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Cheville A, Patil CL, Boyd AD, Crofford LJ, Dailey D, Martelly VD, Fiol GD, Ezenwa MO, Faurot KR, Knisely M, McLeod KR, Morone NE, O'Brien E, Gonzalez-Guarda RM, Sluka KA, Staman K, Thackeray A, Zigler CK, Schlaeger JM. Collection of Patient-Reported Outcome Measures in Rural and Underserved Populations. Appl Clin Inform 2025; 16:259-266. [PMID: 39510534 PMCID: PMC11922614 DOI: 10.1055/a-2462-8699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 09/23/2024] [Indexed: 11/15/2024] Open
Abstract
BACKGROUND The NIH Pragmatic Trials Collaboratory supports the design and conduct of 31 embedded pragmatic clinical trials, and many of these trials use patient-reported outcome measures (PROMs) to provide valuable information about the patients' health and wellness. Often these trials enroll medically underserved patients, including people with incomes below the federal poverty threshold, racial or ethnic minority groups, or rural or frontier communities. OBJECTIVES In this series of trial case reports, we provide lessons learned about collecting PROMs in these populations. Unbiased collection of PROM data is critical to increase the generalizability of trial outcomes and to address health inequities. Use of electronic health records (EHRs) and other digital modes of PROM administration has gained traction. However, engagement with these modes is often low among populations prone to disparity due to lower digital proficiency, device access, and uptake of EHR portals and web interfaces. METHODS To maximize the completeness and representativeness of their trial outcome data, study teams tested a range of strategies to improve PROM response rates with emphasis on disparities prone and underserved patient groups. This manuscript describes the approaches, their implementation, and the targeted populations. CONCLUSION Optimized PROM collection required hybrid approaches with multiple outreach modes, high-touch methods, creativity in promoting digital uptake, multimodal participant engagement, and text messaging.
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Affiliation(s)
- Andrea Cheville
- Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota, United States
| | - Crystal L. Patil
- School of Nursing, University of Michigan, Ann Arbor, Michigan, United States
| | - Andrew D. Boyd
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, Illinois, United States
| | - Leslie J. Crofford
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Dana Dailey
- Department of Physical Tehrapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa, United States
- Physical Therapy Department, St. Ambrose University, Davenport, Iowa, United States
- Physical Therapy and Rehabilitation Department, University of Iowa, Iowa City, Iowa, United States
| | - Victoria de Martelly
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, United States
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Miriam O. Ezenwa
- College of Nursing, University of Florida, Gainesville, Florida, United States
| | - Keturah R. Faurot
- Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
| | - Mitch Knisely
- School of Nursing, Duke University, Durham, North Carolina, United States
| | - Kaitlyn R. McLeod
- Department of Medicine, University of Colorado, Denver, Colorado, United States
| | - Natalia E. Morone
- Chobanian and Avedisian School of Medicine, Boston Medical Center, Boston University, Boston, Massachusetts, United States
| | - Emily O'Brien
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, United States
| | | | - Kathleen A. Sluka
- Department of Physical Tehrapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa, United States
| | - Karen Staman
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, United States
| | - Anne Thackeray
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, United States
| | - Christina K. Zigler
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, United States
| | - Judith M. Schlaeger
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, United States
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de Ligt KM, Hommes S, Vromans RD, Boomstra E, van de Poll LV, Krahmer EJ. Improving the Implementation of Patient-Reported Outcome Measure in Clinical Practice: Tackling Current Challenges With Innovative Digital Communication Technologies. J Med Internet Res 2025; 27:e60777. [PMID: 39908539 PMCID: PMC11840367 DOI: 10.2196/60777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 11/07/2024] [Accepted: 12/18/2024] [Indexed: 02/07/2025] Open
Abstract
Implementation of patient-reported outcome measures (PROMs) in clinical practice is challenging. We believe effective communication is key to realizing the clinical benefits of PROMs. Communication processes for PROMs in clinical practice typically involve (1) health care professionals (HCPs) inviting patients to complete PROMs, (2) patients completing PROMs, (3) HCPs and patients interpreting the resulting patient-reported outcomes (PROs), and (4) HCPs and patients using PROs for health management. Yet, communication around PROMs remains underexplored. Importantly, patients differ in their skills, knowledge, preferences, and motivations for completing PROMs, as well as in their ability and willingness to interpret and apply PROs in managing their health. Despite this, current communication practices often fail to account for these differences. This paper highlights the importance of personalized communication to make PROMs accessible to diverse populations. Personalizing communication manually is highly labor-intensive, but several digital technologies can offer a feasible solution to accommodate various patients. Despite their potential, these technologies have not yet been applied to PROMs. We explore how existing principles and tools, such as automatic data-to-text generation (including multimodal outputs like text combined with data visualizations) and conversational agents, can enable personalized communication of PROMs in practice.
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Affiliation(s)
- Kelly M de Ligt
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders, Tilburg University, Tilburg, Netherlands
| | - Saar Hommes
- Department Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | - Ruben D Vromans
- Department Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | - Eva Boomstra
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Lonneke V van de Poll
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders, Tilburg University, Tilburg, Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Emiel J Krahmer
- Department Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
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Kelly SC, Wegener EK, Kayser L. Creation of Text Vignettes Based on Patient-Reported Data to Facilitate a Better Understanding of the Patient Perspective: Design Study. JMIR Hum Factors 2025; 12:e58077. [PMID: 39908087 PMCID: PMC11840378 DOI: 10.2196/58077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 09/04/2024] [Accepted: 12/31/2024] [Indexed: 02/06/2025] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) data refer to information systematically reported by patients, or on behalf of patients, without the influence of health care professionals. It is a focal point of the health care system's ambition toward becoming more involving and personalized. It is recognized that PROs provide valuable data. However, despite this recognition, there are challenges related to both patients' and clinicians' accurate interpretations of the quantitative data. To overcome these challenges, this study explores text vignettes as a representation of PROs. OBJECTIVE This study aimed to develop data-informed text vignettes based on data from the Readiness and Enablement Index for Health Technology (READHY) instrument as another way of representing PRO data and to examine how these are perceived as understandable and relevant for both patients and clinicians. METHODS The text vignettes were created from participant responses to the READHY instrument, which encompasses health literacy, health education, and eHealth literacy. The text vignettes were created from 13 individual text strings, each corresponding to a scale in the READHY instrument. This study consisted of 3 sequential parts. In part 1, individuals with chronic obstructive pulmonary disease completed the READHY instrument, providing data to be used to create vignettes based on cluster profiles from the READHY instrument. Part 2 focused on the development of scale-based strings representing all READHY dimensions, which were evaluated through iterative cognitive interviews. In part 3, clinicians and patients assessed the understanding and relevance of the text vignettes. RESULTS Clinicians and patients both understood and related to the text vignettes. Patients viewed the text vignettes as an accurate reflection of their PRO responses, and clinicians perceived the text vignettes as aligned with their understanding of patients' experiences. CONCLUSIONS Text vignettes can be developed using PRO instruments, with individual scales as input strings. This provides an opportunity to present numeric values in a text format that is understandable and recognizable to most patients and clinicians. Challenges with the vignette's language and layout require customization and clinician training to ensure meaningful interpretation. Findings also support the need to expand the study and enhance clinical relevance with alternative or contextually relevant text vignettes.
