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Piette JD, Striplin D, Aikens JE, Lee A, Marinec N, Mansabdar M, Chen J, Gregory LA, Kim CS. Impacts of Post-Hospitalization Accessible Health Technology and Caregiver Support on 90-Day Acute Care Use and Self-Care Assistance: A Randomized Clinical Trial. Am J Med Qual 2021; 36:145-155. [PMID: 32723072 DOI: 10.1177/1062860620943673] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hospitalized patients often are readmitted soon after discharge, with many hospitalizations being potentially preventable. The authors evaluated a mobile health intervention designed to improve post-hospitalization support for older adults with common chronic conditions. All participants enrolled with an informal caregiver or "CarePartner" (CP). Intervention patients received automated assessment and behavior change calls. CPs received automated, structured feedback following each assessment. Clinicians received alerts about serious problems identified during patient calls. Controls had a 65% greater risk of hospitalization within 90 days post discharge than intervention patients (P = .041). For every 6.8 enrollees, the intervention prevented 1 rehospitalization or emergency department encounter. The intervention improved physical functioning at 90 days (P = .012). The intervention also improved medication adherence and indicators of the quality of communication with CPs (all P < .01). Automated telephone patient monitoring and self-care advice with feedback to primary care teams and CPs reduces readmission rates over 90 days.
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Affiliation(s)
- John D Piette
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI University of Michigan, Ann Arbor, MI University of Mississippi, Oxford, MS MidMichigan Health Network, Midland, MI University of Washington, Seattle, WA
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2
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Amid COVID-19 pandemic: Challenges with access to care for COPD patients. Res Social Adm Pharm 2020; 17:1934-1937. [PMID: 32513515 PMCID: PMC7266601 DOI: 10.1016/j.sapharm.2020.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 11/27/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammation in the lungs that causes obstruction in the airway, poor airflow, and irreversible loss of lung function. In clinical practice, comprehensive care for COPD patients includes the diagnosis using spirometry, clinical examination and comprehensive pharmacological and non-pharmacological management. The diagnosis is based on symptoms, dyspnea and lung function impairment and can be mild to very severe. Symptoms are examined using the COPD assessment test (CAT) score, and dyspnea grade are examined using a modified MRC from GOLD guidelines. When mild, the care includes self-management education, smoking cessation, lifestyle modifications, vaccination, and short-acting bronchodilators. Self-management education involves inhaler device training, breathing technique, early recognition of acute exacerbations and writing action plans. As the disease progresses, other care measures are added. These measures include the addition of long-acting inhaler therapies, pulmonary rehabilitation, oral therapies, oxygen and lung transplantation. During the final stages of COPD, patients receive end-of-life care (Bourbeau et al., 2019).1 The novel coronavirus disease (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is spread through respiratory droplets. This infectious disease has led to a pandemic and is affecting the lives of many around the world, including Canadians. During this pandemic, the non-essential health services, including caring for patients with COPD, have been put on hold to reduce the risk of spread. Other implications of this pandemic for COPD patients include the health risk in case of infection. A meta-analysis including studies from January to March 2020 in Wuhan showed that pre-existing COPD worsens the risk of COVID-19 progression and leads to poorer prognostics. The sub-group analysis showed a significantly higher risk of ICU requirements and death in COPD patients who are infected with the SARS-CoV-2 virus. Studies suggest strong efforts to mitigate the risk of infection in this population (Zhao et al., May 2020).2 This makes caring for this population even more critical during the pandemic.
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Amith M, Roberts K, Tao C. Conceiving an application ontology to model patient human papillomavirus vaccine counseling for dialogue management. BMC Bioinformatics 2019; 20:706. [PMID: 31865902 PMCID: PMC6927108 DOI: 10.1186/s12859-019-3193-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In the United States and parts of the world, the human papillomavirus vaccine uptake is below the prescribed coverage rate for the population. Some research have noted that dialogue that communicates the risks and benefits, as well as patient concerns, can improve the uptake levels. In this paper, we introduce an application ontology for health information dialogue called Patient Health Information Dialogue Ontology for patient-level human papillomavirus vaccine counseling and potentially for any health-related counseling. Results The ontology’s class level hierarchy is segmented into 4 basic levels - Discussion, Goal, Utterance, and Speech Task. The ontology also defines core low-level utterance interaction for communicating human papillomavirus health information. We discuss the design of the ontology and the execution of the utterance interaction. Conclusion With an ontology that represents patient-centric dialogue to communicate health information, we have an application-driven model that formalizes the structure for the communication of health information, and a reusable scaffold that can be integrated for software agents. Our next step will to be develop the software engine that will utilize the ontology and automate the dialogue interaction of a software agent.
