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Carrera A, Manetti S, Lettieri E. Rewiring care delivery through Digital Therapeutics (DTx): a machine learning-enhanced assessment and development (M-LEAD) framework. BMC Health Serv Res 2024; 24:237. [PMID: 38395905 PMCID: PMC10885456 DOI: 10.1186/s12913-024-10702-z] [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: 12/04/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Digital transformation has sparked profound change in the healthcare sector through the development of innovative digital technologies. Digital Therapeutics offer an innovative approach to disease management and treatment. Care delivery is increasingly patient-centered, data-driven, and based on real-time information. These technological innovations can lead to better patient outcomes and support for healthcare professionals, also considering resource scarcity. As these digital technologies continue to evolve, the healthcare field must be ready to integrate them into processes to take advantage of their benefits. This study aims to develop a framework for the development and assessment of Digital Therapeutics. METHODS The study was conducted relying on a mixed methodology. 338 studies about Digital Therapeutics resulting from a systematic literature review were analyzed using descriptive statistics through RStudio. Machine learning algorithms were applied to analyze variables and find patterns in the data. The results of these analytical analyses were summarized in a framework qualitatively tested and validated through expert opinion elicitation. RESULTS The research provides M-LEAD, a Machine Learning-Enhanced Assessment and Development framework that recommends best practices for developing and assessing Digital Therapeutics. The framework takes as input Digital Therapeutics characteristics, regulatory aspects, study purpose, and assessment domains. The framework produces as outputs recommendations to design the Digital Therapeutics study characteristics. CONCLUSIONS The framework constitutes the first step toward standardized guidelines for the development and assessment of Digital Therapeutics. The results may support manufacturers and inform decision-makers of the relevant results of the Digital Therapeutics assessment.
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Zhang Y, Stayt L, Sutherland S, Greenway K. How clinicians make decisions for patient management plans in telehealth. J Adv Nurs 2024. [PMID: 38380577 DOI: 10.1111/jan.16104] [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: 10/17/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
AIM This systematic integrative literature review explores how clinicians make decisions for patient management plans in telehealth. BACKGROUND Telehealth is a modality of care that has gained popularity due to the development of digital technology and the COVID-19 pandemic. It is recognized that telehealth, compared to traditional clinical settings, carries a higher risk to patients due to its virtual characteristics. Even though the landscape of healthcare service is increasingly moving towards virtual systems, the decision-making process in telehealth remains not fully understood. DESIGN A systematic integrative review. DATA SOURCES Databases include CINAHL, APA PsycInfo, Academic Search Complete, PubMed, Web of Science and Google Scholar. REVIEW METHODS This systematic integrative review method was informed by Whittemore and Knafl (2005). The databases were initially searched with keywords in November 2022 and then repeated in October 2023. Thematic synthesis was conducted to analyse and synthesize the data. RESULTS The search identified 382 articles. After screening, only 10 articles met the eligibility criteria and were included. Five studies were qualitative, one quantitative and four were mixed methods. Five main themes relevant to decision-making processes in telehealth were identified: characteristics of decision-making in telehealth, patient factor, clinician factor, CDSS factor and external influencing factor. CONCLUSIONS The decision-making process in telehealth is a complicated cognitive process influenced by multi-faceted components, including patient factors, clinician factors, external influencing factors and technological factors. IMPACT Telehealth carries higher risk and uncertainty than face-to-face encounters. CDSS, rather than bringing unification and clarity, seems to bring more divergence and ambiguity. Some of the clinical reasoning processes in telehealth remain unknown and need to be verbalized and made transparent, to prepare junior clinicians with skills to minimize risks associated with telehealth. PATIENT OR PUBLIC CONTRIBUTION Not applicable.