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Affiliation(s)
| | | | - Lars Kayser
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Mangal S, Hyder M, Zarzuela K, McDonald W, Masterson Creber RM, Kronish IM, Konigorski S, Maurer MS, Safford MM, Lachs MS, Goyal P. "It Attracts Your Eyes and Brain": Refining Visualizations for Shared Decision-Making with Heart Failure Patients. Appl Clin Inform 2024; 15:1013-1024. [PMID: 39178891 PMCID: PMC11617074 DOI: 10.1055/a-2402-5832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/22/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND N-of-1 trials have emerged as a personalized approach to patient-centered care, where patients can compare evidence-based treatments using their own data. However, little is known about optimal methods to present individual-level data from medication-related N-of-1 trials to patients to promote decision-making. OBJECTIVES We conducted qualitative interviews with patients with heart failure with preserved ejection fraction undergoing N-of-1 trials to iterate, refine, and optimize a patient-facing data visualization tool for displaying the results of N-of-1 medication trials. The goal of optimizing this tool was to promote patients' understanding of their individual health information and to ultimately facilitate shared decision-making about continuing or discontinuing their medication. METHODS We conducted 32 semistructured qualitative interviews with 9 participants over the course of their participation in N-of-1 trials. The N-of-1 trials were conducted to facilitate a comparison of continuing versus discontinuing a β-blocker. Interviews were conducted in person or over the phone after each treatment period to evaluate participant perspectives on a data visualization tool prototype. Data were coded using directed content analysis by two independent reviewers and included a third reviewer to reach a consensus when needed. Major themes were extracted and iteratively incorporated into the patient-facing data visualization tool. RESULTS Nine participants provided feedback on how their data were displayed in the visualization tool. After qualitative analysis, three major themes emerged that informed our final interface. Participants preferred: (1) clearly stated individual symptom scores, (2) a reference image with labels to guide their interpretation of symptom information, and (3) qualitative language over numbers alone conveying the meaning of changes in their scores (e.g., better, worse). CONCLUSION Feedback informed the design of a patient-facing data visualization tool for medication-related N-of-1 trials. Future work should include usability and comprehension testing of this interface on a larger scale.
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Affiliation(s)
- Sabrina Mangal
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, Washington, United States
| | - Maryam Hyder
- Department of Medicine, Weill Cornell Medicine, New York, New York, United States
- Program for the Care and Study of the Aging Heart, Weill Cornell Medicine, New York, New York, United States
| | - Kate Zarzuela
- Department of Medicine, Weill Cornell Medicine, New York, New York, United States
- Program for the Care and Study of the Aging Heart, Weill Cornell Medicine, New York, New York, United States
| | - William McDonald
- Department of Medicine, Weill Cornell Medicine, New York, New York, United States
| | | | - Ian M. Kronish
- Department of Medicine, Columbia University, New York, New York, United States
| | - Stefan Konigorski
- Digital Health Cluster, Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Mathew S. Maurer
- Department of Medicine, Columbia University, New York, New York, United States
| | - Monika M. Safford
- Department of Medicine, Weill Cornell Medicine, New York, New York, United States
| | - Mark S. Lachs
- Department of Medicine, Weill Cornell Medicine, New York, New York, United States
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York, United States
- Program for the Care and Study of the Aging Heart, Weill Cornell Medicine, New York, New York, United States
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Hettiarachchi Senarath GM, Delir Haghighi P, Bai L, Shannon MM, Andrew NE, Srikanth V, Snowdon DA, O’Connor DA. Barriers and facilitators to the uptake of electronic collection and use of patient-reported measures in routine care of older adults: a systematic review with qualitative evidence synthesis. JAMIA Open 2024; 7:ooae068. [PMID: 39100988 PMCID: PMC11296862 DOI: 10.1093/jamiaopen/ooae068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/20/2024] [Accepted: 07/15/2024] [Indexed: 08/06/2024] Open
Abstract
Objective The aims of this systematic review were to (1) synthesize the available qualitative evidence on the barriers and facilitators influencing implementation of the electronic collection and use of patient-reported measures (PRMs) in older adults' care from various stakeholder perspectives and (2) map these factors to the digital technology implementation framework Non-adoption, Abandonment, challenges to the Scale-up, Spread, Sustainability (NASSS) and behavior change framework Capability, Opportunity, Motivation, Behaviour (COM-B). Materials and Methods A search of MEDLINE, CINAHL Plus, and Web of Science databases from 1 January 2001 to 27 October 2021 was conducted and included English language qualitative studies exploring stakeholder perspectives on the electronic collection and use of PRMs in older adults' care. Two authors independently screened studies, conducted data extraction, quality appraisal using the Critical Appraisal Skills Programme (CASP), data coding, assessed confidence in review findings using Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research (GRADE CERQual), and mapped the findings to NASSS and COM-B. An inductive approach was used to synthesize findings describing the stakeholder perspectives of barriers and facilitators. Results Twenty-two studies were included from the 3368 records identified. Studies explored older adult, caregiver, healthcare professional, and administrative staff perspectives. Twenty nine of 34 review findings (85%) were graded as having high or moderate confidence. Key factors salient to older adults related to clinical conditions and socio-cultural factors, digital literacy, access to digital technology, and user interface. Factors salient to healthcare professionals related to resource availability to collect and use PRMs, and value of PRMs collection and use. Conclusion Future efforts to implement electronic collection and use of PRMs in older adults' care should consider addressing the barriers, facilitators, and key theoretical domains identified in this review. Older adults are more likely to adopt electronic completion of PRMs when barriers associated with digital technology access, digital literacy, and user interface are addressed. Future research should explore the perspectives of other stakeholders, including those of organizational leaders, digital technology developers and implementation specialists, in various healthcare settings and explore factors influencing implementation of PREMs. PROSPERO registration number CRD42022295894.
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Affiliation(s)
| | - Pari Delir Haghighi
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Clayton, VIC 3800, Australia
| | - Lu Bai
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Clayton, VIC 3800, Australia
| | - Michelle M Shannon
- Academic Unit, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia
| | - Nadine E Andrew
- Academic Unit, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC 3199, Australia
- National Centre for Healthy Ageing, Frankston, VIC 3199, Australia
| | - Velandai Srikanth
- Academic Unit, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC 3199, Australia
- National Centre for Healthy Ageing, Frankston, VIC 3199, Australia
| | - David A Snowdon
- Academic Unit, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC 3199, Australia
- National Centre for Healthy Ageing, Frankston, VIC 3199, Australia
| | - Denise A O’Connor
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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Mak S, Ash G, Liang LJ, Der-McLeod E, Ghadimi S, Kewalramani A, Naeem S, Zeidler M, Fung C. Testing a Consumer Wearables Program to Promote the Use of Positive Airway Pressure Therapy in Patients With Obstructive Sleep Apnea: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e60769. [PMID: 39207912 PMCID: PMC11450346 DOI: 10.2196/60769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/26/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Although positive airway pressure (PAP) therapy is considered first-line treatment for obstructive sleep apnea (OSA), nonadherence is common. Numerous factors influence PAP use, including a belief that the therapy is important and effective. In theory, providing information to patients about their blood oxygen levels during sleep (which may be low when PAP is not used), juxtaposed to information about their PAP use, may influence a patient's beliefs about therapy and increase PAP use. With the advent of consumer wearable smartwatches' blood oxygen saturation monitoring capability (and the existing routine availability of PAP use data transmitted via modem to clinical dashboards), there is an opportunity to provide this combination of information to patients. OBJECTIVE This study aims to test the feasibility, acceptability, and preliminary efficacy of the Chronic Care Management With Wearable Devices in Patients Prescribed Positive Airway Pressure Therapy (mPAP), a program that augments current PAP therapy data with consumer-grade wearable device to promote self-management of PAP therapy for OSA in a pilot randomized waitlist-controlled clinical trial. METHODS This is a single-blinded randomized controlled trial. We will randomize 50 individuals with a history of OSA, who receive care from a Department of Veterans Affairs medical center in the Los Angeles area and are nonadherent to prescribed PAP therapy, into either an immediate intervention group or a waitlist control group. During a 28-day intervention, the participants will wear a study-provided consumer wearable device and complete a weekly survey about their OSA symptoms. A report that summarizes consumer wearable-provided oxygen saturation values, PAP use derived from modem data, and patient-reported OSA symptoms will be prepared weekly and shared with the patient. The immediate intervention group will begin intervention immediately after randomization (T1). Assessments will occur at week 5 (T3; 1 week after treatment for the immediate intervention group and repeat baseline for the waitlist control group) and week 11 (T5; follow-up for the immediate intervention group and 1 week after treatment for the waitlist control group). The primary outcome will be the change in 7-day PAP adherence (average minutes per night) from T1 to T3. The primary analysis will be a comparison of the primary outcome between the immediate intervention and the waitlist control groups (intention-to-treat design), using a 2-sample, 2-sided t test on change scores (unadjusted). RESULTS Recruitment began in October 2023. Data analysis is expected to begin in October 2024 when all follow-ups are complete, and a manuscript summarizing trial results will be submitted following completion of data analysis. CONCLUSIONS Findings from the study may provide additional insights on how patients with OSA might use patient-generated health data collected by consumer wearables to inform self-management of OSA and possibly increase their use of PAP therapy. TRIAL REGISTRATION ClinicalTrials.gov NCT06039865; https://clinicaltrials.gov/study/NCT06039865. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/60769.
