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iproc (iproceedings) is a peer-review and publishing platform for conference papers, abstracts, posters, and presentations. JMIR Publications partners with leading conferences such as Medicine 2.0 or the Connected Health Conference to provide peer-review and editing services, and/or to publish proceedings, posters, or abstracts. If you are a conference organizer or conference chair running a leading medical or technology conference, and wish to outsource the submission and peer-reviewing process, or are interested in hosting a virtual poster show or wish to publish electronic proceedings, or if you are looking for a permanent and open dissemination venue for presentations at your conference, please contact us to discuss partnership options. Starting in 2017, we will also accept individual submissions from researchers who wish to disseminate their poster presented at a major peer-reviewed conference.

 

 

Recent Articles:

  • An mHealth App Designed for Fertility Patients: From Conception to Pilot Testing

    Abstract:

    Background: Infertility is a distressing chronic condition affecting one in six couples; many of them seek to achieve a pregnancy via assisted reproductive technologies. Online resources for information and support are a mainstay of the self-help strategies of fertility patients. Patients seek explanations online about their diagnoses and treatment options, and hope to connect with others who have lived through a diagnosis of infertility. However, medical information found online is often inaccurate or hard to understand. Importantly, online forums that might provide social support are seldom monitored, allowing for the dissemination of potentially misleading information. In this study we describe the development of an mhealth app, Infotility™, designed to provide evidence-based reproductive health information and a monitored message board to provide social support to users. Objective: To describe the steps involved in the production of an mhealth app created specifically for fertility patients. Methods: Our team followed guidelines established for the development of complex health interventions. To evaluate the existing online information sources, we assessed web-based information on infertility using standardized tools for readability, suitability and quality. To determine our stakeholders’ perspectives on what content to include in the app, a needs assessment survey was conducted in a sample of 289 male and 370 female fertility patients and 127 health care providers at clinics in Montreal and Toronto. A comprehensive review of the literature on the medical and psychosocial aspects of infertility was undertaken; summaries were then reviewed for accuracy and pertinence by patients, clinicians, researchers and professionals in the field of fertility. A technology partner was hired to create a user-friendly mobile app that contained the informational summaries, with separate portals for men and women, leading to content specifically curated for the user’s interests. There was also a closed discussion platform “Connect”, monitored by 18 previous or current fertility patients. Peer monitors underwent one-on-one training, and received an instructional manual created to assist with responding to forum messages from participants. Between November 2018 and April 2019, the app was pilot tested in a sample of 72 male and 187 female fertility patients to assess feasibility of recruitment, acceptability, and user satisfaction. Results: Initial results show that men and women appreciated Infotility. The most popular sections included information on modifiable lifestyle risks (e.g. diet, exercise, environment), medical and psychosocial information. Men preferentially visited pages about lifestyle factors whereas the most common pages visited by women related to medical information. Importantly the “Connect” social network logged 39 open forum conversations with 258 total posts, as well as 14 private messages. Both men and women lurked and posted on the board; women posted more often than men. Conclusions: The design of a mobile health app for fertility patients should consider user experience and design along with the quality and accessibility of information. A fertility mhealth app should provide access to monitored social support through the interface and consider how to effectively tailor information to men and women.

  • Improving Orthopedic Care Delivery Through Digital Engagement

    Abstract:

    Background: Patient activation has been hypothesized to improve medical and surgical outcomes by increasing patient involvement in the care plan. We tested this hypothesis by utilizing a patient activation tool in a population of adults having total hip or total knee replacement. We hypothesized that patient activation would be associated with: • Increased discharge to home as opposed to a skilled nursing facility (SNF) • Reduced hospital length of stay (LOS) • Decreased inpatient readmissions • Decreased emergency department (ED) visits Objective: Using an email patient activation tool, we sought to increase patients’ involvement in their care before and after total joint replacement. Outcomes examined included: • Day of surgery cancellation (DOSC) • Length of hospital stay • Discharge to home vs. discharge to SNF • Any ED visit within 30 days of discharge • Any inpatient readmission within 30 days of discharge Methods: This was a quasi-experimental design comparing Jan-Jun 2017 to Jan-Jun 2018. We instituted an email patient activation tool for all patients with total knee or total hip replacement surgery beginning in January 2018. This tool was integrated with the electronic medical record (EMR) system during the six month study period and patients could opt out at anytime if they desired. The tool was designed to prepare patients both educationally and emotionally for their operation with multiple easy-to-read emails starting from the time they were scheduled for surgery through six months post-op. Percent of emails opened and clicked were used as measures of engagement for the intervention participants. Results: 2,027 TJR patients were included: 720 hip patients, 1,307 knee patients. Pre- and post-intervention groups were similar in gender and age. For Hip Replacement Patients: • LOS was nearly 1/4 day lower in the post-intervention group (β=-0.23; p=0.001) after adjusting for gender, age and insurance. • ED visits were lower among the post-intervention group (OR=0.45; p=0.05) after adjusting for gender, age and insurance. • Post-intervention patients were less likely to have DOSC, any revisit (ED or readmission), and were more likely to be discharged home; but these associations did not reach statistical significance. Conclusions: Among patients who received the intervention, higher engagement was significantly associated with positive changes in almost all outcomes. Use of the digital patient activation tool demonstrated significant savings in LOS and reduced ED visits among hip replacement patients. Although just under 50% of patients in the intervention group were enrolled to use the tool, these findings were still significant even when non-participants were included in the post-intervention group.

  • Pilot Study of a Prototype Integrated Diabetes Management System and the Relationship of Use to Diabetes Management Behaviors and HbA1c Among Type 2 Diabetes...

    Abstract:

    Background: Type 2 Diabetes (T2D) is the 7th leading cause of death (2017) in the United States and by 2030 it is estimated that it will affect 439 million globally. Effective glycemic control can be challenging for patients. A tool to guide patients’ in their self-management behaviors and share this data with their physician may improve insulin adherence leading to lower HbA1c. We examined an Integrated Diabetes Management (IDM) system that utilizes a Bluetooth (BT)-enabled insulin event capture device, a BT-enabled glucometer, and an Android smartphone application. IDM data can be viewed by clinicians in the electronic medical record (EMR). Objective: The primary aim of this study is to describe how app use is related to insulin adherence, blood glucose measurements, meal snapshots, and step count. Secondarily, we assessed the impact on HbA1c levels over a 3- and 6-month period. Methods: 35 participants were enrolled from Boston area hospitals in this single-arm pilot study. Use of the IDM system was defined as the number of days per week participants logged into the app and moved past the home screen. Three app use groups were created: Low App Use (0.33-2.46 days per week), Medium App Use (2.54-5.08 days per week), and High App Use (>5.4 days per week). Adherence to insulin, blood glucose measurements, and meal snapshots were defined as a ratio of actual weekly events recorded by participants’ app use, divided by their physician’s recommendation. Step count was defined as the total weekly steps for each participant. Daily app-generated data on app use and indicators of diabetes management were collected. HbAlc levels were assessed via blood test at enrollment, 3-months, and 6-months. Using a hierarchical linear mixed model, we examined changes in outcome measures while accounting for random intercepts and slopes to control for variation in individual outcomes over the study. Results: Overall app use (average unique days using the app per week) declined from 6.19 days to 3.00 days (at 1 and 24 weeks, respectively). Participants with high app use had significant improvement in bolus and basal insulin adherence per week [0.009 p=0.041 (95% CI: 0.0004, .018) and 0.016 p=0.000 (95% CI: .0079, 0.023), respectively], but participants had no significant improvements in blood glucose and meal snapshot adherence, or absolute step count. HbA1c significantly decreased per week [coeff. -.025 (95% CI: -.044, -.007) p=0.007] with an overall change of 0.6. Participants with high app use significantly improved their HbA1c per week [-.037 p=0.016 (-.066, -.0067)] compared to participants with medium and low app use, yielding a total improvement of 0.88 over 24 weeks. Conclusions: Results show that bolus and basal insulin may have increased with higher app use. HbA1c significantly improved over the course of the study, along with significantly greater improvement in HbA1c among participants with higher app use compared to participants in the middle or low app use groups. This study is not designed or intended to evaluate efficacy but provides results to guide the future design and development of this prototype IDM system.

