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Chadha RM, Paulson MR, Avila FR, Torres-Guzman RA, Maita KC, Garcia JP, Forte AJ, Matcha GV, Pagan RJ, Maniaci MJ. The ASA Classification System as a Predictive Factor to Stay at the Virtual Hybrid Care Hotel. Am Surg 2023; 89:4707-4714. [PMID: 36154300 DOI: 10.1177/00031348221129524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
INTRODUCTION The Care Hotel is a virtual hybrid care model for postoperative patients after low-risk procedures which allow recovery in an outpatient environment. This study aimed to analyze if the American Society of Anesthesiologists Physical Status (ASA PS) Classification System can be used as a predictive factor for staying at Mayo Clinic's Care Hotel. METHODS This retrospective cohort study was conducted between July 23, 2020, and June 4, 2021, at Mayo Clinic in Florida, a 306-bed community academic hospital. ASA PS Class and post-procedure care setting (Care Hotel vs inpatient ward) were collected. Patients were classified into two ASA PS groups (ASA PS Classes 1-2 and 3-4). Pearson's Chi-square test was used to determine if the ASA PS Class and having stayed or not at the Care Hotel were independent and an Odds Ratio (OR) calculated. RESULTS Out of 392 surgical and procedural patients, 272 (69.39%) chose the Care Hotel and 120 (30.61%) chose the inpatient ward. There was a statistically significant association between ASA PS Class and staying at the Care Hotel, P < .01. The OR of preferring to stay at the Care Hotel in patients with ASA PS Class 1-2 vs ASA PC Class 3-4 was 1.91 (P = .0041, 95% CI: 1.229-2.982). CONCLUSION Patients with ASA PS Classes 1-2 are almost twice as likely to elect to stay at the Care Hotel compared to those with ASA PS Classes 3-4. This finding may help care teams focus their Care hotel recruitment efforts.
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Affiliation(s)
- Ryan M Chadha
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
| | - Margaret R Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, WI, USA
| | | | | | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Gautam V Matcha
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ricardo J Pagan
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
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Haddad TC, Maita KC, Inselman JW, Avila FR, Torres-Guzman RA, Coffey JD, Christopherson LA, Leuenberger AM, Bell SJ, Pahl DF, Garcia JP, Manka L, Forte AJ, Maniaci MJ. Patient Satisfaction With a Multisite, Multiregional Remote Patient Monitoring Program for Acute and Chronic Condition Management: Survey-Based Analysis. J Med Internet Res 2023; 25:e44528. [PMID: 37343182 PMCID: PMC10415939 DOI: 10.2196/44528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Remote patient monitoring (RPM) is an option for continuously managing the care of patients in the comfort of their homes or locations outside hospitals and clinics. Patient engagement with RPM programs is essential for achieving successful outcomes and high quality of care. When relying on technology to facilitate monitoring and shifting disease management to the home environment, it is important to understand the patients' experiences to enable quality improvement. OBJECTIVE This study aimed to describe patients' experiences and overall satisfaction with an RPM program for acute and chronic conditions in a multisite, multiregional health care system. METHODS Between January 1, 2021, and August 31, 2022, a patient experience survey was delivered via email to all patients enrolled in the RPM program. The survey encompassed 19 questions across 4 categories regarding comfort, equipment, communication, and overall experience, as well as 2 open-ended questions. Descriptive analysis of the survey response data was performed using frequency distribution and percentages. RESULTS Surveys were sent to 8535 patients. The survey response rate was 37.16% (3172/8535) and the completion rate was 95.23% (3172/3331). Survey results indicated that 88.97% (2783/3128) of participants agreed or strongly agreed that the program helped them feel comfortable managing their health from home. Furthermore, 93.58% (2873/3070) were satisfied with the RPM program and ready to graduate when meeting the program goals. In addition, patient confidence in this model of care was confirmed by 92.76% (2846/3068) of the participants who would recommend RPM to people with similar conditions. There were no differences in ease of technology use according to age. Those with high school or less education were more likely to agree that the equipment and educational materials helped them feel more informed about their care plans than those with higher education levels. CONCLUSIONS This multisite, multiregional RPM program has become a reliable health care delivery model for the management of acute and chronic conditions outside hospitals and clinics. Program participants reported an excellent overall experience and a high level of satisfaction in managing their health from the comfort of their home environment.