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Affiliation(s)
- Muhammad Amith
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin Road, Suite 600, Houston, TX, 77030, USA
| | - Kirk Roberts
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin Road, Suite 600, Houston, TX, 77030, USA
| | - Cui Tao
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin Road, Suite 600, Houston, TX, 77030, USA.
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Fernandez-Granero MA, Sanchez-Morillo D, Leon-Jimenez A. An artificial intelligence approach to early predict symptom-based exacerbations of COPD. BIOTECHNOL BIOTEC EQ 2018. [DOI: 10.1080/13102818.2018.1437568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | - Daniel Sanchez-Morillo
- Biomedical Engineering and Telemedicine Lab, School of Engineering, University of Cádiz, Cádiz, Spain
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SymptomCare@Home: Developing an Integrated Symptom Monitoring and Management System for Outpatients Receiving Chemotherapy. Comput Inform Nurs 2017; 35:520-529. [PMID: 28570285 DOI: 10.1097/cin.0000000000000364] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
SymptomCare@Home, an integrated symptom monitoring and management system, was designed as part of randomized clinical trials to help patients with cancer who receive chemotherapy in ambulatory clinics and often experience significant symptoms at home. An iterative design process was informed by chronic disease management theory and features of assessment and clinical decision support systems used in other diseases. Key stakeholders participated in the design process: nurse scientists, clinical experts, bioinformatics experts, and computer programmers. Especially important was input from end users, patients, and nurse practitioners participating in a series of studies testing the system. The system includes both a patient and clinician interface and fully integrates two electronic subsystems: a telephone computer-linked interactive voice response system and a Web-based Decision Support-Symptom Management System. Key features include (1) daily symptom monitoring, (2) self-management coaching, (3) alerting, and (4) nurse practitioner follow-up. The nurse practitioner is distinctively positioned to provide assessment, education, support, and pharmacologic and nonpharmacologic interventions to intensify management of poorly controlled symptoms at home. SymptomCare@Home is a model for providing telehealth. The system facilitates using evidence-based guidelines as part of a comprehensive symptom management approach. The design process and system features can be applied to other diseases and conditions.
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Piette JD, Striplin D, Marinec N, Chen J, Gregory LA, Sumerlin DL, DeSantis AM, Gibson C, Crause I, Rouse M, Aikens JE. Improving Post-Hospitalization Transition Outcomes through Accessible Health Information Technology and Caregiver Support: Protocol for a Randomized Controlled Trial. JOURNAL OF CLINICAL TRIALS 2016; 5. [PMID: 26779394 PMCID: PMC4711915 DOI: 10.4172/2167-0870.1000240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective The goal of this trial is to evaluate a novel intervention designed to improve post-hospitalization support for older adults with chronic conditions via: (a) direct tailored communication to patients using regular automated calls post discharge, (b) support for informal caregivers outside of the patient’s household via structured automated feedback about the patient’s status plus advice about how caregivers can help, and (c) support for care management including a web-based disease management tool and alerts about potential problems. Methods 846 older adults with common chronic conditions are being identified upon hospital admission. Patients are asked to identify a “CarePartner” (CP) living outside their household, i.e., an adult child or other social network member willing to play an active role in their post-discharge transition support. Patient-CP pairs are randomized to the intervention or usual care. Intervention patients receive automated assessment and behavior change calls, and their CPs receives structured feedback and advice via email and automated calls following each assessment. Clinical teams have access to assessment results via the web and receive automated reports about urgent health problems. Patients complete surveys at baseline, 30 days, and 90 days post discharge; utilization data is obtained from hospital records. CPs, other caregivers, and clinicians are interviewed to evaluate intervention effects on processes of self-care support, caregiver stress and communication, and the intervention’s potential for broader implementation. The primary outcome is 30-day readmission rates; other outcomes measured at 30 days and 90 days include functional status, self-care behaviors, and mortality risk. Conclusion This trial uses accessible health technologies and coordinated communication among informal caregivers and clinicians to fill the growing gap between what discharged patients need and available resources. A unique feature of the intervention is the provision of transition support not only for patients but also for their informal caregivers.