  • Evaluating the Usability and Acceptability of the HARP Mobile App

    Abstract:

    Background: Studies show that good communication between doctors and patients and among all caregivers who interface with patients directly results in better clinical outcomes, reduced costs, greater patient satisfaction, and lower rates of physician burnout. The main purpose of this pilot study was to test the acceptability and usability of a mobile phone application (HARP), an application designed to improve communication and data collection among non-clinical care givers such as home health aides (HHAs) and case managers (CMs) of patients who receive care at home. The HHAs collected information on patient’s mood, energy, medication adherence, potential falls and appetite level for the day. This information is summarized in post-visit, weekly and final discharge summary reports via an online dashboard and sent to the patient’s CM at different time points. We assessed the usability and acceptability of the HARP mobile application. Objective: This is a quality improvement pilot project geared towards assessing the usability and acceptability of a mobile application developed to facilitate patient data collection by trained HHAs who work together on a regular basis to provide home-based care to discrete subpopulations of patients. Methods: Four HHAs were recruited from Partners Healthcare at Home (PHH) to use the app to collect data on at least 12 patients. Eligible patients received care from one of the 4 HHAs for at least 23 days and scheduled to have at least 5 home visits during this time. Each of the patients were followed for a minimum of 23 days and a maximum 60 days in which HHAs collected patient data using the app. Post-visit reports, weekly reports and discharge summary reports were shared with the patient’s CMs. Data collection included acceptability and satisfaction data from all HHAs and CMs via surveys. A sub-group of 2 CMs and 2 HHAs participated in semi-structured interviews. Results: 9 have completed the project till date, 5 patients dropped out due to discharge from PHH care. The interim data included is from 8 CMs and 4 HHAs who provide care to one or more of the 9 patients who completed the project. Most CMs (75%) found post-visit and weekly reports useful and 87% found tracking mood and energy helpful. About 75% felt tracking appetite and falls via the HARP app helpful. Almost all CMs (87%), agreed that integrating a tool like the HARP app to the EMR would help them provide better care to their patients. Three out of four HHAs (75%) felt that the app easy to use or learn about once they received instructions and were willing to consider using the app in their workflow. Conclusions: Acceptability and usability of HARP application was considerably high among CMs. The acceptability of the app varied among HHAs, some found information useful and believed the application has potential to help personalize patient care. Future research would require exploring other patient information that is useful to all staff involved in the clinical workflow and increase adoption of tool in clinical settings. Such tools could potentially reduce clinician burnout and improve patient outcomes.

  • Evaluating the Accuracy of the VitalWellness Device

    Abstract:

    Background: Wellness devices for health tracking have gained popularity in recent years. Additionally, portable and readily accessible wellness devices have several advantages when compared to traditional medical devices found in clinical environments The VitalWellness device (VW) is a portable wellness device that can potentially aide vital sign measuring for those interested in tracking their health. Objective: In this diagnostic accuracy study, we evaluated the performance of the VW, a wireless, compact, non-invasive device that measures four vital signs (blood pressure (BP), heart rate (HR), respiratory rate (RR) and body temperature using the index finger and forehead. Methods: Volunteers age ≥18 years were enrolled to provide blood pressure (BP), heart rate (HR), respiratory rate (RR) and body temperature. We recruited participants with vital signs that fell within and outside of the normal physiological range.. A sub-group of eligible participants were asked to undergo an exercise test, aerobic step test and/or a paced breathing test to analyze the VW device’s performance on vital signs outside of the normal physiological ranges for HR and RR. Vital signs measurements were collected with the VW device and FDA-approved reference devices. Mean, standard deviation, mean difference, standard deviation of difference, standard error of mean difference and correlation coefficients were calculated for measurements collected; these measurements were plotted on a scatter plot and a Bland-Altman plot. Sensitivity analyses were performed to evaluate the performance of the VW device by gender, skin color, finger size and in the presence of artifacts. Results: 265 volunteers enrolled in the study and 2 withdrew before study completion. Majority of the volunteers were female (62%), predominately white (63%), graduated from college or post college (67%) and employed (59%). There was a moderately strong linear relationship between VW BP and reference BP, r = 0.7, P<0.05; and VW RR and reference RR measurements, r=0.7, P<0.05. The VW HR readings were significantly in line with the reference HR readings, r= 0.9, P<0.05. There was a weaker linear relationship between VW temperature and reference temperature, r = 0.3, P<0.05. There were no differences in performance of the VW device by gender, skin color or in the presence of artifacts. Finger size was associated with differential performance for RR. Conclusions: Overall, the VW device performed well in taking BP, HR and RR when compared to FDA-approved reference devices and has potential serve as a wellness device. To test adaptability and acceptability, future research may evaluate user’s interactions and experiences with the VW device at home. In addition, the next phase of the study will evaluate transmitting vital sign information from the VW device to an online secured database where information can be shared with HCPs within seconds of measurement.