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Affiliation(s)
- Yuhan Zhang
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
- Oxford Brookes University, Oxford, UK
| | - Louise Stayt
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
- Oxford Brookes University, Oxford, UK
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GoTO: A Process-Navigation Tool for Telehealth and -Care Solutions, Designed to Ensure an Efficient Trajectory from Goal Setting to Outcome Evaluation. INFORMATICS 2022. [DOI: 10.3390/informatics9030069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: The digital transformation of the healthcare sector involves the procurement and implementation of new health technologies, which will likely be a challenge to healthcare providers who are not part of large organizations. In response to the needs of small and middle-sized health and care organizations, we have developed a process navigator to guide providers of healthcare through the processes of innovation, the procurement of mature products, and their implementation in telehealth and telecare projects. Methods: A narrative overview identified health-technology-assessment-inspired models. Conversations with national and international colleagues identified project and implementation models. The origin of the included models was identified, and relevant articles were referred to to describe the essential principles, including the nature of stakeholder involvement and the evaluation processes when appropriate. Based on the inputs, we proposed the process navigator GoTO. Results: Six health-technology-assessment-inspired models, six project models, one implementation model, and one innovation model were identified and informed the creation of the GoTO process navigator. The navigator consists of four parts: inception (eight steps); materialization (three tracks, depending on the maturity of the planned solution); implementation (five steps); and the final assessment and evaluation. Conclusion: The GoTO process navigator is an intuitive guide for innovation, procurement, and implementation in telehealth and -care. The GoTo navigator can assist providers of digital health and care services throughout the process from the initial identification of goals to the final evaluation of outcomes.
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Sunner C, Giles MT, Kable A, Foureur M. Experiences of nurses working in RACFs and EDs utilising visual telehealth consultation to assess the need for RACF resident transfer to ED: A qualitative descriptive study. J Clin Nurs 2022. [PMID: 36081333 DOI: 10.1111/jocn.16529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to explore whether an intervention using visual telehealth improves care outcomes for residents in residential aged care facilities during acute illness events from the perspective of the nurses from residential aged care facilities and emergency departments. The intervention was the addition of visual telehealth, to an already existing outreach service called Aged Care Emergency. BACKGROUND Older people who are residents of residential aged care facilities commonly experience potentially avoidable visits and hospitalisations. Adopting visual telehealth or telemedicine has emerged as a care transition solution across several domains in health care, including residential aged care. METHOD This study used an interpretive descriptive methodological approach and was part of a larger study called the PACE-IT project that implemented a visual telehealth assisted model of care in four emergency departments and 16 residential aged care facilities to prevent unnecessary resident presentations to emergency departments. We report findings from six focus groups that explored key issues relating to the experiences of emergency department and residential aged care nurses who participated in the PACE-IT project. This study adhered to COREQ research guidelines. RESULTS There were four overarching themes that emerged from the six focus groups; facilitated person centred care; built confidence, relationships and trust; enabled bidirectional communication that strengthens decision making, but there were issues with technology access, connectivity and usability between the acute care setting and the residential aged care facility. RELEVANCE TO CLINICAL PRACTICE Understanding the experiences of residential aged care facility and emergency nurses' experiences when using visual telehealth will better inform practice development in aged care, in particular enhancing decision making and increasing safe practices using telehealth. The knowledge gained in this study in terms of enhanced assessments for residents will provide policy makers with valuable insights for future health care planning and implementation of telehealth. TRIAL REGISTRATION ACTRN12619001692123.
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Affiliation(s)
- Carla Sunner
- Nursing and Midwifery Research Centre, Hunter New England Area Health Service, Newcastle, New South Wales, Australia.,School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Michelle Therese Giles
- Nursing and Midwifery Research Centre, Hunter New England Area Health Service, Newcastle, New South Wales, Australia.,School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Ashley Kable
- School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Maralyn Foureur
- Nursing and Midwifery Research Centre, Hunter New England Area Health Service, Newcastle, New South Wales, Australia.,School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
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Abouzid MR, Elshafei SM, Elkhawas I, Elbana MK. Applications of Telemedicine in the Middle East and North Africa Region: Benefits Gained and Challenges Faced. Cureus 2022; 14:e26611. [PMID: 35936169 PMCID: PMC9355518 DOI: 10.7759/cureus.26611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/05/2022] Open
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Singh A, Sahoo AK, Dhaneria S, Gupta D. The outlook of doctors toward telemedicine: A cross-sectional study of knowledge, awareness, and attitude in central India. J Family Med Prim Care 2021; 10:3617-3624. [PMID: 34934656 PMCID: PMC8653445 DOI: 10.4103/jfmpc.jfmpc_62_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/21/2021] [Accepted: 06/26/2021] [Indexed: 11/04/2022] Open
Abstract
Background In an underdeveloped country like India where there are varied constraints in accessing healthcare, telemedicine can prove to be instrumental in providing access to the scant medical resources and infrastructures. The irony lies in its underutilization, which is multifactorial. Objective The present research was planned to evaluate the level of awareness, knowledge, and attitude toward telemedicine among the faculty members of tertiary-care teaching centers in Chhattisgarh, India. Methods A questionnaire-based survey was conducted to collect appropriate data, which were utilized for analysis as well as various intergroup analyses (among different designations, age groups, sex, and worksite). The data have been presented as median and percentage, while for intergroup comparison Mann-Whitney Test was performed. Results Among the 115 respondents, only 34% were females. The mean age was around 40.7 years, and 58% were <40 years of age. Their median scores of awareness, knowledge, and attitude were estimated to be 06, 14, and +9, respectively. No statistically significant difference was observed in the awareness, knowledge, and attitude among the faculty members belonging to different designations, age groups, and worksites. Conclusions Though, in general, the faculty members have demonstrated a favorable attitude toward the use of telemedicine yet most of them scored below the median mark. Furthermore, the estimated level of knowledge and awareness was also mediocre.
