57–1.48), or length of stay in days (TSM = 0.54 vs. COM = 0.91). Number of all-cause hospitalizations was significantly lower for COM (TSM = 0.78 vs. COM = 0.55; p = 0.03). COM patients reported greater anxiety reduction from baseline to 90 days (TSM = 50–28%; COM = 57–13%; p = 0.05). Conclusions: These findings suggest that TSM is not effective in reducing utilization or improving QoL for underserved patients with HF. Future studies are needed to determine whether TSM can be effective for populations facing health care access issues.
Collapse
Affiliation(s)
- Renee Pekmezaris
- Department of Medicine, Northwell Health, Manhasset, New York.,Department of Medicine and Department of Community Health, Zucker School of Medicine, Hempstead, New York.,Department of Occupational Medicine Epidemiology and Prevention, Northwell Health, Great Neck, New York.,Department of Biostatistics, The Feinstein Institute of Medical Research, Manhasset, New York
| | - Christian N Nouryan
- Department of Medicine, Northwell Health, Manhasset, New York.,Department of Medicine and Department of Community Health, Zucker School of Medicine, Hempstead, New York.,Department of Biostatistics, The Feinstein Institute of Medical Research, Manhasset, New York
| | - Rebecca Schwartz
- Department of Occupational Medicine Epidemiology and Prevention, Northwell Health, Great Neck, New York
| | - Stacy Castillo
- Department of Cardiology, Heart Failure Center, Nassau University Medical Center, East Meadow, New York
| | - Amgad N Makaryus
- Department of Medicine, Northwell Health, Manhasset, New York.,Department of Cardiology, Heart Failure Center, Nassau University Medical Center, East Meadow, New York
| | - Deborah Ahern
- Department of Cardiology, Heart Failure Center, Nassau University Medical Center, East Meadow, New York
| | - Meredith B Akerman
- Department of Biostatistics, The Feinstein Institute of Medical Research, Manhasset, New York
| | - Martin L Lesser
- Department of Medicine, Northwell Health, Manhasset, New York.,Department of Medicine and Department of Community Health, Zucker School of Medicine, Hempstead, New York.,Department of Biostatistics, The Feinstein Institute of Medical Research, Manhasset, New York
| | - Lorinda Bauer
- Department of Cardiology, Heart Failure Center, Nassau University Medical Center, East Meadow, New York
| | - Lawrence Murray
- Community Advisory Board, Northwell Health, Manhasset, New York
| | - Kathleen Pecinka
- Nursing Department, Queensborough Community College, Bayside, New York
| | - Roman Zeltser
- Department of Medicine, Northwell Health, Manhasset, New York.,Department of Cardiology, Heart Failure Center, Nassau University Medical Center, East Meadow, New York
| | - Meng Zhang
- Department of Medicine, Northwell Health, Manhasset, New York.,Department of Biostatistics, The Feinstein Institute of Medical Research, Manhasset, New York
| | - Paola DiMarzio
- Department of Medicine, Northwell Health, Manhasset, New York.,Department of Medicine and Department of Community Health, Zucker School of Medicine, Hempstead, New York.,Department of Occupational Medicine Epidemiology and Prevention, Northwell Health, Great Neck, New York.,Department of Biostatistics, The Feinstein Institute of Medical Research, Manhasset, New York
| |
Collapse
|
26
|
Abstract
Background: If blood pressure (BP) measurement is important to monitor blood hypertension and other cardiac diseases, and can be taken using a wrist device, learned societies recommend to take it in specific conditions. In a telemedicine context, patients are likely to perform it without any help from a medical practitioner. Therefore, the device must guide individuals using it. Materials and Methods: A smartwatch application integrating an Attitude and Heading Reference System algorithm was developed. It was combined with a wrist BP monitor to help users position the BP monitor properly. Results: The system was tested on 30 individuals and a survey conducted to evaluate its usability. The experiment showed that individuals needed to be guided to measure correctly their BP and our application helped them in positioning the wrist BP monitor in a user-friendly way. Conclusions: In a telemedicine context, it is possible to guide easily individuals to position correctly any commercialized wrist BP monitor using a smartwatch. Manufacturers could also integrate affordable sensors into their BP monitors to provide this assistance without the need of external devices.
Collapse
Affiliation(s)
- Nawras Georgi
- Signal and Image Processing Laboratory, University of Rennes, Rennes, France.,AZNetwork, Alençon, France
| | - Aline Corvol
- Geriatric Service, University Hospital of Rennes, Rennes, France.,Center for Research on Political Action in Europe, University of Rennes, Rennes, France
| | | |
Collapse
|
27
|
Tophøj KH, Petersen MG, Sæbye C, Baad-Hansen T, Wagner S. Validity and Reliability Evaluation of Four Commercial Activity Trackers' Step Counting Performance. Telemed J E Health 2018; 24:669-677. [PMID: 29303680 DOI: 10.1089/tmj.2017.0264] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 11/12/2022] Open
Abstract
INTRODUCTION Activity trackers are useful tools for physical rehabilitation purposes. Most available activity trackers are designed for fitness and wellness use, lacking in both accuracy and precision at lower speeds. Validity and reliability at all clinically relevant speeds are crucial selection criteria for use in clinical practice. The aim of this study was to assess the validity and reliability of four consumer-based activity trackers at clinical relevant walking speeds for patient groups undergoing rehabilitation. METHODS The four commercial activity trackers Fitbit Surge (FS), Fitbit Charge HR (FC), Microsoft Band 2 (MB), and A&D 101NFC Activity Monitor (A&D) were evaluated at 2, 4, 4.5, and 5.5 km/h. Twenty healthy participants aged 25.6 ± 2 years walked on a treadmill at the four velocities in two trials of 100 steps each. Mean average percentage error (MAPE), intraclass correlation coefficient (ICC), and Bland-Altman 95% limits of agreement were calculated to assess validity and reliability. RESULTS MAPE levels were between -8% and -6% for FS, -15% and 0% for MB, 7% and 21% for FC, and -53% and 1% for AD. The biggest inaccuracies were seen at 2 km/h, where AD underestimated by 53%. The highest accuracy was predominantly found with MB and AD, which overestimated ≤2% at velocities ≥4 km/h. ICC was moderate (0.73) for FS, good (0.88) for MB, moderate (0.52) for FC, and excellent (0.98) for AD. CONCLUSIONS MB, FS, and AD accurately counted steps, when participants walked with velocities corresponding to a brisk walk (≥4 km/h). Walking at lower speeds (≤2 km/h) was not counted accurately. Thus, the four evaluated activity trackers are not useful for patient groups walking at lower speeds during rehabilitation, nor for counting indoor walking.