  • Developing a Comprehensive Model for Improving Quality of Life in Individuals with Alzheimer Disease and Related Dementia and Their Informal Caregivers:...

    Abstract:

    Background: It is estimated that more than five million Americans are living with Alzheimer’s Disease and Related Dementia (ADRD), and the population of people living with the disease is expected to triple by 2060. Most care for persons living with ADRD is provided by informal caregivers. However, current strategies to improve the quality of life for both people living with ADRD and their informal caregivers are not optimal, especially from a comprehensive approach. Social media and online forums have become increasingly popular tools for ADRD caregivers to manage the burden of caregiving. Objective: This study was to: 1) explore informal caregivers’ discussion topics by analyzing the caregiver online forum data, and 2) develop a comprehensive model based on their discussion topics, with the aim to improve quality of life for both persons living with ADRD and their informal caregivers. Methods: Publicly available peer interactions of 4102 registered users, with 96% self-claimed as informal caregivers (67% as a child of a person with dementia, 13% as a partner/spouse , and 7% as a relative ) on the Alzheimer’s Association ALZ Connected Caregivers Forum were extracted in January 2019 using computer programming. A total of 40,798 postings were collected. All authors agreed to use a triangular model to serve as the predetermined three major themes to categorize all codes. The three major themes were: Factors of Caregivers, Factors of Individuals with ADRD, and Factors of Care Context. Inductive coding was used to derive in vivo codes from the data and the codes were further refined throughout the coding process. Two researchers independently coded postings until saturation was reached. Discrepancies were discussed among the two researchers to reach consensus. A third senior researcher’s opinion was referred to whenever necessary. Results: For Factors of Caregivers, the most frequent sub-themes were perceived caregiver burden, caregiver’s life balance, caregiving strategies, communication, expectations, personal health issues, poor relationship, and ineffective coping. Sub-themes of Factors of Individuals with ADRD included changes in abilities and capacities, commodities, behaviors, health conditions, daily living function, disengagement, and ineffective coping. Lastly, for Factors of Care Context, the most frequent sub-themes were family support, financial support, informational support, professional support, length of care provided, living arrangement, activities and stimulation, patient health care coordination, unexpected situations, communication, and physical environment. One sub-theme under one of the triangular factors may influence another sub-theme under another triangular factor, and vice versa. Conclusions: By analyzing the discussions of informal caregivers on ALZ online forum, we found that taking care of a loved one with ADRD is challenging for informal caregivers, the challenges may affect the quality of life for both caregivers and the caregiver recipients; factors of care recipients, caregivers, and the care context interactively affect perceived challenges of caregivers. This study has identified a comprehensive model, which may be used to help improve quality of life for both informal caregivers and people living with ADRD. Our next step is to use these manually determined codes to analyze all extracted postings via machine learning to improve this model.