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Affiliation(s)
- Selene Mak
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Garrett Ash
- Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, United States
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States
- Center for Pain, Research, Informatics, Medical Comorbidities and Education Center (PRIME), VA Connecticut Health System, West Haven, CT, United States
| | - Li-Jung Liang
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Erin Der-McLeod
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Geriatric Research Education and Clinical Center, North Hills, CA, United States
| | - Sara Ghadimi
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- Geriatric Research Education and Clinical Center, North Hills, CA, United States
| | - Anjali Kewalramani
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- Sleep Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Saadia Naeem
- Sleep Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Michelle Zeidler
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- Sleep Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Constance Fung
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- Geriatric Research Education and Clinical Center, North Hills, CA, United States
- Sleep Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
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Mangal S, Niño de Rivera S, Reading Turchioe M, Myers A, Benda N, Goyal P, Dugdale L, Masterson Creber R. Perceptions of patient-reported outcome data access and sharing among patients with heart failure: ethical implications for research. Eur J Cardiovasc Nurs 2024; 23:145-151. [PMID: 37172035 PMCID: PMC10640657 DOI: 10.1093/eurjcn/zvad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/14/2023]
Abstract
AIMS In the face of growing expectations for data transparency and patient engagement in care, we evaluated preferences for patient-reported outcome (PRO) data access and sharing among patients with heart failure (HF) using an ethical framework. METHODS AND RESULTS We conducted qualitative interviews with a purposive sample of patients with HF who participated in a larger 8-week study that involved the collection and return of PROs using a web-based interface. Guided by an ethical framework, patients were asked questions about their preferences for having PRO data returned to them and shared with other groups. Interview transcripts were coded by three study team members using directed content analysis. A total of 22 participants participated in semi-structured interviews. Participants were mostly male (73%), White (68%) with a mean age of 72. Themes were grouped into priorities, benefits, and barriers to data access and sharing. Priorities included ensuring anonymity when data are shared, transparency with intentions of data use, and having access to all collected data. Benefits included: using data as a communication prompt to discuss health with clinicians and using data to support self-management. Barriers included: challenges with interpreting returned results, and potential loss of benefits and anonymity when sharing data. CONCLUSION Our interviews with HF patients highlight opportunities for researchers to return and share data through an ethical lens, by ensuring privacy and transparency with intentions of data use, returning collected data in comprehensible formats, and meeting individual expectations for data sharing.
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Affiliation(s)
- Sabrina Mangal
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, 1959 NE Pacific Street, Seattle, WA, USA
| | | | | | - Annie Myers
- Columbia University School of Nursing, New York, NY, USA
| | - Natalie Benda
- Columbia University School of Nursing, New York, NY, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lydia Dugdale
- Department of Medicine, Center for Clinical Medical Ethics, Columbia University, New York, NY, USA
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Salaffi F, Carotti M, Farah S, Di Carlo M. The Psoriatic Arthritis 5-Thermometer Scales (PsA-5Ts): Measurement Properties of a New Multidimensional Composite Tool for the Quick Assessment of the Overall Health Status in Psoriatic Arthritis. J Pers Med 2023; 13:1153. [PMID: 37511768 PMCID: PMC10381869 DOI: 10.3390/jpm13071153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Psoriatic arthritis (PsA) is a heterogeneous condition that is difficult to assess. The goal of this research was to evaluate the clinimetric properties of the Psoriatic Arthritis 5-Thermometer Scales (PsA-5Ts), a new patient-reported outcome (PRO) to measure the overall health status in PsA patients. METHODS The PsA-5Ts were compared to composite measures of disease activity (DAPSA, PASDAS, CPDAI) and PROs (PsAID-12 and SF-36). The convergent validity was assessed through the Spearman's correlation coefficient and the discriminant validity through the receiver operating characteristic (ROC) curve analysis, applying the Minimal Disease Activity (MDA) as an external criterion. RESULTS The cross-sectional assessment included 155 patients. Significant high correlations were observed when comparing PsA-5Ts to composite indices of disease activity and PROs (all at significance levels of p < 0.0001). The PsA-5Ts subscales were highly significantly different in terms of MDA status (all at p < 0.0001). The PsA-5Ts had good discriminant validity like that of the DAPSA, CPDAI, PASDAS, and PsAID-12, and better than that of the SF-36, with an area under the ROC curve of 0.944 (65% CI 0.895-0.974). CONCLUSIONS The PsA-5Ts are an easy-to-use PRO that can be integrated with disease activity indices in the assessment of PsA in daily clinical practice.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Clinic, Ospedale "Carlo Urbani", Università Politecnica delle Marche, 60035 Jesi, Italy
| | - Marina Carotti
- Dipartimento di Scienze Cliniche Specialistiche e Odontostomatologiche, Università Politecnica delle Marche, Clinica di Radiologia, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Sonia Farah
- Rheumatology Clinic, Ospedale "Carlo Urbani", Università Politecnica delle Marche, 60035 Jesi, Italy
| | - Marco Di Carlo
- Rheumatology Clinic, Ospedale "Carlo Urbani", Università Politecnica delle Marche, 60035 Jesi, Italy
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Anderson NE, Kyte D, McMullan C, Cockwell P, Aiyegbusi OL, Verdi R, Calvert M. Global use of electronic patient-reported outcome systems in nephrology: a mixed methods study. BMJ Open 2023; 13:e070927. [PMID: 37438075 DOI: 10.1136/bmjopen-2022-070927] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES The use of electronic patient-reported outcome (ePRO) systems to support the management of patients with chronic kidney disease is increasing. This mixed-methods study aimed to comprehensively identify existing and developing ePRO systems, used in nephrology settings globally, ascertaining key characteristics and factors for successful implementation. STUDY DESIGN ePRO systems and developers were identified through a scoping review of the literature and contact with field experts. Developers were invited to participate in a structured survey, to summarise key system characteristics including: (1) system objectives, (2) population, (3) PRO measures used, (4) level of automation, (5) reporting, (6) integration into workflow and (7) links to electronic health records/national registries. Subsequent semistructured interviews were conducted to explore responses. SETTING AND PARTICIPANTS Eligible systems included those being developed or used in nephrology settings to assess ePROs and summarise results to care providers. System developers included those with a key responsibility for aspects of the design, development or implementation of an eligible system. ANALYTICAL APPROACH Structured survey data were summarised using descriptive statistics. Interview transcripts were analysed using Codebook Thematic Analysis using domains from the Consolidated Framework for Implementation Research. RESULTS Fifteen unique ePRO systems were identified across seven countries; 10 system developers completed the structured survey and 7 participated in semistructured interviews. Despite system heterogeneity, reported features required for effective implementation included early and sustained patient involvement, clinician champions and expanding existing electronic platforms to integrate ePROs. Systems demonstrated several common features, with the majority being implemented within research settings, thereby affecting system implementation readiness for real-world application. CONCLUSIONS There has been considerable research investment in ePRO systems. The findings of this study outline key system features and factors to support the successful implementation of ePROs in routine kidney care.Cite Now.