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Affiliation(s)
- Alok Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Ajaya K Sahoo
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Suryaprakash Dhaneria
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Dhyuti Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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HTA and HIV: The Case of Dual NRTI Backbones in the Italian Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239010. [PMID: 33287274 PMCID: PMC7729444 DOI: 10.3390/ijerph17239010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 11/17/2022]
Abstract
The aim of this study is to analyze the potential advantages of emtricitabine/tenofovir alafenamide (FTC/TAF) introduction, creating evidence-based information to orient strategies to reduce costs, thus preserving effectiveness and appropriateness. An Health Technology Assessment (HTA) was implemented in the years 2017–2018 comparing the dual backbones available in the Italian market: FTC/TAF, FTC/TDF (tenofovir disoproxil fumarate/emtricitabine) and ABC/3TC (abacavir/lamivudine). From an efficacy point of view, FTC/TAF ensured a higher percentage of virologic control and a better safety impact than FTC/TDF (improving the renal and bone safety profile, as well as the lipid picture). From an economic point of view, the results revealed a 4% cost saving for the Italian National Healthcare Service NHS with FTC/TAF introduction compared with the baseline scenario. Qualitative perceptions’ results showed that FTC/TAF would decrease the burden of adverse events management, increasing the accessibility of patients to healthcare providers (FTC/TAF: 0.95, FTC/TDF: 0.10, ABC/3TC: 0.28; p-value: 0.016) and social costs (FTC/TDF: −0.23, FTC/TAF: 1.04, ABC/3TC: 0.23; p-value < 0.001), improving patient quality of life (FTC/TDF: 0.31, FTC/TAF: 1.85, ABC/3TC: 0.38; p-value < 0.001). Healthcare services may consider the evidence provided by the present study as an opportunity to include HIV patients in a more adequate antiretroviral treatment arm, guaranteeing a personalized clinical pathway, thus becoming more efficient and effective over time.
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Castelnuovo G, Pietrabissa G, Manzoni GM, Sicurello F, Zoppis I, Molinari E. Fighting the COVID-19 pandemic using the technology-based second-line in Italy and Lombardy: The urgent need of home-based remote monitoring systems to avoid the collapse of the hospital-centred first line. J Glob Health 2020; 10:010371. [PMID: 33214881 PMCID: PMC7648900 DOI: 10.7189/jogh.10.020371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Gianluca Castelnuovo
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, San Giuseppe Hospital, Verbania, Italy.,Catholic University of Milan, Department of Psychology, Milan, Italy
| | - Giada Pietrabissa
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, San Giuseppe Hospital, Verbania, Italy.,Catholic University of Milan, Department of Psychology, Milan, Italy
| | - Gian Mauro Manzoni
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, San Giuseppe Hospital, Verbania, Italy.,Faculty of Psychology, eCampus University, Novedrate (Como), Italy
| | - Francesco Sicurello
- AITIM, Italian Association of Telemedicine and Biomedical Informatics, Italy
| | - Italo Zoppis
- Department of Computer Science, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Enrico Molinari
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, San Giuseppe Hospital, Verbania, Italy.,Catholic University of Milan, Department of Psychology, Milan, Italy
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White VM, Molfenter T, Gustafson DH, Horst J, Greller R, Gustafson DH, Kim JS, Preuss E, Cody O, Pisitthakarm P, Toy A. NIATx-TI versus typical product training on e-health technology implementation: a clustered randomized controlled trial study protocol. Implement Sci 2020; 15:94. [PMID: 33097097 PMCID: PMC7582427 DOI: 10.1186/s13012-020-01053-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/12/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Substance use disorders (SUDs) lead to tens-of-thousands of overdose deaths and other forms of preventable deaths in the USA each year. This results in over $500 billion per year in societal and economic costs as well as a considerable amount of grief for loved ones of affected individuals. Despite these health and societal consequences, only a small percentage of people seek treatment for SUDs, and the majority of those that seek help fail to achieve long-term sobriety. E-health applications in healthcare have proven to be effective at sustaining treatment and reaching patients traditional treatment pathways would have missed. However, e-health adoption and sustainment rates in healthcare are poor, especially in the SUD treatment sector. Implementation engineering can address this gap in the e-health field by