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Affiliation(s)
- John D Piette
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA; Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Dana Striplin
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicolle Marinec
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Jenny Chen
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Lynn A Gregory
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Denise L Sumerlin
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Angela M DeSantis
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Carolyn Gibson
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Ingrid Crause
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Marylena Rouse
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - James E Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Nimmon L, Poureslami I, FitzGerald M. Telehealth Interventions for Management of Chronic Obstructive Lung Disease (COPD) and Asthma. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2013. [DOI: 10.4018/jhisi.2013010103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The authors systematically collated, classified, and evaluated the evidence of intervention studies from recent systematic reviews about the effects of telehealth interventions on COPD and asthma care. Eight electronic databases were searched. Eligible articles were those published between 2001 and 2011 in English. Eleven review articles are included. Asthma and COPD are better controlled when patients use interactive technological tools to monitor their chronic disease. The effects of telehealth interventions on emergency department attendance, specific quality of life, and mortality remained less certain. Only some reviews mentioned if the cost-effectiveness was systematically analyzed. Telehealth promises to be a highly effective intervention in managing chronic lung diseases while also potentially reducing some of the economic burdens of asthma and COPD. New directions in telehealth developments, implementations, and evaluations should be made, in which the exchange of health information should not be over simplified, but rather reflect the different socio-cultural practices of population groups and individuals.
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Affiliation(s)
- Laura Nimmon
- Faculty of Education, Department of Language and Literacy, University of British Columbia, Vancouver, BC, Canada
| | - Iraj Poureslami
- Faculty of Medicine, Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Mark FitzGerald
- UBC and VGH Divisions of Respiratory Medicine & The Lung Centre, Vancouver, BC, Canada
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Kim J, Kim S, Kim H, Kim K, Lee CT, Yang S, Kong HJ, Shin Y, Lee K. Acceptability of the Consumer-Centric u-Health Services for Patients with Chronic Obstructive Pulmonary Disease. Telemed J E Health 2012; 18:329-38. [DOI: 10.1089/tmj.2011.0140] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jeongeun Kim
- College of Nursing, Seoul National University, Seoul, Korea
- College of Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| | - Sukwha Kim
- College of Medicine, Seoul National University, Seoul, Korea
- Seoul National University Hospital, Seoul, Korea
| | - Heechan Kim
- College of Medicine, Seoul National University, Seoul, Korea
- Seoul National University Hospital, Seoul, Korea
| | - Kyungwhan Kim
- College of Medicine, Seoul National University, Seoul, Korea
- Seoul National University Hospital, Seoul, Korea
| | - Choon-taek Lee
- College of Medicine, Seoul National University, Seoul, Korea
- Seoul National University Bundang Hospital, Seoul, Korea
| | - Sukchul Yang
- College of Medicine, Seoul National University, Seoul, Korea
- Seoul National University Hospital, Seoul, Korea
| | | | - Yoonju Shin
- College of Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| | - Kyungsoon Lee
- Graduate Course, College of Nursing, Seoul National University, Seoul, Korea
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Halpin DMG, Laing-Morton T, Spedding S, Levy ML, Coyle P, Lewis J, Newbold P, Marno P. A randomised controlled trial of the effect of automated interactive calling combined with a health risk forecast on frequency and severity of exacerbations of COPD assessed clinically and using EXACT PRO. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 20:324-31, 2 p following 331. [PMID: 21687919 DOI: 10.4104/pcrj.2011.00057] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We have developed a winter forecasting service to predict when patients with COPD are at higher risk of an exacerbation and alert them via an automated telephone call. AIMS To assess the effect of the service and its ability to predict periods of increased risk. METHODS A 4-month prospective randomised controlled trial using clinical criteria and the EXACT PRO questionnaire to identify exacerbations. Patients were randomly allocated to receive alert calls. All patients completed a diary including the EXACT PRO questionnaire on a BlackBerry Smartphone each day. They were contacted and assessed if they appeared to be exacerbating. RESULTS 79 patients participated, 40 received alert calls. The exacerbation frequency per patient per week was significantly greater during periods of predicted high risk (0.086 ± 0.010 v 0.055 ± 0.010). The exacerbation frequency (± standard error of the mean, SEM) in patients receiving alert calls was lower (0.95 ± 0.27 v 1.17 ± 0.29) but this was not statistically significant. Fewer patients receiving alert calls had one or more EXACT event compared to the controls (34% v 53%, p=0.11), their duration was shorter (8.2 ± 2.0 v10.1 ± 1.9 days, p=0.481) and they were less severe (AUC 65 ± 21 v 115 ± 22, p=0.118). There were no significant differences in the mean change (± SEM) in SGRQ scores between the groups. CONCLUSIONS The ability of the forecast to predict high risk periods was confirmed unequivocally. Alert calls appeared to reduce the frequency and severity of exacerbations but these effects did not reach statistical significance, perhaps because of the number of participants, lower than expected exacerbation rates, and the fact that there was contact with patients in both groups whenever they appeared to be exacerbating.