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Affiliation(s)
- Tufia C Haddad
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Karla C Maita
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Jonathan W Inselman
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Francisco R Avila
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Ricardo A Torres-Guzman
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Jordan D Coffey
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | | | - Angela M Leuenberger
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Sarah J Bell
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Dominick F Pahl
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - John P Garcia
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Lukas Manka
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Antonio J Forte
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
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Siragusa L, Pellino G, Sensi B, Panis Y, Bellato V, Khan J, Sica GS. Ambulatory laparoscopic colectomies: a systematic review. Colorectal Dis 2023. [PMID: 36790358 DOI: 10.1111/codi.16511] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/29/2022] [Accepted: 01/29/2023] [Indexed: 02/16/2023]
Abstract
AIM Ambulatory laparoscopic colectomy (ALC), meaning discharge within 24 h of surgical colonic resection, has recently been proposed in a few, selected patients. This systematic review was performed with the aim of reviewing protocols for ALC and assessing feasibility, safety and outcomes after ALC. METHOD A PRISMA-compliant systematic review and pooled analysis was performed searching all English studies published until October 2022 in PubMed, Cochrane Library, Web of Science (PROSPERO, CRD42022334463). Inclusion criteria were original articles including patients undergoing ALC, specifying at least one outcome of interest. Exclusion criteria were articles reporting a robotic-assisted procedure; unable to retrieve patient data from articles; the same patient series included in different studies. Primary outcomes were success, overall complications and readmission rates. Secondary outcomes included mortality and specific complications such us surgical site infection, anastomotic leak, ileus, bleeding, rate of ALC acceptance, and unscheduled consultation and reoperation rate. RESULTS Among 1087 studies imported for screening, 11 were included (1296 patients). The success rate was 47% with an overall morbidity of 14%. Readmission and reoperation rates were 5% and 1%, respectively. No mortality was recorded. Protocols of ALC differ significantly among published studies. CONCLUSIONS Overall, ALC appears to be safe and feasible in selected cases with an acceptable success rate and a low risk of readmission after hospital discharge. Future studies should evaluate patients' benefits and discharge criteria, as well as uniformity and standardization of eligibility criteria. This systematic review may help inform on ALC adoption in clinical practice.
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Affiliation(s)
- Leandro Siragusa
- Department of Surgical Sciences, Università degli studi di Roma 'Tor Vergata', Rome, Italy
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli studi della Campania Luigi Vanvitelli, Naples, Italy.,Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Bruno Sensi
- Department of Surgical Sciences, Università degli studi di Roma 'Tor Vergata', Rome, Italy
| | - Yves Panis
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly sur Seine, France
| | - Vittoria Bellato
- Department of Surgical Sciences, Università degli studi di Roma 'Tor Vergata', Rome, Italy
| | - Jim Khan
- Colorectal Surgery, Portsmouth Hospitals University NHS Trust, University of Portsmouth, Portsmouth, UK
| | - Giuseppe S Sica
- Department of Surgical Sciences, Università degli studi di Roma 'Tor Vergata', Rome, Italy
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Torres-Guzman RA, Paulson MR, Avila FR, Maita K, Garcia JP, Forte AJ, Maniaci MJ. Smartphones and Threshold-Based Monitoring Methods Effectively Detect Falls Remotely: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:1323. [PMID: 36772364 PMCID: PMC9920087 DOI: 10.3390/s23031323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
In the US, at least one fall occurs in at least 28.7% of community-dwelling seniors 65 and older each year. Falls had medical costs of USD 51 billion in 2015 and are projected to reach USD 100 billion by 2030. This review aims to discuss the extent of smartphone (SP) usage in fall detection and prevention across a range of care settings. A computerized search was conducted on six electronic databases to investigate the use of remote sensing technology, wireless technology, and other related MeSH terms for detecting and preventing falls. After applying inclusion and exclusion criteria, 44 studies were included. Most of the studies targeted detecting falls, two focused on detecting and preventing falls, and one only looked at preventing falls. Accelerometers were employed in all the experiments for the detection and/or prevention of falls. The most frequent course of action following a fall event was an alarm to the guardian. Numerous studies investigated in this research used accelerometer data analysis, machine learning, and data from previous falls to devise a boundary and increase detection accuracy. SP was found to have potential as a fall detection system but is not widely implemented. Technology-based applications are being developed to protect at-risk individuals from falls, with the objective of providing more effective and efficient interventions than traditional means. Successful healthcare technology implementation requires cooperation between engineers, clinicians, and administrators.