augmenting existing implementation models, which explain organizational and individual e-health behaviors retrospectively, with prospective resources that can guide implementation. METHODS This cluster randomized control trial is designed to test two implementation strategies at adopting an evidence-based mobile e-health technology for SUD treatment. The proposed e-health implementation model is the Network for the Improvement of Addiction Treatment-Technology Implementation (NIATx-TI) Framework. This project, based in Iowa, will compare a control condition (using a typical software product training approach that includes in-person staff training followed by access to on-line support) to software implementation utilizing NIATx-TI, which includes change management training, followed by coaching on how to implement and use the mobile application. While e-health spans many modalities and health disciplines, this project will focus on implementing the Addiction Comprehensive Health Enhancement Support System (A-CHESS), an evidence-based SUD treatment recovery app framework. This trial will be conducted in Iowa at 46 organizational sites within 12 SUD treatment agencies. The control arm consists of 23 individual treatment sites based at five organizations, and the intervention arm consists of 23 individual SUD treatment sites based at seven organizations DISCUSSION: This study addresses an issue of substantial public health significance: enhancing the uptake of the growing inventory of patient-centered evidence-based addiction treatment e-health technologies. TRIAL REGISTRATION ClinicalTrials.gov , NCT03954184 . Posted 17 May 2019.
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Affiliation(s)
- Veronica M White
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA.
| | - Todd Molfenter
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - David H Gustafson
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Julie Horst
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Rachelle Greller
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - David H Gustafson
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Jee-Seon Kim
- Department of Educational Psychology, University of Wisconsin-Madison, Educational Sciences, 1025 West Johnson St, Madison, WI, 53706-1706, USA
| | - Eric Preuss
- Division of Behavioral Health, Iowa Department of Public Health, Lucas State Office Building, 321 E. 12th Street, Des Moines, IA, 50319-0075, USA
| | - Olivia Cody
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Praan Pisitthakarm
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Alexander Toy
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
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Gunasekeran DV, Liu Z, Tan WJ, Koh J, Cheong CP, Tan LH, Lau CS, Phuah GK, Manuel NDA, Chia CC, Seng GS, Tong N, Huin MH, Dulce SV, Yap S, Ponampalam K, Ying H, Ong MEH, Ponampalam R. Evaluating Safety and Efficacy of Follow-up for Patients With Abdominal Pain Using Video Consultation (SAVED Study): Randomized Controlled Trial. J Med Internet Res 2020; 22:e17417. [PMID: 32459637 PMCID: PMC7324993 DOI: 10.2196/17417] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/20/2020] [Accepted: 02/29/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The benefits of telemedicine include cost savings and decentralized care. Video consultation is one form that enables early detection of deteriorating patients and promotion of self-efficacy in patients who are well but anxious. Abdominal pain is a common symptom presented by patients in emergency departments. These patients could benefit from video consultation, as it enables remote follow-up of patients who do not require admission and facilitates early discharge of patients from overcrowded hospitals. OBJECTIVE The study aimed to evaluate the safety and efficacy of the use of digital telereview in patients presenting with undifferentiated acute abdominal pain. METHODS The SAVED study was a prospective randomized controlled trial in which follow-up using existing telephone-based telereview (control) was compared with digital telereview (intervention). Patients with undifferentiated acute abdominal pain discharged from the emergency department observation ward were studied based on intention-to-treat. The control arm received routine, provider-scheduled telereview with missed reviews actively coordinated and rescheduled by emergency department staff. The intervention arm received access to a platform for digital telereview (asynchronous and synchronous format) that enabled patient-led appointment rescheduling. Patients were followed-up for 2 weeks for outcomes of service utilization, efficacy (compliance with their disposition plan), and safety (re-presentation for the same condition). RESULTS A total of 70 patients participated, with patients randomly assigned to each arm (1:1 ratio). Patients were a mean age of 40.0 (SD 13.8; range 