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Sparrow D, Gottlieb DJ, Demolles D, Fielding RA. Increases in muscle strength and balance using a resistance training program administered via a telecommunications system in older adults. J Gerontol A Biol Sci Med Sci 2011; 66:1251-7. [PMID: 21852283 DOI: 10.1093/gerona/glr138] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Resistance training programs have been found to improve muscle strength, physical function, and depressive symptoms in middle-aged and older adults. These programs have typically been provided in clinical facilities, health clubs, and senior centers, which may be inconvenient and/or cost prohibitive for some older adults. The purpose of this study was to investigate the effectiveness of an automated telemedicine intervention that provides real-time guidance and monitoring of resistance training in the home. METHODS A randomized clinical trial in 103 middle-aged or older participants. Participants were assigned to use of a theory-driven interactive voice response system designed to promote resistance training (Telephone-Linked Computer-based Long-term Interactive Fitness Trainer; n = 52) or to an attention control (n = 51) for a period of 12 months. Measurements of muscle strength, balance, walk distance, and mood were obtained at baseline, 3, 6, and 12 months. RESULTS We observed increased strength, improved balance, and fewer depressive symptoms in the intervention group than in the control group. Using generalized estimating equations modeling, group differences were statistically significant for knee flexion strength (p = .035), single-leg stance time (p = .029), and Beck Depression Inventory (p = .030). CONCLUSIONS This computer-based telecommunications exercise intervention led to improvements in participants' strength, balance, and depressive symptoms. Because of their low cost and easy accessibility, computer-based interventions may be a cost-effective way of promoting exercise in the home.
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Affiliation(s)
- David Sparrow
- Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA.
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A new multidisciplinary home care telemedicine system to monitor stable chronic human immunodeficiency virus-infected patients: a randomized study. PLoS One 2011; 6:e14515. [PMID: 21283736 PMCID: PMC3024968 DOI: 10.1371/journal.pone.0014515] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Accepted: 12/01/2010] [Indexed: 12/02/2022] Open
Abstract
Background Antiretroviral therapy has changed the natural history of human immunodeficiency virus (HIV) infection in developed countries, where it has become a chronic disease. This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals. Methodology We developed a new internet-based home care model covering the entire management of chronic HIV-infected patients. This was called Virtual Hospital. We report the results of a prospective randomised study performed over two years, comparing standard care received by HIV-infected patients with Virtual Hospital care. HIV-infected patients with access to a computer and broadband were randomised to be monitored either through Virtual Hospital (Arm I) or through standard care at the day hospital (Arm II). After one year of follow up, patients switched their care to the other arm. Virtual Hospital offered four main services: Virtual Consultations, Telepharmacy, Virtual Library and Virtual Community. A technical and clinical evaluation of Virtual Hospital was carried out. Findings Of the 83 randomised patients, 42 were monitored during the first year through Virtual Hospital (Arm I) and 41 through standard care (Arm II). Baseline characteristics of patients were similar in the two arms. The level of technical satisfaction with the virtual system was high: 85% of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system. Neither clinical parameters [level of CD4+ T lymphocytes, proportion of patients with an undetectable level of viral load (p = 0.21) and compliance levels >90% (p = 0.58)] nor the evaluation of quality of life or psychological questionnaires changed significantly between the two types of care. Conclusions Virtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients. Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection. Trial Registration Clinical-Trials.gov: NCT01117675.