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Affiliation(s)
- Nicola Elizabeth Anderson
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Research, Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Applied Research Collaboration, West Midlands, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- School of Allied Health and Community, University of Worcester, Worcester, UK
| | - Christel McMullan
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR SRMRC, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Applied Research Collaboration, West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Rav Verdi
- Patient Partner, Institute of Applied Health Research,Centre for Patient-Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Applied Research Collaboration, West Midlands, University of Birmingham, Birmingham, UK
- NIHR SRMRC, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
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10
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Wegener EK, Bergschöld JM, Whitmore C, Winters M, Kayser L. Involving Older People With Frailty or Impairment in the Design Process of Digital Health Technologies to Enable Aging in Place: Scoping Review. JMIR Hum Factors 2023; 10:e37785. [PMID: 36705959 PMCID: PMC9919541 DOI: 10.2196/37785] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/08/2022] [Accepted: 11/20/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND With an increase in life expectancy globally, the focus on digital health technologies that can enhance physical and mental health among older people with frailty and impairment has increased. Similarly, research interest in how digital health technology can promote well-being and self-management of health in older age has increased, including an increased focus on methods for designing digital health technologies that meet the various medical, psychological, and social needs of older population. Despite the increased focus, there remains a necessity to further understand the needs of this population group to ensure uptake and to avoid introduction of additional challenges when introducing technologies, for example, because of poor technological design. The scope is limited to digital health technologies meant to enable older people with frailty and impairment to age in place. OBJECTIVE In this study, we aimed to explore how older people with frailty and impairment are involved in various parts of the design processes of digital health technologies and identify gaps or neglected steps in a user-involving design process. This included a focus on recruitment strategies, contributions, and methods used to address the perspectives, needs, and desires of older people with frailty and impairment in the development of digital health technologies. METHODS A scoping review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting from February 2021 to April 2021. Literature searches were conducted in PubMed, Scopus, Embase, and IEEE using a search string covering the concepts of health technology, older people, frailty and impairment, user-centered design, and self-management. RESULTS In total, 1891 studies were imported for screening from the initial search. A total of 22 studies were included in this review after full-text screening and manual search. Invitation through partners was the most reported recruitment strategy to involve older people with frailty and impairment in the design process of digital health technologies. Furthermore, they were commonly involved in the final evaluation of the development process. Three main gaps identified were the use of outreach approaches to recruit older people with frailty and impairment in the design process of digital health technologies, description of the value of involvement and outcome of the contribution of participants, and knowledge regarding involvement in all parts of the design process. CONCLUSIONS Although there is literature on methods for involving older people with frailty and impairment in the design of digital health technology, there is little methodological dialogue on the nuances of how different methods for involvement relate to and shape the outcome of the development process.
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Affiliation(s)
| | | | - Carly Whitmore
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | | | - Lars Kayser
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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11
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Kim SH. A Systematic Review on Visualizations for Self-Generated Health Data for Daily Activities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11166. [PMID: 36141443 PMCID: PMC9517532 DOI: 10.3390/ijerph191811166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
Due to the development of sensing technology people can easily track their health in various ways, and the interest in personal healthcare data is increasing. Individuals are interested in controlling their wellness, which requires self-awareness and an understanding of various health conditions. Self-generated health data are easily accessed through mobile devices, and data visualization is commonly used in applications. A systematic literature review was conducted to better understand the role of visualizations and learn how to develop effective ones. Thirteen papers were analyzed for types of data, characteristics of visualizations, and effectiveness for healthcare management. The papers were selected because they represented research on personal health data and visualization in a non-clinical setting, and included health data tracked in everyday life. This paper suggests six levels for categorizing the efficacy of visualizations that take into account cognitive and physical changes in users. Recommendations for future work on conducting evaluations are also identified. This work provides a foundation for personal healthcare data as more applications are developed for mobile and wearable devices.
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Affiliation(s)
- Sung-Hee Kim
- Department of Industrial ICT Engineering, Dong-Eui Univesrity, Busan 47340, Korea
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12
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Kim MT, Heitkemper EM, Hébert ET, Hecht J, Crawford A, Nnaka T, Hutson TS, Rhee H, Radhakrishnan K. Redesigning culturally tailored intervention in the precision health era: Self-management science context. Nurs Outlook 2022; 70:710-724. [PMID: 35933178 PMCID: PMC9722518 DOI: 10.1016/j.outlook.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/18/2022] [Accepted: 05/27/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Nurse scientists have significantly contributed to health equity and ensuring cultural tailoring of interventions to meet unique needs of individuals. Methodologies for cultural tailoring of self-mangament interventions among marginalized populations have limitedly accommodated intersectionality and group heterogeneity when addressing health needs. PURPOSE Identify methodological limitations in cultural tailoring of interventions among priority populations and issue recommendations on cultural elements that researchers can target to ensure valid cultural tailoring approaches. METHODS Synthesis of literature on health equity, self-management, and implementation and dissemination research. FINDINGS Among priority populations, intersectionality and group heterogeneity has made group-based cultural tailoring approaches less effective in eliciting desirable health outcomes. Precision health methodology could be useful for cultural tailoring of interventions due to the methodology's focus on individual-level tailoring approaches. DISCUSSION We offer ways to advance health equity research using precision health approaches in cultural tailoring through targeting unique elements of culture and relevant psychosocial phenotypes.
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Affiliation(s)
- Miyong T Kim
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX.
| | - Elizabeth M Heitkemper
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Emily T Hébert
- The Center for Health Equity Research, Health Science Center at Houston, School of Publics Health Austin, The University of Texas, Austin, TX
| | - Jacklyn Hecht
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Alison Crawford
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Tonychris Nnaka
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Tara S Hutson
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Hyekyun Rhee
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Kavita Radhakrishnan
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
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13
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Harji DP, Williams A, McKigney N, Boissieras L, Denost Q, Fearnhead NS, Jenkins JT, Griffiths B. Utilising quality of life outcome trajectories to aid patient decision making in pelvic exenteration. Eur J Surg Oncol 2022; 48:2238-2249. [PMID: 36030134 DOI: 10.1016/j.ejso.2022.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Shared decision-making in pelvic exenteration is a complex and detailed process, which must balance clinical, oncological and patient-reported outcomes (PROs), whilst addressing and valuing the patient priorities. Communicating patient-centred information on quality of life (QoL) and functional outcomes is an essential component of this. The aim of this systematic review was to understand the impact of pelvic exenteration on QoL PROs over a longitudinal period and to develop QoL trajectories to support decision-making in this context. METHODS MEDLINE, Embase and Web of Science databases were searched between 1st January 2000 and 20th December 2021 Studies reporting on PROs, including QoL, in adults undergoing pelvic exenteration were included. Risk of bias was assessed using the ROBINS-I assessment tool. Data from studies reporting QoL using the same outcome measure at the same candidate timepoint were extracted and synthesised to develop a longitudinal QoL trajectory. RESULTS Fourteen studies consisting of 1370 patients were included in this review. QoL trajectories were constructed in the domains of physical function, psychological function, role function, sexual function, body image and general and specific symptoms. Decision-making was only assessed by one study, with satisfaction with decision-making reported to be high. There is an initial decline in QoL scores in the domains of physical function, role function, sexual function, body image and general health and symptoms deteriorating during the first 3-6 months post-operatively. Psychological function is the only QoL domain that remains stable throughout the post-operative period. CONCLUSION Mapping QoL trajectories provides a visual representation of post-operative progress, highlighting the enduring impact of pelvic exenteration on patients and can be used to inform pre-operative shared decision-making.