22-71) years, predominantly female (47/70, 67%), and predominantly of Chinese ethnicity (39/70, 56%). The telereview service was used by 32 patients in the control arm (32/35, 91%) and 18 patients in the intervention arm (18/35, 51%). Most patients in control (33/35, 94%; 95% CI 79.5%-99.0%) and intervention (34/35, 97%; 95% CI 83.4%-99.9%) arms were compliant with their final disposition. There was a low rate of re-presentation at 72 hours and 2 weeks for both control (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 2/35, 6%, 95% CI 1.0%-20.5%) and intervention (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 3/35, 9%, 95% CI 2.2%-24.2%) arms. There were no significant differences in safety (P>.99) and efficacy (P>.99) between the two groups. CONCLUSIONS The application of digital telereview for the follow-up of patients with abdominal pain may be safe and effective. Future studies are needed to evaluate its cost-effectiveness and usefulness for broader clinical application. TRIAL REGISTRATION ISRCTN Registry ISRCTN28468556; http://www.isrctn.com/ISRCTN28468556.
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Affiliation(s)
- Dinesh Visva Gunasekeran
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zhenghong Liu
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Win Jim Tan
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Joshua Koh
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Chiu Peng Cheong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Lay Hong Tan
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Chee Siang Lau
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Gaik Kheng Phuah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Che Chong Chia
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Gek Siang Seng
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Nancy Tong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - May Hang Huin
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Susan Yap
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Kishanti Ponampalam
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Hao Ying
- Health Services Research Center, Singhealth Services, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- Health Services Research Center, Singhealth Services, Singapore, Singapore
- Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - R Ponampalam
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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Rahimi B, Nadri H, Lotfnezhad Afshar H, Timpka T. A Systematic Review of the Technology Acceptance Model in Health Informatics. Appl Clin Inform 2018; 9:604-634. [PMID: 30112741 PMCID: PMC6094026 DOI: 10.1055/s-0038-1668091] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/24/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND One common model utilized to understand clinical staff and patients' technology adoption is the technology acceptance model (TAM). OBJECTIVE This article reviews published research on TAM use in health information systems development and implementation with regard to application areas and model extensions after its initial introduction. METHOD An electronic literature search supplemented by citation searching was conducted on February 2017 of the Web of Science, PubMed, and Scopus databases, yielding a total of 492 references. Upon eliminating duplicates and applying inclusion and exclusion criteria, 134 articles were retained. These articles were appraised and divided into three categories according to research topic: studies using the original TAM, studies using an extended TAM, and acceptance model comparisons including the TAM. RESULTS The review identified three main information and communication technology (ICT) application areas for the TAM in health services: telemedicine, electronic health records, and mobile applications. The original TAM was found to have been extended to fit dynamic health service environments by integration of components from theoretical frameworks such as the theory of planned behavior and unified theory of acceptance and use of technology, as well as by adding variables in specific contextual settings. These variables frequently reflected the concepts subjective norm and self-efficacy, but also compatibility, experience, training, anxiety, habit, and facilitators were considered. CONCLUSION Telemedicine applications were between 1999 and 2017, the ICT application area most frequently studied using the TAM, implying that acceptance of this technology was a major challenge when exploiting ICT to develop health service organizations during this period. A majority of the reviewed articles reported extensions of the original TAM, suggesting that no optimal TAM version for use in health services has been established. Although the review results indicate a continuous progress, there are still areas that can be expanded and improved to increase the predictive performance of the TAM.