Collapse
Affiliation(s)
| | | | - Casper Sæbye
- 2 Department of Orthopedic Surgery, Aarhus University Hospital , Aarhus, Denmark
| | - Thomas Baad-Hansen
- 2 Department of Orthopedic Surgery, Aarhus University Hospital , Aarhus, Denmark
| | - Stefan Wagner
- 1 Department of Engineering, Aarhus University , Aarhus, Denmark
| |
Collapse
|
28
|
Abstract
BACKGROUND Health monitoring within a telehealth program is a strategy to efficiently care for older adults with heart failure (HF). Limited description is identified in the literature for the extent participant submissions trigger an alert or monitoring nurses transfer telehealth alert-range data to the medical record. INTRODUCTION The aim was to describe the initial 90 days of participant submissions measuring within alert range and nurse response to alerts with documentation to the medical record. MATERIALS AND METHODS Review of telehealth and medical records of 187 older veterans with HF participating at one Veterans Administration Care Coordination Home Telehealth program led to reporting the proportion of participant telehealth submissions measuring within alert range and nurse response to alert-range data. RESULTS Less than 2.5% of self-rated health status and nearly one-quarter of physiologic submissions measured within alert range. Timely nurse response averaged 28.7% and increased when submissions for vital signs, weight, or medication alerted for consecutive days. Neither alert nor nurse response data were significantly associated with characteristic measures. DISCUSSION Clinical relevance of alert-range telehealth data is uncertain partly due to frequent alerts triggered by physiologic submissions, few health status changes noted by the participant or the monitoring nurse, and the nonsignificant association between the proportion of alerts or nurse response, respectively, with demographic or clinical baseline measures. CONCLUSIONS Future studies are needed to identify telehealth program measures that decrease alerting data not associated with clinical worsening and increase recognition-of-change in HF health status by the participant and monitoring nurse.
Collapse
Affiliation(s)
- Mary M Murphy
- Egan School of Nursing and Health Studies, Fairfield University , Fairfield, Connecticut
| |
Collapse
|
29
|
Bright P, Hambly K. What Is the Proportion of Studies Reporting Patient and Practitioner Satisfaction with Software Support Tools Used in the Management of Knee Pain and Is This Related to Sample Size, Effect Size, and Journal Impact Factor? Telemed J E Health 2017; 24:562-576. [PMID: 29265954 DOI: 10.1089/tmj.2017.0207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION E-health software tools have been deployed in managing knee conditions. Reporting of patient and practitioner satisfaction in studies regarding e-health usage is not widely explored. The objective of this review was to identify studies describing patient and practitioner satisfaction with software use concerning knee pain. MATERIALS AND METHODS A computerized search was undertaken: four electronic databases were searched from January 2007 until January 2017. Keywords were decision dashboard, clinical decision, Web-based resource, evidence support, and knee. Full texts were scanned for effect of size reporting and satisfaction scales from participants and practitioners. Binary regression was run; impact factor and sample size were predictors with indicators for satisfaction and effect size reporting as dependent variables. RESULTS Seventy-seven articles were retrieved; 37 studies were included in final analysis. Ten studies reported patient satisfaction ratings (27.8%): a single study reported both patient and practitioner satisfaction (2.8%). Randomized control trials were the most common design (35%) and knee osteoarthritis the most prevalent condition (38%). Electronic patient-reported outcome measures and Web-based training were the most common interventions. No significant dependency was found within the regression models (p > 0.05). DISCUSSION AND CONCLUSIONS The proportion of reporting of patient satisfaction was low; practitioner satisfaction was poorly represented. There may be implications for the suitability of administering e-health, a medium for capturing further meta-evidence needs to be established and used as best practice for implicated studies in future. This is the first review of its kind to address patient and practitioner satisfaction with knee e-health.
Collapse
Affiliation(s)
- Philip Bright
- 1 Research Department, European School of Osteopathy , Kent, United Kingdom
- 2 School of Sports and Exercise Sciences, University of Kent at Medway , Kent, United Kingdom
| | - Karen Hambly
- 2 School of Sports and Exercise Sciences, University of Kent at Medway , Kent, United Kingdom
| |
Collapse
|
30
|
Huis In't Veld R, Peters A, Vollenbroek-Hutten M, Hermens H, van den Hoven C. Patient Needs for an Ambulant Dislocation Alert System Following Total Hip Arthroplasty. Telemed J E Health 2017; 24:386-394. [PMID: 29252130 DOI: 10.1089/tmj.2017.0092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/05/2023] Open
Abstract
INTRODUCTION One of the major complications in total hip arthroplasty (THA) is dislocation of the prosthesis. To prevent early dislocation, patients are instructed with movement restrictions. The first goal in this development is to obtain insight in the movement restrictions that are reported to have low levels of self-efficacy during activities of daily life. The second goal is to reveal the design needs for an ambulant hip dislocation alert system (HipDas) and the third goal is to explore its usability among patients. METHODS Patient-centered experiences with THA were explored by the use of a questionnaire and a semistructured focus group. The questionnaire was administered among n = 32 THA patients at 1 week preoperative and at 3 and 6 weeks postoperative. The questions addressed self-efficacy, performance and effort expectancy, and usefulness and social influence. The focus group consisted of patient journeys and scenario composition. The usability of a prototype version of the HipDas system was evaluated (n = 5). RESULTS Flexion of the hip >90°, bending over while sitting in a chair, and sleeping in a supine position are the restrictions that have the lowest self-efficacy. The majority of patients (>86.6%) believe that a future HipDas is useful. Focus group outcomes suggest there is a gradual decrease in the threshold for feedback. The system is preferably used in the first 6 weeks after surgery and appeared to be usable and highly clinically relevant. DISCUSSION HipDas is considered an interesting concept that can accelerate functional recovery of patients following THA by providing support on how to properly apply postoperative movement restrictions to prevent a dislocation.
Collapse
Affiliation(s)
| | - Anil Peters
- 1 Hip Unit, OCON Centre for Orthopaedic Surgery , Hengelo, The Netherlands
| | | | | | | |
Collapse
|
31
|
Tomlinson S, Behrmann S, Cranford J, Louie M, Hashikawa A. Accuracy of Smartphone-Based Pulse Oximetry Compared with Hospital-Grade Pulse Oximetry in Healthy Children. Telemed J E Health 2017; 24:527-535. [PMID: 29215972 DOI: 10.1089/tmj.2017.0166] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 11/12/2022] Open
Abstract
BACKGROUND Pulse oximetry, a ubiquitous, noninvasive method to monitor oxygen saturation (SpO2), requires larger, nonportable equipment. Smartphone pulse oximeter applications (apps) provide a portable, cost-effective option, but are untested in children. We hypothesize that smartphone pulse oximetry will not be inferior to standard pulse oximetry measured in healthy children. MATERIALS AND METHODS Two main types of pulse oximetry apps, a camera-based app (CBA) that uses a phone camera flash and lens and a probe-based app (PBA) that uses an external plug-in probe, were compared with standard pulse oximetry measured in children ages 2-13 years without a respiratory complaint and a triage SpO2 ≥97% seen in a pediatric Emergency Department. Two investigators obtained heart rate and SpO2 using each app. Inter-rater reliability was tested using interclass correlations (ICCs), and Bland-Altman method was used to compare app values to triage measurements. RESULTS Eighty-one patients were enrolled. ICC for SpO2 for PBA and CBA were 0.73 and -0.24, respectively. The 95% limits of agreement between the PBA SpO2 and triage SpO2 were -2.8 to +2.5 compared with -4.1 to +3.5 for the CBA SpO2 and triage SpO2. Mean differences between triage SpO2 and the PBA SpO2 (-0.17%) and triage SpO2 and CBA SpO2 (-0.33%) were not statistically significant. DISCUSSION AND CONCLUSIONS Smartphone-based pulse oximetry is not inferior to standard pulse oximetry in pediatric patients without hypoxia. Reliability was superior for PBA compared with CBA, with more precise agreement for the PBA compared with the CBA. Future studies should test pulse oximetry apps in a hypoxic pediatric population.