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Design and development of a Telephone-Linked Care (TLC) system to reduce impulsivity among violent forensic outpatients and probationers. J Med Syst 2010; 36:1031-42. [PMID: 20721686 DOI: 10.1007/s10916-010-9565-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 07/14/2010] [Indexed: 10/19/2022]
Abstract
Forensic services face the challenge of reducing relapse among clients with a history of violent crime. An automated interactive voice response (IVR) service of the complex Telephone-Linked Care (TLC) type, with a focus on reducing impulsivity, could improve the adequacy of service responses to client needs. Theoretically based in Dialectical Behavior Therapy (DBT), Cognitive Behavior Therapy (CBT) and Motivational Interviewing (MI), the forensic TLC system offers interactive conversations on coping with the emotions of anger, shame and loneliness; activities of daily life such as getting out of bed, asking for help, visiting social services and taking medication; and other areas such as hearing voices, drinking alcohol and self-critical thoughts. We describe the user's flow through the system, with an in-depth synopsis of the hearing voices intervention. Issues regarding voluntary versus mandatory use of the system are addressed in connection with prospective introduction of the system in forensic settings.
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Boisseau N, Burde A, Bachmann P, Senesse P, Hebuterne X. A telephone-linked computer system for home enteral nutrition. J Telemed Telecare 2010; 16:363-7. [DOI: 10.1258/jtt.2010.090912] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We studied the effect of telephone-linked computer (TLC) communication in patients being treated with home enteral nutrition. A total of 290 patients were enrolled in the study which compared two groups of patients who were recruited at different times (control: 193, TLC: 97). At baseline there were no significant differences in characteristics or clinical practice between the two groups. Over a three-month period, 823 automatic telephone calls were dialled out to the TLC patients and in 787 of the calls (96%) there were complete responses to all questions. A total of 205 alert messages were generated for the 823 calls. Less than 10% were false alerts. All health outcome measures, the EQ-5D and three components of the SF-36 improved slightly with time in both groups, but there was no significant difference between the groups. The patients' body mass index increased slightly in both groups, but the change was not significant. Home enteral nutrition prevented weight loss and improved some components of the QOL scores. The TLC system detected a high number of abnormal nutritional symptoms.
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Bartoli L, Zanaboni P, Masella C, Ursini N. Systematic Review of Telemedicine Services for Patients Affected by Chronic Obstructive Pulmonary Disease (COPD). Telemed J E Health 2009; 15:877-83. [DOI: 10.1089/tmj.2009.0044] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Laura Bartoli
- Department of Management, Economics, and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Paolo Zanaboni
- Department of Management, Economics, and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Cristina Masella
- Department of Management, Economics, and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Niccoló Ursini
- Department of Management, Economics, and Industrial Engineering, Politecnico di Milano, Milan, Italy
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Farzanfar R, Stevens A, Vachon L, Friedman R, Locke SE. Design and development of a mental health assessment and intervention system. J Med Syst 2007; 31:49-62. [PMID: 17283922 DOI: 10.1007/s10916-006-9042-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Mental health disorders are the leading cause of disability and functional impairment in the United States (1 in 5). The negative effect of mental health disorders is felt both in the personal and public lives of the affected individuals, particularly in the workplace where it adversely impacts productivity. Only a small fraction of the affected people in the work force seeks help. The cost to employers and the economy of these untreated individuals is staggering. Some employers have tried to address employees' emotional well-being by establishing Employee Assistance Programs. Yet, even these programs do not sufficiently address existing barriers to the detection and treatment of mental health disorders in the workplace. This paper describes the design of an automated workplace program that uses an Interactive, computer-assisted telephonic system (Interactive Voice Response or IVR) to assess workers for a variety of mental health disorders and subsequently refers untreated and inadequately treated workers to appropriate treatment settings.