  • Incorporation of Potential User Feedback to Inform the Design of a Prototype Integrated Diabetes Management System

    Authors List:

    Abstract:

    Background: Type II Diabetes (T2D) is a complex and burdensome chronic disease. Most patients, including uncontrolled (HbA1c > 7%) patients, only see their Health Care Provider (HCP) once every three months. Thus, a tremendous amount of patient self-management is required outside the clinic to maintain blood glucose (BG) levels within a healthy range and prevent worsening of the disease. Additionally, HCP’s overseeing diabetes care often rely on patient self-report and lack key data about how well the patient is managing the condition. We hypothesized that the development of an Integrated Diabetes Management (IDM) system which helps patients better track their BG, insulin and diet would support patient self-management. By sharing a data summary with HCPs through an EMR-integrated, web-based portal, the patient’s HCP could would have access to data to help inform treatment decisions and patient education strategies to improve outcomes. Objective: The goal of this design research was to better understand how an IDM platform might support patient self-management and care, and, based on this data, create a prioritized list of requirements for a prototype of the system. Methods: We used one-hour, semi-structured, in-person interviews and observations with HCPs (n=18) and T2D patients (n=14, recruited via HCP referral). Interview and observation data (via summary notes and transcripts) were analyzed, coding for pain points and workflows. Personas and journey-maps of patients and clinicians were created to inform product design. Pain points and unmet needs were categorized by task and informed the design of features in the IDM system. High fidelity paper prototypes of the solution were tested with HCPs and patients to gather feedback on design options. Results: HCPs interviewed ranged from MDs (n=4), NPs (n=7), RNs (n=3), CDEs/ RDs (n=2) and health coaches (n=2). For HCPs, tasks along the patient journey consist of diagnosis, training, titration, follow-up, and long-term maintenance. Titration and follow-up are the most resource intensive, with the largest number of tasks falling to RNs and NPs. Key HCPs needs included a way to better track patients’ behaviors and a way to illustrate the relationship between diet, physical activity and BG/insulin readings to educate patients, improving communication between the patient and their HCP. Patient demographics were predominantly male (57%), between 50-59 years old (36%), high-school educated (57%), and 50% Android/50% iOS users. 50% of patients had been diagnosed 1-5 years prior to interview, and 58% only used long-acting insulin. Patients had the greatest need for help with self-management of their T2D, including reminders and automatic logging of BG and insulin dose, simplified meal and exercise logging, and the ability to share this information with their HCPs. Conclusions: Design research with T2D patients and HCPs was critical to inform the design of a prototype IDM system. User feedback was incorporated to generate an IDM system which included a patient mobile application, BT-connected insulin event capture device, BT-glucose meter, daily meal log, physical activity tracker and an HCP clinical portal.

  • Attitudes and Response to a Smartphone-Based Digital Pill Intervention to Enhance PrEP Adherence Among Men Who Have Sex With Men With Stimulant Use

    Abstract:

    Background: Digital pills contain a radiofrequency emitter and gelatin capsule that over-encapsulate a study medication. The radiofrequency emitter, activated by the chloride ion gradient in the stomach, transmits a signal to a wearable Reader device following ingestion. The Reader relays ingestion data to a smartphone application and cloud-based server, allowing for real-time verification of ingestion events and adherence measurement. Digitized pre-exposure prophylaxis (PrEP) may improve outcomes in populations with suboptimal adherence related to substance use. Stimulant use is particularly prevalent among men who have sex with men (MSM) and is associated with increased HIV risk behavior and transmission. We conducted seven focus groups with MSM who use stimulants (N=16) to inform the development of PrEPsteps, a novel smartphone-based adherence intervention respondent to data from digitized PrEP and designed to augment adherence. Objective: To inform the specification of the design, content, and delivery of the smartphone-based PrEPsteps adherence system via focus groups with HIV-negative MSM who use stimulants. Methods: Seven focus groups were conducted with HIV-negative MSM reporting stimulant use (e.g., cocaine, methamphetamine) in the past six months. Participants self-reported medical history, substance use and sexual activity. Focus groups explored responses to digital pill technology, willingness and barriers to use, content and timing of adherence messaging, and three intervention components: (1) abbreviated cognitive behavioral therapy (CBT) adherence counseling (LifeSteps); (2) contingent reinforcement/corrective feedback; and (3) substance use-related Screening, Brief Intervention and Referral to Treatment (SBIRT). Focus groups were transcribed and analyzed using applied thematic analysis. Results: Sixteen individuals participated in focus groups. All were male; age ranged from 24 to 63 (M=39.9; SD=14.1) and most self-identified as gay (N=13). Participants were primarily non-Hispanic or Latino (N=12); 10 identified as White, two as Black, and four as multiracial. Most had at least a college degree (N=14). Twelve participants were taking PrEP; five reported missed doses in the past two weeks. Number of sexual partners in the past three months ranged from 1 to 200 (M=28.1; SD=50.9). Fifteen participants reported using stimulants during the last 30 days. Participants viewed digital pills as a tool to enhance PrEP adherence and accountability. They expressed a willingness to use the digital pill and identified physicians, family members and partners as people with whom they would share adherence data. The Reader was viewed as the most difficult technological component to use, although participants also described the device as itself an adherence reminder. Participants identified customizability as a valuable aspect of the technology; message and reminder content, structure, and scheduling were all considered customizable. With regard to the intervention, participants were accepting of and willing to interact with corrective feedback messages linked to a brief CBT LifeSteps booster session. Conclusions: PrEPsteps, a smartphone-based adherence intervention, was viewed as acceptable by HIV-negative MSM who use stimulants. Individuals perceived corrective feedback notifications to be the most helpful component of the system, and expressed a strong preference for customizability across the intervention.