Collapse
Affiliation(s)
- Sarah Tomlinson
- Department of Emergency Medicine, Michigan Medicine at University of Michigan , Ann Arbor, Michigan
| | - Sydney Behrmann
- Department of Emergency Medicine, Michigan Medicine at University of Michigan , Ann Arbor, Michigan
| | - James Cranford
- Department of Emergency Medicine, Michigan Medicine at University of Michigan , Ann Arbor, Michigan
| | - Marisa Louie
- Department of Emergency Medicine, Michigan Medicine at University of Michigan , Ann Arbor, Michigan
| | - Andrew Hashikawa
- Department of Emergency Medicine, Michigan Medicine at University of Michigan , Ann Arbor, Michigan
| |
Collapse
|
32
|
Ciemins EL, Arora A, Coombs NC, Holloway B, Mullette EJ, Garland R, Walsh Bishop-Green S, Penso J, Coon PJ. Improving Blood Pressure Control Using Smart Technology. Telemed J E Health 2017; 24:222-228. [PMID: 28930497 DOI: 10.1089/tmj.2017.0028] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 01/25/2023] Open
Abstract
BACKGROUND The authors sought to determine if wireless oscillometric home blood pressure monitoring (HBPM) that integrates with smartphone technology improves blood pressure (BP) control among patients with new or existing uncontrolled hypertension (HTN). METHODS A prospective observational cohort study monitored BP control before and after an educational intervention and introduction to HBPM. Patients in the intervention group were instructed to track their BP using a smartphone device three to seven times per week. Cases were matched to controls at a 1:3 allocation ratio on several clinical characteristics over the same period and received usual care. The proportion of patients with controlled BP was compared between groups at pre- and postintervention, ∼9 months later. Results and Materials: The total study population included 484 patients with mean age 60 years (range 23-102 years), 47.7% female, and 84.6% Caucasian. Mean preintervention BP was 137.8 mm Hg systolic and 81.4 mm Hg diastolic. Mean BP control rates improved for patients who received HBPM from 42% to 67% compared with matched control patients who improved from 59% to 67% (p < 0.01). CONCLUSION HBPM with smartphone technology has the potential to improve HTN management among patients with uncontrolled or newly diagnosed HTN. Technology needs to be easy to use and operate and would work best when integrated into local electronic health record systems. In systems without this capability, medical assistants or other personnel may be trained to facilitate the process. Nurse navigator involvement was instrumental in bridging communication between the patients and provider.
Collapse
|
33
|
Tillis W, Bond WF, Svendsen J, Guither S. Implementation of Activity Sensor Equipment in the Homes of Chronic Obstructive Pulmonary Disease Patients. Telemed J E Health 2017; 23:920-929. [PMID: 28557641 DOI: 10.1089/tmj.2016.0201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Telemedicine care models for managing advanced chronic obstructive pulmonary disease (COPD) may benefit from the addition of motion sensing, spirometry, and tablet-based symptom diary tracking. METHODS We conducted a feasibility study of telemedicine in the home setting using multiple activity sensor monitoring equipment. Deployment and monitoring were supported by home health nurses with technical advice from the equipment makers as needed. Data analytics for motion sensing was provided by the research sponsor, but was not used for care decisions. On study intake, a health risk assessment, Quality of Life (SF-36) survey, and the St. George Respiratory Questionnaire were administered to assess patients' self-perception of quality of life, activities of daily life function, and difficulty living with COPD. RESULTS Twenty-eight patients were enrolled and data were gathered for a minimum of 6 months and maximum of 9 months. The researchers demonstrated that augmentation of traditional telemedicine methods with motion sensing, spirometry, and symptom diaries appears feasible. The technical, process, logistics barriers, and solutions required for system deployment are described. The researchers demonstrated that augmentation of traditional telemedicine methods with motion sensing, spirometry, and symptom diaries appears feasible. CONCLUSIONS Further exploration will be needed to determine the value of this information in preventing outcomes relevant to patients.
Collapse
Affiliation(s)
- William Tillis
- 1 OSF Healthcare, Illinois Lung Institute , Peoria, Illinois
| | - William F Bond
- 2 OSF Healthcare, Jump Trading Simulation and Education Center , Peoria, Illinois
| | - Jessica Svendsen
- 2 OSF Healthcare, Jump Trading Simulation and Education Center , Peoria, Illinois
| | | |
Collapse
|
34
|
Abstract
BACKGROUND Shared-risk models encourage providers to engage young patients early. Telemedicine may be well suited for younger, healthier patients although it is unclear how best to incorporate telemedicine into routine clinical care. INTRODUCTION We test the assumptions surrounding the use of telemedicine, younger and rising-risk patients, and primary care in ClickWell Care (CWC), a care model developed at our institution for our own accountable care organization. MATERIALS AND METHODS CWC's team of physicians and wellness coaches work together to provide comprehensive primary care through in-person, phone, and video visits. This study examines usage of the clinic over its initial year in operation. RESULTS 1,464 unique patients conducted a total of 3,907 visits. 2,294 (58.7%) visits were completed virtually (1,382 [35.4%] by phone and 912 [23.3%] by video). Patients were more inclined to see the physician in-person for a new visit (1,065 visits [70.5%] vs. 362 [24%] phone and 83 [6%] video) and more likely to see the physician virtually for a return visit (606 [43.2%] phone and 249 [17.7%] video vs. 548 [39.1%] in-person), a statistically significant difference (X2 = 306.7, p < 0.00001). CONCLUSION This new care model successfully engaged a younger population of patients. However, our data suggest young patients may not be inclined to establish care with a primary care physician virtually and, in fact, choose an initial in-person touch point, although many are willing to conduct return visits virtually. This new model of care could have a large impact on how care is delivered to low- and rising-risk patients.