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Affiliation(s)
- Deena P Harji
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
| | | | - Niamh McKigney
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Lara Boissieras
- Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Quentin Denost
- Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Nicola S Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospitals, Cambridge, UK
| | - John T Jenkins
- Department of Surgery, St Mark's Hospital, Watford Road, Harrow, UK
| | - Ben Griffiths
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
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14
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van der Horst D, van Uden-Kraan C, Parent E, Bart J, Waverijn G, Verberk-Jonkers I, van den Dorpel M, Pieterse A, Bos W. Optimizing the use of patients’ individual outcome information – development and usability tests of a Chronic Kidney Disease dashboard. Int J Med Inform 2022; 166:104838. [DOI: 10.1016/j.ijmedinf.2022.104838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022]
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15
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Hilhorst L, Stappen JVD, Lokkerbol J, Hiligsmann M, Risseeuw AH, Tiemens BG. Patients’ and Psychologists’ Preferences for Feedback Reports on Expected Mental Health Treatment Outcomes: A Discrete-Choice Experiment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:707-721. [PMID: 35428931 PMCID: PMC9393149 DOI: 10.1007/s10488-022-01194-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/27/2022]
Abstract
In recent years, there has been an increasing focus on routine outcome monitoring (ROM) to provide feedback on patient progress during mental health treatment, with some systems also predicting the expected treatment outcome. The aim of this study was to elicit patients’ and psychologists’ preferences regarding how ROM system-generated feedback reports should display predicted treatment outcomes. In a discrete-choice experiment, participants were asked 12–13 times to choose between two ways of displaying an expected treatment outcome. The choices varied in four different attributes: representation, outcome, predictors, and advice. A conditional logistic regression was used to estimate participants’ preferences. A total of 104 participants (68 patients and 36 psychologists) completed the questionnaire. Participants preferred feedback reports on expected treatment outcome that included: (a) both text and images, (b) a continuous outcome or an outcome that is expressed in terms of a probability, (c) specific predictors, and (d) specific advice. For both patients and psychologists, specific predictors appeared to be most important, specific advice was second most important, a continuous outcome or a probability was third most important, and feedback that includes both text and images was fourth in importance. The ranking in importance of both the attributes and the attribute levels was identical for patients and psychologists. This suggests that, as long as the report is understandable to the patient, psychologists and patients can use the same ROM feedback report, eliminating the need for ROM administrators to develop different versions.
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Affiliation(s)
- Loes Hilhorst
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
| | - Jip van der Stappen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Joran Lokkerbol
- Centre of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health), Utrecht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care & Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Bea G Tiemens
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Pro Persona Research, Renkum, The Netherlands
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16
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Albers EAC, Fraterman I, Walraven I, Wilthagen E, Schagen SB, van der Ploeg IM, Wouters MWJM, van de Poll-Franse LV, de Ligt KM. Visualization formats of patient-reported outcome measures in clinical practice: a systematic review about preferences and interpretation accuracy. J Patient Rep Outcomes 2022; 6:18. [PMID: 35239055 PMCID: PMC8894516 DOI: 10.1186/s41687-022-00424-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The use of Patient-Reported Outcome Measures (PROMs) for individual patient management within clinical practice is becoming increasingly important. New evidence about graphic visualization formats for PROMs scores has become available. This systematic literature review evaluated evidence for graphic visualization formats of PROMs data in clinical practice for patients and clinicians, for both individual and group level PROMs data. METHODS Studies published between 2000 and 2020 were extracted from CINAHL, PubMed, PsychInfo, and Medline. Studies included patients ≥ 18 years old in daily clinical practice. Papers not available in English, without full-text access, or that did not specifically describe visualization of PROMs data were excluded. Outcomes were: visualization preferences; interpretation accuracy; guidance for clinical interpretation. RESULTS Twenty-five out of 789 papers were included for final analysis. Most frequently studied formats were: bar charts, line graphs, and pie charts. Patients preferred bar charts and line graphs as these were easy and quick for retrieving information about their PROMs scores over time. Clinicians' interpretation accuracy and preferences were similar among graphic visualization formats. Scores were most often compared with patients' own previous scores; to further guide clinical interpretation, scores were compared to norm population scores. Different 'add-ons' improved interpretability for patients and clinicians, e.g. using colors, descriptions of measurement scale directionality, descriptive labels, and brief definitions. CONCLUSION There was no predominant graphical visualization format approach in terms of preferences or interpretation accuracy for both patients and clinicians. Detailed clarification of graph content is essential.
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Affiliation(s)
- Elaine A C Albers
- Department of Psychosocial Research, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Itske Fraterman
- Department of Psychosocial Research, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Iris Walraven
- Department of Psychosocial Research, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | - Erica Wilthagen
- Library and Scientific Information Department, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Iris M van der Ploeg
- Department of Surgical Oncology, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Michel W J M Wouters
- Department of Surgical Oncology, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Psychosocial Research, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, Center of Research On Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Kelly M de Ligt
- Department of Psychosocial Research, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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17
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Göttgens I, Oertelt-Prigione S. The Application of Human-Centered Design Approaches in Health Research and Innovation: A Narrative Review of Current Practices. JMIR Mhealth Uhealth 2021; 9:e28102. [PMID: 34874893 PMCID: PMC8691403 DOI: 10.2196/28102] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/16/2021] [Accepted: 10/21/2021] [Indexed: 12/14/2022] Open
Abstract
Background Human-centered design (HCD) approaches to health care strive to support the development of innovative, effective, and person-centered solutions for health care. Although their use is increasing, there is no integral overview describing the details of HCD methods in health innovations. Objective This review aims to explore the current practices of HCD approaches for the development of health innovations, with the aim of providing an overview of the applied methods for participatory and HCD processes and highlighting their shortcomings for further research. Methods A narrative review of health research was conducted based on systematic electronic searches in the PubMed, CINAHL, Embase, Cochrane Library, Web of Science, PsycINFO, and Sociological Abstracts (2000-2020) databases using keywords related to human-centered design, design thinking (DT), and user-centered design (UCD). Abstracts and full-text articles were screened by 2 reviewers independently based on predefined inclusion criteria. Data extraction focused on the methodology used throughout the research process, the choice of methods in different phases of the innovation cycle, and the level of engagement of end users. Results This review summarizes the application of HCD practices across various areas of health innovation. All approaches prioritized the user’s needs and the participatory and iterative nature of the design process. The design processes comprised several design cycles during which multiple qualitative and quantitative methods were used in combination with specific design methods. HCD- and DT-based research primarily targeted understanding the research context and defining the problem, whereas UCD-based work focused mainly on the direct generation of solutions. Although UCD approaches involved end users primarily as testers and informants, HCD and DT approaches involved end users most often as design partners. Conclusions We have provided an overview of the currently applied methodologies and HCD guidelines to assist health care professionals and design researchers in their methodological choices. HCD-based techniques are challenging to evaluate using traditional biomedical research methods. Previously proposed reporting guidelines are a step forward but would require a level of detail that is incompatible with the current publishing landscape. Hence, further development is needed in this area. Special focus should be placed on the congruence between the chosen methods, design strategy, and achievable outcomes. Furthermore, power dimensions, agency, and intersectionality need to be considered in co-design sessions with multiple stakeholders, especially when including vulnerable groups.