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Affiliation(s)
- Ramesh Farzanfar
- Medical Information Systems Unit, Boston University Medical Campus, Massachusetts 02118, USA.
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Migneault JP, Farzanfar R, Wright JA, Friedman RH. How to write health dialog for a talking computer. J Biomed Inform 2006; 39:468-81. [PMID: 16564749 DOI: 10.1016/j.jbi.2006.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2005] [Revised: 02/13/2006] [Accepted: 02/13/2006] [Indexed: 10/25/2022]
Abstract
Automated dialogue systems delivered over the telephone offer a promising approach to delivering health-related interventions to populations of individuals at low-cost. Over the past two decades, an automated telephone system called Telephone-Linked Care or TLC has been successfully designed and evaluated by the authors and their colleagues. This work has resulted in over twenty systems for various health-related conditions and lifestyle behaviors. This paper describes our approach to developing and writing dialogue for these automated telephone systems, including determining the program objectives, defining the target population, and selecting a theory of behavior change to guide the intervention. Both macro and micro issues are considered in constructing dialogue systems that are engaging for the target population, easy to use, and effective at promoting positive health behaviors and outcomes.
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Affiliation(s)
- Jeffrey P Migneault
- Medical Information Systems Unit, Department of Medicine, Boston University and Boston Medical Center, USA.
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de Toledo P, Jiménez S, del Pozo F, Roca J, Alonso A, Hernandez C. Telemedicine experience for chronic care in COPD. ACTA ACUST UNITED AC 2006; 10:567-73. [PMID: 16871726 DOI: 10.1109/titb.2005.863877] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Information and telecommunication technologies are called to play a major role in the changes that healthcare systems have to face to cope with chronic disease. This paper reports a telemedicine experience for the home care of chronic patients suffering from chronic obstructive pulmonary disease (COPD) and an integrated system designed to carry out this experience. To determine the impact on health, the chronic care telemedicine system was used during one year (2002) with 157 COPD patients in a clinical experiment; endpoints were readmissions and mortality. Patients in the intervention group were followed up at their homes and could contact the care team at any time through the call center. The care team shared a unique electronic chronic patient record (ECPR) accessible through the web-based patient management module or the home visit units. Results suggest that integrated home telemedicine services can support health professionals caring for patients with chronic disease, and improve their health. We have found that simple telemedicine services (ubiquitous access to ECPR, ECPR shared by care team, accessibility to case manager, problem reporting integrated in ECPR) can increase the number of patients that were not readmitted (51% intervention, 33% control), are acceptable to professionals, and involve low installation and exploitation costs. Further research is needed to determine the role of telemonitoring and televisit services for this kind of patients.
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Affiliation(s)
- Paula de Toledo
- Informatics Department, Carlos III University, Madrid, Spain.
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Nouvelles technologies et pneumologie. Rev Mal Respir 2006. [DOI: 10.1016/s0761-8425(06)77715-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bickmore T, Giorgino T. Health dialog systems for patients and consumers. J Biomed Inform 2006; 39:556-71. [PMID: 16464643 DOI: 10.1016/j.jbi.2005.12.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Revised: 12/12/2005] [Accepted: 12/14/2005] [Indexed: 11/17/2022]
Abstract
There is a growing need for automated systems that can interview patients and consumers about their health and provide health education and behavior change interventions using natural language dialog. A number of these health dialog systems have been developed over the last two decades, many of which have been formally evaluated in clinical trials and shown to be effective. This article provides an overview of the theories, technologies and methodologies that are used in the construction and evaluation of these systems, along with a description of many of the systems developed and tested to date. The strengths and weaknesses of these approaches are also discussed, and the needs for future work in the field are delineated.
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Affiliation(s)
- Timothy Bickmore
- College of Computer and Information Science, Northeastern University, Boston, MA, USA.