Collapse
Affiliation(s)
- Lauren Cheung
- Department of Medicine, Stanford University School of Medicine and Stanford Center for Digital Health, Stanford Medicine, Stanford University , Stanford, California
| | - Justin Norden
- Department of Medicine, Stanford University School of Medicine and Stanford Center for Digital Health, Stanford Medicine, Stanford University , Stanford, California
| | - Robert A Harrington
- Department of Medicine, Stanford University School of Medicine and Stanford Center for Digital Health, Stanford Medicine, Stanford University , Stanford, California
| | - Sumbul A Desai
- Department of Medicine, Stanford University School of Medicine and Stanford Center for Digital Health, Stanford Medicine, Stanford University , Stanford, California
| |
Collapse
|
35
|
Abstract
OBJECTIVE To determine if mobile videoconferencing technology can facilitate the discharge of low-acuity patients receiving in-home care without compromising short-term health outcomes. METHODS A 6-month trial commenced in July 2015 with 345 patients considered unsuited to Criteria Led Discharge (CLD) receiving in-home care included as participants. Nurses providing clinical support to patients in their homes were supplied with a tablet computer (Apple iPad) with Internet connectivity (Telstra 4G Network) and videoconferencing software (Cisco Jabber for Telepresence). Device usage data combined with hospital admission records were collected to determine (a) instances where a telemedicine-facilitated discharge occurred and (b) if the accepted measure of short-term health outcomes (readmission within 28 days) was adversely affected by this alternative method. RESULTS Telemedicine technology facilitated the discharge of 10.1% (n = 35) of patients considered unsuitable for CLD from the Hospital in the Home model during the trial period. Statistically insignificant differences in rates of readmission between patients discharged in person versus those participating in the telemedicine-supported model suggest that the clinical standards of the service have been maintained. CONCLUSION The results of evaluating telemedicine support for nurses providing low-acuity in-home care indicate that patients may be discharged remotely while maintaining the existing clinical standards of the service.
Collapse
Affiliation(s)
- Edwin P Greenup
- 1 Healthcare Improvement Unit, Queensland Health , Brisbane, Australia
| | - Melissa McCusker
- 2 Patient Flow Program, Metro South Hospital and Health Service , Brisbane, Australia
| | - Boyd A Potts
- 3 Australian Institute for Suicide Research and Prevention , Brisbane, Australia
| | - Andrew Bryett
- 1 Healthcare Improvement Unit, Queensland Health , Brisbane, Australia
| |
Collapse
|
36
|
Abstract
Healthcare delivered at home via telehealth technology may save on both individual and societal healthcare costs. Three studies investigated potential attitudinal barriers to home healthcare adoption. Results from the first concerning adults' privacy concerns and mobile device preferences showed that attitudes clustered into 4 factors and that older adults, particularly males, showed less concern than younger adults about privacy. The second and third studies explored comfort with a wearable device and the role of aesthetics over 2-week and 6-month intervals. Results showed that older adults had stable ratings for comfort while wearing a watch device designed to collect data in real time and that aspects of physical comfort predicted use over a six-month time period. Taken together, the studies provide evidence that attitudes about privacy and comfort for wearable health devices are unlikely to be significant barriers to adoption, though first impressions are important for all age groups.
Collapse
Affiliation(s)
- Neil Charness
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Ryan Best
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Jarrett Evans
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| |
Collapse
|
37
|
He K, Palen BN, Mattox EA, Parsons EC. Veteran Preferences Regarding Wireless Management of Positive Airway Pressure for Obstructive Sleep Apnea at a Tertiary Health-Care System. Respir Care 2016; 62:357-362. [PMID: 27879382 DOI: 10.4187/respcare.05002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/05/2022]
Abstract
BACKGROUND Timely monitoring of obstructive sleep apnea (OSA) therapy can be a challenge amid conflicting pressures of rising patient volume and shortage of sleep medicine providers. Positive airway pressure (PAP) devices with wireless modem technology have the potential to improve patient access to care and streamline work load, yet little is known about patient attitudes toward telehealth integration among veterans with sleep apnea. As part of a larger quality improvement initiative at the Veterans Affairs (VA) Puget Sound Health Care System, we elicited veterans' preferences toward modem versus traditional PAP data download, including patient attitudes and factors affecting those preferences. METHODS We conducted an anonymous survey of veterans without previous CPAP experience presenting for initial device setup and training at VA Puget Sound PAP clinics. Surveys assessed subject demographics, PAP download preferences (modem vs mail), and Likert-type scale ratings of importance placed on factors including convenience and information privacy. Using multinomial logistic regression, we examined the association between convenience rating and download preference, adjusting for information privacy rating, age, and commute time. RESULTS Of 444 surveys analyzed, respondents were primarily male with a mean age of 52 y. Most respondents reported taking ≥ 30 min to commute to the PAP clinic. Convenience was rated as the most important factor affecting download preferences. Veteran preferences regarding PAP download method were mixed, with 47% preferring modem, 38% preferring memory card mail-in, and 15% undecided. A higher rating of convenience was significantly associated with modem preference, both before and after adjustment for information privacy rating, commute time, and veteran age (adjusted relative risk ratio 1.67, P < .001, 95% CI 1.40-1.99). CONCLUSIONS PAP data download preferences were mixed among new veteran users. Veterans placed a high value on the potentially competing concerns of convenience and information privacy. Veterans preferring modem factored convenience as important in their decision making, independent of privacy concerns.
Collapse
Affiliation(s)
- Ken He
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Brian N Palen
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington.,Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | | | - Elizabeth C Parsons
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington. .,Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| |
Collapse
|
38
|
Brown Connolly NE. A better way to evaluate remote monitoring programs in chronic disease care: receiver operating characteristic analysis. Telemed J E Health 2016; 20:1143-9. [PMID: 25405337 DOI: 10.1089/tmj.2014.0007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 11/12/2022] Open
Abstract
BACKGROUND This foundational study applies the process of receiver operating characteristic (ROC) analysis to evaluate utility and predictive value of a disease management (DM) model that uses RM devices for chronic obstructive pulmonary disease (COPD). The literature identifies a need for a more rigorous method to validate and quantify evidence-based value for remote monitoring (RM) systems being used to monitor persons with a chronic disease. ROC analysis is an engineering approach widely applied in medical testing, but that has not been evaluated for its utility in RM. Classifiers (saturated peripheral oxygen [SPO2], blood pressure [BP], and pulse), optimum threshold, and predictive accuracy are evaluated based on patient outcomes. MATERIALS AND METHODS Parametric and nonparametric methods were used. Event-based patient outcomes included inpatient hospitalization, accident and emergency, and home health visits. Statistical analysis tools included Microsoft (Redmond, WA) Excel(®) and MedCalc(®) (MedCalc Software, Ostend, Belgium) version 12 © 1993-2013 to generate ROC curves and statistics. Persons with COPD were monitored a minimum of 183 days, with at least one inpatient hospitalization within 12 months prior to monitoring. Retrospective, de-identified patient data from a United Kingdom National Health System COPD program were used. Datasets included biometric readings, alerts, and resource utilization. RESULTS SPO2 was identified as a predictive classifier, with an optimal average threshold setting of 85-86%. BP and pulse were failed classifiers, and areas of design were identified that may improve utility and predictive capacity. Cost avoidance methodology was developed. CONCLUSIONS RESULTS can be applied to health services planning decisions. Methods can be applied to system design and evaluation based on patient outcomes. This study validated the use of ROC in RM program evaluation.
