Eunme Cha

Chronic obstructive pulmonary disease as an independent risk factor for cardiovascular morbidity

Rationale: Recent studies described association between chronic obstructive pulmonary disease (COPD) and increased risk of cardiovascular diseases (CVD). In their analysis none of these studies accounted for sociodemographic factors, health behaviors, and patient comorbidities simultaneously. Objective: To study whether COPD diagnosis is an independent risk factor for CVD. Methods: Subjects aged 40 years and older (N = 18,342) from the sample adult file of the 2002 National Health Interview Survey (NHIS) were included in the analysis. Chi-squared tests and odds ratios (OR) were utilized to compare the data. Multiple logistic regression was employed to analyze the association between COPD and CVD with simultaneous control for sociodemographic factors (age, gender, race, marital status, education, income), health behaviors (tobacco use, alcohol consumption, physical activity), and patient comorbidities (diabetes, hypertension, high cholesterol, and obesity). The analysis employed NHIS sampling weights to generate data representative of the entire US population. Results: The COPD population had increased prevalence of CVD (56.5% vs 25.6%; P < 0.0001). Adjusted logistic regression showed that COPD patients (N = 958) were at higher risk of having coronary heart disease (OR = 2.0, 95% CI: 1.5–2.5), angina (OR = 2.1, 95% CI: 1.6–2.7), myocardial infarction (OR = 2.2, 95% CI: 1.7–2.8), stroke (OR = 1.5, 95% CI: 1.1–2.1), congestive heart failure (OR = 3.9, 95% CI: 2.8–5.5), poor circulation in lower extremities (OR = 2.5, 95% CI: 2.0–3.0), and arrhythmia (OR = 2.4, 95% CI: 2.0–2.8). Overall, the presence of COPD increased the odds of having CVD by a factor of 2.7 (95% CI: 2.3–3.2). Conclusions: These findings support the conclusion that COPD is an independent risk factor for CVD.

Feasibility of congestive heart failure telemanagement using a wii-based telecare platform

A gaming platform has been used to implement a Home Automated Telemanagement (HAT) system for chronic disease management in the patients home. The system questions patients with congestive heart failure (CHF) to monitor symptoms, weight changes, and quality of life while educating the patient on their disease. The system is designed to run on the Nintendo Wii videogame console using an active internet connection and the consoles built in internet browser. It questions the patient daily on their condition, monitors their weight, and provides the patient with instant feedback on their condition in the form of a 3 zone CHF action plan. The system is designed to be as simple as possible, making it usable by patients with no prior computer or videogame experience. This telemanagement system has been successfully designed and implemented to optimize the care of patients with CHF.

Feasibility of Promoting Smoking Cessation Among Methadone Users Using Multimedia Computer-Assisted Education

Background The prevalence of smoking is very high among methadone users. As a method of delivering health education, computers can be utilized effectively. However computer-assisted education in methadone users has not been evaluated systematically. Objective This study was aimed at assessing feasibility and patient acceptance of an interactive educational module of a multi-component smoking cessation counseling computer program for former illicit drug users treated in an outpatient methadone clinic. Methods The computer-mediated education for hazards of smoking utilized in this study was driven by major constructs of adult learning theories. The program interface was tailored to individuals with minimal computer experience and was implemented on a touch screen tablet PC. The number of consecutive methadone-treated current smokers enrolled in the study was 35. After providing socio-demographic and smoking profiles, the patients were asked to use the educational program for 40 minutes. The impact of the computer-mediated education was assessed by administering a pre- and post-intervention Hazards of Smoking Knowledge Survey (HSKS). An attitudinal survey and semi-structured qualitative interview were used after the educational session to assess the opinions of participants about their educational experience. Results The computer-mediated education resulted in significant increase of HSKS scores from 60.5 ± 16.3 to 70.4 ± 11.7 with t value 3.69 and P < .001. The majority of the patients (78.8%) felt the tablet PC was easy to use, and most of the patients (91.4%) rated the educational experience as good or excellent. After controlling for patient baseline characteristics, the effect of computer-mediated education remained statistically significant. Conclusions Computer-assisted education using tablet PCs was feasible, well-accepted, and an effective means of providing hazards of smoking education among methadone users.

Exploring feasibility of home telemanagement in African Americans with congestive heart failure.

Existing telemonitoring systems provide limited support in implementing personalized treatment plans. We developed a Home Automated Telemanagement (HAT) system for patients with congestive heart failure (CHF) to provide support in following individualized treatment plans as well as to monitor symptoms, weight changes, and quality of life, while educating the patient on their disease. The system is designed to be placed in the patients home and to communicate all patient data to a central server implementing real-time clinical decision support. The system questions the patient daily on their condition, monitors their weight, and provides the patient with instant feedback on their condition in the form of a 3-zone CHF action plan. Their medication regimen and suggested actions are determined by their care management team and integrated into the system, keeping a personalized approach to disease management while taking advantage of the technology available. The system is designed to be as simple as possible, making it usable by patients with no prior computer experience. A feasibility assessment in African American patients with CHF and without prior computer experience demonstrated high level of acceptance of the CHF HAT system.