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Koizumi T, Takizawa M, Nakai K, Yamamoto Y, Murase S, Fujii T, Kobayashi T, Hatayama O, Fujimoto K, Kubo K. Trial of Remote Telemedicine Support for Patients with Chronic Respiratory Failure at Home through a Multistation Communication System. Telemed J E Health 2005; 11:481-6. [PMID: 16149895 DOI: 10.1089/tmj.2005.11.481] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To create and test a multistation telemedicine support system, three remote locations were connected: the homes of two patients with chronic respiratory failure, the hospital of the attending physician, and the hospital of the pulmonary specialist. Real-time connections were set up between the three locations. Medical history and biologic variables were noninvasively recorded, including blood pressure, arterial oxygen saturation, three-lead electrocardiogram, and end-tidal carbon dioxide. Both physicians shared in these data real-time. If necessary, the respiratory specialist could provide medical advice to the attending physician based on the patient's condition. The trial program resulted in the same information being exchanged remotely using the multi-station telemedicine system that would be exchanged in a direct, face-to-face encounter. This result, together with the improvement in quality of life and the establishment of appropriate treatment and cooperation between the respiratory specialist and attending physician, suggests our system can be considered useful and promising for further use.
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Affiliation(s)
- T Koizumi
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
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Giorgino T, Azzini I, Rognoni C, Quaglini S, Stefanelli M, Gretter R, Falavigna D. Automated spoken dialogue system for hypertensive patient home management. Int J Med Inform 2005; 74:159-67. [PMID: 15694621 DOI: 10.1016/j.ijmedinf.2004.04.026] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2003] [Revised: 03/17/2004] [Accepted: 04/02/2004] [Indexed: 12/11/2022]
Abstract
Recent advances in automatic speech recognition and related technologies allow computers to carry on conversations by telephone. We developed an intelligent dialogue system that interacts with hypertensive patients to collect data about their health status. Patients thus avoid the inconvenience of traveling for frequent face to face visits to monitor the clinical variables they can easily measure at home; the physician is facilitated in acquiring patient information and cardiovascular risk, which is evaluated from the data according to noted guidelines. Controlled trials to assess the clinical efficacy are under way.
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Affiliation(s)
- Toni Giorgino
- Laboratory for Medical Informatics, Dipartimento di Informatica e Sistemistica, Università di Pavia, Via Ferrata 1, I-27100 Pavia, Italy.
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Farzanfar R, Frishkopf S, Migneault J, Friedman R. Telephone-linked care for physical activity: a qualitative evaluation of the use patterns of an information technology program for patients. J Biomed Inform 2004; 38:220-8. [PMID: 15896695 DOI: 10.1016/j.jbi.2004.11.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Accepted: 11/15/2004] [Indexed: 11/23/2022]
Abstract
Automated health behavior interventions that involve discretionary use by patients or consumers over extended periods of time are becoming more common and it is generally assumed that adherence to the recommended schedule is related to the impact of the system on users. Yet reasons for use or non-use of such systems have not been carefully explored. An understanding of factors that influence people to use, not use, or underutilize these automated behavioral change and self-care management systems can help in designing systems that are more effective and acceptable to users. Using qualitative research methods, this study explored the experiences of 45 users of a multiple-contact health promotion application with the goal of understanding the major factors that affect patterns of use (frequency of and duration of contact). The in-depth exploration of users' perceptions and views made possible by the qualitative research methods revealed a number of important themes. Reported reasons for underutilization or non-use were found to be both user-related and system-related. User-related reasons encompassed personal and individual events that prevented or impeded system utilization. System-related reasons included those that related to the medium itself as well as the content of the application. The qualitative methods employed in this study created a forum through which users' feedback could be fully explored and then synthesized to assist in the improvement of this and other automated health behavior interventions.
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Affiliation(s)
- Ramesh Farzanfar
- Medical Information Systems Unit, Boston University Medical Center, 720 Harrison Avenue, Suite 1102, Boston, MA 02118, USA.