Collapse
Affiliation(s)
- Nancy E Brown Connolly
- Department of Engineering, Information Systems, and Computing, Brunel University , Uxbridge, United Kingdom
| |
Collapse
|
39
|
Kwon S, Kim J, Kang S, Lee Y, Baek H, Park K. CardioGuard: a brassiere-based reliable ECG monitoring sensor system for supporting daily smartphone healthcare applications. Telemed J E Health 2016; 20:1093-102. [PMID: 25405527 DOI: 10.1089/tmj.2014.0008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 12/20/2022] Open
Abstract
We propose CardioGuard, a brassiere-based reliable electrocardiogram (ECG) monitoring sensor system, for supporting daily smartphone healthcare applications. It is designed to satisfy two key requirements for user-unobtrusive daily ECG monitoring: reliability of ECG sensing and usability of the sensor. The system is validated through extensive evaluations. The evaluation results showed that the CardioGuard sensor reliably measure the ECG during 12 representative daily activities including diverse movement levels; 89.53% of QRS peaks were detected on average. The questionnaire-based user study with 15 participants showed that the CardioGuard sensor was comfortable and unobtrusive. Additionally, the signal-to-noise ratio test and the washing durability test were conducted to show the high-quality sensing of the proposed sensor and its physical durability in practical use, respectively.
Collapse
Affiliation(s)
- Sungjun Kwon
- 1 Interdisciplinary Program of Bioengineering, Seoul National University , Seoul, Republic of Korea
| | | | | | | | | | | |
Collapse
|
40
|
Kang Y, McHugh MD, Chittams J, Bowles KH. Risk Factors for All-Cause Rehospitalization Among Medicare Recipients with Heart Failure Receiving Telehomecare. Telemed J E Health 2016; 23:305-312. [PMID: 27689956 DOI: 10.1089/tmj.2016.0048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 12/31/2022] Open
Abstract
OBJECTIVE To identify potential risk factors associated with rehospitalization among Medicare recipients with heart failure (HF) receiving telehomecare. MATERIALS AND METHODS This study is a nonexperimental, cross-sectional secondary data analysis of the Centers for Medicare and Medicaid (CMS) mandated assessment called the Outcome and Assessment Information Set (OASIS)-C, provided by a large home care company. A total of 526 patients who received telehomecare from January 1, 2011 to August 31, 2013 were included in the analyses, which used multiple logistic regression. RESULTS The overall rate of rehospitalization was 36% while patients were receiving telehomecare. Moderately frail health status (p = 0.01), the presence of severe pain (p = 0.01), the presence of dermatologic problems (p = 0.03), and independence in dressing one's lower body (compared to slightly dependent [p = 0.01] or mostly dependent patient groups [p = 0.02]) were identified as risk factors for rehospitalization. CONCLUSIONS The risk factors identified from this study may be used to drive more effective telehomecare placements, and referrals for additional services among telehomecare patients with HF.
Collapse
Affiliation(s)
- Youjeong Kang
- 1 University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania
| | - Matthew D McHugh
- 1 University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania.,2 Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania
| | - Jesse Chittams
- 1 University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania
| | - Kathryn H Bowles
- 1 University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania.,3 vanAmeringen Professor in Nursing Excellence, University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania.,4 Director of the Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York
| |
Collapse
|
41
|
Abstract
BACKGROUND Remote health monitoring applications are being adopted to improve the health of chronically ill individuals. Little work has focused on the effects of these technologies on informal caregivers (CG) of patients with chronic illnesses. OBJECTIVES To examine differences in caregiving appraisal between CG of enrolled and nonenrolled Veterans in the home telehealth (HT) program. METHODS Cross-sectional survey methodology in 244 dyads (Veteran and CG) from 6 rural Midwestern Veterans Affairs Medical Centers. Survey variables were derived from the 2004 National Alliance for Caregiving survey, along with measures of caregiving strain, burden, and satisfaction. RESULTS We found no differences when comparing HT and non-HT CG. In multivariate analyses combining the two groups, CG characteristics associated with CG strain included younger age, providing help with activities of daily living and instrumental activities of daily living, use of coping skills, depressive symptoms, and less use of unpaid help (all p ≤ 0.001). Burden was associated with CG use of coping skills, caregiving confidence, and relationship quality with the Veteran (all p < 0.0001). CG satisfaction was associated with presence of social support (p < 0.0001). High CG strain was associated with Veteran hospitalization in the combined group (p = 0.03). Burden (p = 0.0002) was significantly associated with CG satisfaction. DISCUSSION Existing HT infrastructure provides an opportunity to incorporate training and support programs for CG of chronically ill patients. Such programs could improve CG confidence and use of positive coping skills, lower strain and burden, and potentially improve the health of both the care recipient and CG.
Collapse
Affiliation(s)
- Bonnie J Wakefield
- 1 Center for Comprehensive Access & Delivery Research and Evaluation , Iowa City Veteran's Affairs Healthcare System, Iowa City, Iowa.,2 Rural Health Resource Center-Central Region , Iowa City Veteran's Affairs Healthcare System, Iowa City, Iowa.,3 Sinclair School of Nursing, University of Missouri , Columbia, Missouri
| | - Mary Vaughan-Sarrazin
- 1 Center for Comprehensive Access & Delivery Research and Evaluation , Iowa City Veteran's Affairs Healthcare System, Iowa City, Iowa.,2 Rural Health Resource Center-Central Region , Iowa City Veteran's Affairs Healthcare System, Iowa City, Iowa.,4 Department of Internal Medicine, University of Iowa Roy and Lucille Carver College of Medicine , Iowa City, Iowa
| |
Collapse
|
42
|
Cuadros L, Ismail H, Ho K. Evaluation of Reliability of MYZONE MZ-3 Heart Rate Monitor: A Study for the Future of Telephysiotherapy for Preoperative Prehabilitation in Cancer Patients. Telemed J E Health 2016; 23:334-338. [PMID: 27537777 DOI: 10.1089/tmj.2016.0138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/13/2022] Open
Abstract
BACKGROUND There are a number of commercially available heart rate (HR) monitors on the market. The reliability of these monitors has had varying results. To the best of our knowledge, there are no telemonitoring services utilizing these devices for perioperative prehabilitation services for patients undergoing major surgery. The goal of this study is to pilot the MYZONE® MZ-3 HR monitor to assess its level of reliability to provide a feasible telephysiotherapy prehabilitation service through prescription-based exercise programs to patients presenting for major cancer surgery within our leading oncological health service. MATERIALS AND METHODS Paired HR data from each participant were captured and analyzed using a Bland-Altman plot. RESULTS Seven healthy participants were included in the study with a total number of paired HR data points of 1,928. The bias (mean difference) between electrocardiogram and the MYZONE MZ-3 was 0.4 beats per minute (bpm) with an adjusted 95% limits of agreement of -4.5 to 5.3 bpm. CONCLUSION The commercially available MYZONE MZ-3 HR monitor is a reliable tool for delivering telephysiotherapy to patients undergoing major cancer surgery. Further studies are needed to validate its use in this setting.