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Affiliation(s)
- Irene Göttgens
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
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18
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Stonbraker S, Liu J, Sanabria G, George M, Cunto-Amesty S, Alcántara C, Abraído-Lanza AF, Halpern M, Rowell-Cunsolo T, Bakken S, Schnall R. Clinician Use of HIV-Related Infographics During Clinic Visits in the Dominican Republic is Associated with Lower Viral Load and Other Improvements in Health Outcomes. AIDS Behav 2021; 25:4061-4073. [PMID: 34129143 PMCID: PMC8602767 DOI: 10.1007/s10461-021-03331-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 02/05/2023]
Abstract
We designed an infographic intervention to help clinicians provide health information to persons living with HIV. In this study, we assessed the extent to which our intervention may improve objectively and subjectively measured health outcomes (CD4 count, viral load, and engagement with clinician among others) when integrated into routine visits in the Dominican Republic. In this pretest-posttest study, we followed participants for 9 months at 3-month intervals. Physicians administered the intervention during participants' first 3 visits. Outcome measures, selected using a conceptual model, were assessed at 4 time points. We assessed changes in outcomes over time with general linear regressions and Wilcoxon Signed-Rank tests. Participants (N = 50) were mostly female (56%) and had been living with HIV for a mean of 6.3 years (SD = 6.1). All outcomes, except CD4 count, demonstrated statistically significant improvements by study end. This provides preliminary evidence our intervention may improve outcomes, but further testing is needed.
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Affiliation(s)
- Samantha Stonbraker
- Anschutz Medical Campus, University of Colorado College of Nursing, 13120 E. 19th Ave, Aurora, CO, 80045, USA.
- Clínica de Familia La Romana, La Romana, Dominican Republic.
| | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, USA
| | | | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
| | | | | | | | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | | | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, USA
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19
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Bass M, Oncken C, McIntyre AW, Dasilva C, Spuhl J, Rothrock NE. Implementing an Application Programming Interface for PROMIS Measures at Three Medical Centers. Appl Clin Inform 2021; 12:979-983. [PMID: 34670293 PMCID: PMC8528565 DOI: 10.1055/s-0041-1736464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND There is an increasing body of literature advocating for the collection of patient-reported outcomes (PROs) in clinical care. Unfortunately, there are many barriers to integrating PRO measures, particularly computer adaptive tests (CATs), within electronic health records (EHRs), thereby limiting access to advances in PRO measures in clinical care settings. OBJECTIVE To address this obstacle, we created and evaluated a software integration of an Application Programming Interface (API) service for administering and scoring Patient-Reported Outcomes Measurement Information System (PROMIS) measures with the EHR system. METHODS We created a RESTful API and evaluated the technical feasibility and impact on clinical workflow at three academic medical centers. RESULTS Collaborative teams (i.e., clinical, information technology [IT] and administrative staff) performed these integration efforts addressing issues such as software integration as well as impact on clinical workflow. All centers considered their implementation successful based on the high rate of completed PROMIS assessments (between January 2016 and January 2021) and minimal workflow disruptions. CONCLUSION These case studies demonstrate not only the feasibility but also the pathway for the integration of PROMIS CATs into the EHR and routine clinical care. All sites utilized diverse teams with support and commitment from institutional leadership, initial implementation in a single clinic, a process for monitoring and optimization, and use of custom software to minimize staff burden and error.
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Affiliation(s)
- Michael Bass
- Department of Medical Social Science, Northwestern University, Chicago, Illinois, United States
| | - Christian Oncken
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, United States
| | - Allison W McIntyre
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York, United States
| | - Chris Dasilva
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York, United States
| | - Joshua Spuhl
- Enterprise Data Warehouse, University of Utah Health System, Salt Lake City, Utah, United States
| | - Nan E Rothrock
- Department of Medical Social Science, Northwestern University, Chicago, Illinois, United States
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20
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Masterson Creber R, Spadaccio C, Dimagli A, Myers A, Taylor B, Fremes S. Patient-Reported Outcomes in Cardiovascular Trials. Can J Cardiol 2021; 37:1340-1352. [PMID: 33974992 PMCID: PMC8487900 DOI: 10.1016/j.cjca.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/31/2021] [Accepted: 04/11/2021] [Indexed: 12/25/2022] Open
Abstract
Patient-reported outcomes (PROs) are reports of a person's health status that provide a global perspective of patient well-being. PROs can be classified into 4 primary domains: global, mental, physical, and social health. In this descriptive review, we focus on how PROs can be used in cardiac clinical trials, with an emphasis on cardiac surgical trials for patients with coronary heart disease and heart failure. We also highlight ongoing challenges and provide specific suggestions and novel opportunities to advance cardiac clinical trials. Current challenges include the long-term measurement of PROs in clinical trials beyond 1 year, inconsistency in the choice of the outcome measures among studies, and the lack of measurement of PROs across multiple domains. Opportunities for advancement include measuring PROs using consumer health informatics tools, including returning information back to participants in formats that they can understand using visualization. Future opportunities include quantifying cohort-specific minimal clinically important differences for PROs.
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Affiliation(s)
- Ruth Masterson Creber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA.
| | - Cristiano Spadaccio
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Arnaldo Dimagli
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Annie Myers
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Brittany Taylor
- School of Nursing, Columbia University, New York, New York, USA
| | - Stephen Fremes
- Sunnybrook Health Science, University of Toronto, Toronto, Ontario, Canada
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Masterson Creber R, Turchioe MR. Returning Cardiac Rhythm Data to Patients: Opportunities and Challenges. Card Electrophysiol Clin 2021; 13:555-567. [PMID: 34330381 PMCID: PMC8328196 DOI: 10.1016/j.ccep.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Spurred by federal legislation, professional organizations, and patients themselves, patient access to data from electronic cardiac devices is increasingly transparent. Patients can collect data through consumer devices and access data traditionally shared only with health care providers. These data may improve screening, self-management, and shared decision-making for cardiac arrhythmias, but challenges remain, including patient comprehension, communication with providers, and sustained engagement. Ways to address these challenges include leveraging visualizations that support comprehension, involving patients in designing and developing patient-facing digital tools, and establishing clear practices and goals for data exchange with health care providers.
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Affiliation(s)
- Ruth Masterson Creber
- Division of Health Informatics, Weill Cornell Medicine, 425 E 61st St, Floor 3, New York, NY 10065, USA.
| | - Meghan Reading Turchioe
- Division of Health Informatics, Weill Cornell Medicine, 425 E 61st St, Floor 3, New York, NY 10065, USA
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22
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Mitchell EG, Heitkemper EM, Burgermaster M, Levine ME, Miao Y, Hwang ML, Desai PM, Cassells A, Tobin JN, Tabak EG, Albers DJ, Smaldone AM, Mamykina L. From Reflection to Action: Combining Machine Learning with Expert Knowledge for Nutrition Goal Recommendations. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2021; 2021:206. [PMID: 35514864 PMCID: PMC9067367 DOI: 10.1145/3411764.3445555] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Self-tracking can help personalize self-management interventions for chronic conditions like type 2 diabetes (T2D), but reflecting on personal data requires motivation and literacy. Machine learning (ML) methods can identify patterns, but a key challenge is making actionable suggestions based on personal health data. We introduce GlucoGoalie, which combines ML with an expert system to translate ML output into personalized nutrition goal suggestions for individuals with T2D. In a controlled experiment, participants with T2D found that goal suggestions were understandable and actionable. A 4-week in-the-wild deployment study showed that receiving goal suggestions augmented participants' self-discovery, choosing goals highlighted the multifaceted nature of personal preferences, and the experience of following goals demonstrated the importance of feedback and context. However, we identified tensions between abstract goals and concrete eating experiences and found static text too ambiguous for complex concepts. We discuss implications for ML-based interventions and the need for systems that offer more interactivity, feedback, and negotiation.
