Bree Holtz

Diabetes Management via Mobile Phones: A Systematic Review

BACKGROUND This study sought to understand the most common uses and functions of mobile phones in monitoring and managing diabetes, their potential role in a clinical setting, and the current state of research in this area. METHODS We identified peer-reviewed articles published between 2000 and 2010. Twenty-one articles were analyzed for this systematic literature review. RESULTS The majority of studies examined the use of mobile phones from the patients perspective. Subjects with type 1 diabetes were enrolled exclusively in over 50% of the studies. Seventy-one percent of the studies used a study-specific application, which had supplemental features in addition to text messaging. The outcomes assessed varied considerably across studies, but some positive trends were noted, such as improved self-efficacy, hemoglobin A1c, and self-management behaviors. CONCLUSIONS The studies evaluated showed promise in using mobile phones to help people with diabetes manage their condition effectively. However, many of these studies lacked sufficient sample sizes or intervention lengths to determine whether the results might be clinically or statistically significant. Future research should examine other key issues, such as provider perceptions, integration into a healthcare practice, and cost, which would provide important insight into the use of mobile phones for chronic disease management.

One Size Doesn’t Fit All: Bringing Telehealth Services to Special Populations

Telehealth applications and information communication technologies can be customized and scaled to meet the healthcare service needs of a wide variety of special populations. Categorization of those special groups can be viewed from a spectrum of perspectives such as by gender, age, culture, families, communities, chronic conditions, or particular types of locations, as well as when addressing a specific or unique health need. The emergence of innovations in the use of a range of technologies and connectivity offers exciting new approaches to the integration of telehealth aimed at improving quality and continuity of care to better meet the needs of special populations.

Keys to a successful and sustainable telemedicine program

OBJECTIVES The aim of this study was to determine organizational characteristics evident in successful telemedicine programs. The study proposed four research questions to identify the key organizational characteristics for successful telemedicine programs. METHODS Data were collected through an online survey using modified unified theory of acceptance and use of technology (UTAUT) and organizational change readiness (ORC) validated assessments. RESULTS Using the UTAUT instrument and the ORC assessment, themes of successful telemedicine programs emerged. Overarching themes of successful programs included being formally structured, forward thinking, seeking to improve the quality of patient care, and being financially stable. CONCLUSIONS This research provides a data-driven understanding of organizational issues that serve to maximize a telemedicine programs ability to achieve the overall goals and mission of a healthcare organization.

Improving chronic illness care for veterans within the framework of the Patient-Centered Medical Home: experiences from the Ann Arbor Patient-Aligned Care Team Laboratory

ABSTRACTWhile key components of the Patient-Centered Medical Home (PCMH) have been described, improved patient outcomes and efficiencies have yet to be conclusively demonstrated. We describe the rationale, conceptual framework, and progress to date as part of the VA Ann Arbor Patient-Aligned Care Team (PACT) Demonstration Laboratory, a clinical care-research partnership designed to implement and evaluate PCMH programs. Evidence and experience underlying this initiative is presented. Key components of this innovation are: (a) a population-based registry; (b) a navigator system that matches veterans to programs; and (c) a menu of self-management support programs designed to improve between-visit support and leverage the assistance of patient–peers and informal caregivers. This approach integrates PCMH principles with novel implementation tools allowing patients, caregivers, and clinicians to improve disease management and self-care. Making changes within a complex organization and integrating programmatic and research goals represent unique opportunities and challenges for evidence-based healthcare improvements in the VA.

Telehospice: reasons for slow adoption in home hospice care

We investigated why hospice nurses were slow to adopt videophones to care for their patients. We used the unified theory of acceptance and use of technology (UTAUT) model and the organizational readiness for change (ORC) assessment via interviews and focus groups with hospice staff. Twenty-five hospice employees participated. Eighteen (72%) were in clinical positions and seven were in non-clinical positions (28%). Thirty-nine percent of respondents reported no videophone training, despite the fact that every employee had received training. Only four staff members actually used a videophone with patients. The respondents overwhelmingly stated that they had the organizational resources necessary to use the videophone and that it was easy to operate. Despite initial enthusiasm, leaders in the hospice agency did not endorse the videophones for work, nor offer incentives for using the videophones or providing them to patients. It is important to note that videophone technology is not meant to replace face-to-face visits, but to supplement them and to provide an additional tool for the nurses.

