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Bradbury TL, McConnell MJ, Whitacre D, Naylor B, Gibson B, DeCook C. A Remote Physical Therapy Program Demonstrates Similar Outcomes Compared to In-Person, Supervised Physical Therapy after Same-Day Discharge Total Knee Arthroplasty: A Randomized Clinical Trial. J Arthroplasty 2024:S0883-5403(24)00512-6. [PMID: 38768768 DOI: 10.1016/j.arth.2024.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/12/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND A growing number of total knee arthroplasty (TKA) patients are candidates for same-day discharge (SDD). Previous research has shown that internet-based remote physical therapy (RPT) can produce equivalent outcomes to supervised outpatient physical therapy (OPT) after TKA. We sought to compare outcomes between RPT and OPT in patients undergoing SDD TKA using an electronic remote perioperative management (ERPM) program. METHODS Patients undergoing SDD TKA were enrolled in an ERPM program and randomized to ERPM + RPT or ERPM + OPT. Preoperative and 6-week functional assessments included knee range of motion (ROM), timed up and go (TUG), and 4-meter gait speed. Numerical Rating Scale (NRS) pain scores were evaluated preoperatively, at 6 and 12 weeks, and satisfaction was assessed at 6, 12, and 52 weeks postoperatively. Participants completed the Veterans Rand 12 Item Health Survey (VR-12 MCS/PCS) and Knee Injury and Osteoarthritis Outcome Score (KOOS, Jr.) preoperatively and at 6, 12, and 52 weeks postoperatively. Outpatient PT utilization was collected 90 days postoperatively. RESULTS Out of 197 initially randomized patients, 76 remained in the ERPM + RPT group and 95 in the ERPM + OPT group after withdrawals and crossovers. Baseline characteristics showed no significant differences between the two groups. No clinically relevant differences were observed in knee ROM, NRS pain, patient-reported outcomes, functional assessments, or satisfaction at any follow-up time. Participants in the ERPM + OPT group attended an average of 11.57 PT sessions, incurring a total cost of $462.8 and 133 minutes of travel. Conversely, the ERPM + RPT group experienced no expenses or travel time. CONCLUSION Patients in the ERPM + RPT group had similar outcomes, lower costs, and saved time compared to patients in the ERPM + OPT group after SDD TKA. Further analysis is needed to determine predictive indicators for crossovers.
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Affiliation(s)
- Thomas L Bradbury
- Total Joint Specialists, LLC, Advanced Center for Joint Surgery and Northside Hospital Forsyth, 2000 Howard Farm Dr., Cumming, Ga, 30041.
| | - Mary Jane McConnell
- Total Joint Specialists, LLC, Advanced Center for Joint Surgery and Northside Hospital Forsyth, 2000 Howard Farm Dr., Cumming, Ga, 30041
| | - Deanna Whitacre
- Total Joint Specialists, LLC, Advanced Center for Joint Surgery and Northside Hospital Forsyth, 2000 Howard Farm Dr., Cumming, Ga, 30041
| | - Brandon Naylor
- Total Joint Specialists, LLC, Advanced Center for Joint Surgery and Northside Hospital Forsyth, 2000 Howard Farm Dr., Cumming, Ga, 30041
| | - Ben Gibson
- Total Joint Specialists, LLC, Advanced Center for Joint Surgery and Northside Hospital Forsyth, 2000 Howard Farm Dr., Cumming, Ga, 30041
| | - Charles DeCook
- Total Joint Specialists, LLC, Advanced Center for Joint Surgery and Northside Hospital Forsyth, 2000 Howard Farm Dr., Cumming, Ga, 30041
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Ren S, McDonald CC, Corwin DJ, Wiebe DJ, Master CL, Arbogast KB. Response Rate Patterns in Adolescents With Concussion Using Mobile Health and Remote Patient Monitoring: Observational Study. JMIR Pediatr Parent 2024; 7:e53186. [PMID: 38722194 PMCID: PMC11089889 DOI: 10.2196/53186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/05/2024] [Accepted: 03/26/2024] [Indexed: 05/15/2024] Open
Abstract
Background A concussion is a common adolescent injury that can result in a constellation of symptoms, negatively affecting academic performance, neurobiological development, and quality of life. Mobile health (mHealth) technologies, such as apps for patients to report symptoms or wearables to measure physiological metrics like heart rate, have been shown to be promising in health maintenance. However, there is limited evidence about mHealth engagement in adolescents with a concussion during their recovery course. Objective This study aims to determine the response rate and response rate patterns in concussed adolescents reporting their daily symptoms through mHealth technology. It will also examine the effect of time-, demographic-, and injury-related characteristics on response rate patterns. Methods Participants aged between 11-18 years (median days since injury at enrollment: 11 days) were recruited from the concussion program of a tertiary care academic medical center and a suburban school's athletic teams. They were asked to report their daily symptoms using a mobile app. Participants were prompted to complete the Post-Concussion Symptom Inventory (PCSI) 3 times (ie, morning, afternoon, and evening) per day for 4 weeks following enrollment. The primary outcome was the response rate pattern over time (by day since initial app use and the day since injury). Time-, demographic-, and injury-related differences in reporting behaviors were compared using Mann Whitney U tests. Results A total of 56 participants were enrolled (mean age 15.3, SD 1.9 years; n=32, 57% female). The median response rate across all days of app use in the evening was 37.0% (IQR 27.2%-46.4%), which was significantly higher than the morning (21.2%, IQR 15.6%-30.5%) or afternoon (26.4%, IQR 21.1%-31.5%; P<.001). The median daily response was significantly different by sex (female: 53.8%, IQR 46.2%-64.2% vs male: 42.0%, IQR 28.6%-51.1%; P=.003), days since injury to app use (participants starting to use the app >7 days since injury: 54.1%, IQR 47.4%-62.2% vs starting to use the app ≤7 days since injury: 38.0%, IQR 26.0%-53.3%; P=.002), and concussion history (participants with a history of at least one prior concussion: 57.4%, IQR 44.5%-70.5% vs participants without concussion history: 42.3%, IQR 36.8%-53.5%; P=.03). There were no significant differences by age. Differences by injury mechanism (sports- and recreation-related injury: 39.6%, IQR 36.1%-50.4% vs non-sports- or recreation-related injury: 30.6%, IQR 20.0%-42.9%; P=.04) and initial symptom burden (PCSI scores greater than the median score of 47: 40.9%, IQR 35.2%-53.8% vs PCSI scores less than or equal to the median score: 31.9%, IQR 24.6%-40.6%; P=.04) were evident in the evening response rates; however, daily rates were not statistically different. Conclusions Evening may be the optimal time to prompt for daily concussion symptom assessment among concussed adolescents compared with morning or afternoon. Multiple demographic- and injury-related characteristics were associated with higher daily response rates, including for female participants, those with more than 1 week from injury to beginning mHealth monitoring, and those with a history of at least one previous concussion. Future studies may consider incentive strategies or adaptive digital concussion assessments to increase response rates in populations with low engagement.
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Affiliation(s)
- Sicong Ren
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Catherine C McDonald
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel J Corwin
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Douglas J Wiebe
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, PA, United States
| | - Christina L Master
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Sports Medicine and Performance Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
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Pannunzio V, Morales Ornelas HC, Gurung P, van Kooten R, Snelders D, van Os H, Wouters M, Tollenaar R, Atsma D, Kleinsmann M. Patient and Staff Experience of Remote Patient Monitoring-What to Measure and How: Systematic Review. J Med Internet Res 2024; 26:e48463. [PMID: 38648090 DOI: 10.2196/48463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/25/2023] [Accepted: 02/20/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Patient and staff experience is a vital factor to consider in the evaluation of remote patient monitoring (RPM) interventions. However, no comprehensive overview of available RPM patient and staff experience-measuring methods and tools exists. OBJECTIVE This review aimed at obtaining a comprehensive set of experience constructs and corresponding measuring instruments used in contemporary RPM research and at proposing an initial set of guidelines for improving methodological standardization in this domain. METHODS Full-text papers reporting on instances of patient or staff experience measuring in RPM interventions, written in English, and published after January 1, 2011, were considered for eligibility. By "RPM interventions," we referred to interventions including sensor-based patient monitoring used for clinical decision-making; papers reporting on other kinds of interventions were therefore excluded. Papers describing primary care interventions, involving participants under 18 years of age, or focusing on attitudes or technologies rather than specific interventions were also excluded. We searched 2 electronic databases, Medline (PubMed) and EMBASE, on February 12, 2021.We explored and structured the obtained corpus of data through correspondence analysis, a multivariate statistical technique. RESULTS In total, 158 papers were included, covering RPM interventions in a variety of domains. From these studies, we reported 546 experience-measuring instances in RPM, covering the use of 160 unique experience-measuring instruments to measure 120 unique experience constructs. We found that the research landscape has seen a sizeable growth in the past decade, that it is affected by a relative lack of focus on the experience of staff, and that the overall corpus of collected experience measures can be organized in 4 main categories (service system related, care related, usage and adherence related, and health outcome related). In the light of the collected findings, we provided a set of 6 actionable recommendations to RPM patient and staff experience evaluators, in terms of both what to measure and how to measure it. Overall, we suggested that RPM researchers and practitioners include experience measuring as part of integrated, interdisciplinary data strategies for continuous RPM evaluation. CONCLUSIONS At present, there is a lack of consensus and standardization in the methods used to measure patient and staff experience in RPM, leading to a critical knowledge gap in our understanding of the impact of RPM interventions. This review offers targeted support for RPM experience evaluators by providing a structured, comprehensive overview of contemporary patient and staff experience measures and a set of practical guidelines for improving research quality and standardization in this domain.
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Affiliation(s)
- Valeria Pannunzio
- Department of Design, Organisation and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Hosana Cristina Morales Ornelas
- Department of Sustainable Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Pema Gurung
- Walaeus Library, Leiden University Medical Center, Leiden, Netherlands
| | - Robert van Kooten
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Dirk Snelders
- Department of Design, Organisation and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Hendrikus van Os
- National eHealth Living Lab, Department of Public Health & Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Michel Wouters
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Rob Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Douwe Atsma
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Maaike Kleinsmann
- Department of Design, Organisation and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
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Lichtenstein MRL, Levit LA, Schenkel C, Kirkwood K, Fashoyin-Aje LA, Bruinooge SS, Kelley MJ, Mailman JA, Magnuson A, Mirda DP, Natesan D, Hershman DL. Researcher Experience and Comfort With Telemedicine and Remote Patient Monitoring in Cancer Treatment Trials. Oncologist 2024; 29:356-363. [PMID: 37676048 PMCID: PMC10994398 DOI: 10.1093/oncolo/oyad237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/26/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Since the onset of COVID-19, oncology practices across the US have integrated telemedicine (TM) and remote patient monitoring (RPM) into routine care and clinical trials. The extent of provider experience and comfort with TM/RPM in treatment trials, however, is unknown. We surveyed oncology researchers to assess experience and comfort with TM/RPM. METHODS Between April 10 and June 1, 2022, we distributed email surveys to US-based members of the American Society of Clinical Oncology (ASCO) whose member records indicated interest or specialization in clinical research. We collected respondent demographic data, clinical trial experience, workplace characteristics, and comfort and experience with TM/RPM use across trial components in phase I and phase II/III trials. TM/RPM was defined as clinical trial-related healthcare and monitoring for patients geographically separated from trial site. RESULTS There were 141 surveys analyzed (5.1% response rate). Ninety percent of respondents had been Principal Investigators, 98% practiced in a norural site. Most respondents had enrolled patients in phase I (82%) and phase II/III trials (99%). Across all phases and trial components, there was a higher frequency of researcher comfort compared to experience. Regarding remote care in treatment trials, 75% reported using TM, RPM, or both. Among these individuals, 62% had never provided remote care to trial patients before the pandemic. CONCLUSION COVID-19 spurred the rise of TM/RPM in cancer treatment trials, and some TM/RPM use continues in this context. Among oncology researchers, higher levels of comfort compared with real-world experience with TM/RPM reveal opportunities for expanding TM/RPM policies and guidelines in oncology research.
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Affiliation(s)
- Morgan R L Lichtenstein
- Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Laura A Levit
- Center for Research and Analytics, American Society of Clinical Oncology, Alexandria, VA, USA
| | - Caroline Schenkel
- Center for Research and Analytics, American Society of Clinical Oncology, Alexandria, VA, USA
| | - Kelsey Kirkwood
- Center for Research and Analytics, American Society of Clinical Oncology, Alexandria, VA, USA
| | - Lola A Fashoyin-Aje
- Oncology Center of Excellence, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Suanna S Bruinooge
- Center for Research and Analytics, American Society of Clinical Oncology, Alexandria, VA, USA
| | - Michael J Kelley
- Department of Medicine, Duke Cancer Institute and Medical Oncology, Duke University Medical Center, and Hematology-Oncology, Durham VA Medical Center, Durham, NC, USA
| | | | - Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Daniel P Mirda
- Providence Medical Group Northern California Napa, CA, USA
| | | | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
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Baumann S, Stone R, Kim JYM. Introducing the Pi-CON Methodology to Overcome Usability Deficits during Remote Patient Monitoring. Sensors (Basel) 2024; 24:2260. [PMID: 38610471 PMCID: PMC11014368 DOI: 10.3390/s24072260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024]
Abstract
The adoption of telehealth has soared, and with that the acceptance of Remote Patient Monitoring (RPM) and virtual care. A review of the literature illustrates, however, that poor device usability can impact the generated data when using Patient-Generated Health Data (PGHD) devices, such as wearables or home use medical devices, when used outside a health facility. The Pi-CON methodology is introduced to overcome these challenges and guide the definition of user-friendly and intuitive devices in the future. Pi-CON stands for passive, continuous, and non-contact, and describes the ability to acquire health data, such as vital signs, continuously and passively with limited user interaction and without attaching any sensors to the patient. The paper highlights the advantages of Pi-CON by leveraging various sensors and techniques, such as radar, remote photoplethysmography, and infrared. It illustrates potential concerns and discusses future applications Pi-CON could be used for, including gait and fall monitoring by installing an omnipresent sensor based on the Pi-CON methodology. This would allow automatic data collection once a person is recognized, and could be extended with an integrated gateway so multiple cameras could be installed to enable data feeds to a cloud-based interface, allowing clinicians and family members to monitor patient health status remotely at any time.