Collapse
Affiliation(s)
- Luis Cuadros
- 1 Peter MacCallum Cancer Centre , Melbourne, Victoria, Australia
| | - Hilmy Ismail
- 1 Peter MacCallum Cancer Centre , Melbourne, Victoria, Australia
| | - Kwok Ho
- 2 Royal Perth Hospital , Perth, Western Australia, Australia .,3 School of Population Health, University of Western Australia , Crawley, Western Australia, Australia
| |
Collapse
|
43
|
Jongstra S, Beishuizen C, Andrieu S, Barbera M, van Dorp M, van de Groep B, Guillemont J, Mangialasche F, van Middelaar T, Moll van Charante E, Soininen H, Kivipelto M, Richard E. Development and Validation of an Interactive Internet Platform for Older People: The Healthy Ageing Through Internet Counselling in the Elderly Study. Telemed J E Health 2016; 23:96-104. [PMID: 27463120 DOI: 10.1089/tmj.2016.0066] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 01/14/2023] Open
Abstract
BACKGROUND A myriad of Web-based applications on self-management have been developed, but few focus on older people. In the face of global aging, older people form an important target population for cardiovascular prevention. This article describes the full development of an interactive Internet platform for older people, which was designed for the Healthy Ageing Through Internet Counselling in the Elderly (HATICE) study. We provide recommendations to design senior-friendly Web-based applications for a new approach to multicomponent cardiovascular prevention. METHODS The development of the platform followed five phases: (1) conceptual framework; (2) platform concept and functional design; (3) platform building (software and content); (4) testing and pilot study; and (5) final product. RESULTS We performed a meta-analysis, reviewed guidelines for cardiovascular diseases, and consulted end users, experts, and software developers to create the platform concept and content. The software was built in iterative cycles. In the pilot study, 41 people aged ≥65 years used the platform for 8 weeks. Participants used the interactive features of the platform and appreciated the coach support. During all phases adjustments were made to incorporate all improvements from the previous phases. The final platform is a personal, secured, and interactive platform supported by a coach. DISCUSSION When carefully designed, an interactive Internet platform is acceptable and feasible for use by older people with basic computer skills. To improve acceptability by older people, we recommend involving the end users in the process of development, to personalize the platform and to combine the application with human support. The interactive HATICE platform will be tested for efficacy in a multinational randomized controlled trial (ISRCTN48151589).
Collapse
Affiliation(s)
- Susan Jongstra
- 1 Department of Neurology, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands
| | - Cathrien Beishuizen
- 1 Department of Neurology, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands
| | - Sandrine Andrieu
- 2 INSERM, University of Toulouse , Toulouse, France .,3 Department of Epidemiology and Public Health, Toulouse University Hospital , Toulouse, France
| | - Mariagnese Barbera
- 4 Institute of Clinical Medicine/Neurology, University of Eastern Finland , Kuopio, Finland
| | | | | | | | - Francesca Mangialasche
- 6 Ageing Research Center, Karolinska Institutet/Stockholm University , Stockholm, Sweden
| | - Tessa van Middelaar
- 1 Department of Neurology, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands .,7 Department of Neurology, Radboud University Medical Center , Nijmegen, The Netherlands
| | - Eric Moll van Charante
- 8 Department of General Practice, Academic Medical Centre, University of Amsterdam , Amsterdam, The Netherlands
| | - Hilkka Soininen
- 4 Institute of Clinical Medicine/Neurology, University of Eastern Finland , Kuopio, Finland
| | - Miia Kivipelto
- 4 Institute of Clinical Medicine/Neurology, University of Eastern Finland , Kuopio, Finland .,6 Ageing Research Center, Karolinska Institutet/Stockholm University , Stockholm, Sweden .,9 Chronic Disease Prevention Unit, National Institute for Health and Welfare , Helsinki, Finland
| | - Edo Richard
- 1 Department of Neurology, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands .,7 Department of Neurology, Radboud University Medical Center , Nijmegen, The Netherlands
| |
Collapse
|
44
|
Kolominsky-Rabas PL, Kriza C, Djanatliev A, Meier F, Uffenorde S, Radeleff J, Baumgärtel P, Leb I, Sedlmayr M, Gaiser S, Adamson PB. Health Economic Impact of a Pulmonary Artery Pressure Sensor for Heart Failure Telemonitoring: A Dynamic Simulation. Telemed J E Health 2016; 22:798-808. [PMID: 27285946 DOI: 10.1089/tmj.2015.0226] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 11/13/2022] Open
Abstract
AIMS Recently, a permanently implantable wireless system, designed to monitor and manage pulmonary artery (PA) pressures remotely, demonstrated significant reductions in heart failure (HF) hospitalizations in high-risk symptomatic patients, regardless of ejection fraction. The objectives of this study were to simulate the estimated clinical and economic impact in Germany of generalized use of this PA pressure monitoring system considering reductions of HF hospitalizations and the improvement in Quality of Life. MATERIALS AND METHODS Based on the Prospective Health Technology Assessment approach, we simulated the potential of the widespread application of PA pressure monitoring on the German healthcare system for the period 2009-2021. RESULTS This healthcare economic simulation formulated input assumptions based on results from the CHAMPION Trial, a multicenter, prospective, randomized controlled U.S. trial that demonstrated a 37% reduction of hospitalizations in persistently symptomatic previous HF patients. Based on these results, an estimated 114,800 hospitalizations would expected to be avoided. This effect would potentially save an estimated €522 million, an equivalent of $575 million, during the entire simulation period. CONCLUSION This healthcare economic modeling of the PA pressure monitoring system's impact demonstrates substantial clinical and economic benefits in the German healthcare system.
