Flexible patient-reported outcome-based telehealth follow-up for type 1 diabetes: A qualitative study

A scoping review of digital solutions in diabetes outpatient care: Functionalities and outcomes

BACKGROUND

Digital interventions are increasingly used in outpatient diabetes care to address growing healthcare demands and workforce limitations. This study investigates the functionalities of digital solutions and their impact on Quadruple Aim outcomes: enhancing population health, improving patient experience, supporting clinician well-being, and reducing healthcare costs.

METHODS

We followed Joanna Briggs Institute guidelines, searching PubMed, Embase, Cochrane, Scopus, and Web of Science (January 2019-February 2024). Included studies reported digital diabetes interventions with outcomes directly relevant to the Quadruple Aim. Each intervention was mapped to a digital solution horizon: Horizon 1 involves foundational digital workflows; Horizon 2 leverages real-time data to create analytics; Horizon 3 encompasses transformative uses, such as predictive analytics.

RESULTS

We identified 4,397 articles with 56 meeting the inclusion criteria. Interventions included telehealth (n = 15), mobile health (mHealth) (n = 20), combined telehealth and mHealth (n = 14), robotics (n = 1), electronic medical records (n = 1), and artificial intelligence (n = 5). Most interventions (n = 51) were categorised as Horizon 1, with 10 adopting Horizon 2, 5 using Horizon 3, and 10 spanning multiple horizons. Regarding Quadruple Aim outcomes, 44 studies addressed population health (41 positive), 31 targeted patient experience (29 positive), 4 focused on clinician well-being (3 positive), and 6 on cost reduction (4 positive).

CONCLUSION

Digital solutions have demonstrated measurable benefits, particularly in population health and patient experience. Most interventions remain at Horizon 1. Advancing these digital solutions to Horizon 2 and 3 is essential for system-wide transformation. Future research should include cost efficiency and clinician experience alongside evaluations of population health and patient experience.

Expert consensus on implementing patient-reported outcomes in telehealth: findings from an international Delphi study

BACKGROUND

Using Patient Reported Outcomes (PROs) in clinical care can reduce healthcare service utilization by improving the quality of care. Telehealth, defined by WHO, as the use of "telecommunications and virtual technology to deliver healthcare outside of traditional healthcare facilities", can facilitate a dynamic dialogue between patients and healthcare providers for timely interventions. With the increased use of telehealth facilitated by the infrastructure development during the COVID-19 pandemic, there is an opportunity to utilize telehealth for PRO implementation and a need for guidelines for using PROs via telehealth. This study aimed to generate expert consensus on the utilization of PROs in telehealth.

METHODS

Delphi methodology was used to achieve consensus among international experts with a predetermined consensus threshold of 70%. Experts were mainly identified through the ISOQOL Clinical Practice SIG. Surveys asked a combination of structured and open-ended questions about the conceptualization of PROs in telehealth, its applicability, target population, implementation challenges and successful strategies, evaluation approaches, and the essential stakeholders. Data from each round were iteratively analyzed using descriptive statistics (quantitative data) and content analysis (qualitative data).

RESULTS

Out of 24 invitations sent, 17 completed the first round, and 11 completed all three rounds. Respondents were equally distributed between clinicians and researchers and 70% had used PROs via telehealth before the pandemic. Consensus was achieved and some of the relevant aspects are monitoring patients for applicability; individuals with chronic diseases as the target population; resources, staff buy-in, and clinical workflow as the implementation challenges and strategies; utilization metrics for evaluation; and clinicians and patients as essential stakeholders. Though consensus was not reached for the conceptualization of PROs using telehealth, the modified FDA definition of telehealth with the addition of its purpose, and the mode of administration was the most acceptable version. See attached table.

CONCLUSION

The expert consensus achieved provides important insights from an international perspective on how PROs are currently used via telehealth and the needed implementation support to advance their expansion in research and practice. Lack of consensus on the definition of PROs in telehealth signals the continued rapid evolution of their use and the need for additional research.

Defining patient-reported outcomes in diabetes, obesity, cardiovascular disease, and chronic kidney disease for clinical practice guidelines - perspectives of the taskforce of the Guideline Workshop

Recent clinical practice guidelines for diabetes, obesity, cardiovascular disease (CVD) and chronic kidney disease (CKD) emphasise a holistic, person-centred approach to care. However, they do not include recommendations for the assessment of patient-reported outcomes (PROs), which would - dependent on the topic of guideline - be important for improving shared decision-making, patients' concordance with guideline recommendations, clinical outcomes and health-related quality of life (HRQoL). The Taskforce of the Guideline Workshop discussed PROs in diabetes, obesity, CVD and CKD as well as the relevance of their inclusion in clinical practice guidelines for the management of these conditions.