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Affiliation(s)
| | | | - Joseph Yun-Ming Kim
- Industrial and Manufacturing Systems Engineering, Iowa State University, 2529 Union Dr, Ames, IA 50011, USA; (S.B.); (R.S.)
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Civelek Y, Oakes A, Robinson M, Chi W. Distribution of a Remote Medical Exam Device Associated with an Increase in Telehealth Use. Telemed J E Health 2024; 30:e1197-e1202. [PMID: 38016132 DOI: 10.1089/tmj.2023.0492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Background: The COVID-19 pandemic accelerated telehealth adoption, but its effects on care quality and costs remain unclear. This study evaluates a remote patient monitoring device's impact on utilization and spending. Methods: A large insurer launched a pilot program involving 2,880 households, representing 6,731 members in three states. Administrative claims data compared participant households to a matched group lacking necessary contact information for participation. Results: Participants had a 0.19 per member (p = 0.03) increase in telehealth visits and a 0.19 per member (p = 0.08) decrease in outpatient in-person visits relative to nonparticipants during the post 6-month period. No significant differences were observed in total outpatient and emergency department visits or total spending. Subgroup analyses revealed a significant reduction in telehealth visits followed by in-person outpatient visits in households with younger children (-9.1%; p < 0.05). Conclusion: This evaluation suggests that remote devices may boost telehealth utilization without increasing costs.
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Affiliation(s)
- Yasin Civelek
- Enterprise Analytics Core, Elevance Health Inc., Wilmington, Delaware, USA
| | - Allison Oakes
- Enterprise Analytics Core, Elevance Health Inc., Wilmington, Delaware, USA
| | - Michael Robinson
- Enterprise Analytics Core, Elevance Health Inc., Wilmington, Delaware, USA
| | - Winnie Chi
- Enterprise Analytics Core, Elevance Health Inc., Wilmington, Delaware, USA
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Acharya M, Ali MM, Bogulski CA, Pandit AA, Mahashabde RV, Eswaran H, Hayes CJ. Association of Remote Patient Monitoring with Mortality and Healthcare Utilization in Hypertensive Patients: a Medicare Claims-Based Study. J Gen Intern Med 2024; 39:762-773. [PMID: 37973707 PMCID: PMC11043264 DOI: 10.1007/s11606-023-08511-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Hypertension management is complex in older adults. Recent advances in remote patient monitoring (RPM) have warranted evaluation of RPM use and patient outcomes. OBJECTIVE To study associations of RPM use with mortality and healthcare utilization measures of hospitalizations, emergency department (ED) utilization, and outpatient visits. DESIGN A retrospective cohort study. PATIENTS Medicare beneficiaries aged ≥65 years with an outpatient hypertension diagnosis between July 2018 and September 2020. The first date of RPM use with a corresponding hypertension diagnosis was recorded (index date). RPM non-users were documented from those with an outpatient hypertension diagnosis; a random visit was selected as the index date. Six months prior continuous enrollment was required. MAIN MEASURES Outcomes studied within 180 days of index date included (i) all-cause mortality, (ii) any hospitalization, (iii) cardiovascular-related hospitalization, (iv) non-cardiovascular-related hospitalization, (v) any ED, (vi) cardiovascular-related ED, (vii) non-cardiovascular-related ED, (viii) any outpatient, (ix) cardiovascular-related outpatient, and (x) non-cardiovascular-related outpatient. Patient demographics and clinical variables were collected from baseline and index date. Propensity score matching (1:4) and Cox regression were performed. Hazard ratios (HR) and 95% confidence intervals (CI) are reported. KEY RESULTS The matched sample had 16,339 and 63,333 users and non-users, respectively. Cumulative incidences of mortality outcome were 2.9% (RPM) and 4.3% (non-RPM), with a HR (95% CI) of 0.66 (0.60-0.74). RPM users had lower hazards of any [0.78 (0.75-0.82)], cardiovascular-related [0.79 (0.73-0.87)], and non-cardiovascular-related [0.79 (0.75-0.83)] hospitalizations. No significant association was observed between RPM use and the three ED measures. RPM users had higher hazards of any [1.10 (1.08-1.11)] and cardiovascular-related outpatient visits [2.17 (2.13-2.19)], while a slightly lower hazard of non-cardiovascular-related outpatient visits [0.94 (0.93-0.96)]. CONCLUSIONS RPM use was associated with substantial reductions in hazards of mortality and hospitalization outcomes with an increase in cardiovascular-related outpatient visits.
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Affiliation(s)
- Mahip Acharya
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mir M Ali
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Cari A Bogulski
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ambrish A Pandit
- Divison of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ruchira V Mahashabde
- Divison of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hari Eswaran
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Corey J Hayes
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare Systems, North Little Rock, AR, USA.
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Cooper LB, Schwamm LH. Winning the Battle of Timely Guideline-Directed Medical Therapy Titration. JACC Heart Fail 2024; 12:691-692. [PMID: 38569822 DOI: 10.1016/j.jchf.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Lauren B Cooper
- Northwell, New Hyde Park, New York, USA; Cardiovascular Institute, Manhasset, New York, USA.
| | - Lee H Schwamm
- Department of Biomedical Informatics and Data Sciences, Yale School of Medicine, New Haven, Connecticut, USA
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Liu AW, Brown Iii W, Madu NE, Maiorano AR, Bigazzi O, Medina E, Sorric C, Hays SR, Odisho AY. Patient Engagement With and Perspectives on a Mobile Health Home Spirometry Intervention: Mixed Methods Study. JMIR Mhealth Uhealth 2024; 12:e51236. [PMID: 38506896 PMCID: PMC10993125 DOI: 10.2196/51236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/27/2023] [Accepted: 12/12/2023] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Patient engagement attrition in mobile health (mHealth) remote patient monitoring (RPM) programs decreases program benefits. Systemic disparities lead to inequities in RPM adoption and use. There is an urgent need to understand patients' experiences with RPM in the real world, especially for patients who have stopped using the programs, as addressing issues faced by patients can increase the value of mHealth for patients and subsequently decrease attrition. OBJECTIVE This study sought to understand patient engagement and experiences in an RPM mHealth intervention in lung transplant recipients. METHODS Between May 4, 2020, and November 1, 2022, a total of 601 lung transplant recipients were enrolled in an mHealth RPM intervention to monitor lung function. The predictors of patient engagement were evaluated using multivariable logistic and linear regression. Semistructured interviews were conducted with 6 of 39 patients who had engaged in the first month but stopped using the program, and common themes were identified. RESULTS Patients who underwent transplant more than 1 year before enrollment in the program had 84% lower odds of engaging (odds ratio [OR] 0.16, 95% CI 0.07-0.35), 82% lower odds of submitting pulmonary function measurements (OR 0.18, 95% CI 0.09-0.33), and 78% lower odds of completing symptom checklists (OR 0.22, 95% CI 0.10-0.43). Patients whose primary language was not English had 78% lower odds of engaging compared to English speakers (OR 0.22, 95% CI 0.07-0.67). Interviews revealed 4 prominent themes: challenges with devices, communication breakdowns, a desire for more personal interactions and specific feedback with the care team about their results, understanding the purpose of the chat, and understanding how their data are used. CONCLUSIONS Care delivery and patient experiences with RPM in lung transplant mHealth can be improved and made more equitable by tailoring outreach and enhancements toward non-English speakers and patients with a longer time between transplant and enrollment. Attention to designing programs to provide personalization through supplementary provider contact, education, and information transparency may decrease attrition rates.
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Affiliation(s)
- Andrew W Liu
- Center for Digital Health Innovation, University of California, San Francisco, CA, United States
| | - William Brown Iii
- Center for Digital Health Innovation, University of California, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, United States
| | - Ndubuisi E Madu
- Center for Digital Health Innovation, University of California, San Francisco, CA, United States
| | - Ali R Maiorano
- Center for Digital Health Innovation, University of California, San Francisco, CA, United States
| | - Olivia Bigazzi
- Center for Digital Health Innovation, University of California, San Francisco, CA, United States
| | - Eli Medina
- Center for Digital Health Innovation, University of California, San Francisco, CA, United States
| | - Christopher Sorric
- Center for Digital Health Innovation, University of California, San Francisco, CA, United States
| | - Steven R Hays
- Department of Medicine, University of California, San Francisco, CA, United States
| | - Anobel Y Odisho
- Center for Digital Health Innovation, University of California, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
- Department of Urology, University of California, San Francisco, CA, United States
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Hall TAG, Cegla F, van Arkel RJ. Passive Biotelemetric Detection of Tibial Debonding in Wireless Battery-Free Smart Knee Implants. Sensors (Basel) 2024; 24:1696. [PMID: 38475232 DOI: 10.3390/s24051696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024]
Abstract
Aseptic loosening is the dominant failure mechanism in contemporary knee replacement surgery, but diagnostic techniques are poorly sensitive to the early stages of loosening and poorly specific in delineating aseptic cases from infections. Smart implants have been proposed as a solution, but incorporating components for sensing, powering, processing, and communication increases device cost, size, and risk; hence, minimising onboard instrumentation is desirable. In this study, two wireless, battery-free smart implants were developed that used passive biotelemetry to measure fixation at the implant-cement interface of the tibial components. The sensing system comprised of a piezoelectric transducer and coil, with the transducer affixed to the superior surface of the tibial trays of both partial (PKR) and total knee replacement (TKR) systems. Fixation was measured via pulse-echo responses elicited via a three-coil inductive link. The instrumented systems could detect loss of fixation when the implants were partially debonded (+7.1% PKA, +32.6% TKA, both p < 0.001) and fully debonded in situ (+6.3% PKA, +32.5% TKA, both p < 0.001). Measurements were robust to variations in positioning of the external reader, soft tissue, and the femoral component. With low cost and small form factor, the smart implant concept could be adopted for clinical use, particularly for generating an understanding of uncertain aseptic loosening mechanisms.
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Affiliation(s)
- Thomas A G Hall
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - Frederic Cegla
- Non-Destructive Evaluation Group, Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - Richard J van Arkel
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
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Miranda R, Silvério R, Baptista FM, Oliveira MD. Unlocking Continuous Improvement in Heart Failure Remote Monitoring: A Participatory Approach to Unveil Value Dimensions and Performance Indicators. Telemed J E Health 2024. [PMID: 38436266 DOI: 10.1089/tmj.2023.0560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Introduction: Heart failure (HF) constitutes a public health concern affecting quality of life, survival, and costs. Remote patient monitoring (RPM) can enhance HF management, involving patients actively and improving follow-up. While current HF RPM assessments emphasise cost-effectiveness analysis, there is a need to consider wider RPM impacts and integrate stakeholders' perspectives into assessments for better comprehensiveness. Methods: We developed a four-stage participatory approach to select value dimensions and indicators for continuous HF RPM assessment: Stage 1 involved building a literature-informed initial list; Stage 2 utilized expert interviews for validation and list expansion; Stage 3 involved a web-Delphi process with Portuguese stakeholders and experts for agreement assessment; and Stage 4 included a conclusive expert interview. Results: A literature review identified fourteen studies on telehealth, RPM, and HF, informing an initial list of four value dimensions (Access, Clinical aspects, Acceptability, and Costs) and 22 indicators. Seven semistructured interviews validated and further adjusted the list to 38 indicators. Subsequently, the web-Delphi process engaged 29 stakeholders, giving their opinions regarding assessment aspects' relevance and proposing additional elements - 1 dimension and 12 indicators. Five value dimensions and 38 indicators (76.0%) reached group agreement for selection, while 12 did not reach an agreement. Upon expert appreciation, 5 dimensions, 43 indicators, and 6 case-mix parameters were considered relevant. Discussion: This comprehensive social approach captured diverse stakeholder perspectives, achieving agreement on pertinent HF RPM monitoring and evaluation indicators. Findings can inform visualization and management tool development, aiding day-to-day RPM evaluation and identification of improvement opportunities.
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Affiliation(s)
- Rafael Miranda
- Centro de Estudos de Gestão do Instituto Superior Técnico, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- Enterprise Services Portugal, Siemens Healthineers, Erlangen, Germany
| | - Rita Silvério
- Centro de Estudos de Gestão do Instituto Superior Técnico, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | | | - Mónica Duarte Oliveira
- Centro de Estudos de Gestão do Instituto Superior Técnico, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- iBB-Institute for Bioengineering and Biosciences and i4HB-Associate Laboratory Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
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12
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Abraham C, Jensen C, Rossiter L, Dittman Hale D. Telenursing and Remote Patient Monitoring in Cardiovascular Health. Telemed J E Health 2024; 30:771-779. [PMID: 37682280 DOI: 10.1089/tmj.2023.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Background: Since the decline in death rates from cardiovascular diseases has slowed down recently, promoting cardiovascular health in patients and the general public has become more important than ever, particularly for elder and rural patients. This study is a collaborative effort between a regional health network in Virginia and associated organizations to implement and assess telenursing and remote patient monitoring (RPM) to help home care patients better manage their own cardiovascular related diseases and promote sustainable health delivery options. Method: Eighty cardiovascular patients with diabetes, congestive heart failure, or both who had a recent disease-related hospital stay were enrolled in the RPM program to receive services, including care coordination, coaching, referral for behavioral health, and aging-related services for 90+ days. The program used telenursing and RPM through home care monitoring equipment to coach patients on effective measures to stay compliant with posthospitalization regimens, track and evaluate readmissions, and assess physiological status and mental health. Result: There was a decline in hospital admissions of 65%, 85% for observations and related inpatient services for enrolled CVD patients in the RPM program. In addition, the longer the patient was enrolled the less likely they were to readmit. The program saved ∼$615,127 in patient claims costs and had net savings of $390,296, ∼173% of the total program expenses. Discussion: Evidence showed that 90+ day enrollments are sufficient for realization of readmissions and Emergency Department reductions, increased health care access, and lower costs. This resulted from consistent monitoring using the technology to alert nurses and care coordinators who were able to respond and facilitate patients accessing care in the most helpful and generally less costly care environment. Conclusion: The study has confirmed that care coordination and RPM are effective in supporting self-management of chronic conditions and cost reductions through telenursing and RPM.