  • Impact of Automated Digital Navigation Program on Bowel Preparation Quality and Patient Satisfaction for Colonoscopy: A Comparative Study Across Multiple Sites

    Abstract:

    Background: Nearly 1 in 5 patients suffers from inadequate or poor bowel preparation in advance of a colonoscopy. Prior studies have shown that this leads to a decrease in adenoma detection rate, increased time spent in completing efficiency in endoscopy suite, as well as an overall increase in cost of care from 13-20%. With the shift to value-based care in the American healthcare system, there is an urgent need for solutions that can automate pre-procedure guidance and post-procedure follow up. Objective: As part of the American Gastroenterology Association (AGA) digital transformation network, we sought to automate and improve pre-procedure navigation for colonoscopy using connected health technologies (specifically digital navigation). At Arizona Center for Digestive Health (AZCDH), we assessed the impact of digital navigation on bowel preparation quality, patient engagement, and patient satisfaction. We also sought to assess the reproducibility of outcomes seen at AZCDH at additional sites that have implemented digital navigation for endoscopic procedures as part of the AGA network, including Yale New Haven Hospital (YNHH) and three Mount Sinai Hospital locations. Methods: At AZCDH, we compared two cohorts of patients (usual care versus digital navigation) scheduled for colonoscopy. The digital navigation cohort received usual care in addition to time based messages and education content pathways on Smartphones, and delivered through Rx.Health’s digital medicine platform. Bowel preparation quality was then assessed, as well as patient satisfaction with the digital navigation intervention. Patient engagement and satisfaction were then compared with initial data from other sites within the network. Results: Of the 217 patients prescribed the digital navigation program at AZCDH, 93 completed the procedure to date, and had bowel preparation results documented in the electronic endoscopic record system. After implementing the digital navigation program the rate of aborted procedures decreased from 2.2% at baseline to 1.07%. In a follow up survey, 93% of respondents “strongly agreed” or “agreed” that the digital navigation program was helpful in preparing for their colonoscopy. At other locations to date, 433 patients have been prescribed the pathway at YNHH, and 213 patients at Mount Sinai locations. 100% and 94% of respondents “strongly agreed” or “agreed” that the digital navigation program was helpful in preparing for their procedure at YNHH and Mount Sinai locations, respectively. Conclusions: Our single-site study at AZCDH paved the way to implementing digital navigation pathways at YNHH and Mount Sinai endoscopy locations by demonstrating that colonoscopy instructions are well received by patients, can reduce the rate of aborted procedures, and can result in higher patient satisfaction as well as a higher quality of bowel preparation. Further, patient engagement rates and satisfaction with the program was consistent at all sites across the US where the digital navigation program has been implemented. In the future, we plan to report on patient outcomes (including reduction in no shows, poor bowel preparation) to allow benchmarking on a national scale.