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Affiliation(s)
- Bahlol Rahimi
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamed Nadri
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Hadi Lotfnezhad Afshar
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
| | - Toomas Timpka
- Department of Computer and Information Sciences, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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TECHNOLOGY ASSESSMENT IN HOSPITALS: LESSONS LEARNED FROM AN EMPIRICAL EXPERIMENT. Int J Technol Assess Health Care 2017; 33:288-296. [PMID: 28578752 DOI: 10.1017/s0266462317000356] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Hospital Based Health Technology Assessment (HBHTA) practices, to inform decision making at the hospital level, emerged as urgent priority for policy makers, hospital managers, and professionals. The present study crystallized the results achieved by the testing of an original framework for HBHTA, developed within Lombardy Region: the IMPlementation of A Quick hospital-based HTA (IMPAQHTA). The study tested: (i) the HBHTA framework efficiency, (ii) feasibility, (iii) the tool utility and completeness, considering dimensions and sub-dimensions. METHODS The IMPAQHTA framework deployed the Regional HTA program, activated in 2008 in Lombardy, at the hospital level. The relevance and feasibility of the framework were tested over a 3-year period through a large-scale empirical experiment, involving seventy-four healthcare professionals organized in different HBHTA teams for assessing thirty-two different technologies within twenty-two different hospitals. Semi-structured interviews and self-reported questionnaires were used to collect data regarding the relevance and feasibility of the IMPAQHTA framework. RESULTS The proposed HBHTA framework proved to be suitable for application at the hospital level, in the Italian context, permitting a quick assessment (11 working days) and providing hospital decision makers with relevant and quantitative information. Performances in terms of feasibility, utility, completeness, and easiness proved to be satisfactory. CONCLUSIONS The IMPAQHTA was considered to be a complete and feasible HBHTA framework, as well as being replicable to different technologies within any hospital settings, thus demonstrating the capability of a hospital to develop a complete HTA, if supported by adequate and well defined tools and quantitative metrics.
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Ghezzi A, Gastaldi L, Lettieri E, Martini A, Corso M. A role for startups in unleashing the disruptive power of social media. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT 2016. [DOI: 10.1016/j.ijinfomgt.2016.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
INTRODUCTION Telemedicine includes the use of information and communication technology for education in the health sector, tele-education. Sub-Saharan Africa has an extreme shortage of health professionals and as a result, doctors to teach doctors and students. Tele-education has the potential to provide access to education both formal and continuing medical education. While the uptake of telemedicine in Africa is low, there are a number of successful and sustained tele-education programs. The aims of this study were (i) to review the literature on tele-education in South Africa, (ii) describe tele-education activities at the University of KwaZulu-Natal (UKZ-N) in South Africa, and (iii) review the development of these programs with respect to current thinking on eHealth project implementation. METHOD A literature review of tele-education in South Africa was undertaken. The development of the tele-education services at UKZ-N from 2001 to present is described. The approaches taken are compared with current teaching on eHealth implementation and a retrospective design-reality gap analysis is made. RESULTS Tele-education has been in use in South Africa since the 1970s. Several forms of tele-education are in place at the medical schools and in some Provincial Departments of Health (DOH). Despite initial attempts by the National DOH, there are no national initiatives in tele-education. At UKZ-N, a tele-education service has been running since 2001 and appears to be sustainable and reaching maturity, with over 1,400 h of videoconferenced education offered per year. The service has expanded to offer videoconferenced education into Africa using different ways of delivering tele-education. CONCLUSION Tele-education has been used in different forms for many years in the health sector in South Africa. There is little hard evidence of its educational merit or economic worth. What it apparent is that it improves access to education and training in resource constrained settings. The development of local and international tele-education at the UKZ-N has not followed what is currently considered to be best practice but shows how programs can develop if there is a real need and the solution assists in meeting the need. Further work is required to analyze the economics of these tele-education endeavors.