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Affiliation(s)
- Chon Abraham
- Mason School of Business, William & Mary, Williamsburg, Virginia, USA
| | - Christine Jensen
- Riverside Center for Excellence in Aging and Lifelong Health, Williamsburg, Virginia, USA
| | - Louis Rossiter
- Mason School of Business, William & Mary, Williamsburg, Virginia, USA
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13
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Augustyńska J, Lichodziejewska-Niemierko M, Naumnik B, Seweryn M, Leszczyńska A, Gellert R, Lindholm B, Lange J, Kopel J. Automated Peritoneal Dialysis With Remote Patient Monitoring: Clinical Effects and Economic Consequences for Poland. Value Health Reg Issues 2024; 40:53-62. [PMID: 37976660 DOI: 10.1016/j.vhri.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 08/24/2023] [Accepted: 09/06/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Remote patient monitoring (RPM) of patients treated with automated peritoneal dialysis (APD) at home allows clinicians to supervise and adjust the dialysis process remotely. This study aimed to review recent scientific studies on the use of RPM in patients treated with APD and based on extracted relevant data assess possible clinical implications and potential economic value of introducing such a system into practice in Poland. METHODS A systematic literature review was performed in the MEDLINE, EMBASE, and Cochrane databases. The model of clinical effects and costs associated with APD was built as a cost-effectiveness analysis with a 10-year time horizon from the Polish National Health Fund perspective. Cost-effectiveness analysis compared 2 strategies: APD with RPM versus APD without RPM. RESULTS Thirteen publications assessing the clinical value of RPM among patients with APD were found. The statistical significance of APD with RPM compared with APD without RPM was identified for the main clinical outcomes: frequency and length of hospitalizations, APD technique failure, and death. An incremental cost-effectiveness ratio was equal to €27 387 per quality-adjusted life-year. The obtained incremental cost-effectiveness ratio is below the willingness-to-pay threshold for the use of medical technologies in Poland (€36 510 per quality-adjusted life-year), which means that APD with RPM was a cost-effective technology. CONCLUSIONS RPM in patients starting APD is a clinical option that is worth considering in Polish practice because it has the potential to decrease the frequency of APD technique failure and shorten the length of hospitalization.
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Affiliation(s)
| | | | - Beata Naumnik
- The First Department of Nephrology and Transplantation with Dialysis Unit, Medical University of Białystok, Białystok, Poland
| | | | | | - Ryszard Gellert
- Department of Nephrology and Internal Medicine, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Bengt Lindholm
- Division of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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14
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Vudathaneni VKP, Lanke RB, Mudaliyar MC, Movva KV, Mounika Kalluri L, Boyapati R. The Impact of Telemedicine and Remote Patient Monitoring on Healthcare Delivery: A Comprehensive Evaluation. Cureus 2024; 16:e55534. [PMID: 38576693 PMCID: PMC10993086 DOI: 10.7759/cureus.55534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/03/2024] [Indexed: 04/06/2024] Open
Abstract
Background Telemedicine and remote patient monitoring have emerged as transformative solutions in contemporary healthcare. This study aimed to conduct a comprehensive evaluation of the impact of these technologies on healthcare delivery, focusing on patient outcomes, economic parameters, and overall satisfaction. Methods A prospective observational study was conducted in various healthcare facilities, involving 186 participants with chronic diseases. Inclusion criteria included patients actively using telemedicine services. Data collection methods included surveys, interviews, and review of medical records, focusing on patient demographics, clinical outcomes, and economic parameters. The intervention involved a seamless integration of telemedicine technologies into the existing health system. Results Primary outcomes revealed significant improvements in patient health, including a decrease in disease-specific markers (mean reduction of 12,000 to 11,000, p = 0.002), a substantial reduction in severity of symptoms (mean reduction from 3,500 to 2,500, p < 0.001), and a general improvement in health status (mean increase from 7,200 to 8,500, p < 0.001). The savings in healthcare costs were evident, with direct costs decreasing from 25,000 to 12,000 (p < 0.001) and indirect costs decreasing from <10,000 to <5,000 (p = 0.004). Secondary results demonstrated increased patient satisfaction with communication (increase from 80% to 95%, p < 0.001) and convenience of services (increase from 75% to 90%, p < 0.001). Patient satisfaction also increased significantly (from 80% to 95%, p < 0.001). Accessibility to healthcare services improved, with a reduction in geographic barriers (increase from 65% to 90%, p < 0.001) and a decrease in the frequency of healthcare utilization (decrease from 2.5 to 1.5, p < 0.001). Conclusion The study provides robust evidence of the positive impact of telemedicine and remote patient monitoring on healthcare delivery. Significant improvements in patient outcomes, coupled with substantial cost savings and increased satisfaction levels, underscore the transformative potential of these technologies.
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15
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Walters J, Denker K, Curry S, Burkhardt MC. Post-Discharge Remote Patient Monitoring for Children Hospitalized with Acute Asthma Exacerbations. Acad Pediatr 2024; 24:373-375. [PMID: 38065283 DOI: 10.1016/j.acap.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/20/2023] [Accepted: 11/25/2023] [Indexed: 01/16/2024]
Affiliation(s)
- Jessica Walters
- General and Community Pediatrics (J Walters, K Denker, S Curry, and MC Burkhardt), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati College of Medicine (J Walters and MC Burkhardt), Department of Pediatrics, Cincinnati, Ohio.
| | - Kylee Denker
- General and Community Pediatrics (J Walters, K Denker, S Curry, and MC Burkhardt), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Center for Telehealth at Cincinnati Children's Hospital Medical Center (K Denker and S Curry), Information Services, Cincinnati, Ohio
| | - Sarah Curry
- General and Community Pediatrics (J Walters, K Denker, S Curry, and MC Burkhardt), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Center for Telehealth at Cincinnati Children's Hospital Medical Center (K Denker and S Curry), Information Services, Cincinnati, Ohio
| | - Mary C Burkhardt
- General and Community Pediatrics (J Walters, K Denker, S Curry, and MC Burkhardt), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati College of Medicine (J Walters and MC Burkhardt), Department of Pediatrics, Cincinnati, Ohio
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16
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Thompson JA, Hersch D, Kasozi RN, Miner MH, Adam P. Disparities in Offering Enrollment in Remote Patient Monitoring for COVID-19. Telemed J E Health 2024; 30:715-721. [PMID: 37707989 PMCID: PMC10924046 DOI: 10.1089/tmj.2023.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Introduction: Remote patient monitoring (RPM) programs are increasingly common. There is a risk that inequitable use of RPM will perpetuate existing health care disparities. We conducted a study to determine if enrollment in a COVID-19 RPM program was offered differentially across demographic groups. Methods: From March through September 2020, patients with COVID-19 were evaluated within a large academic health system with a standardized care pathway that directed providers to refer the patients for RPM. We conducted a retrospective cohort study to evaluate the effects of social vulnerability and urbanicity of residence on the odds of referral. We estimated vulnerability using the CDC social vulnerability index (SVI) and used logistic regression to determine odds ratios (ORs) for referral based on SVI and urbanicity. Results: Of 16,739 patients who had a qualifying health care encounter, 2,946 (17.6%) were referred for RPM. Patients in census tracts with higher social vulnerability were less likely to be referred than those in tracts with lower vulnerability (OR 0.73, 95% confidence interval 0.63-0.84). Patients living in Micropolitan/Large Rural Cities or Small Towns/Small Rural Towns were more likely to be referred than those in Metropolitan/Urban areas. In the full regression model, including both SVI and urbanicity, urbanicity was the strongest predictor of referral, and patients living in Metropolitan/Urban areas were the most likely to be referred. Conclusions: We found disparities in who is offered access to remote monitoring despite the use of standardized care pathways. Health systems need to evaluate how they implement RPM programs and care pathways to ensure equitable care delivery.
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Affiliation(s)
- Joshua A Thompson
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Derek Hersch
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Ramla N Kasozi
- Department of Family Medicine, Mayo Clinic College of Medicine and Sciences, Jacksonville, Florida, USA
| | - Michael H Miner
- Eli Coleman Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Patricia Adam
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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17
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Shih CD, Scholten HJ, Ripp G, Srikanth K, Smith C, Ma R, Fu J, Reyzelman AM. Effectiveness of a Continuous Remote Temperature Monitoring Program to Reduce Foot Ulcers and Amputations: Multicenter Postmarket Registry Study. JMIR Diabetes 2024; 9:e46096. [PMID: 38285493 PMCID: PMC10862242 DOI: 10.2196/46096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 11/18/2023] [Accepted: 12/20/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Neuropathic foot ulcers are the leading cause of nontraumatic foot amputations, particularly among patients with diabetes. Traditional methods of monitoring and managing these patients are periodic in-person clinic visits, which are passive and may be insufficient for preventing neuropathic foot ulcers and amputations. Continuous remote temperature monitoring has the potential to capture the critical period before the foot ulcers develop and to improve outcomes by providing real-time data and early interventions. For the first time, the effectiveness of such a strategy to prevent neuropathic foot ulcers and related complications among high-risk patients in a real-world commercial setting is reported. OBJECTIVE This study aims to evaluate the effectiveness of a real-world continuous remote temperature monitoring program in preventing neuropathic foot ulcers and amputations in patients with diabetes. METHODS In this retrospective analysis of a real-world continuous remote temperature monitoring program, 115 high-risk patients identified by clinical providers from 15 geographically diverse private podiatry offices were analyzed. Patients received continuous remote monitoring socks as part of the program. The enrollment was based on medical necessity as decided by their managing physician. We evaluated data from up to 2 years before enrollment and up to 3 years during the program. The primary outcome was the rate of wound development. Secondary outcomes included amputation rate, the severity of the foot ulcers, and the number of visits to an outpatient podiatry clinic after enrolling in the program. RESULTS We observed significantly lower rates of foot ulceration (relative risk reduction [RRR] 0.68; 95% CI 0.52-0.79; number needed to treat [NNT] 5.0; P<.001), less moderate to severe ulcers (RRR 0.86; 95% CI 0.70-0.93; NNT 16.2; P<.001), less amputations (RRR 0.83; 95% CI 0.39-0.95; NNT 41.7; P=.006), and less hospitalizations (RRR 0.63; 95% CI 0.33-0.80; NNT 5.7; P<.002). We found a decrease in outpatient podiatry office visits during the program (RRR 0.31; 95% CI 0.24-0.37; NNT 0.46; P<.001). CONCLUSIONS Our findings suggested that a real-world continuous remote temperature monitoring program was an effective strategy to prevent foot ulcer development and nontraumatic foot amputation among high-risk patients.
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Affiliation(s)
- Chia-Ding Shih
- California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA, United States
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | | | - Gavin Ripp
- Premier Podiatry & Orthopedics Sacramento, Roseville, CA, United States
| | | | - Caileigh Smith
- Samuel Merritt University, San Francisco, CA, United States
| | - Ran Ma
- Siren Care Inc, San Francisco, CA, United States
| | - Jie Fu
- Siren Care Inc, San Francisco, CA, United States
| | - Alexander M Reyzelman
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
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Majidi S, Agarwal S, Rioles N, Rapaport R, Ebekozien O. Commentary on the T1D exchange quality improvement collaborative learning session November 2023 abstracts. J Diabetes 2024. [PMID: 38234239 DOI: 10.1111/1753-0407.13496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 01/19/2024] Open
Affiliation(s)
- Shideh Majidi
- Children's National Hospital, Washington, District of Columbia, USA
| | - Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
- NY-Regional Center for Diabetes Translational Research, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | | | - Robert Rapaport
- Mount Sinai Kravis Children's Hospital, Icahn School of Medicine, New York, New York, USA
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Creton S, Saadi M, Monfort H, Yaghobian S, Pages N, Nisse-Durgeat S, Diebold B. The Clinical Impact and Good Practices of Remote Patient Monitoring for Chronic Heart Failure: A French Case Report. Patient Prefer Adherence 2024; 18:131-135. [PMID: 38249685 PMCID: PMC10799566 DOI: 10.2147/ppa.s445638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/06/2024] [Indexed: 01/23/2024] Open
Abstract
Purpose Remote patient monitoring (RPM) can improve the management of chronic diseases. Since 2019, RPM in chronic heart failure (CHF) management has been internationally supported. However, evidence on the clinical impact and good practices of RPM is scarce. We present a case of a patient with CHF that used RPM in France. Patients and Methods A 74-year-old male was diagnosed with CHF (NYHA I) at the AP-HP Cochin Hospital in January 2020. He faced repetitive hospitalizations for acute heart failure and acute kidney injury. The causes of these acute episodes were unknown. Three therapeutic interventions were implemented (diuretic treatment, RPM and therapeutic education sessions). The patient answered questionnaires regularly and directly through the RPM web application named Satelia®Cardio. Therapeutic education was provided to instruct the patient about his symptoms and treatment management. Results Since November 11, 2020, the patient had seven hospitalizations representing a total length of stay of 76 days over a period of 15 months and 2 weeks. Pericarditis was diagnosed as a potential cause and a pre-operative checkup was performed. No tangible benefits were found with diuretic treatment and therapeutic education since they had no effect on stopping the acute episodes leading to hospitalization. RPM did not trigger any clinical alerts until his last hospitalization. During this stay, a clinical telehealth nurse reviewed the patient's clinical setup and found that his initial baseline weight was incorrectly inputted. Since amending this, there were no new episodes. A high-risk, complex and costly heart surgery for pericardial decortication was avoided, and patient satisfaction has increased. Conclusion To respect good practices, inclusion not only involves adding or registering a patient to a telehealth activity and database but involves redesigning the management and pathway of patients in order to conduct periodic and personalized clinical care via integrated technology into routine care.