  • Improving the Pediatric Hospital Experience Using Telepresence Robotics

    Abstract:

    Background: In a hospital setting, pediatric patients miss out on routine stress coping mechanisms, such as normative play, socialization, and exploration. Previous work has established that a lack of healthy coping mechanisms negatively impacts the psychosocial development and well-being of hospitalized children. To help alleviate the stress of hospitalization, we created a novel, normative play robotics program that utilizes telepresence technology to give children live, virtual tours of museums and cultural attractions. Objective: To 1) demonstrate feasibility and 2) assess quality and impact on mood of telepresence tours as a new normative play intervention. Methods: A prospective, cross-sectional study was conducted on inpatients at the Johns Hopkins Children's Center and the University of Maryland Children's Hospital from the ages of 3 to 19. Subjects were selected through convenience sampling by Child Life Specialists. The intervention consisted of a 30-minute session in which a volunteer 1) remotely connected a laptop in the hospital room to a telepresence robot at the Maryland Science Center or the National Aquarium 2) introduced the child to their venue tour guide and taught the child how to drive the robot 3) facilitated a tour in conjunction with the venue tour guide on site with the robot. Feasibility was assessed by the rate of completed tours. Quality of the experience and mood were evaluated with surveys answered with a 5 or 7-point Likert scale. Surveys were administered in 2 phases: phase 1 evaluated quality of the experience after the tour; phase 2 included the phase 1 survey plus mood assessment before and after the tour. The two-tailed Wilcoxon signed-rank test was used to determine statistical significance in difference in mood before and after the tour. Verbal consent was obtained from patient guardians and assent was obtained from the patient. Results: 77 tours were conducted with pediatric inpatients, and no tours were terminated due to technical difficulty. Out of 77 children, 68 completed surveys. In phase 1 (n=40) participants’ average age was 7.8 years. On average, patients rated their overall experience a 4.8/5, ease of driving 4.1/5, ease of communicating with other guests at the venues a 4.3/5, and their tour guides a 4.7/5. In phase 2 (n=37), average age was 10.1 years. Childrens’ self-reported mood improved from pre-visit (3.7/5) to post visit (4.4/5) (p < 0.001). Additionally, patients rated their overall ease of driving a 5.8/7, ease of communicating with other guests at the venues a 5.3/7, and their tour guides a 6.8/7. Conclusions: Patients reported positive assessments of their overall experience, ease of driving, communication with tour guides and guests at the venues, and elevated mood after the tour. This study demonstrates that telepresence tours are a feasible and enjoyable intervention for hospitalized pediatric patients, and significantly improve mood. This unique program adds to existing child life specialist strategies by allowing children to engage in normative behaviors outside of the hospital. This novel use of telepresence robotics as a normative play intervention warrants future studies to further characterize the improvement in mood and impact on the patient’s overall hospital satisfaction.

  • Participation in a Virtual Diabetes Clinic Improves Glycemic Control in Adults with Type 2 Diabetes

    Abstract:

    Background: Telemedicine for people with type 2 diabetes (T2D) has the potential to positively impact self-management behaviors and improve health outcomes. The Onduo Virtual Diabetes Clinic (VDC) is a comprehensive telehealth program for people with T2D that combines mobile app technology, remote personalized lifestyle coaching from certified diabetes educators and health coaches, connected devices including blood glucose (BG) meters and continuous glucose monitoring systems, and clinical support from board certified endocrinologists. Objective: To describe the VDC care delivery model and present preliminary data on change in glycemic control in program participants with up to 6 months of follow-up. Methods: Adults ≥18 years of age with T2D and who were members of sponsoring health plans and employers throughout the U.S. were eligible to participate. Those who elected to enroll downloaded the VDC app to their smartphone, provided demographic and clinical information, completed an onboarding survey, and were mailed a self-management kit that included a connected BG meter, test strips and a home HbA1c testing kit. Participants interacted with their care team primarily through the VDC app, with occasional phone calls, and by synchronous video consultations with endocrinologists, as clinically appropriate. Change in glycemic control in participants who completed a baseline survey from February 2018 through December 31, 2018 with an initial HbA1c measurement within 30 days of enrollment and a follow-up measurement between 90 and 180 days after baseline was analyzed. Results: Participants (n=740) were (mean±SD): 53.8±8.8 years of age, 62% female, BMI 35.6±8.5, initial HbA1c 7.7%±1.8, 31.0% were on insulin and 25.9% were on sulfonylureas at baseline, and 30.0% lived in a rural area. HbA1c decreased significantly by 2.3%±1.9, 0.7%±1.0 and 0.2%±0.8 across the baseline categories of >9.0%, 8.0% to 9.0% and 7.0% to <8.0%, respectively (all p<0.001). Within these categories, HbA1c improved in 91.9%, 77.3% and 63.5% of participants. For the group with an initial HbA1c >9.0%, HbA1c decreased from 10.7%±1.4 to 8.3%±1.5, and when stratified by HbA1c ≥8.0% the mean decrease in HbA1c was 1.5%, from 9.5%±1.5 to 8.0%±1.3, with 84.5% of participants demonstrating improvement. Participants with an initial HbA1c <7.0% who were meeting treatment targets at baseline, HbA1c 6.3%±0.4, continued to maintain this level of glycemic control at follow-up, HbA1c 6.4%±0.6 (n.s.). Conclusions: Participation in the VDC was associated with a significant improvement in HbA1c in adults with T2D who were not meeting treatment targets, with the greatest improvement observed in those with an initial HbA1c >9.0%. Importantly, the majority of program participants experienced an improvement in glycemic control. Our findings suggest that the VDC program is an effective approach to support individuals with T2D and their clinicians in diabetes management between office visits.

  • Development of an Accident and Emergency Triage Mobile App Using Open Data Kit

    Authors List:

    Abstract:

    Background: The process of triaging is performed as an effective solution to balance limited resources against high patient volumes, based on an assessment of the patient’s medical condition and the application of an established patient categorization protocol. In Princess Marina Hospital (PMH), a national referral government hospital in the capital city of Botswana, the Princess Marina Hospital Accident and Emergency Centre Triage Scale (PATS) has been in use since 2010. Because the rules of these triage scales are very well defined, these protocols have been shown to be amenable to translation into computer algorithms. Thus, clinical decision support systems (CDSSs) that can assist with information management to support clinicians’ decision-making abilities can be developed, leading to improved healthcare quality and patient safety. Objective: This study aims to determine the feasibility of development of a mobile triage application based on the adult PATS using Open Data kit (ODK) open source software to be used as a CDSS on smartphones and tablet computers for correct patient categorization. Methods: A user-centred design approach was used in designing the application, with participants recruited from the staff at the Accident and Emergency Department (A&E) at PMH. 40 clinical vignettes were used in the evaluation of the performance of the application as compared to the paper-based system currently in use, with the emergency physician at PMH providing the gold standard categorisation of these vignettes. Usability testing was also performed. Results: The application scored 90% (n=36) of the vignettes correctly, as compared to the paper-based system which scored 82.5% (n=33) of the vignettes correctly. Both systems achieved an over-triage score of 7.5% with an equal number of vignettes over-triaged (n=3). The results of the chi-squared test indicate that the difference in triage scores between the paper-based system and the mobile application is statistically significant at a p = 0.001 in favour of the ODK application. An overall positive outcome was also achieved in the usability test, with ease of use and speed of triage determined to be the most recurring themes in the user feedback survey. While the application does not require an internet connection for triaging patients, a reliable wireless internet connection is required to upload data to the server for viewing by medical officers and physicians in real-time, and this can be provided by the hospital as part of the Botswana government eHealth strategy. Additionally, the application developed in this research allows for data collection up to the point of triage categorization, meaning that a separate form would be required for capturing the rest of the information on the PMH A&E triage form. Conclusions: The triage application developed in this research was found to determine the triage category of patient vignettes more accurately than the traditional paper-based system based on PATS triage guidelines, with good results obtained in usability testing. Future work includes use of the application developed in this research in a live setting involving real patients in the A&E in PMH.

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