Collapse
Affiliation(s)
- Peter L Kolominsky-Rabas
- 1 Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen , Germany .,2 National Cluster of Excellence, Medical Technologies-Medical Valley EMN' , Erlangen, Germany
| | - Christine Kriza
- 1 Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen , Germany .,2 National Cluster of Excellence, Medical Technologies-Medical Valley EMN' , Erlangen, Germany
| | - Anatoli Djanatliev
- 3 Chair of Computer Science 7-Computer Networks and Communication Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen , Germany
| | - Florian Meier
- 4 School of Business and Economics, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen , Germany
| | | | | | - Philipp Baumgärtel
- 6 Chair of Computer Science 6-Data management, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen , Germany
| | - Ines Leb
- 7 Chair of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen , Germany
| | - Martin Sedlmayr
- 7 Chair of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg Erlangen , Germany
| | - Sebastian Gaiser
- 8 St. Jude Medical, Coordination Center BVBA , Zaventem, Belgium
| | | |
Collapse
|
45
|
Abstract
BACKGROUND The Apple (Cupertino, CA) HealthKit is a new telemonitoring platform that promises to make it easier for patients and healthcare institutions to collect, transmit, and store data from devices that monitor common conditions such as diabetes, hypertension, and asthma. To assess the potential use for this platform in primary care, we need to know how many Apple Healthkit users there are and if they have conditions that could benefit from telemonitoring. MATERIALS AND METHODS We examined patients in the Mayo Clinic primary care practice in Rochester, MN, who registered to connect to their Mayo Clinic medical record with Apple HealthKit. We used the primary care registry to identify users with chronic conditions of diabetes, hypertension, asthma, and depression. We also examined users for recent measurements of blood pressure, glucose, hemoglobin A1C, and cholesterol. RESULTS Of 98,151 patients there were 503 registrants of HealthKit. There were 95 (19%) who had hypertension, 37 (7.4%) who had diabetes, 125 (25%) who had depression, and 56 (11%) who had asthma. Overall, there were 245 (49%) who had readily telemonitorable conditions. CONCLUSIONS Almost half of primary care Apple HealthKit registrants have conditions that could benefit from telemonitoring. This pre-installed telemonitoring platform, available on every new iPhone(®) (Apple), can be used to monitor a significant number of primary care patients. However, it also has continued provider and informatics barriers that need to be addressed.
Collapse
Affiliation(s)
- Frederick North
- Primary Care Internal Medicine, Mayo Clinic , Rochester, Minnesota
| | - Rajeev Chaudhry
- Primary Care Internal Medicine, Mayo Clinic , Rochester, Minnesota
| |
Collapse
|
46
|
Okura T, Enomoto D, Miyoshi KI, Nagao T, Kukida M, Tanino A, Pei Z, Higaki J, Uemura H. The Importance of Walking for Control of Blood Pressure: Proof Using a Telemedicine System. Telemed J E Health 2016; 22:1019-1023. [PMID: 27167766 DOI: 10.1089/tmj.2016.0008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 01/24/2023] Open
Abstract
BACKGROUND Regular physical activity (PA), including daily walking, reduces the risk of many chronic diseases, especially hypertension. Pedometer is a potential motivational aid for increasing PA. In the present study, we used a telemedicine system and analyzed the relationship between daily walking, calculated by pedometers, and blood pressure (BP). METHODS BP was measured at home twice a day (morning and evening) using an oscillometric automatic device. Body weight (BW) and percent body fat (%BF) were measured after BP measurement. Daily walking steps (DWS) were calculated by a pedometer. These daily parameters were transmitted through the Internet to a central server computer and sent to the Medical Health Center. RESULTS Sixty-nine (N = 69) hypertensive patients were included in this study. The mean follow-up period was 378 days. Electronic data from a pedometer (DWS) were associated with reduced BW, body mass index, and %BF. Hypertensive patients were divided into two groups based on the DWS. In the high DWS group, morning systolic BP and diastolic BP and evening systolic BP were reduced after induction of the telemedicine system. CONCLUSION A telemedicine system confirmed the usefulness of walking to control BP in hypertensive patients.
Collapse
Affiliation(s)
- Takafumi Okura
- 1 Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine , Ehime, Japan
| | - Daijiro Enomoto
- 2 Department of Community Emergency Medicine, Ehime University Graduate School of Medicine , Ehime, Japan
| | - Ken-Ichi Miyoshi
- 1 Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine , Ehime, Japan
| | - Tomoaki Nagao
- 1 Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine , Ehime, Japan
| | - Masayoshi Kukida
- 1 Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine , Ehime, Japan
| | - Akiko Tanino
- 1 Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine , Ehime, Japan
| | - Zouwei Pei
- 1 Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine , Ehime, Japan
| | - Jitsuo Higaki
- 1 Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine , Ehime, Japan
| | | |
Collapse
|
47
|
Abstract
UNLABELLED In 2009, President Barack Obama signed into law the Health Information Technology for Economic and Clinical Health (HITECH) Act, which aims for the universal adoption of electronic health records (EHRs) in primary care settings and "meaningful use" of this technology. The objectives of "meaningful use" are well defined and executed in stages; one of the objectives of stage 2, beginning in 2014, was implementation of a secure messaging system between patients and providers. Secure messaging has been shown to positively affect patients who struggle with managing chronic diseases on a day to day basis. This review aims to assess the clinical evidence supporting the use of secure messaging in EHRs in self-management of diabetes. METHODS A systematic search of PubMed was conducted, and 320 results were returned. Of these, 11 were selected based on outlined criteria. CONCLUSIONS Evidence from 7 of the 11 included studies suggests significant improvement in patients' hemoglobin A1c (HbA1c) with the use of secure messaging. However, improvements in patients' secondary outcomes, such as blood pressure and cholesterol, were inconsistent. Further work must be done to determine how to best maximize the potential of available tools such as secure messaging and EHRs to improve patient outcomes.
Collapse
Affiliation(s)
- Alyce Kuo
- 1 University of Miami , Coral Gables, Florida
| | - Stuti Dang
- 2 Miami VA Healthcare System Geriatric, Research Education and Clinical Center and Extended Care and Research Services , Miami, Florida.,3 Division of Geriatrics and Palliative Care, Department of Medicine, University of Miami Miller School of Miami , Miami, Florida
| |
Collapse
|
48
|
Garcia-Zapirain B, de la Torre Díez I, Sainz de Abajo B, López-Coronado M. Development, Technical, and User Evaluation of a Web Mobile Application for Self-Control of Diabetes. Telemed J E Health 2016; 22:778-85. [PMID: 26981852 DOI: 10.1089/tmj.2015.0233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 11/12/2022] Open
Abstract
OBJECTIVE The main objective of this research was to develop and evaluate a Web-based mobile application (app) known as "Diario Diabetes" on both a technical and user level, by means of which individuals with diabetes may monitor their illness easily at any time and in any place using any device that has Internet access. METHODS The technologies used to develop the app were HTML, CSS, JavaScript, PHP, and MySQL, all of which are an open source. Once the app was developed, it was evaluated on a technical level (by measuring loading times) and on a user level, through a survey. RESULTS Different loading times for the application were measured, with it being noted that under no circumstances does this exceed 2 s. Usability was evaluated by 150 users who initially used the application. A majority (71%) of users used a PC to access the app, 83% considered the app's design to be attractive, 67% considered the tasks to be very useful, and 67% found it very easy to use. CONCLUSIONS Although applications exist for controlling diabetes both at mobile virtual shops or on a research level, our app may help to improve the administration of these types of patients and they are the ones who will ultimately opt for one or the other. According to the results obtained, we can state that all users would recommend the app's use to other users.