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Affiliation(s)
- Sonia Creton
- Cardiology Department, AP-HP Cochin Hospital, Paris, 75014, France
| | - Malika Saadi
- Cardiology Department, AP-HP Cochin Hospital, Paris, 75014, France
| | - Hélène Monfort
- Cardiology Department, AP-HP Cochin Hospital, Paris, 75014, France
| | | | | | | | - Benoit Diebold
- Cardiology Department, AP-HP Cochin Hospital, Paris, 75014, France
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Sulieman L, Ashworth D, Wright A, Cole C, White J, Findley N, Riels G, Riels M, Stegall C, Moran R, Studebaker G, Pirtle CJ. A Case Report on the Effectiveness of Virtual Monitoring of Postdischarge COVID-19 Positive Patients in a Rural Hospital Setting: A Retrospective Review. Telemed J E Health 2024; 30:291-297. [PMID: 37384922 DOI: 10.1089/tmj.2023.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Objective: The pandemic has pushed hospital system to re-evaluate the ways they provide care. West Tennessee Healthcare (WTH) developed a remote patient monitoring (RPM) program to monitor positive COVID-19 patients after being discharged from the hospital for any worsening symptomatology and preemptively mitigate the potential of readmission. Methods: We sought to compare the readmission rates of individuals placed on our remote monitoring protocol with individuals not included in the program. We selected remotely monitored individuals discharged from WTH from October 2020 to December 2020 and compared these data points with a control group. Results: We analyzed 1,351 patients with 241 patients receiving no RPM intervention, 969 patients receiving standard monitoring, and 141 patients enrolled in our 24-h remote monitoring. Our lowest all cause readmission rate was 4.96% (p = 0.37) in our 24-h remote monitoring group. We also collected 641 surveys from the monitored patients with two statistically significant answers. Discussion: The low readmission rate noted in our 24-h remotely monitored cohort signifies a potential opportunity that a program of this nature can create for a health care system struggling during a resource-limited time to continue to provide quality care. Conclusion: The program allowed the allocation of hospital resources for individuals with more acute states and monitored less critical patients without using personal protective equipment. The novel program was able to offer an avenue to improve resource utilization and provide care for a health system in a rural area. Further investigation is needed; however, significant opportunities can be seen with data obtained during the study.
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Affiliation(s)
- Lina Sulieman
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Debbie Ashworth
- Department of Virtual Care, West Tennessee Healthcare, Jackson, Tennessee, USA
| | - Adam Wright
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cynthia Cole
- Department of Virtual Care, West Tennessee Healthcare, Jackson, Tennessee, USA
| | - John White
- Department of Family Medicine, The University of Tennessee Health Sciences Center, Jackson, Tennessee, USA
| | - Nikki Findley
- Department of Family Medicine, The University of Tennessee Health Sciences Center, Jackson, Tennessee, USA
| | - Glynn Riels
- Department of Family Medicine, The University of Tennessee Health Sciences Center, Jackson, Tennessee, USA
| | - Madelyn Riels
- Department of Family Medicine, The University of Tennessee Health Sciences Center, Jackson, Tennessee, USA
| | - Cassidy Stegall
- Department of Family Medicine, The University of Tennessee Health Sciences Center, Jackson, Tennessee, USA
| | - Richard Moran
- Department of Family Medicine, The University of Tennessee Health Sciences Center, Jackson, Tennessee, USA
| | - Grant Studebaker
- Department of Family Medicine, The University of Tennessee Health Sciences Center, Jackson, Tennessee, USA
| | - Claude J Pirtle
- Department of Virtual Care, West Tennessee Healthcare, Jackson, Tennessee, USA
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21
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Reid D, Mehta J, Anis K, Mehta S. Impact of Remote Patient Monitoring Platform on Patients With Moderate to Severe Persistent Asthma: Observational Study. JMIR Form Res 2023; 7:e51065. [PMID: 38153783 PMCID: PMC10784973 DOI: 10.2196/51065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Asthma is one of the most common respiratory diseases, with an ever-growing health care burden. Remote patient monitoring (RPM) has gained increasing importance in the respiratory care area with the outbreak of the COVID-19 pandemic. In this pilot study, we introduced a novel platform that remotely monitors patients with chronic respiratory illnesses using Centers for Disease Control and Prevention guidelines to reduce hospitalizations and emergency department visits. OBJECTIVE This study aimed to understand patient and physician engagement with a new virtual care solution (KevaTalk app and Keva365 platform) and the value, for both patients and providers, of using an RPM tool. We assessed real-world use of the platform from both physician and patient perspectives and the impact of devices on engagement and monitoring. METHODS Participants with a history of moderate to severe persistent asthma, seen by a pulmonologist at a hospital, were included in this study. The inclusion criteria involved being aged ≥18 years and having access to an Android or iOS mobile device with internet. We provided patient questionnaires to assess the app's usefulness and evaluate its features. We monitored remote spirometry and oximetry data, app check-ins, alerts, and escalations during this study's time window. Data were reviewed daily and predetermined criteria were set to escalate for physician review based on the patient's symptoms and objective data. RESULTS Overall, 25 patients were included in this pilot. The mean age was 57 (SD 10.7) years and a majority (n=23, 92%) were female. A baseline questionnaire, which was used to rate the app, indicated that the ease of check-in and ease of modification to the patient's asthma plan were the 2 highest rated features. In total, 2066 check-ins (1550 green, 506 yellow, and 10 red check-ins) and 1155 spirometry sessions were recorded during this 3-month period. Further, 64% (14/22) and 91% (20/22) of patients were found to have peak flows in their red and yellow zones at least once, respectively. During the course of this study, 484 alerts were recorded and evaluated by the team, of which 37.2% (n=180) required an escalation to the physician; this included a transfer to a medical facility, change in respiratory medication, or further education. CONCLUSIONS In this pilot study, we demonstrated the feasibility of implementing a novel RPM platform in patients with asthma. Our platform showed high patient engagement and satisfaction and provided physicians with real-time subjective data to evaluate patients remotely that aids in clinical decision-making. The escalations prevented patients from having an exacerbation or flare up, which led to the prevention of an emergency department visit. Continuous monitoring of chronic disease has benefits over episodic monitoring. It allows for improved quality of life, better outcomes, and huge health care savings.
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Affiliation(s)
- Denzil Reid
- Baystate Health, Springfield, MA, United States
| | | | - Karim Anis
- Baystate Health, Springfield, MA, United States
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Yaacoby-Bianu K, Cohen-Cymberknoh M, Shoseyov D, Lavi T, Ostrovski A, Shteinberg M, Livnat G. Optimizing CFTR modulator therapy management for cystic fibrosis through the ReX platform. Front Pediatr 2023; 11:1300968. [PMID: 38178914 PMCID: PMC10766369 DOI: 10.3389/fped.2023.1300968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/28/2023] [Indexed: 01/06/2024] Open
Abstract
Background Cystic fibrosis (CF) is a chronic multi-systemic disease that requires a complex daily treatment regimen. Therefore, there is sub-optimal adherence to CF therapies, and it was shown to impact its clinical and economic burden. Cystic fibrosis transmembrane conductance regulator modulators (CFTRm) are high-cost medications that demonstrated significant benefit in clinical trials. The aim of this study was to evaluate the safety, usability, and efficacy of the ReX platform in medication management of CFTRm for the treatment of people with CF (pwCF). Methods ReX is a patient engagement platform consisting of a cloud-based management system and a cell-enabled handheld device intended to dispense oral medication into the patient's mouth, following a pre-programmed treatment protocol. It provides real-time adherence data to caregivers and timely, personalized reminders to patients. This is a prospective multi-center open study for pwCFs older than 12 years, who had been prescribed CFTRm [elexacaftor/tezacaftor/ivacaftor (ETI) or tezacaftor/ivacaftor (TI)], and provided consent to use ReX platform to receive CFTRm and record their health condition. Study duration was 12-24 months, with clinic visits where physical examination, body mass index (BMI), and pulmonary function tests were performed, and user experience questionnaires were filled in. Results Ten pwCFs from two CF centers in Israel were included. The mean age was 31.5 years (range 15-74 years); eight were taking ETI and two TI. Median adherence to CFTRm was 97.5% (range 70%-100%) in the first year and 94% (range 84%-99%) in the second year, which is higher than the previously reported CFTRm adherence of ∼80%. No adverse events related to the use of the platform were reported. Patients reported ReX to be valuable to their treatment management and user friendly. Estimated mean forced expiratory volume in 1 s (FEV1%) increased from 74.4% to 80.8% (p = 0.004) over 2 years. Similarly, estimated BMI percentile increased from 53.5 to 59.0 (p < 0.001). Conclusions Using the ReX platform in medication management of pwCF treated by CFTRm is safe, easy to use, and effective in improving the adherence to treatment and the clinical outcomes. Consequently, this device may potentially reduce costs to healthcare providers. Further larger and long-term studies are required to examine the clinical benefits of the ReX platform.
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Affiliation(s)
- Karin Yaacoby-Bianu
- Pediatric Pulmonology Unit and CF Center, Carmel Medical Center, Haifa, Israel
- B. Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
| | - Malena Cohen-Cymberknoh
- Pediatric Pulmonology Unit and Cystic Fibrosis Center, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Shoseyov
- Pediatric Pulmonology Unit and Cystic Fibrosis Center, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tal Lavi
- Pharmacy Services, Carmel Medical Center, Haifa, Israel
| | - Ana Ostrovski
- Pediatric Pulmonology Unit and CF Center, Carmel Medical Center, Haifa, Israel
| | - Michal Shteinberg
- B. Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
- Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel
| | - Galit Livnat
- Pediatric Pulmonology Unit and CF Center, Carmel Medical Center, Haifa, Israel
- B. Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
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Kriara L, Zanon M, Lipsmeier F, Lindemann M. Physiological sensor data cleaning with autoencoders. Physiol Meas 2023; 44:125003. [PMID: 38029439 DOI: 10.1088/1361-6579/ad10c7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/29/2023] [Indexed: 12/01/2023]
Abstract
Objective.Physiological sensor data (e.g. photoplethysmograph) is important for remotely monitoring patients' vital signals, but is often affected by measurement noise. Existing feature-based models for signal cleaning can be limited as they might not capture the full signal characteristics.Approach.In this work we present a deep learning framework for sensor signal cleaning based on dilated convolutions which capture the coarse- and fine-grained structure in order to classify whether a signal is noisy or clean. However, since obtaining annotated physiological data is costly and time-consuming we propose an autoencoder-based semi-supervised model which is able to learn a representation of the sensor signal characteristics, also adding an element of interpretability.Main results.Our proposed models are over 8% more accurate than existing feature-based approaches with half the false positive/negative rates. Finally, we show that with careful tuning (that can be improved further), the semi-supervised model outperforms supervised approaches suggesting that incorporating the large amounts of available unlabeled data can be advantageous for achieving high accuracy (over 90%) and minimizing the false positive/negative rates.Significance.Our approach enables us to reliably separate clean from noisy physiological sensor signal that can pave the development of reliable features and eventually support decisions regarding drug efficacy in clinical trials.
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Affiliation(s)
- Lito Kriara
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, 4070 Basel, Switzerland
| | - Mattia Zanon
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, 4070 Basel, Switzerland
| | - Florian Lipsmeier
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, 4070 Basel, Switzerland
| | - Michael Lindemann
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, 4070 Basel, Switzerland
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Snoswell CL, Vitangcol KJ, Haydon HM, Gray LC, Leedie F, Smith AC, Caffery LJ. Cost-effectiveness of remote patient monitoring for First Nations peoples living with diabetes in regional Australia. J Telemed Telecare 2023; 29:3S-7S. [PMID: 38007695 DOI: 10.1177/1357633x231214019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
The aim of this study was to determine the cost-effectiveness of remote patient monitoring (RPM) with First Nations peoples living with diabetes. This study was set at the Goondir Health Service (GHS), an Aboriginal and Torres Strait Islander Community-Controlled Health in South-West Queensland. Electronic medical records and RPM data were provided by the GHS. Clinical effectiveness was determined by comparing mean HbA1c before and after enrolment in the RPM service. Our analysis found no statistically significant effect between the mean HbA1c before and after enrolment, so this analysis focused on net-benefit and return on investment for costs from the perspective of the GHS. The 6-month RPM service for 84 clients cost AUD $67,841 to cover RPM equipment, ongoing technology costs, and a dedicated Virtual Care Manager, equating to $808 per client. There were 199 additional client-clinician interactions in the period after enrolment resulting in an additional $4797 revenue for the GHS. Therefore, the program cost the GHS $63,044 to deliver, representing a return on investment of around 7 cents for every dollar they spent. Whilst the diabetes RPM service was equally effective as usual care and resulted in increased interactions with clients, the cost for the service was substantially more than the additional revenue generated from increased interactions. This evidence highlights the need for alternative funding models for RPM services and demonstrates the need to focus future research on long-term clinical effects and the extra-clinical benefits resulting from services of this type.
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Affiliation(s)
- Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Kathryn J Vitangcol
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Leonard C Gray
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | | | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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Foster CC, Kaat AJ, Shah AV, Hodgson CA, Hird-McCorry LP, Janus A, Swanson P, Massey LF, De Sonia A, Cella D, Goodman DM, Davis MM, Laguna TA. Codesign of remote data collection for chronic management of pediatric home mechanical ventilation. Pediatr Pulmonol 2023; 58:3416-3427. [PMID: 37701973 PMCID: PMC10840705 DOI: 10.1002/ppul.26665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/19/2023] [Accepted: 08/21/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Outpatient monitoring of children using invasive home mechanical ventilation (IHMV) is recommended, but access to care can be difficult. This study tested if remote (home-based) data collection was feasible and acceptable in chronic IHMV management. METHODS A codesign study was conducted with an IHMV program, home nurses, and English- and Spanish-speaking parent-guardians of children using IHMV (0-17 years; n = 19). After prototyping, parents used a remote patient monitoring (RPM) bundle to collect patient heart rate, respiratory rate (RR), oxygen saturation, end-tidal carbon dioxide (EtCO2 ), and ventilator pressure/volume over 8 weeks. User feedback was analyzed using qualitative methods and the System Usability Scale (SUS). Expected marginal mean differences within patient measures when awake, asleep, or after a break were calculated using mixed effects models. RESULTS Patients were a median 2.9 years old and 11 (58%) took breaks off the ventilator. RPM data were entered on a mean of 83.7% (SD ± 29.1%) weeks. SUS scores were 84.8 (SD ± 10.5) for nurses and 91.8 (SD ± 10.1) for parents. Over 90% of parents agreed/strongly agreed that RPM data collection was feasible and relevant to their child's care. Within-patient comparisons revealed that EtCO2 (break-vs-asleep 2.55 mmHg, d = 0.79 [0.42-1.15], p < .001; awake-vs-break 1.48, d = -0.49 [0.13-0.84], p = .02) and RR (break-vs-asleep 16.14, d = 2.12 [1.71-2.53], p < .001; awake-vs-break 3.44, d = 0.45 [0.10-0.04], p = .03) were significantly higher during ventilator breaks. CONCLUSIONS RPM data collection in children with IHMV was feasible, acceptable, and captured clinically meaningful vital sign changes during ventilator breaks, supporting the clinical utility of RPM in IHMV management.