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Affiliation(s)
- Maurice Mars
- Department of TeleHealth, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , Durban , South Africa
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Hernandez C, Mallow J, Narsavage GL. Delivering telemedicine interventions in chronic respiratory disease. Breathe (Sheff) 2014; 10:198-212. [PMID: 26843894 PMCID: PMC4734754 DOI: 10.1183/20734735.008314] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Jennifer Mallow
- School of Nursing and West Virginia Clinical Translational Science Institute (WVCTSI), West Virginia University (WVU), Morgantown, WV, USA
| | - Georgia L. Narsavage
- Robert C. Byrd Health Sciences Center, Mary Babb Randolph Cancer Center, and WVCTSI, West Virginia University, Morgantown, WV, USA
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Zanaboni P, Knarvik U, Wootton R. Adoption of routine telemedicine in Norway: the current picture. Glob Health Action 2014; 7:22801. [PMID: 24433942 PMCID: PMC3888886 DOI: 10.3402/gha.v7.22801] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 12/12/2013] [Indexed: 12/17/2022] Open
Abstract
Background Telemedicine appears to be ready for wider adoption. Although existing research evidence is useful, the adoption of routine telemedicine in healthcare systems has been slow. Objective We conducted a study to explore the current use of routine telemedicine in Norway, at national, regional, and local levels, to provide objective and up-to-date information and to estimate the potential for wider adoption of telemedicine. Design A top-down approach was used to collect official data on the national use of telemedicine from the Norwegian Patient Register. A bottom-up approach was used to collect complementary information on the routine use of telemedicine through a survey conducted at the five largest publicly funded hospitals. Results Results show that routine telemedicine has been adopted in all health regions in Norway and in 68% of hospitals. Despite being widely adopted, the current level of use of telemedicine is low compared to the number of face-to-face visits. Examples of routine telemedicine can be found in several clinical specialties. Most services connect different hospitals in secondary care, and they are mostly delivered as teleconsultations via videoconference. Conclusions Routine telemedicine in Norway has been widely adopted, probably for geographical reasons, as in other settings. However, the level of use of telemedicine in Norway is rather low, and it has significant potential for further development as an alternative to face-to-face outpatient visits. This study is a first attempt to map routine telemedicine at regional, institutional, and clinical levels, and it provides useful information to understand the adoption of telemedicine in routine healthcare and to measure change in future updates.
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Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway;
| | - Undine Knarvik
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
| | - Richard Wootton
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway; Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
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Zanaboni P, Landolina M, Marzegalli M, Lunati M, Perego GB, Guenzati G, Curnis A, Valsecchi S, Borghetti F, Borghi G, Masella C. Cost-utility analysis of the EVOLVO study on remote monitoring for heart failure patients with implantable defibrillators: randomized controlled trial. J Med Internet Res 2013; 15:e106. [PMID: 23722666 PMCID: PMC3670725 DOI: 10.2196/jmir.2587] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/25/2013] [Accepted: 05/09/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Heart failure patients with implantable defibrillators place a significant burden on health care systems. Remote monitoring allows assessment of device function and heart failure parameters, and may represent a safe, effective, and cost-saving method compared to conventional in-office follow-up. OBJECTIVE We hypothesized that remote device monitoring represents a cost-effective approach. This paper summarizes the economic evaluation of the Evolution of Management Strategies of Heart Failure Patients With Implantable Defibrillators (EVOLVO) study, a multicenter clinical trial aimed at measuring the benefits of remote monitoring for heart failure patients with implantable defibrillators. METHODS Two hundred patients implanted with a wireless transmission-enabled implantable defibrillator were randomized to receive either remote monitoring or the conventional method of in-person evaluations. Patients were followed for 16 months with a protocol of scheduled in-office and remote follow-ups. The economic evaluation of the intervention was conducted from the perspectives of the health care system and the patient. A cost-utility analysis was performed to measure whether the intervention was cost-effective in terms of cost per quality-adjusted life year (QALY) gained. RESULTS Overall, remote monitoring did not show significant annual cost savings for the health care system (€1962.78 versus €2130.01; P=.80). There was a significant reduction of the annual cost for the patients in the remote arm in comparison to the standard arm (€291.36 versus €381.34; P=.01). Cost-utility analysis was performed for 180 patients for whom QALYs were available. The patients in the remote arm gained 0.065 QALYs more than those in the standard arm over 16 months, with a cost savings of €888.10 per patient. Results from the cost-utility analysis of the EVOLVO study show that remote monitoring is a cost-effective and dominant solution. CONCLUSIONS Remote management of heart failure patients with implantable defibrillators appears to be cost-effective compared to the conventional method of in-person evaluations. TRIAL REGISTRATION ClinicalTrials.gov NCT00873899; http://clinicaltrials.gov/show/NCT00873899 (Archived by WebCite at http://www.webcitation.org/6H0BOA29f).
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Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
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Chapter 4 Can Technology Enable Sustainable Effectiveness in Health Care Delivery? Some Lessons from a Rehabilitation Hospital. ACTA ACUST UNITED AC 2012. [DOI: 10.1108/s2045-0605(2012)0000002008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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