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Affiliation(s)
| | - Margaret R. Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, 1221 Whipple St., Eau Claire, WI 54703, USA
| | - Francisco R. Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Karla Maita
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - John P. Garcia
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Antonio J. Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Michael J. Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
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Lozada-Martinez ID. Virtual hybrid hotel care model for the surgical patient: New goal of global academic surgery to improve global outcomes. Ann Med Surg (Lond) 2022; 77:103529. [PMID: 35493412 PMCID: PMC9043351 DOI: 10.1016/j.amsu.2022.103529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/10/2022] [Accepted: 03/26/2022] [Indexed: 11/21/2022] Open
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Maniaci MJ, Torres-Guzman RA, Garcia JP, Avila FR, Maita KC, Forte AJ, Paulson MR. Overall patient experience with a virtual hybrid hospital at home program. SAGE Open Med 2022; 10:20503121221092589. [PMID: 35481244 PMCID: PMC9036381 DOI: 10.1177/20503121221092589] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/19/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: Traditional hospital at home models often have high patient experience scores. The purpose of this study is to look at the patient experience of a new virtual hybrid model of hospital at home called Advanced Care at Home. Methods: Patients in Mayo Clinic’s Advanced Care at Home program received a survey via email from 1 January–31 May 2021. Each survey consisted of 20 questions divided into 18 multiple-choice and two open-ended questions. Results: Ninety-nine surveys were sent and 41 partially or completely finished surveys were returned for a response rate of 41.4%. Patients responded positively, denoted by answering “strongly agree or somewhat agree,” with regard to the ability to reach the team right away 100% of the time, being kept informed 92% of the time, the command center responding promptly to their needs 95% of the time, the team providing comfort and support 98% of the time, feeling comfortable with interacting with their provider by phone or tablet 95% of the time, the ease of use from the equipment 97% of the time, the virtual and in-person staff working well together 98% of the time, the staff treating patients with courtesy and respect 100% of the time, and the ease of understanding the discharge process and feeling ready to leave the program 100% of the time. All providers received positive responses on listening ⩾88% of the time. Patients gave a top rating in likelihood to recommend the program 100% of the time. Conclusion: Overall, the Advanced Care at Home model of hospital at home was highly recommended by patients. Patients scored the program high on responsiveness, staff engagement and communication, ease of equipment use, and readiness for discharge, strengthening the overall confidence in this novel program.
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Affiliation(s)
- Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Margaret R Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, WI, USA
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Dainty KN, Seaton MB, Estacio A, Hicks LK, Jamieson T, Ward S, Yu CH, Mosko JD, Kassardjian CD. Virtual Specialist Care during the COVID-19 Pandemic: A Multi-Method Study of Patient Experience. JMIR Med Inform 2022; 10:e37196. [PMID: 35482950 PMCID: PMC9239568 DOI: 10.2196/37196] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Transitioning nonemergency, ambulatory medical care to virtual visits in light of the COVID-19 global pandemic has been a massive shift in philosophy and practice that naturally came with a steep learning curve for patients, physicians, and clinic administrators. Objective We undertook a multimethod study to understand the key factors associated with successful and less successful experiences of virtual specialist care, particularly as they relate to the patient experience of care. Methods This study was designed as a multimethod patient experience study using survey methods, descriptive qualitative interview methodology, and administrative virtual care data collected by the hospital decision support team. Six specialty departments participated in the study (endoscopy, orthopedics, neurology, hematology, rheumatology, and gastroenterology). All patients who could speak and read English and attended a virtual specialist appointment in a participating clinic at St. Michael’s Hospital (Toronto, Ontario, Canada) between October 1, 2020, and January 30, 2021, were eligible to participate. Results During the study period, 51,702 virtual specialist visits were conducted in the departments that participated in the study. Of those, 96% were conducted by telephone and 4% by video. In both the survey and interview data, there was an overall consensus that virtual care is a satisfying alternative to in-person care, with benefits such as reduced travel, cost, time, and SARS-CoV-2 exposure, and increased convenience. Our analysis further revealed that the specific reason for the visit and the nature and status of the medical condition are important considerations in terms of guidance on where virtual care is most effective. Technology issues were not reported as a major challenge in our data, given that the majority of “virtual” visits reported by our participants were conducted by telephone, which is an important distinction. Despite the positive value of virtual care discussed by the majority of interview participants, 50% of the survey respondents still indicated they would prefer to see their physician in person. Conclusions Patient experience data collected in this study indicate a high level of satisfaction with virtual specialty care, but also signal that there are nuances to be considered to ensure it is an appropriate and sustainable part of the standard of care.
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Affiliation(s)
- Katie N Dainty
- North York General Hospital, 4001 Leslie StreetLE-140, Toronto, CA
| | - M Bianca Seaton
- North York General Hospital, 4001 Leslie StreetLE-140, Toronto, CA
| | | | - Lisa K Hicks
- Unity Health - St. Michael's Hospital, Toronto, CA
| | | | - Sarah Ward
- Unity Health - St. Michael's Hospital, Toronto, CA
| | | | - Jeff D Mosko
- Unity Health - St. Michael's Hospital, Toronto, CA
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