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Affiliation(s)
- Carolyn C. Foster
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine
- Mary Ann & J. Milburn Smith Child Health Outcomes Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago
- Digital Health, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | | | - Avani V. Shah
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine
- Pulmonary Habilitation Program, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Caroline A. Hodgson
- Pulmonary Habilitation Program, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | | | - Angela Janus
- Pulmonary Habilitation Program, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Philip Swanson
- Pulmonary Habilitation Program, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Liana F. Massey
- Mary Ann & J. Milburn Smith Child Health Outcomes Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Anna De Sonia
- Mary Ann & J. Milburn Smith Child Health Outcomes Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - David Cella
- Departments of Medicine, Medical Social Sciences
| | - Denise M. Goodman
- Pulmonary Habilitation Program, Ann & Robert H. Lurie Children’s Hospital of Chicago
- Division of Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine
| | - Matthew M. Davis
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine
- Mary Ann & J. Milburn Smith Child Health Outcomes Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago
- Departments of Medicine, Medical Social Sciences
| | - Theresa A. Laguna
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine
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Eisenkraft A, Goldstein N, Fons M, Tabi M, Sherman AD, Ben Ishay A, Merin R, Nachman D. Comparing body temperature measurements using the double sensor method within a wearable device with oral and core body temperature measurements using medical grade thermometers-a short report. Front Physiol 2023; 14:1279314. [PMID: 38033330 PMCID: PMC10685445 DOI: 10.3389/fphys.2023.1279314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction: Body temperature is essential for diagnosing, managing, and following multiple medical conditions. There are several methods and devices to measure body temperature, but most do not allow continuous and prolonged measurement of body temperature. Noninvasive skin temperature sensor combined with a heat flux sensor, also known as the "double sensor" technique, is becoming a valuable and simple method for frequently monitoring body temperature. Methods: Body temperature measurements using the "double sensor" method in a wearable monitoring device were compared with oral and core body temperature measurements using medical grade thermometers, analyzing data from two prospective clinical trials of different clinical scenarios. One study included 45 hospitalized COVID-19 patients in which oral measurements were taken using a hand-held device, and the second included 18 post-cardiac surgery patients in which rectal measurements were taken using a rectal probe. Results: In study 1, Bland-Altman analysis showed a bias of -0.04°C [0.34-(-0.43)°C, 95% LOA] with a correlation of 99.4% (p < 0.001). In study 2, Bland-Altman analysis showed a bias of 0.0°C [0.27-(-0.28)°C, 95% LOA], and the correlation was 99.3% (p < 0.001). In both studies, stratifying patients based on BMI and skin tone showed high accordance in all sub-groups. Discussion: The wearable monitor showed high correlation with oral and core body temperature measurements in different clinical scenarios.
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Affiliation(s)
- Arik Eisenkraft
- Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Force Medical Corps, Jerusalem, Israel
- Biobeat Technologies Ltd., Petah Tikva, Israel
| | | | - Meir Fons
- Biobeat Technologies Ltd., Petah Tikva, Israel
| | | | | | | | - Roei Merin
- Biobeat Technologies Ltd., Petah Tikva, Israel
| | - Dean Nachman
- Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Force Medical Corps, Jerusalem, Israel
- Heart Institute, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
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Simonson JK, Anderson M, Polacek C, Klump E, Haque SN. Characterizing Real-World Implementation of Consumer Wearables for the Detection of Undiagnosed Atrial Fibrillation in Clinical Practice: Targeted Literature Review. JMIR Cardio 2023; 7:e47292. [PMID: 37921865 PMCID: PMC10656655 DOI: 10.2196/47292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF), the most common cardiac arrhythmia, is often undiagnosed because of lack of awareness and frequent asymptomatic presentation. As AF is associated with increased risk of stroke, early detection is clinically relevant. Several consumer wearable devices (CWDs) have been cleared by the US Food and Drug Administration for irregular heart rhythm detection suggestive of AF. However, recommendations for the use of CWDs for AF detection in clinical practice, especially with regard to pathways for workflows and clinical decisions, remain lacking. OBJECTIVE We conducted a targeted literature review to identify articles on CWDs characterizing the current state of wearable technology for AF detection, identifying approaches to implementing CWDs into the clinical workflow, and characterizing provider and patient perspectives on CWDs for patients at risk of AF. METHODS PubMed, ClinicalTrials.gov, UpToDate Clinical Reference, and DynaMed were searched for articles in English published between January 2016 and July 2023. The searches used predefined Medical Subject Headings (MeSH) terms, keywords, and search strings. Articles of interest were specifically on CWDs; articles on ambulatory monitoring tools, tools available by prescription, or handheld devices were excluded. Search results were reviewed for relevancy and discussed among the authors for inclusion. A qualitative analysis was conducted and themes relevant to our study objectives were identified. RESULTS A total of 31 articles met inclusion criteria: 7 (23%) medical society reports or guidelines, 4 (13%) general reviews, 5 (16%) systematic reviews, 5 (16%) health care provider surveys, 7 (23%) consumer or patient surveys or interviews, and 3 (10%) analytical reports. Despite recognition of CWDs by medical societies, detailed guidelines regarding CWDs for AF detection were limited, as was the availability of clinical tools. A main theme was the lack of pragmatic studies assessing real-world implementation of CWDs for AF detection. Clinicians expressed concerns about data overload; potential for false positives; reimbursement issues; and the need for clinical tools such as care pathways and guidelines, preferably developed or endorsed by professional organizations. Patient-facing challenges included device costs and variability in digital literacy or technology acceptance. CONCLUSIONS This targeted literature review highlights the lack of a comprehensive body of literature guiding real-world implementation of CWDs for AF detection and provides insights for informing additional research and developing appropriate tools and resources for incorporating these devices into clinical practice. The results should also provide an impetus for the active involvement of medical societies and other health care stakeholders in developing appropriate tools and resources for guiding the real-world use of CWDs for AF detection. These resources should target clinicians, patients, and health care systems with the goal of facilitating clinician or patient engagement and using an evidence-based approach for establishing guidelines or frameworks for administrative workflows and patient care pathways.
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Najarian M, Goudie A, Bona JP, Rezaeiahari M, Young SG, Bogulski CA, Hayes CJ. Socioeconomic Determinants of Remote Patient Monitoring Implementation Among Rural and Urban Hospitals. Telemed J E Health 2023; 29:1624-1633. [PMID: 37010391 PMCID: PMC11074434 DOI: 10.1089/tmj.2022.0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 04/04/2023] Open
Abstract
Introduction: Remote patient monitoring (RPM) is a form of telehealth that improves quality of care for chronic disease treatment and reduces hospital readmission rates. Geographical proximity to health care is important for individuals of low socioeconomic status (SES) who face additional financial and transportation barriers. The goal of this study was to assess the association between social determinants of health and adoption of RPM. Methods: This cross-sectional study analyzed data from hospitals that responded to the American Hospital Association's Annual Survey (2018) and spatially linked census tract-level environmental and social determinants of health obtained from the Social Vulnerability Index (2018). Results: A total of 4,206 hospitals (1,681 rural and 2,525 urban hospitals) met study criteria. Rural hospitals near households in the lower middle quartile SES were associated with a 33.5% lower likelihood of having adopted RPM for chronic care management compared with rural hospitals near households in the highest quartile SES (adjusted odds ratios [aOR] = 0.665; 95% confidence interval [CI]: 0.453-0.977). Urban hospitals near households in the lowest quartile SES were associated with a 41.9% lower likelihood of having adopted RPM for chronic care management compared with urban hospitals near households in the highest quartile SES (aOR = 0.581; 95% CI: 0.435-0.775). Similar trends in accessibility were found with RPM for postdischarge services among urban hospitals. Conclusion: Our findings highlight the importance of hospital responsibility and state and federal policy approaches toward ensuring equitable access to RPM services for patients characterized by lower SES.
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Affiliation(s)
- Matthew Najarian
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Anthony Goudie
- Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jonathan P. Bona
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mandana Rezaeiahari
- Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sean G. Young
- Department of Environmental Health Sciences, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cari A. Bogulski
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Corey J. Hayes
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Psychiatry and Behavioral Sciences and University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Jones RD, Peng C, Odom L, Moody H, Eswaran H. Use of Cellular-Enabled Glucometer for Diabetes Management in High-Risk Pregnancy. Telemed Rep 2023; 4:307-316. [PMID: 37908627 PMCID: PMC10615046 DOI: 10.1089/tmr.2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 11/02/2023]
Abstract
Background Type 1 and type 2 diabetes during pregnancy requires intensive glucose monitoring to ensure optimal health outcomes for mothers and infants. Standard practice includes patients monitoring their glucose four to six times a day using a standard glucometer and paper diary. Remote patient monitoring (RPM) offers an alternative method for diabetes management. This study aimed at measuring the patient's satisfaction with and feasibility of using a cellular-enabled RPM device for glucose management in pregnancies complicated by type 1 or type 2 diabetes. Methods In a mixed-methods pilot study, 59 pregnant women with type 1 or type 2 diabetes were given a cellular-enabled iGlucose glucometer. Participants completed a pre-survey, used the device for 30 days, and then completed a post-survey and semi-structured interview. Results Participants were divided into two groups based on duration of device use: high-use >50 days and low-use ≤50 days. A significant difference (p < 0.0001) in Appraisal of Diabetes scores was seen between the pre- and post-survey for both groups, which indicates that the use of iGlucose glucometer significantly improved participants' appraisal of their diabetes. There was a significant difference (p = 0.0409) in pre-post General Life Satisfaction in the high-use group, which indicates that iGlucose glucometer significantly improved participants' life satisfaction when used for an extended amount of time. Participants scored high on system usability for all groups and reported positive associations with iGlucose use. Conclusion The use of cellular-enabled RPM glucometers is a valuable tool for the management of type 1 diabetes mellitus and type 2 diabetes mellitus during pregnancy.
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Affiliation(s)
- Rebecca D. Jones
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cheng Peng
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Lettie Odom
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Heather Moody
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hari Eswaran
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Andrusov VE, Pakhuridze MD, Skvortsova EV. [Aspects of the use of medical devices for remote patient monitoring]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2023; 31:1138-1145. [PMID: 38069876 DOI: 10.32687/0869-866x-2023-31-s2-1138-1145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/05/2023] [Indexed: 12/18/2023]
Abstract
In the Russian Federation, it is legally determined that telemedicine technologies are considered as any actions with any data obtained during a remote communication between doctors (councils, consultations), remote medical patient monitoring, including using medical devices. Medical devices with a function of remote transmission of the measurement data are used to detect diseases in some workers that impede their duty performance. There are hardly any publications on the experience of using such devices in other aspects of medical care. The issue of medical devices enhanced with remote data transmission to ensure standard of measurements has been elaborated in great detail. In terms of applicability in telemedicine technologies, remote patient monitoring devices are used to measure blood pressure and human body temperature, detect alcohol vapors in the exhaled air, record electrocardiogram. There is also patent activity. In 2019-2023, remote transmission of the measurement data including by medical devices was protected by a large number of invention or utility model patents. Nowadays, there are no legal, technological barriers to the use of medical devices enhanced with remote data transmission in primary care. In 2023-2024, 8 constituent entities of the Russian Federation are conducting a pilot project on remote patient monitoring with medical devices.
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Affiliation(s)
- V E Andrusov
- Research Institute for Healthcare Organization and Medical Management, 115088, Moscow, Russia,
| | - M D Pakhuridze
- Center for Medical Prevention of Moscow Healthcare Department, 123060, Moscow, Russia
| | - E V Skvortsova
- Center for Medical Prevention of Moscow Healthcare Department, 123060, Moscow, Russia
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Chugh R, Liu AW, Idomsky Y, Bigazzi O, Maiorano A, Medina E, Pierce L, Odisho AY, Mahadevan U. A Digital Health Intervention to Improve the Clinical Care of Inflammatory Bowel Disease Patients. Appl Clin Inform 2023; 14:855-865. [PMID: 37586416 PMCID: PMC10599806 DOI: 10.1055/a-2154-9172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/14/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a chronic condition that requires close monitoring. Digital health virtual care platforms can enable self-monitoring and allow providers to remotely surveil patients and efficiently identify those with active disease. OBJECTIVES The primary aim was to design and implement an IBD remote monitoring program, identify predictors of patient engagement, and determine who found the chat to be a valuable tool. METHODS We developed the IBD Virtual Care Chat, an electronic health record (EHR)-integrated chat to monitor electronic patient reported outcomes (ePROs), medication changes, and disease activity, and subsequently report concerning findings to providers via the EHR. All patients in the IBD practice over age 18 with a clinical encounter in the preceding 12 months were eligible to be enrolled. The primary aim was to identify predictors of patient engagement and determine who found the chat to be a valuable tool. RESULTS Between May 2021 and March 2022, 2,934 patients were enrolled. A total of 1,160 engaged at least once and 687 (23.4%) continually engaged, submitting at least three ePROs. Disease severity (based on Harvey-Bradshaw Index or Simple Clinical Colitis Activity Index) did not impact ePRO submissions. Patients were significantly more likely to be continually engaged if they self-reported the presence of extraintestinal manifestations (7%, 95% confidence interval: 0.01-0.14; p = 0.04). Patient satisfaction remained moderately high with a median score of 8 (interquartile range: 5-10) on a scale of 1 (poor) to 10 (good). CONCLUSION Our program demonstrates the potential for EHR-integrated digital health as part of routine IBD care to achieve sustained engagement with high patient satisfaction.