Provider Utilization of Telemedicine: The Elephant in the Room

This paper addresses the challenge of provider underutilization of telehealth which continues to surface as an ongoing problem. In addition, this essay offers a list of ideas to serve as a starting point from which to address this key issue.

Connected Motherhood: Social Support for Moms and Moms-to-Be on Facebook

BACKGROUND Research addressing online social support, especially for new mothers, has typically focused on forums and dedicated Web sites, and not on social networking sites like Facebook. Here we expand on this existing body of work by addressing a Facebook page, Ask the Chicks, themed around questions and answers related to motherhood. Using the uses and gratification lens, we explore motivations for participation as they relate to engagement with the page. MATERIALS AND METHODS Individuals were recruited to participant in an online survey through posts on the Ask the Chicks Facebook page made by the page owner over a 1-week period. To be eligible to complete the survey, participants had to be 18 years old or older, female, and pregnant or have at least one child under the age of 5 years. RESULTS Analyses of survey data collected from users of the page (n=647) revealed that engagement has a positive relationship with the motives of relaxing entertainment, expressive information sharing, social interaction, and information seeking. CONCLUSIONS Online support groups, and especially Facebook, appear to be a more convenient method than traditional online support groups for people who want to obtain information about certain topics, in this case, about motherhood and raising kids. Having this type of social support tool is important, as social support has been found to reduce levels of stress, which can improve overall health and quality of life. This study provides a better understanding of why people use this type of social support group for questions about parenting.

Understanding Nurse Perceptions of a Newly Implemented Electronic Medical Record System

Nurses are the frontline of healthcare; however, there has been little theoretically-driven research on their acceptance of information technology use in care delivery. This research utilized the unified theory of acceptance and use of technology (UTAUT) model to understand how hospital nurses perceived the implementation of a new electronic medical record (EMR) system. This study used mix methods. The survey responses indicated that social influence and performance expectancy were significant factors in system adoption. Effort expectancy did not have a significant influence on the intention to use the EMR. The interviews were utilized to better understand these results. The UTAUT model highlighted factors that are important to nurses during an EMR deployment and can help in future implementations of technology in healthcare.

The Use of Multiple Qualitative Methods to Characterize Communication Events Between Physicians and Nurses

Despite the importance of communication to patient safety in hospital settings, we know surprisingly little about communication patterns between physicians and nurses, particularly on general medical–surgical units. Poor communication is the leading cause of preventable adverse events in hospitals, as well as a major root cause of sentinel events. The literature provides little guidance on what qualitative methods are best for capturing different types of communication events and patterns. The purpose of this study was to develop a methodology for identifying and characterizing communication events between physicians and nurses to better understand communication patterns on general medical–surgical units. We used a sequential qualitative mixed method design beginning with general observation, progressing to shadowing and focus groups of physicians and nurses who worked on two medical–surgical units at one academically affiliated U.S. Department of Veterans Affairs (VA) hospital. Each data collection method (observation, shadowing, and focus groups) had its own advantages and disadvantages for capturing communication events and patterns. Through observation we were able to see the “what”: communication activities. Shadowing was most useful for understanding “how” physicians and nurses communicated. Focus groups helped answer “why” certain patterns emerged and allowed us to further explore communication events within a group setting. By using all three methods we were able to more thoroughly characterize communication events than by using a single method alone, providing a more holistic picture of how communication occurs on an inpatient medical–surgical unit.

Visioning Technology for the Future of Telehealth

By its very nature, telehealth relies on technology. Throughout history, as new technologies emerged and afforded people the ability to send information across distances, it was not long before this capability was applied to the most basic need of all: maintaining health. While much of the early work in telehealth was driven by technology (e.g., making opportunistic use of the systems and devices that were available at the time), recent trends are beginning to push the demand for and the development of new technologies specific to the individual needs of telehealth applications. The future of telehealth will benefit greatly from this technology innovation, in particular, in areas such as home telehealth and remote monitoring, e-health and patient portal applications, personal health records, interactive Internet technologies, and robotics. Telehealth, while not a panacea for all of the challenges facing modern healthcare systems, has a substantial and ever-expanding potential to revolutionize the ways in which people receive medical care while offering the possibility to contain costs, manage chronic diseases, and prevent secondary complications. By demanding innovative solutions and speaking out in support of the field, the telehealth community can and should be leading the charge for greater attention to human factors in technology development, interoperable medical records, staff training and competencies, standards and guidelines, and support for expanded telehealth coverage at the national, state, and local levels.