Investigating Digital Patient-Reported Outcome Measures in Patient-Centered Diabetes Specialist Outpatient Care (DigiDiaS): Protocol for a Multimethod Prospective Observational Study

BACKGROUND

Living with type 1 diabetes is challenging, and to support self-management, repeated consultations in specialist outpatient care are often required. The emergence of new digital solutions has revolutionized how health care services can be patient centered, providing unprecedented opportunities for flexible, high-quality care. However, there is a lack of studies exploring how the use of digital patient-reported outcome measures (PROMs) for flexible specialist care affects diabetes self-management. To provide new knowledge on the relevance of using PROMs in standard care, we have designed a multimethod prospective study.

OBJECTIVE

The overall aim of this protocol is to describe our prospective multimethod observational study designed to investigate digital PROMs in a routine specialist outpatient setting for flexible patient-centered diabetes care (DigiDiaS).

METHODS

This protocol outlines the design of a multimethod prospective observational cohort study that includes data from electronic health records, self-reported questionnaires, clinical consultation field observations, and individual in-depth interviews with patients and diabetes health care personnel. All patients with type 1 diabetes at a designated outpatient clinic were invited to participate and use the digital PROM implemented in clinical care. Both users and nonusers of the digital PROM were eligible for the prospective study, allowing for a comparison of the two groups. Data were collected at baseline and after 12 months, including self-management as the primary outcome assessed using the Patient Activation Measure, along with the secondary outcomes of digital health literacy, quality of life, health economy, and clinical variables such as glycated hemoglobin.

RESULTS

The digital solution was implemented for routine clinical care in the department in November 2021, and data collection for the prospective study started in October 2022. As of September 6, 2023, 84.6% (186/220) of patients among those in the digital PROM and 15.5% (34/220) of patients among the nonusers have consented to participate. We expect the study to have enough participants by the autumn of 2023. With 1 year of follow-up, the results are expected by spring 2025.

CONCLUSIONS

In conclusion, a multimethod prospective observational cohort study can offer valuable insights into the relevance, effectiveness, and acceptability of digital tools using PROMs in diabetes specialist care. Such knowledge is crucial for achieving broad and successful implementation and use of these tools in a large diabetes outpatient clinic.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52766.

Virtual care in the health care system: A concept analysis

BACKGROUND

Health care providers need a better understanding of virtual care to recognise and use it for service delivery.

AIM

To provide a more comprehensive definition of the concept of virtual care.

METHOD

This study was conducted based on Walker and Avant's concept analysis method. A comprehensive review of the published texts in English from 2012 to 2022 was performed using the PubMed, Web of Science, Scopus, ProQuest, Science Direct, Ovid, CINAHL and Google Scholar databases.

RESULTS

The main aspects and attributes of virtual care, including the use of any information and communication technology in various formats such as platforms, telephone calls, messages, email consultation, remote monitoring, secure and two-way digital communication between health care providers and patients, the possibility of providing remote care synchronously or asynchronously, more interaction between patients and caregivers, the possibility of transferring information between patients and health care providers and within the teams themselves, symptom management, sending diagnostic results in the form of video visits, and providing follow-up care, are attributes that distinguish virtual care from telehealth, telemedicine and other methods of providing remote healthcare services.

CONCLUSION

Considering the positive and negative consequences of implementing virtual care, the findings of this study developed a basis for an operational definition of the concept so that providers can understand the meaning of virtual care and consider it when providing virtual care to patients. The findings of this study can be used in many international and national contexts in the health care system and in future studies on interventions to increase the use of virtual care.

Patient-reported outcome measures in diabetes outpatient care: a scoping review

BACKGROUND

Patient-reported outcome (PRO) measures are increasingly used in clinical diabetes care to increase patient involvement and improve healthcare services. The objectives were to identify instruments used to measure PROs in outpatient diabetes clinics and to investigate the use of these PRO measures alongside the experiences of patients and healthcare personnel in a clinical setting.

RESEARCH DESIGN AND METHODS

A scoping review was conducted according to the framework of Arksey and O'Malley with scoping searches of Cinahl, EMBASE, Medline and Health and Psychosocial Instruments. Studies reporting on adults with diabetes in a clinical setting where the PRO measure response directly affected patient care were eligible for inclusion.

RESULTS

In total, 35 197 citations were identified, of which 7 reports presenting 4 different PRO measures were included in the review. All four of the included items measured psychosocial aspects of diabetes, and three included elements of the Problem Areas in Diabetes scale. All the patients were satisfied with the use of PRO measures in clinical care, whereas the level of satisfaction among healthcare personnel with PRO measures varied within and among studies.

CONCLUSIONS

The limited number of eligible studies in this review suggests that research on PRO measures for diabetes outpatient care is scarce. Patients welcome the opportunity to express their concerns through the systematic collection of PRO measures, and some healthcare personnel value the broader insight that PRO measures provide into the impact of diabetes on patients' lives. However, the heterogeneity among services and among patients challenges the implementation of PRO measures. Research is needed to explore how PRO measures in clinical outpatient care affect healthcare personnel workflow.

REVIEW REGISTRATION

https://doi.org/10.17605/OSF.IO/46AHC.