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Affiliation(s)
- Rishika Chugh
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, California, United States
| | - Andrew W. Liu
- Center for Digital Health Innovation, University of California San Francisco, California, United States
| | - Yelena Idomsky
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, California, United States
| | - Olivia Bigazzi
- Center for Digital Health Innovation, University of California San Francisco, California, United States
| | - Ali Maiorano
- Center for Digital Health Innovation, University of California San Francisco, California, United States
| | - Eli Medina
- Center for Digital Health Innovation, University of California San Francisco, California, United States
| | - Logan Pierce
- Center for Digital Health Innovation, University of California San Francisco, California, United States
- Department of Medicine, University of California San Francisco, San Francisco, California, United States
| | - Anobel Y. Odisho
- Center for Digital Health Innovation, University of California San Francisco, California, United States
- Department of Urology, University of California San Francisco, San Francisco, California, United States
| | - Uma Mahadevan
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, California, United States
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Le Goff-Pronost M, Bongiovanni-Delarozière I. Economic evaluation of remote patient monitoring and organizational analysis according to patient involvement: a scoping review. Int J Technol Assess Health Care 2023; 39:e59. [PMID: 37750813 DOI: 10.1017/s0266462323002581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND A literature review concerning the economic evaluation of telemonitoring was requested by the authority in charge of health evaluation in France, in a context of deployment of remote patient monitoring and identification of its financing. Due to the heterogeneity of existing telemonitoring solutions, it was necessary to stratify the evaluation according to patient involvement. Three levels of patient involvement are considered: weak (automated monitoring), medium (monitoring supported by a professional), and strong (active remote participation). OBJECTIVES We performed a scoping review to provide a comprehensive overview of different systems of telemonitoring and their reported cost-effectiveness. METHODS Following PRISMA-ScR guidelines, a search was performed in four databases: PubMed, MEDLINE, EMBASE, and Cochrane Library between January 1, 2013 and May 19, 2020. Remote patient monitoring should include the combination of three elements: a connected device, an organizational solution for data analysis and alert management, and a system allowing personalized interactions, and three degrees of involvement. RESULTS We identified 61 eligible studies among the 489 records identified. Heart failure remains the pathology most represented in the studies selected (n = 24). The cost-utility analysis was chosen in a preponderant way (n = 41). Forty-four studies (72 percent) reported that the intervention was expected cost-effective. Heterogeneity has been observed in the remote monitoring solutions but all systems are reported cost-effective. The small number of long-term studies does not allow conclusions to be drawn on the transposability. CONCLUSIONS Remote patient monitoring is reported to be cost-effective whatever the system and patient involvement.
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Holmstrand EC, Sato H, Li J, Mukherjee A, Fitzpatrick NE, Rayl KR, Colangelo FR. Digital hypertension management: clinical and cost outcomes of a pilot implementation of the OMRON hypertension management platform. Front Digit Health 2023; 5:1128553. [PMID: 37800090 PMCID: PMC10548242 DOI: 10.3389/fdgth.2023.1128553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/23/2023] [Indexed: 10/07/2023] Open
Abstract
Importance Home monitoring of blood pressure (BP) in hypertensive patients can improve outcomes, but challenges to both patient compliance and the effective transmission of home BP readings to physicians can limit the extent to which physicians can use this information to improve care. The OMRON Hypertension Management Platform (OMRON HMP) pairs a home BP cuff with a digital product that tracks data, provides reminders to improve patient compliance, and provides a streamlined source of information to physicians. Objective The primary objective of the quality improvement (QI) project was to test the hypothesis that use of the OMRON HMP could reduce the number and cost of hypertension related claims, relative to a retrospectively matched cohort of insured members. A secondary objective was to demonstrate improvement in control of BP among patients. Design Eligible members were recruited to the QI project between December 1, 2018 and December 30, 2020 and data collected for six months following recruitment. All members received the OMRON HMP intervention. Setting Enrollment and data collection were coordinated on-site at selected PCP partner providers in Western Pennsylvania. Eligible members were identified from insurance claims data as those receiving care for primary hypertension from participating primary care physicians and/or cardiologists. Participants Eligible members were between the ages of 35 and 85, with a diagnosis of primary hypertension. The retrospective cohort was selected from electronic medical records of Highmark-insured patients with hypertension who received care at Allegheny Health Network (AHN), a subsidiary of Highmark Health. Members were matched on baseline BP and lipid measures, age, smoking status, diabetes status, race and sex. Intervention Daily home BP readings were recorded by the OMRON HMP app. Patient data was reviewed by clinical staff on a weekly basis and treatment plans could be adjusted in response to this data. Results OMRON HMP users showed a significant increase in the number and cost of hypertension-related claims, contrary to the hypothesis, but did display improvements in control of BP. Conclusions and Relevance The use of a digital platform to facilitate at-home BP monitoring appeared to improve BP control but led to increased hypertension-related costs in the short-term.
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Affiliation(s)
| | - Hironori Sato
- Technology Development HQ, Omron Healthcare Co., Ltd., Kyoto, Japan
| | - Jim Li
- Technology Development HQ, Omron Healthcare Co., Ltd., Kyoto, Japan
| | - Abhishek Mukherjee
- VITAL Innovation Program, Highmark Health, Pittsburgh, PA, United States
| | | | - Kenneth R. Rayl
- VITAL Innovation Program, Highmark Health, Pittsburgh, PA, United States
| | - Francis R. Colangelo
- Premier Medical Associates, Allegheny Health Network, Monroeville, PA, United States
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Mazzeo M, Hernan G, Veerubhotla A. Usability and ease of use of long-term remote monitoring of physical activity for individuals with acquired brain injury in community: a qualitative analysis. Front Neurosci 2023; 17:1220581. [PMID: 37781244 PMCID: PMC10534037 DOI: 10.3389/fnins.2023.1220581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Objective and continuous monitoring of physical activity over the long-term in the community is perhaps the most important step in the paradigm shift toward evidence-based practice and personalized therapy for successful community integration. With the advancement in technology, physical activity monitors have become the go-to tools for objective and continuous monitoring of everyday physical activity in the community. While these devices are widely used in many patient populations, their use in individuals with acquired brain injury is slowly gaining traction. The first step before using activity monitors in this population is to understand the patient perspective on usability and ease of use of physical activity monitors at different wear locations. However, there are no studies that have looked at the feasibility and patient perspectives on long-term utilization of activity monitors in individuals with acquired brain injury. Methods This pilot study aims to fill this gap and understand patient-reported aspects of the feasibility of using physical activity monitors for long-term use in community-dwelling individuals with acquired brain injury. Results This pilot study found that patients with acquired brain injury faced challenges specific to their functional limitations and that the activity monitors worn on the waist or wrist may be better suited in this population. Discussion The unique wear location-specific challenges faced by individuals with ABI need to be taken into account when selecting wearable activity monitors for long term use in this population.
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Affiliation(s)
| | | | - Akhila Veerubhotla
- Department of Rehabilitation Medicine, New York University - Grossman School of Medicine, New York, NY, United States
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Chang A, Gao MZ, Ferstad JO, Dupenloup P, Zaharieva DP, Maahs DM, Prahalad P, Johari R, Scheinker D. A quantitative model to ensure capacity sufficient for timely access to care in a remote patient monitoring program. Endocrinol Diabetes Metab 2023; 6:e435. [PMID: 37345227 PMCID: PMC10495556 DOI: 10.1002/edm2.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION Algorithm-enabled remote patient monitoring (RPM) programs pose novel operational challenges. For clinics developing and deploying such programs, no standardized model is available to ensure capacity sufficient for timely access to care. We developed a flexible model and interactive dashboard of capacity planning for whole-population RPM-based care for T1D. METHODS Data were gathered from a weekly RPM program for 277 paediatric patients with T1D at a paediatric academic medical centre. Through the analysis of 2 years of observational operational data and iterative interviews with the care team, we identified the primary operational, population, and workforce metrics that drive demand for care providers. Based on these metrics, an interactive model was designed to facilitate capacity planning and deployed as a dashboard. RESULTS The primary population-level drivers of demand are the number of patients in the program, the rate at which patients enrol and graduate from the program, and the average frequency at which patients require a review of their data. The primary modifiable clinic-level drivers of capacity are the number of care providers, the time required to review patient data and contact a patient, and the number of hours each provider allocates to the program each week. At the institution studied, the model identified a variety of practical operational approaches to better match the demand for patient care. CONCLUSION We designed a generalizable, systematic model for capacity planning for a paediatric endocrinology clinic providing RPM for T1D. We deployed this model as an interactive dashboard and used it to facilitate expansion of a novel care program (4 T Study) for newly diagnosed patients with T1D. This model may facilitate the systematic design of RPM-based care programs.
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Affiliation(s)
- Annie Chang
- Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Management Science and EngineeringStanford UniversityStanfordCaliforniaUSA
| | - Michael Z. Gao
- Department of Management Science and EngineeringStanford UniversityStanfordCaliforniaUSA
| | - Johannes O. Ferstad
- Department of Management Science and EngineeringStanford UniversityStanfordCaliforniaUSA
| | - Paul Dupenloup
- Department of Management Science and EngineeringStanford UniversityStanfordCaliforniaUSA
| | - Dessi P. Zaharieva
- Department of Paediatric, Division of Paediatric EndocrinologyStanford UniversityStanfordCaliforniaUSA
| | - David M. Maahs
- Department of Paediatric, Division of Paediatric EndocrinologyStanford UniversityStanfordCaliforniaUSA
- Stanford Diabetes Research CentreStanford UniversityStanfordCaliforniaUSA
| | - Priya Prahalad
- Department of Paediatric, Division of Paediatric EndocrinologyStanford UniversityStanfordCaliforniaUSA
| | - Ramesh Johari
- Department of Management Science and EngineeringStanford UniversityStanfordCaliforniaUSA
- Stanford Diabetes Research CentreStanford UniversityStanfordCaliforniaUSA
| | - David Scheinker
- Department of Management Science and EngineeringStanford UniversityStanfordCaliforniaUSA
- Department of Paediatric, Division of Paediatric EndocrinologyStanford UniversityStanfordCaliforniaUSA
- Stanford Diabetes Research CentreStanford UniversityStanfordCaliforniaUSA
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Park S, Kum HC, Zheng Q, Lawley MA. Real-World Adherence and Effectiveness of Remote Patient Monitoring Among Medicaid Patients With Diabetes: Retrospective Cohort Study. J Med Internet Res 2023; 25:e45033. [PMID: 37606977 PMCID: PMC10481216 DOI: 10.2196/45033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/28/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The prevalence of diabetes in the United States is high and increasing, and it is also the most expensive chronic condition in the United States. Self-monitoring of blood glucose or continuous glucose monitoring are potential solutions, but there are barriers to their use. Remote patient monitoring (RPM) with appropriate support has the potential to provide solutions. OBJECTIVE We aim to investigate the adherence of Medicaid patients with diabetes to daily RPM protocols, the relationship between adherence and changes in blood glucose levels, and the impact of daily testing time on blood glucose changes. METHODS This retrospective cohort study analyzed real-world data from an RPM company that provides services to Texas Medicaid patients with diabetes. Overall, 180 days of blood glucose data from an RPM company were collected to assess transmission rates and blood glucose changes, after the first 30 days of data were excluded due to startup effects. Patients were separated into adherent and nonadherent cohorts, where adherent patients transmitted data on at least 120 of the 150 days. z tests and t tests were performed to compare transmission rates and blood glucose changes between 2 cohorts. In addition, we analyzed blood glucose changes based on their testing time-between 1 AM and 10 AM, 10 AM and 6 PM, and 6 PM and 1 AM. RESULTS Mean patient age was 70.5 (SD 11.8) years, with 66.8% (n=255) of them being female, 91.9% (n=351) urban, and 89% (n=340) from south Texas (n=382). The adherent cohort (n=186, 48.7%) had a mean transmission rate of 82.8% before the adherence call and 91.1% after. The nonadherent cohort (n=196, 51.3%) had a mean transmission rate of 45.9% before and 60.2% after. The mean blood glucose levels of the adherent cohort decreased by an average of 9 mg/dL (P=.002) over 5 months. We also found that variability of blood glucose level of the adherent cohort improved 3 mg/dL (P=.03) over the 5-month period. Both cohorts had the majority of their transmissions between 1 AM and 10 AM, with 70.5% and 53.2% for the adherent and nonadherent cohorts, respectively. The adherent cohort had decreasing mean blood glucose levels over 5 months, with the largest decrease during the 6 PM to 1 AM time period (30.9 mg/dL). Variability of blood glucose improved only for those tested from 10 AM to 6 PM, with improvements of 6.9 mg/dL (P=.02). Those in the nonadherent cohort did not report significant changes. CONCLUSIONS RPM can help manage diabetes in Medicaid clients by improving adherence rates and glycemic control. Adherence calls helped improve adherence rates, but some patients still faced challenges in transmitting blood glucose levels. Nonetheless, RPM has the potential to reduce the risk of adverse outcomes associated with diabetes.
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Affiliation(s)
- Sulki Park
- Population Informatics Lab, Texas A&M University, College Station, TX, United States
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Hye-Chung Kum
- Population Informatics Lab, Texas A&M University, College Station, TX, United States
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
- Department of Health Policy and Management, Texas A&M University, College Station, TX, United States
| | - Qi Zheng
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX, United States
| | - Mark A Lawley
- Population Informatics Lab, Texas A&M University, College Station, TX, United States
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX, United States
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Coutu FA, Iorio OC, Ross BA. Remote patient monitoring strategies and wearable technology in chronic obstructive pulmonary disease. Front Med (Lausanne) 2023; 10:1236598. [PMID: 37663662 PMCID: PMC10470466 DOI: 10.3389/fmed.2023.1236598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is highly prevalent and is associated with a heavy burden on patients and health systems alike. Exacerbations of COPD (ECOPDs) are a leading cause of acute hospitalization among all adult chronic diseases. There is currently a paradigm shift in the way that ECOPDs are conceptualized. For the first time, objective physiological parameters are being used to define/classify what an ECOPD is (including heart rate, respiratory rate, and oxygen saturation criteria) and therefore a mechanism to monitor and measure their changes, particularly in an outpatient ambulatory setting, are now of great value. In addition to pre-existing challenges on traditional 'in-person' health models such as geography and seasonal (ex. winter) impacts on the ability to deliver in-person visit-based care, the COVID-19 pandemic imposed additional stressors including lockdowns, social distancing, and the closure of pulmonary function labs. These health system stressors, combined with the new conceptualization of ECOPDs, rapid advances in sophistication of hardware and software, and a general openness by stakeholders to embrace this technology, have all influenced the propulsion of remote patient monitoring (RPM) and wearable technology in the modern care of COPD. The present article reviews the use of RPM and wearable technology in COPD. Context on the influences, factors and forces which have helped shape this health system innovation is provided. A focused summary of the literature of RPM in COPD is presented. Finally, the practical and ethical principles which must guide the transition of RPM in COPD into real-world clinical use are reviewed.