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Brooks D, Fancott CA, Falter LB, McFarlane A, Nonoyama ML. The development of a helpline for chronic obstructive pulmonary disease (COPD). PATIENT EDUCATION AND COUNSELING 2004; 54:329-336. [PMID: 15324984 DOI: 10.1016/j.pec.2003.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2003] [Revised: 05/05/2003] [Accepted: 06/30/2003] [Indexed: 05/24/2023]
Abstract
BACKGROUND The goal of the helpline is to assist individuals with chronic obstructive pulmonary disease (COPD) better manage their disease through improved understanding of COPD, its symptoms and treatment. OBJECTIVES The purpose of this project was to develop and validate a protocol for a COPD helpline. METHODS Ten key informants with expertise in helpline development or COPD were interviewed. Fifty individuals with COPD participated in content validation of the protocol. RESULTS An initial protocol for the helpline aimed to provide: (1) information and education regarding COPD and its management via the telephone and with written materials; (2) guidance regarding course of management; (3) resource links to other support services and programs locally, provincially, and/or nationally; and (4) caring support and reassurance to those with COPD and their families. The majority of the calls from individuals with COPD sought medical information (74%) and required 36.6 +/- 14.5 min (range: 15-85) to complete. Many different topics were discussed, with medication and exercise being the most common. The availability of the call center was identified as one means of replacing information sought from other health care providers, mainly physicians and pulmonary rehabilitation staff. CONCLUSION A protocol of a helpline for COPD has been developed based on the literature, theoretical knowledge, and input from key informants and individuals with COPD.
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Affiliation(s)
- Dina Brooks
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, 500 University Avenue, Room 848, Toronto, Ont., Canada M5G 1V7.
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DeMolles DA, Sparrow D, Gottlieb DJ, Friedman R. A pilot trial of a telecommunications system in sleep apnea management. Med Care 2004; 42:764-9. [PMID: 15258478 DOI: 10.1097/01.mlr.0000132353.99209.fe] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is an effective therapy for obstructive sleep apnea syndrome (OSAS), although many patients have difficulty adhering to this therapy. The purpose of this study was to investigate the effectiveness of totally automated telephone technology in improving adherence to prescribed CPAP therapy. RESEARCH DESIGN This pilot study was a randomized clinical trial in 30 patients being started on CPAP therapy for OSAS. Patients were randomly assigned to use of a computer telephone system designed to improve CPAP adherence (telephone-linked communications for CPAP [TLC-CPAP]) in addition to usual care (n = 15) or to usual care alone (n = 15) for a period of 2 months. TLC-CPAP is a computer-based system that monitors patients' self-reported behavior and provides education and reinforcement through a structured dialogue. MEASURES A sleep symptoms checklist and the Functional Outcomes of Sleep Questionnaire were administered at study entry and at 2-month follow up. Hours of CPAP use at effective mask pressure were measured by the CPAP device, stored in its memory, and retrieved at the 2-month visit. RESULTS At 2 months, patients randomized to TLC-CPAP had fewer reported sleep-related symptoms (9.4 vs. 13.4, P = 0.047) than those receiving usual care. The average nightly CPAP use in the TLC-CPAP group was 4.4 hours compared with 2.9 hours (P = 0.076) in the usual-care group. CONCLUSIONS This pilot study suggests that patients with OSAS started on CPAP and a concurrently administered automated education and counseling system had better CPAP adherence and better control of OSAS symptoms.
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Miller SM, Bowen DJ, Campbell MK, Diefenbach MA, Gritz ER, Jacobsen PB, Stefanek M, Fang CY, Lazovich D, Sherman KA, Wang C. Current Research Promises and Challenges in Behavioral Oncology. Cancer Epidemiol Biomarkers Prev 2004; 13:171-80. [PMID: 14973109 DOI: 10.1158/1055-9965.epi-463-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Behavioral Oncology Interest Group of the American Society of Preventive Oncology held a Roundtable session on March 10, 2002, at the American Society of Preventive Oncology annual meeting in Bethesda, Maryland, to discuss the current state-of-the-science in behavioral approaches to cancer prevention and control and to delineate priorities for additional research. Four key areas were considered: (a) behavioral approaches to cancer genetic risk assessment and testing; (b) biological mechanisms of psychosocial effects on cancer; (c) the role of risk perceptions in cancer screening adherence; and (d) the impact of tailored and targeted interventions on cancer prevention and control research. The evidence reviewed indicates that behavioral approaches have made significant contributions to cancer prevention and control research. At the same time, there is a need to more closely link future investigations to the underlying base of behavioral science principles and paradigms that guide them. To successfully bridge the gap between the availability of effective new cancer prevention and control technologies and the participants they are meant to serve will require the development of more integrative conceptual models, the incorporation of more rigorous methodological designs, and more precise identification of the individual and group characteristics of the groups under study.
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