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Affiliation(s)
| | | | - Marissa Burgermaster
- Department of Population Health, Dell Medical School, and Department of Nutritional Sciences, The University of Texas at Austin
| | - Matthew E Levine
- Department of Computing and Mathematical Sciences, California Institute of Technology
| | - Yishen Miao
- Department of Molecular, Cellular, and Developmental Biology, University of California Santa Barbara
| | | | - Pooja M Desai
- Department of Biomedical Informatics, Columbia University
| | | | | | | | - David J Albers
- University of Colorado, Anschutz Medical Campus, Section of Informatics and Data Science, Departments of Pediatrics, Biomedical Engineering, and Biostatistics and Informatics, and Department of Biomedical Informatics, Columbia University
| | | | - Lena Mamykina
- Department of Biomedical Informatics, Columbia University
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23
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Reading Turchioe M, Grossman LV, Myers AC, Baik D, Goyal P, Masterson Creber RM. Visual analogies, not graphs, increase patients' comprehension of changes in their health status. J Am Med Inform Assoc 2021; 27:677-689. [PMID: 31999316 DOI: 10.1093/jamia/ocz217] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/25/2019] [Accepted: 12/12/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Patients increasingly use patient-reported outcomes (PROs) to self-monitor their health status. Visualizing PROs longitudinally (over time) could help patients interpret and contextualize their PROs. The study sought to assess hospitalized patients' objective comprehension (primary outcome) of text-only, non-graph, and graph visualizations that display longitudinal PROs. MATERIALS AND METHODS We conducted a clinical research study in 40 hospitalized patients comparing 4 visualization conditions: (1) text-only, (2) text plus visual analogy, (3) text plus number line, and (4) text plus line graph. Each participant viewed every condition, and we used counterbalancing (systematic randomization) to control for potential order effects. We assessed objective comprehension using the International Organization for Standardization protocol. Secondary outcomes included response times, preferences, risk perceptions, and behavioral intentions. RESULTS Overall, 63% correctly comprehended the text-only condition and 60% comprehended the line graph condition, compared with 83% for the visual analogy and 70% for the number line (P = .05) conditions. Participants comprehended the visual analogy significantly better than the text-only (P = .02) and line graph (P = .02) conditions. Of participants who comprehended at least 1 condition, 14% preferred a condition that they did not comprehend. Low comprehension was associated with worse cognition (P < .001), lower education level (P = .02), and fewer financial resources (P = .03). CONCLUSIONS The results support using visual analogies rather than text to display longitudinal PROs but caution against relying on graphs, which is consistent with the known high prevalence of inadequate graph literacy. The discrepancies between comprehension and preferences suggest factors other than comprehension influence preferences, and that future researchers should assess comprehension rather than preferences to guide presentation decisions.
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Affiliation(s)
- Meghan Reading Turchioe
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - Lisa V Grossman
- Department of Biomedical Informatics, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Annie C Myers
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - Dawon Baik
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Ruth M Masterson Creber
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
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24
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Chiang S, Moss R, Black AP, Jackson M, Moss C, Bidwell J, Meisel C, Loddenkemper T. Evaluation and recommendations for effective data visualization for seizure forecasting algorithms. JAMIA Open 2021; 4:ooab009. [PMID: 33709064 PMCID: PMC7935496 DOI: 10.1093/jamiaopen/ooab009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/05/2021] [Indexed: 12/15/2022] Open
Abstract
Objective Seizure forecasting algorithms have become increasingly accurate and may reduce the morbidity and mortality caused by seizure unpredictability. Translating these benefits into meaningful health outcomes for people with epilepsy requires effective data visualization of algorithm outputs. To date, no studies have investigated patient and physician perspectives on effective translation of algorithm outputs into data visualizations through health information technology. Materials and Methods We developed front-end data visualizations as part of a Seizure Forecast Visualization Toolkit. We surveyed 627 people living with epilepsy and caregivers, and 28 epilepsy healthcare providers. Respondents scored each visualization in terms of international standardized software quality criteria for functionality, appropriateness, and usability. Results People with epilepsy and caregivers ranked hourly radar charts highest for protecting against errors in interpreting forecasts, reducing anxiety from seizure unpredictability, and understanding seizure patterns. Accuracy in interpreting visuals, such as a risk gauge, was dependent on seizure frequency. Visuals showing hourly/daily forecasts were more useful for patients who experienced seizure cycling than those who did not. Hourly line graphs and monthly heat maps were rated highest among clinicians for ease of understanding, anticipated integration into clinical practice, and the likelihood of clinical usage. Epilepsy providers indicated that daily heat maps, daily line graphs, and hourly line graphs were most useful for interpreting seizure diary patterns, assessing therapy impact, and counseling on seizure safety. Discussion The choice of data visualization impacts the effective translation of seizure forecast algorithms into meaningful health outcomes. Conclusion This effort underlines the importance of incorporating standardized, quantitative methods for assessing the effectiveness of data visualization to translate seizure forecast algorithms into clinical practice.
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Affiliation(s)
- Sharon Chiang
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Robert Moss
- Seizure Tracker, LLC, Springfield, Virginia, USA
| | - Angela P Black
- Department of Pediatrics, Corridor Primary Care, San Marcos, Texas, USA
| | - Michele Jackson
- Divison of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chuck Moss
- Seizure Tracker, LLC, Springfield, Virginia, USA
| | - Jonathan Bidwell
- Divison of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Meisel
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Tobias Loddenkemper
- Divison of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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25
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Grossman LV, Masterson Creber RM, Benda NC, Wright D, Vawdrey DK, Ancker JS. Interventions to increase patient portal use in vulnerable populations: a systematic review. J Am Med Inform Assoc 2021; 26:855-870. [PMID: 30958532 DOI: 10.1093/jamia/ocz023] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/05/2019] [Accepted: 02/12/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND More than 100 studies document disparities in patient portal use among vulnerable populations. Developing and testing strategies to reduce disparities in use is essential to ensure portals benefit all populations. OBJECTIVE To systematically review the impact of interventions designed to: (1) increase portal use or predictors of use in vulnerable patient populations, or (2) reduce disparities in use. MATERIALS AND METHODS A librarian searched Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Reviews for studies published before September 1, 2018. Two reviewers independently selected English-language research articles that evaluated any interventions designed to impact an eligible outcome. One reviewer extracted data and categorized interventions, then another assessed accuracy. Two reviewers independently assessed risk of bias. RESULTS Out of 18 included studies, 15 (83%) assessed an intervention's impact on portal use, 7 (39%) on predictors of use, and 1 (6%) on disparities in use. Most interventions studied focused on the individual (13 out of 26, 50%), as opposed to facilitating conditions, such as the tool, task, environment, or organization (SEIPS model). Twelve studies (67%) reported a statistically significant increase in portal use or predictors of use, or reduced disparities. Five studies (28%) had high or unclear risk of bias. CONCLUSION Individually focused interventions have the most evidence for increasing portal use in vulnerable populations. Interventions affecting other system elements (tool, task, environment, organization) have not been sufficiently studied to draw conclusions. Given the well-established evidence for disparities in use and the limited research on effective interventions, research should move beyond identifying disparities to systematically addressing them at multiple levels.
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Affiliation(s)
- Lisa V Grossman
- Department of Biomedical Informatics, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | | | - Natalie C Benda
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
| | - Drew Wright
- Samuel J Wood Library, Information Technologies and Services, Weill Cornell Medicine, New York, New York, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Value Institute, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jessica S Ancker
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
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26
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Reading Turchioe M, Grossman LV, Baik D, Lee CS, Maurer MS, Goyal P, Safford MM, Masterson Creber RM. Older Adults Can Successfully Monitor Symptoms Using an Inclusively Designed Mobile Application. J Am Geriatr Soc 2020; 68:1313-1318. [PMID: 32157679 DOI: 10.1111/jgs.16403] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Patient-Reported Outcomes Measurement Information System (PROMIS) measures can monitor patients with chronic illnesses outside of healthcare settings. Unfortunately, few applications that collect electronic PROMIS measures are designed using inclusive design principles that ensure wide accessibility and usability, thus limiting use by older adults with chronic illnesses. Our aim was to establish the feasibility of using an inclusively designed mobile application tailored to older adults to report PROMIS measures by examining (1) PROMIS scores collected with the application, (2) patient-reported usability of the application, and (3) differences in usability by age. DESIGN Cross-sectional feasibility study. SETTING Inpatient and outpatient cardiac units at an urban academic medical center. PARTICIPANTS A total of 168 English- and Spanish-speaking older adults with heart failure. INTERVENTION Participants used an inclusively designed mobile application to self-report PROMIS measures. MEASUREMENTS Eleven PROMIS Short-Form questionnaires (Anxiety, Ability to Participate in Social Roles and Activities, Applied Cognition-Abilities, Depression, Emotional Distress-Anger, Fatigue, Global Mental Health, Global Physical Health; Pain Interference, Physical Function, Sleep Disturbance), and a validated health technology usability survey measuring Perceived Ease-of-Use and Usefulness of the application. RESULTS Overall, 27% of participants were between 65 and 74 years of age, 10% were 75 years or older, 63% were male, 32% were white, and 96% had two or more medical conditions. There was no missing PROMIS data, and mean PROMIS scores showed the greatest burden of pain, fatigue, and physical function in the sample. Usability scores were high and not associated with age (Perceived Ease-of-Use P = .77; Perceived Usefulness P = .91). CONCLUSION It is feasible for older adults to use an inclusively designed application to report complete PROMIS data with high perceived usability. To ensure data completeness and the opportunity to study multiple domains of physical, mental, and social health, future work should use inclusive design principles for applications collecting PROMIS measures among older adults. J Am Geriatr Soc 68:1313-1318, 2020.