Collapse
Affiliation(s)
| | - Isabel de la Torre Díez
- 2 Department of Signal Theory and Communications, and Telematics Engineering University of Valladolid , Valladolid, Spain
| | - Beatriz Sainz de Abajo
- 2 Department of Signal Theory and Communications, and Telematics Engineering University of Valladolid , Valladolid, Spain
| | - Miguel López-Coronado
- 2 Department of Signal Theory and Communications, and Telematics Engineering University of Valladolid , Valladolid, Spain
| |
Collapse
|
49
|
Crowley MJ, Edelman D, McAndrew AT, Kistler S, Danus S, Webb JA, Zanga J, Sanders LL, Coffman CJ, Jackson GL, Bosworth HB. Practical Telemedicine for Veterans with Persistently Poor Diabetes Control: A Randomized Pilot Trial. Telemed J E Health 2015; 22:376-84. [PMID: 26540163 DOI: 10.1089/tmj.2015.0145] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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: 12/14/2022] Open
Abstract
BACKGROUND Telemedicine-based diabetes management improves outcomes versus clinic care but is seldom implemented by healthcare systems. In order to advance telemedicine-based management as a practical option for veterans with persistent poorly controlled diabetes mellitus (PPDM) despite clinic-based care, we evaluated a comprehensive telemedicine intervention that we specifically designed for delivery using existing Veterans Health Administration (VHA) clinical staffing and equipment. MATERIALS AND METHODS We conducted a 6-month randomized trial among 50 veterans with PPDM; all maintained hemoglobin A1c (HbA1c) levels continuously >9.0% for >1 year despite clinic-based management. Participants received usual care or a telemedicine intervention combining telemonitoring, medication management, self-management support, and depression management; existing VHA clinical staff delivered the intervention. Using linear mixed models, we examined HbA1c, diabetes self-care (measured by the Self-Care Inventory-Revised questionnaire), depression, and blood pressure. RESULTS At baseline, the model-estimated common HbA1c intercept was 10.5%. By 6 months, estimated HbA1c had improved by 1.3% for intervention participants and 0.3% for usual care (estimated difference, -1.0%, 95% confidence interval [CI], -2.0%, 0.0%; p = 0.050). Intervention participants' diabetes self-care (estimated difference, 7.0; 95% CI, 0.1, 14.0; p = 0.047), systolic blood pressure (-7.7 mm Hg; 95% CI, -14.8, -0.6; p = 0.035), and diastolic blood pressure (-5.6 mm Hg; 95% CI, -9.9, -1.2; p = 0.013) were improved versus usual care by 6 months. Depressive symptoms were similar between groups. CONCLUSIONS A comprehensive telemedicine intervention improved outcomes among veterans with PPDM despite clinic-based care. Because we specifically designed this intervention with scalability in mind, it may represent a practical, real-world strategy to reduce the burden of poor diabetes control among veterans.
Collapse
Affiliation(s)
- Matthew J Crowley
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,2 Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Duke University , Durham, North Carolina
| | - David Edelman
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,3 Division of General Internal Medicine, Department of Medicine, Duke University , Durham, North Carolina
| | - Ann T McAndrew
- 4 Home Telehealth Program, Durham Veterans Affairs Medical Center , Durham, North Carolina
| | - Susan Kistler
- 4 Home Telehealth Program, Durham Veterans Affairs Medical Center , Durham, North Carolina
| | - Susanne Danus
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina
| | - Jason A Webb
- 3 Division of General Internal Medicine, Department of Medicine, Duke University , Durham, North Carolina.,5 Department of Psychiatry and Behavioral Medicine, Duke University , Durham, North Carolina.,6 Mental Health Service, Durham Veterans Affairs Medical Center , Durham, North Carolina
| | - Joseph Zanga
- 3 Division of General Internal Medicine, Department of Medicine, Duke University , Durham, North Carolina.,5 Department of Psychiatry and Behavioral Medicine, Duke University , Durham, North Carolina.,6 Mental Health Service, Durham Veterans Affairs Medical Center , Durham, North Carolina
| | - Linda L Sanders
- 3 Division of General Internal Medicine, Department of Medicine, Duke University , Durham, North Carolina
| | - Cynthia J Coffman
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,7 Department of Biostatistics and Bioinformatics, Duke University Medical Center , Durham, North Carolina
| | - George L Jackson
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,3 Division of General Internal Medicine, Department of Medicine, Duke University , Durham, North Carolina
| | - Hayden B Bosworth
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,3 Division of General Internal Medicine, Department of Medicine, Duke University , Durham, North Carolina
| |
Collapse
|
50
|
Evans J, Papadopoulos A, Silvers CT, Charness N, Boot WR, Schlachta-Fairchild L, Crump C, Martinez M, Ent CB. Remote Health Monitoring for Older Adults and Those with Heart Failure: Adherence and System Usability. Telemed J E Health 2015; 22:480-8. [PMID: 26540369 DOI: 10.1089/tmj.2015.0140] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Remote health monitoring technology has been suggested as part of an early intervention and prevention care model. Older adults with a chronic health condition have been shown to benefit from remote monitoring but often have challenges with complex technology. The current study reports on the usability of and adherence with an integrated, real-time monitoring system over an extended period of time by older adults with and without a chronic health condition. MATERIALS AND METHODS Older adults 55 years of age and over with and without heart failure participated in a study in which a telehealth system was used for 6 months each. The system consisted of a wireless wristwatch-based monitoring device that continuously collected temperature and motion data. Other health information was collected daily using a weight scale, blood pressure cuff, and tablet that participants used for health surveys. Data were automatically analyzed and summarized by the system and presented to study nurses. RESULTS Forty-one older adults participated. Seventy-one percent of surveys, 75% of blood pressure readings, and 81% of daily weight measurements were taken. Participants wore the watch monitor 77% of the overall 24/7 time requested. The weight scale had the highest usability rating in both groups. The groups did not otherwise differ on device usage. CONCLUSIONS The findings indicate that a health monitoring system designed for older adults can and will be used for an extended period of time and may help older adults with chronic conditions reside longer in their own homes in partnership with the healthcare system.
Collapse
Affiliation(s)
- Jarrett Evans
- 1 Department of Psychology, Florida State University , Tallahassee, Florida
| | | | | | - Neil Charness
- 1 Department of Psychology, Florida State University , Tallahassee, Florida
| | - Walter R Boot
- 1 Department of Psychology, Florida State University , Tallahassee, Florida
| | | | | | - Michele Martinez
- 4 College of Nursing, Florida State University , Tallahassee, Florida
| | - Carrie Beth Ent
- 4 College of Nursing, Florida State University , Tallahassee, Florida
| |
Collapse
|