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Affiliation(s)
- Felix-Antoine Coutu
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Olivia C. Iorio
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Bryan A. Ross
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
- Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada
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Charkviani M, Barreto EF, Pearson KK, Amberg BM, Amundson RH, Bell SJ, Cleveland EJ, Daniels CE, Kohler CM, Leuenberger AM, Philpot LM, Ramirez DA, Reinschmidt KJ, Zoghby Z, Kattah AG. Development and Implementation of an Acute Kidney Injury Remote Patient Monitoring Program: Research Letter. Can J Kidney Health Dis 2023; 10:20543581231192746. [PMID: 37577175 PMCID: PMC10422882 DOI: 10.1177/20543581231192746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/06/2023] [Indexed: 08/15/2023] Open
Abstract
Acute kidney injury (AKI) survivors have a dynamic posthospital course which warrants close monitoring. Remote patient monitoring (RPM) could be used to improve quality and efficiency of AKI survivor care. Objective The objective of this report was to describe the development and preliminary feasibility of an AKI RPM program launched in October 2021. Setting Academic medical center. Patients Patients enrolled in the AKI RPM program were those who experienced AKI during a hospitalization and underwent nephrology consultation. Measurements/Methods At enrollment, patients were provided with home monitoring technology and underwent weekly laboratory assessments. Nurses evaluated the data daily and adhered to prespecified protocols for management and escalation of care if needed. Results Twenty patients were enrolled in AKI RPM in the first 5 months. Median duration of program participation was 36 (31, 40) days. Eight patients (40%) experienced an unplanned readmission, or an emergency department visit, half (N = 4) of which were attributed to AKI and related circumstances. Of the 9 postgraduation survey respondents, all were satisfied with the RPM program and 89% would recommend RPM to other patients with similar health conditions. Limitations Acute kidney injury RPM was made possible by the existing infrastructure in our integrated health system and the robust resources available in the Mayo Clinic Center for Digital Health. Such infrastructure may not be universally available which could limit scale and generalizability of such a program. Conclusions Remote patient monitoring can offer a unique opportunity to bridge the care transition from hospital to home and increase access to quality care for the AKI survivors.
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Affiliation(s)
- Mariam Charkviani
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | | | - Brigid M. Amberg
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - Sarah J. Bell
- Center of Digital Health, Mayo Clinic, Rochester, MN, USA
| | - Eric J. Cleveland
- Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, USA
| | - Craig E. Daniels
- Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, USA
| | | | | | - Lindsey M. Philpot
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - David A. Ramirez
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - Ziad Zoghby
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Andrea G. Kattah
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Frazier WD, Beins M, DaVanzo J, Heath S, Dobson A. Six Months of Remote Patient Monitoring Is Associated with Blood Pressure Reduction in Hypertensive Patients: An Uncontrolled Observational Study. Telemed J E Health 2023; 29:1164-1170. [PMID: 36576990 PMCID: PMC10440637 DOI: 10.1089/tmj.2022.0418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 09/28/2022] [Accepted: 10/31/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Remote physiological monitoring (RPM) is a form of telehealth that measures vital signs at home and automatically reports the results to providers, thereby possibly improving chronic disease management. Medicare payment for RPM began in 2019. Two potential obstacles to RPM growth are the paucity of published clinical outcomes data and the Medicare requirement that monitoring be done at least 16 days per month to bill for the service. To help address these issues, we report the following uncontrolled observational study. Methods: A total of 1,102 consecutive patients enrolled in RPM were divided into four groups based on initial average mean arterial pressure (MAP) and into six groups based on the number of days per month MAP was measured. We report changes in MAP after 6 months of RPM as a function of initial MAP, and number of days per month MAP was monitored. Results: After 6 months of RPM, average MAP dropped from 97 to 93 (p < 0.01). This drop was greatest in the 50% of patients initially hypertensive. These patients saw average MAP reductions from 106 to 97 (p < 0.001) and became normotensive. Although MAP reduction was greatest the more frequently patients measured, significant reduction occurred in the hypertensive patients whether they measured more or less than 16 days per month (p < 0.001). No minimum threshold of measurements was found that predicted failure of RPM to lower MAP. Conclusions: RPM is associated with clinically and statistically significant reductions in average MAP in patients who were initially hypertensive. This benefit occurred irrespective of the number of days per month patients measured MAP.
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Affiliation(s)
| | - Michael Beins
- Dobson, Devanzo and Associates, LLC, Vienna, Virginia, USA
| | - Joan DaVanzo
- Dobson, Devanzo and Associates, LLC, Vienna, Virginia, USA
| | - Steven Heath
- Dobson, Devanzo and Associates, LLC, Vienna, Virginia, USA
| | - Allen Dobson
- Dobson, Devanzo and Associates, LLC, Vienna, Virginia, USA
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Thompson JA, Hersch D, Miner MH, Melnik TE, Adam P. Remote Patient Monitoring for COVID-19: A Retrospective Study on Health Care Utilization. Telemed J E Health 2023; 29:1179-1185. [PMID: 36706034 PMCID: PMC10440676 DOI: 10.1089/tmj.2022.0299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction: Data are limited on the effectiveness of remote patient monitoring (RPM) for acute illnesses, including COVID-19. We conducted a study to determine if enrollment in a COVID-19 RPM program was associated with better outcomes. Methods: From March through September 2020, patients with respiratory symptoms and presumptive COVID-19 were referred to the health system's COVID-19 RPM program. We conducted a retrospective cohort study comparing outcomes for patients enrolled in the RPM (n = 4,435) with those who declined enrollment (n = 2,742). Primary outcomes were emergency room, hospital, and intensive care unit admissions, and death. We used logistic regression to adjust for demographic differences and known risk factors for severe COVID-19. Results: Patients enrolled in the RPM were less likely to have risk factors for severe COVID-19. There was a significant decrease in the odds of death for the group enrolled in the RPM (adjusted odds ratio [OR] = 0.50; 95% confidence interval [CI], 0.30-0.83) and a nonsignificant decrease in the odds of the other primary outcomes. Increased number of interactions with the RPM significantly decreased the odds of hospital admission (OR = 0.92; 95% CI, 0.88-0.95). Conclusions: COVID-19 RPM enrollment was associated with decreased odds of death, and the more patients interacted with the RPM, the less likely they were to require hospital admission. RPM is a promising tool that has the potential to improve patient outcomes for acute illness, but controlled trials are necessary to confirm these findings.
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Affiliation(s)
- Joshua A. Thompson
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Derek Hersch
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michael H. Miner
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Tanya E. Melnik
- Division of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Patricia Adam
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Abstract
Diabetes mellitus is one of the most commonly encountered pregnancy complications and is associated with multiple adverse perinatal outcomes. Technology has progressed to address the unique challenges patients face in managing diabetes mellitus in pregnancy. Technology has bolstered diabetes mellitus education with smartphone applications focused on nutrition counseling and carbohydrate intake advice. Continuous glucose monitors and insulin infusion systems have shown benefit by simplifying glycemic monitoring and insulin administration. Improvements in glycemic control and perinatal outcomes have been seen with continuous glucose monitor use when compared with intermittent blood glucose monitoring, and more pregnant people are using insulin pumps instead of multiple daily insulin injections. Hybrid closed-loop systems are emerging and are able to integrate continuous glucose monitoring and insulin pump technologies while maximizing automated features in the nonpregnant population, but these have not been endorsed for use in pregnancy yet. Applying telehealth practices has been associated with high patient satisfaction among those with diabetes mellitus in pregnancy, and leveraging remote patient monitoring through telehealth platforms and short-range wireless technologies can reduce the burden of patient visits. As technology becomes more integrated into routine management of diabetes mellitus in pregnancy, practitioners should emphasize individualized counseling and device selection to ensure patient autonomy and safety.
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Affiliation(s)
- Sydney M. Thayer
- Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO (Drs Thayer and Lawlor)
| | - Kelley J. Williams
- Division of Endocrinology, Washington University in St Louis, St Louis, MO (Dr Williams)
| | - Megan L. Lawlor
- Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO (Drs Thayer and Lawlor)
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Waleed M, Kamal T, Um TW, Hafeez A, Habib B, Skouby KE. Unlocking Insights in IoT-Based Patient Monitoring: Methods for Encompassing Large-Data Challenges. Sensors (Basel) 2023; 23:6760. [PMID: 37571543 PMCID: PMC10422369 DOI: 10.3390/s23156760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023]
Abstract
The remote monitoring of patients using the internet of things (IoT) is essential for ensuring continuous observation, improving healthcare, and decreasing the associated costs (i.e., reducing hospital admissions and emergency visits). There has been much emphasis on developing methods and approaches for remote patient monitoring using IoT. Most existing frameworks cover parts or sub-parts of the overall system but fail to provide a detailed and well-integrated model that covers different layers. The leverage of remote monitoring tools and their coupling with health services requires an architecture that handles data flow and enables significant interventions. This paper proposes a cloud-based patient monitoring model that enables IoT-generated data collection, storage, processing, and visualization. The system has three main parts: sensing (IoT-enabled data collection), network (processing functions and storage), and application (interface for health workers and caretakers). In order to handle the large IoT data, the sensing module employs filtering and variable sampling. This pre-processing helps reduce the data received from IoT devices and enables the observation of four times more patients compared to not using edge processing. We also discuss the flow of data and processing, thus enabling the deployment of data visualization services and intelligent applications.
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Affiliation(s)
- Muhammad Waleed
- Department of Electronic Systems, Aalborg University Copenhagen, 2450 København, Denmark;
| | - Tariq Kamal
- Electrical and Computer Engineering, Habib University, Karachi 75290, Pakistan
| | - Tai-Won Um
- Graduate School of Data Science, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Abdul Hafeez
- Computer Science and Applications, Virginia Tech, Blacksburg, VA 24061, USA
| | - Bilal Habib
- Department of Computer Systems Engineering, University of Engineering and Technology (UET), Peshawar 25120, Pakistan
| | - Knud Erik Skouby
- Department of Electronic Systems, Aalborg University Copenhagen, 2450 København, Denmark;
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Haddad TC, Maita KC, Inselman JW, Avila FR, Torres-Guzman RA, Coffey JD, Christopherson LA, Leuenberger AM, Bell SJ, Pahl DF, Garcia JP, Manka L, Forte AJ, Maniaci MJ. Patient Satisfaction With a Multisite, Multiregional Remote Patient Monitoring Program for Acute and Chronic Condition Management: Survey-Based Analysis. J Med Internet Res 2023; 25:e44528. [PMID: 37343182 PMCID: PMC10415939 DOI: 10.2196/44528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Remote patient monitoring (RPM) is an option for continuously managing the care of patients in the comfort of their homes or locations outside hospitals and clinics. Patient engagement with RPM programs is essential for achieving successful outcomes and high quality of care. When relying on technology to facilitate monitoring and shifting disease management to the home environment, it is important to understand the patients' experiences to enable quality improvement. OBJECTIVE This study aimed to describe patients' experiences and overall satisfaction with an RPM program for acute and chronic conditions in a multisite, multiregional health care system. METHODS Between January 1, 2021, and August 31, 2022, a patient experience survey was delivered via email to all patients enrolled in the RPM program. The survey encompassed 19 questions across 4 categories regarding comfort, equipment, communication, and overall experience, as well as 2 open-ended questions. Descriptive analysis of the survey response data was performed using frequency distribution and percentages. RESULTS Surveys were sent to 8535 patients. The survey response rate was 37.16% (3172/8535) and the completion rate was 95.23% (3172/3331). Survey results indicated that 88.97% (2783/3128) of participants agreed or strongly agreed that the program helped them feel comfortable managing their health from home. Furthermore, 93.58% (2873/3070) were satisfied with the RPM program and ready to graduate when meeting the program goals. In addition, patient confidence in this model of care was confirmed by 92.76% (2846/3068) of the participants who would recommend RPM to people with similar conditions. There were no differences in ease of technology use according to age. Those with high school or less education were more likely to agree that the equipment and educational materials helped them feel more informed about their care plans than those with higher education levels. CONCLUSIONS This multisite, multiregional RPM program has become a reliable health care delivery model for the management of acute and chronic conditions outside hospitals and clinics. Program participants reported an excellent overall experience and a high level of satisfaction in managing their health from the comfort of their home environment.
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Affiliation(s)
- Tufia C Haddad
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Karla C Maita
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Jonathan W Inselman
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Francisco R Avila
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Ricardo A Torres-Guzman
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Jordan D Coffey
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | | | - Angela M Leuenberger
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Sarah J Bell
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Dominick F Pahl
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - John P Garcia
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Lukas Manka
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Antonio J Forte
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
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Lawrence K, Singh N, Jonassen Z, Groom LL, Alfaro Arias V, Mandal S, Schoenthaler A, Mann D, Nov O, Dove G. Operational Implementation of Remote Patient Monitoring Within a Large Ambulatory Health System: Multimethod Qualitative Case Study. JMIR Hum Factors 2023; 10:e45166. [PMID: 37498668 PMCID: PMC10415949 DOI: 10.2196/45166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/10/2023] [Accepted: 04/15/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Remote patient monitoring (RPM) technologies can support patients living with chronic conditions through self-monitoring of physiological measures and enhance clinicians' diagnostic and treatment decisions. However, to date, large-scale pragmatic RPM implementation within health systems has been limited, and understanding of the impacts of RPM technologies on clinical workflows and care experience is lacking. OBJECTIVE In this study, we evaluate the early implementation of operational RPM initiatives for chronic disease management within the ambulatory network of an academic medical center in New York City, focusing on the experiences of "early adopter" clinicians and patients. METHODS Using a multimethod qualitative approach, we conducted (1) interviews with 13 clinicians across 9 specialties considered as early adopters and supporters of RPM and (2) speculative design sessions exploring the future of RPM in clinical care with 21 patients and patient representatives, to better understand experiences, preferences, and expectations of pragmatic RPM use for health care delivery. RESULTS We identified themes relevant to RPM implementation within the following areas: (1) data collection and practices, including impacts of taking real-world measures and issues of data sharing, security, and privacy; (2) proactive and preventive care, including proactive and preventive monitoring, and proactive interventions and support; and (3) health disparities and equity, including tailored and flexible care and implicit bias. We also identified evidence for mitigation and support to address challenges in each of these areas. CONCLUSIONS This study highlights the unique contexts, perceptions, and challenges regarding the deployment of RPM in clinical practice, including its potential implications for clinical workflows and work experiences. Based on these findings, we offer implementation and design recommendations for health systems interested in deploying RPM-enabled health care.