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Affiliation(s)
| | - Lisa V Grossman
- Department of Biomedical Informatics, Columbia University Medical Center, New York, New York
| | - Dawon Baik
- College of Nursing, University of Colorado Anschutz Medial Campus, Aurora, Colorado
| | - Christopher S Lee
- Boston College Connell School of Nursing, Chestnut Hill, Massachusetts
| | - Mathew S Maurer
- Clinical Cardiovascular Research Laboratory for the Elderly, Allen Hospital of New York Presbyterian, Columbia University Irving Medical Center, New York, New York
| | - Parag Goyal
- Department of Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Monika M Safford
- Department of Internal Medicine, Weill Cornell Medicine, New York, New York
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Chen YT, Tan YZ, Cheen M, Wee HL. Patient-Reported Outcome Measures in Registry-Based Studies of Type 2 Diabetes Mellitus: a Systematic Review. Curr Diab Rep 2019; 19:135. [PMID: 31748944 DOI: 10.1007/s11892-019-1265-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Patient-reported outcome measures (PROMs) and patient registries both play important roles in assessing patient outcomes. However, no study has examined the use of PROMs among registries involving patients with type 2 diabetes mellitus (T2DM). Our objective is twofold: first, to review the range of PROMs used in registry-based studies of patients with T2DM; second, to describe associations between these PROMs, T2DM and its complications. RECENT FINDINGS The International Consortium for Health Outcomes Measurement (ICHOM) Diabetes Standard Set recommended routine usage of PROMs to assess psychological well-being, diabetes distress, and depression among patients with T2DM. A wide variety of PROMs were used among the 15 studies included in this review. Quality of life, depressive symptoms and treatment adherence were the most common aspects of T2DM that utilised PROMs for assessment. Adoption of PROMs among registries of patients with T2DM remains uncommon, non-routine and with few that are validated before use.
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Affiliation(s)
- Yu Ting Chen
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Yan Zhi Tan
- Department of Health Management and Economics, University of Oslo, Kirkeveien 166, Frederik Holsts hus , 0450, Oslo, Norway
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50 , Rotterdam, PA, 3062, Netherlands
| | - Mcvin Cheen
- Danone Asia Pacific Holdings, 1 Wallich Street, #18-01 Guoco Tower, Singapore, 078881, Singapore
- Medicine Academic Clinical Programme, Duke-NUS Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Hwee-Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore.
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore.
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Turchioe MR, Myers A, Isaac S, Baik D, Grossman LV, Ancker JS, Creber RM. A Systematic Review of Patient-Facing Visualizations of Personal Health Data. Appl Clin Inform 2019; 10:751-770. [PMID: 31597182 DOI: 10.1055/s-0039-1697592] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES As personal health data are being returned to patients with increasing frequency and volume, visualizations are garnering excitement for their potential to facilitate patient interpretation. Evaluating these visualizations is important to ensure that patients are able to understand and, when appropriate, act upon health data in a safe and effective manner. The objective of this systematic review was to review and evaluate the state of the science of patient-facing visualizations of personal health data. METHODS We searched five scholarly databases (PubMed, Embase, Scopus, ACM Digital Library [Association for Computing Machinery Digital Library], and IEEE Computational Index [Institute of Electrical and Electronics Engineers Computational Index]) through December 1, 2018 for relevant articles. We included English-language articles that developed or tested one or more patient-facing visualizations for personal health data. Three reviewers independently assessed quality of included articles using the Mixed methods Appraisal Tool. Characteristics of included articles and visualizations were extracted and synthesized. RESULTS In 39 articles included in the review, there was heterogeneity in the sample sizes and methods for evaluation but not sample demographics. Few articles measured health literacy, numeracy, or graph literacy. Line graphs were the most common visualization, especially for longitudinal data, but number lines were used more frequently in included articles over past 5 years. Article findings suggested more patients understand the number lines and bar graphs compared with line graphs, and that color is effective at communicating risk, improving comprehension, and increasing confidence in interpretation. CONCLUSION In this review, we summarize types and components of patient-facing visualizations and methodologies for development and evaluation in the reviewed articles. We also identify recommendations for future work relating to collecting and reporting data, examining clinically actionable boundaries for diverse data types, and leveraging data science. This work will be critically important as patient access of their personal health data through portals and mobile devices continues to rise.
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Affiliation(s)
- Meghan Reading Turchioe
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
| | - Annie Myers
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
| | - Samuel Isaac
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
| | - Dawon Baik
- Columbia University School of Nursing, New York, New York, United States
| | - Lisa V Grossman
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - Jessica S Ancker
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
| | - Ruth Masterson Creber
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
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Baik D, Reading M, Jia H, Grossman LV, Masterson Creber R. Measuring health status and symptom burden using a web-based mHealth application in patients with heart failure. Eur J Cardiovasc Nurs 2019; 18:325-331. [PMID: 30681003 PMCID: PMC6433527 DOI: 10.1177/1474515119825704] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Symptoms of heart failure markedly impair a patient's health status. The aim of this study was to identify predictors of health status in a sample of racially and ethnically diverse patients with heart failure using a web-based mobile health application, mi.Symptoms. METHODS We conducted a cross-sectional study at an urban academic medical center. Patients with heart failure self-reported symptoms using validated symptom instruments (e.g. patient-reported outcome measurement information system) by way of the mobile health application, mi.Symptoms. The primary study outcome was health status, measured with the Kansas City cardiomyopathy questionnaire clinical summary score. Data were analyzed using descriptive statistics and multiple linear regression. RESULTS The mean age of the sample ( n=168) was 58.7 (±12.5) years, 37% were women, 36% were Black, 36% identified as Hispanic/Latino, 48% were classified as New York Heart Association class III, and 44% reported not having enough income to make ends meet. Predictors of better health status in heart failure included higher physical function ( β=0.89, p=0.001) and ability to participate in social roles and activities ( β=0.58, p=0.002), and predictors of poorer health status were New York Heart Association class IV ( β=-11.68, p=0.006) and dyspnea ( β=-0.77, p<0.001). The predictors accounted for 73% of the variance in health status. CONCLUSION Patient-centered interventions should focus on modifiable risk factors that reduce dyspnea, improve functional status, and enhance engagement in social roles to improve the health status of patients with heart failure.
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Affiliation(s)
- Dawon Baik
- 1 School of Nursing, Columbia University, USA
| | - Meghan Reading
- 2 Department of Healthcare Policy and Research, Weill Cornell Medicine, USA
| | - Haomiao Jia
- 1 School of Nursing, Columbia University, USA
| | - Lisa V Grossman
- 3 Department of Biomedical Informatics, Columbia University, USA
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