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Affiliation(s)
- Katharine Lawrence
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
- Medical Center Information Technology, NYU Langone Health, New York, NY, United States
| | - Nina Singh
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Zoe Jonassen
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Lisa L Groom
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Veronica Alfaro Arias
- Medical Center Information Technology, NYU Langone Health, New York, NY, United States
| | - Soumik Mandal
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Antoinette Schoenthaler
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Devin Mann
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
- Medical Center Information Technology, NYU Langone Health, New York, NY, United States
| | - Oded Nov
- Tandon School of Engineering, New York University, New York, NY, United States
| | - Graham Dove
- Tandon School of Engineering, New York University, New York, NY, United States
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Rozanski G, Delgado A, Putrino D. Spatiotemporal parameters from remote smartphone-based gait analysis are associated with lower extremity functional scale categories. Front Rehabil Sci 2023; 4:1189376. [PMID: 37565184 PMCID: PMC10410151 DOI: 10.3389/fresc.2023.1189376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023]
Abstract
Objective Self-report tools are recommended in research and clinical practice to capture individual perceptions regarding health status; however, only modest correlations are found with performance-based results. The Lower Extremity Functional Scale (LEFS) is one well-validated measure of impairment affecting physical activities that has been compared with objective tests. More recently, mobile gait assessment software can provide comprehensive motion tracking output from ecologically valid environments, but how this data relates to subjective scales is unknown. Therefore, the association between the LEFS and walking variables remotely collected by a smartphone was explored. Methods Proprietary algorithms extracted spatiotemporal parameters detected by a standard integrated inertial measurement unit from 132 subjects enrolled in physical therapy for orthopedic or neurological rehabilitation. Users initiated ambulation recordings and completed questionnaires through the OneStep digital platform. Discrete categories were created based on LEFS score cut-offs and Analysis of Variance was applied to estimate the difference in gait metrics across functional groups (Low-Medium-High). Results The main finding of this cross-sectional retrospective study is that remotely-collected biomechanical walking data are significantly associated with individuals' self-evaluated function as defined by LEFS categorization (n = 132) and many variables differ between groups. Velocity was found to have the strongest effect size. Discussion When patients are classified according to subjective mobility level, there are significant differences in quantitative measures of ambulation analyzed with smartphone-based technology. Capturing real-time information about movement is important to obtain accurate impressions of how individuals perform in daily life while understanding the relationship between enacted activity and relevant clinical outcomes.
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Affiliation(s)
- Gabriela Rozanski
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Ramezani R, Cao M, Earthperson A, Naeim A. Developing a Smartwatch-Based Healthcare Application: Notes to Consider. Sensors (Basel) 2023; 23:6652. [PMID: 37571436 PMCID: PMC10422575 DOI: 10.3390/s23156652] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023]
Abstract
Wearable devices and fitness trackers have gained popularity in healthcare and telemedicine as tools to reduce hospitalization costs, improve personalized health management, and monitor patients in remote areas. Smartwatches, particularly, offer continuous monitoring capabilities through step counting, heart rate tracking, and activity monitoring. However, despite being recognized as an emerging technology, the adoption of smartwatches in patient monitoring systems is still at an early stage, with limited studies delving beyond their feasibility. Developing healthcare applications for smartwatches faces challenges such as short battery life, wearable comfort, patient compliance, termination of non-native applications, user interaction difficulties, small touch screens, personalized sensor configuration, and connectivity with other devices. This paper presents a case study on designing an Android smartwatch application for remote monitoring of geriatric patients. It highlights obstacles encountered during app development and offers insights into design decisions and implementation details. The aim is to assist programmers in developing more efficient healthcare applications for wearable systems.
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Affiliation(s)
- Ramin Ramezani
- Center for Smart Health, University of California, Los Angeles, CA 90095, USA; (M.C.); (A.N.)
| | - Minh Cao
- Center for Smart Health, University of California, Los Angeles, CA 90095, USA; (M.C.); (A.N.)
| | - Arjun Earthperson
- Probabilistic Risk Assessment Group, North Carolina State University, Raleigh, NC 27613, USA;
| | - Arash Naeim
- Center for Smart Health, University of California, Los Angeles, CA 90095, USA; (M.C.); (A.N.)
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47
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Poblete JY, Vawter NL, Lewis SV, Felisme EM, Mohn PA, Shea J, Northrup AW, Liu J, Al-Rousan T, Godino JG. Digitally Based Blood Pressure Self-Monitoring Program That Promotes Hypertension Self-Management and Health Education Among Patients With Low-Income: Usability Study. JMIR Hum Factors 2023; 10:e46313. [PMID: 37486745 PMCID: PMC10407769 DOI: 10.2196/46313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/27/2023] [Accepted: 06/17/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND According to evidence-based clinical guidelines, adults with hypertension are advised to self-monitor their blood pressure (BP) twice daily. Self-measured BP monitoring is a recommended strategy for improving hypertension management. OBJECTIVE We aimed to determine the feasibility and acceptability of a digitally based BP self-monitoring program that promotes hypertension self-management and health education among low-income patients. We hypothesized that the program would be highly feasible and acceptable and that at least 50% of the patients would use the monitor at the rate required for the reimbursement of the device's cost (16 days of measurements in any 30-day period). METHODS Withings BPM Connect was deployed to patients at Family Health Centers of San Diego. Program elements included training, SMS text message reminders, and physician communication. Compliance, use, mean BP, and BP control status were calculated. A Kaplan-Meier time-to-event analysis was conducted to compare time to compliance between a strict definition (≥16 days in any rolling 30-day window) and a lenient definition (≥1 day per week for 4 consecutive weeks). A log-rank test was performed to determine whether the difference in time to compliance between the definitions was statistically significant. Mean systolic BP (SBP) and diastolic BP (DBP) before the intervention and after the intervention and mean change in SBP and DBP across patients were calculated. Paired sample t tests (2-tailed) were performed to assess the changes in SBP and DBP from before to after the intervention. RESULTS A total of 179 patients received the monitors. The mean changes in SBP and DBP from before to after the intervention were +2.62 (SE 1.26) mm Hg and +3.31 (SE 0.71) mm Hg, respectively. There was a statistically significant increase in both SBP and DBP after the intervention compared with before the intervention (P=.04 and P<.001). At the first and last measurements, 37.5% (63/168) and 48.8% (82/168) of the patients had controlled BP, respectively. During the observation period, 83.3% (140/168) of the patients had at least 1 controlled BP measurement. Use decreased over time, with 53.6% (90/168) of the patients using their monitor at week 2 and only 25% (42/168) at week 11. Although only 25.6% (43/168) achieved the strict definition of compliance, 42.3% (71/168) achieved the lenient definition of compliance. The median time to compliance was 130 days for the strict definition and 95 days for the lenient definition. The log-rank test showed a statistically significant difference in time to compliance between the compliance definitions (P<.001). Only 26.8% (45/168) complied with the measurement rate that would result in device cost reimbursement. CONCLUSIONS Few patients used the monitors at a rate that would result in reimbursement, raising financial feasibility concerns. Plans for sustaining costs among low-income patients need to be further evaluated.
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Affiliation(s)
- Jacqueline Yareli Poblete
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Natalie Lauren Vawter
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Sydney Virginia Lewis
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Earl Marc Felisme
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Paloma Adriana Mohn
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Jennifer Shea
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Adam William Northrup
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Jie Liu
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, La Jolla, CA, United States
| | - Job Gideon Godino
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, La Jolla, CA, United States
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Duran AT, Keener-DeNoia A, Stavrolakes K, Fraser A, Blanco LV, Fleisch E, Pieszchata N, Cannone D, Keys McKay C, Whittman E, Edmondson D, Shelton RC, Moise N. Applying User-Centered Design and Implementation Science to the Early-Stage Development of a Telehealth-Enhanced Hybrid Cardiac Rehabilitation Program: Quality Improvement Study. JMIR Form Res 2023; 7:e47264. [PMID: 37440285 PMCID: PMC10375395 DOI: 10.2196/47264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is an evidence-based intervention that improves event-free survival in patients with cardiac conditions, yet <27% of all eligible patients use CR in the United States. CR is traditionally delivered in clinic-based settings where implementation barriers abound. Innovative nontraditional program designs and strategies are needed to support widespread CR uptake. OBJECTIVE This study aimed to demonstrate how user-centered design (UCD) and implementation science (IS) principles and methods can be integrated into the early-stage development of nontraditional CR interventions. METHODS As part of a NewYork-Presbyterian Hospital (NYPH) quality improvement initiative (March 2020-February 2022), we combined UCD and IS principles and methods to design a novel home- and clinic-based telehealth-enhanced hybrid CR (THCR) program. We co-designed this program with multilevel stakeholders using an iterative 3-step UCD process to identify user and contextual barriers and facilitators to CR uptake (using semistructured interviews and contextual inquiry [step 1]), design an intervention prototype that targets contextual and user factors and emulates the evidence-based practice (through design workshops and journey mapping [step 2]), and review and refine the prototype (according to real-world usability testing and feedback [step 3]). The UCD process was informed by the Theoretical Domains Framework and Consolidated Framework for Implementation Research. RESULTS At step 1, we conducted semistructured interviews with 9 provider- and system-level stakeholders (female: n=6, 67%) at 3 geographically diverse academic medical centers, which revealed behavioral (eg, self-efficacy and knowledge) and contextual (eg, social distancing guidelines, physical space, staffing, and reimbursement) barriers to uptake; hybrid delivery was a key facilitator. Step 2 involved conducting 20 design workshops and 3 journey-mapping sessions with multidisciplinary NYPH stakeholders (eg, digital health team, CR clinicians, and creative director) where we identified key design elements (eg, mix of clinic- and home-based CR and synchronous remote patient monitoring), yielding an initial THCR prototype that leveraged NYPH's telehealth infrastructure. At step 3, we conducted usability testing with 2 CR clinicians (both female) administering home-based sessions to 3 CR patients (female: n=1, 33%), which revealed usability themes (eg, ease of using remote patient monitoring devices or a telehealth platform, technology disruptions, and confidence in using the telehealth platform to safely monitor patients) and design solutions (eg, onboarding sessions, safety surveys, and fully supervised remote sessions) to be included in the final THCR prototype. CONCLUSIONS Combining UCD and IS methods while engaging multidisciplinary stakeholders in an iterative process yielded a theory-informed THCR program targeting user and contextual barriers to real-world CR implementation. We provide a detailed summary of the process and guidance for incorporating UCD and IS principles and methods into the early-stage development of a nontraditional CR intervention. The feasibility, acceptability, appropriateness, and usability of the final THCR prototype is being evaluated in an ongoing study.
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Affiliation(s)
- Andrea T Duran
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Adrianna Keener-DeNoia
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | | | - Adina Fraser
- New York Presbyterian Hospital, New York, NY, United States
| | - Luis V Blanco
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Emily Fleisch
- New York Presbyterian Hospital, New York, NY, United States
| | | | - Diane Cannone
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Charles Keys McKay
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Emma Whittman
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Rachel C Shelton
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
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Udoh EE, Hermel M, Bharmal MI, Nayak A, Patel S, Butlin M, Bhavnani SP. Nanosensor technologies and the digital transformation of healthcare. Per Med 2023. [PMID: 37403731 DOI: 10.2217/pme-2022-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Nanosensors are nanoscale devices that measure physical attributes and convert these signals into analyzable information. In preparation, for the impending reality of nanosensors in clinical practice, we confront important questions regarding the evidence supporting widespread device use. Our objectives are to demonstrate the value and implications for new nanosensors as they relate to the next phase of remote patient monitoring and to apply lessons learned from digital health devices through real-world examples.
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Affiliation(s)
- Emem E Udoh
- Artificial Intelligence in Imaging Scholar, Scripps Clinic Divisions of Cardiology & Radiology, CA 92037, USA
| | - Melody Hermel
- Healthcare Innovation & Practice Transformation Laboratory, Scripps Clinic Division of Cardiology, La Jolla, CA 92037, USA
| | - Murtaza I Bharmal
- Department of Medicine, Division of Cardiology, UC Irvine School of Medicine, Irvine, CA 92617, USA
| | - Aditi Nayak
- Center for Advanced Heart Disease, Brigham & Women's Hospital & Harvard Medical School, Boston, MA 02115, USA
| | - Siddharth Patel
- Department of Neurology, Machine Learning Research Fellow, Laboratory for Deep Neurophenotyping, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Mark Butlin
- Faculty of Medicine, Health & Human Sciences, Macquarie University School of Medicine, Sydney, NSW, 2000, Australia
| | - Sanjeev P Bhavnani
- Healthcare Innovation & Practice Transformation Laboratory, Scripps Clinic Division of Cardiology, La Jolla, CA 92037, USA
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Baumann S, Stone RT. Applying user-centered design and the Pi-CON methodology for vital signs sensor development. J Med Eng Technol 2023; 47:277-287. [PMID: 38470566 DOI: 10.1080/03091902.2024.2325964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/24/2024] [Indexed: 03/14/2024]
Abstract
Although telehealth, and in particular RPM, have demonstrated to drive many benefits, such as reduction in cost and hospital-acquired infections, previous research has shown many usability challenges when patients operate a medical device without supervision of a medical professional. To combat this issue, the Pi-CON methodology is applied to develop a novel sensor with the objective to continuously acquire a patient's vital signs from a distance, without the need to attach any markers or sensors to the patient, and with limited user interaction required. Pi-CON stands for passive, continuous and non-contact, and describes a way to improve the user experience for patients or caregivers that have a need to perform a vital signs measurement themselves, without the presence of a medical professional. The developed sensor utilises radar and optical sensing technologies and transmits acquired data to a cloud-based service where it can be viewed in near real-time by the patient or family members from anywhere via an intuitive user interface. This user interface, as well as the sensor itself were designed based on design needs and requirements to adhere to the user-centered design process. The development of the sensor, including utilised technologies, components, and the user interface are presented, including inspirations for future work.
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