Using gaming platforms for telemedicine applications: A cross-platform comparison

The goal of this project was to compare the functionality of the most widely used gaming platforms in terms of their applicability for telemedicine applications and to demonstrate the possibility of implementing a comprehensive telemedicine system using these platforms. We implemented a Home Automated Telemanagement (HAT) system for patients with chronic diseases to provide support in following their individualized treatment plans as well as to monitor symptoms, medication use, and quality of life, while educating the patient on their disease. The system was developed for use on the Nintendo Wii, the Microsoft Xbox 360, and the Sony Playstation 3. All three current generation videogame consoles allow for development of internet-based applications designed to be delivered via the consoles web browsers. The HAT system was implemented to be placed in the patients home and to communicate all patient data to a central server implementing real-time clinical decision support. The system questions patients daily on their condition, monitors their vital signs, and provides the patient with instant feedback on their condition. Cognitive walkthrough was used to see what challenges were posed by each platform and interface. We demonstrated that using any of the three gaming platforms it is possible to build a comprehensive telemedicine system that may be usable by patients with no prior computer or videogame experience.

Computerized Insulin Order Sets Can Lead to Unanticipated Consequences.

Computerized order sets for medication management were recently shown to be associated with increased patient safety risks in primary care setting. This study was aimed at demonstrating similar phenomenon in a hospital setting. After introduction of computerized order set targeting hypoglycemia, the frequency of hypoglycemia significantly decreased from 1/1/07 to 12/31/08. However, the frequency of hyperglycemia also increased at the same time from 1/1/07 to 12/31/07. Only after subsequent introduction of a hospital-wide standardized insulin order set including hyperglycemia policies, the frequency of hyperglycemic episodes declined. Hypo/hyperglycemia is associated with adverse clinical outcomes in the inpatient setting. Retroactive analysis showed that if hypoglycemic and hyperglycemic policies were introduced simultaneously, unexpected increase in frequency of hyperglycemic episodes could have been avoided. These data are informative in identifying unanticipated consequences of an insulin management order sets focused entirely on hypoglycemia. A balanced approach in implementing insulin management EMR order sets that concurrently addresses both hypoglycemia and hyperglycemia policies is warranted.

Introducing physical telerehabilitation in seniors with mobility limitation: System feasibility and acceptance

Physical therapy has been shown effective in geriatric population in addressing mobility limitation. Telerehabilitation systems may support physical therapy programs at patient homes however such systems were not systematically assessed in seniors. The Home Automated Telemanagement (HAT) system for in-home physical telerehabilitation of seniors with mobility limitations was developed and tested. The HAT rehabilitation system was designed to allow patients with mobility limitations to complete an individualized physical therapy plan prescribed by a physical therapist and to allow for clinicians to monitor and assist with in-home rehabilitation. We conducted a 12-week study to assess the feasibility and patient acceptance of the system. Our results showed that home-based physical telerehabilitation is feasible in seniors with mobility limitations, and it can potentially improve patient functional status significantly. Statistically significant improvement was documented using Berg Balance Scale (change from 36.6 ± 12.1 to 41.7 ± 11.1, p<;0.004), Timed 25-foot Walk (change from 13.5 ± 8.6 to 10.6 ± 4.5, p<;0.04), and 6-minute walk (change from 36.6 ± 12.1 to 41.7 ± 11.1, p<;0.004). The participants of the study demonstrated a very high level of support for the home-based physical telerehabilitation program.

Predictors of successful acceptance of home telemanagement in veterans with Multiple Sclerosis

Modern telehealth technologies may be instrumental in overcoming the barriers of optimal care delivery for patients with MS. However, the significant potential of telemedicine approaches in improving MS care has not yet been fully explored. The Multiple Sclerosis Centers of Excellence of the Department of Veterans Affairs (VA) has been actively promoting the use of telemedicine in helping veterans with MS. Particular attention was given to the development of cost-effective care coordination solutions which can be easily delivered directly to each veteran home via internet and accessed via a regular computer or a mobile device. In this article, the design of the MS HAT system is introduced and results of the initial feasibility evaluation are presented. The feasibility of the MS HAT system was assessed by (1) analyzing attitudinal surveys of veterans with MS who used the MS HAT system at home for over a month; (2) identifying factors affecting acceptance of the MS HAT system; (3) reviewing adherence of MS HAT users to self-testing regimen; (4) analyzing veteran feedback on MS HAT functionality using semi-structured qualitative interviews.

Feasibility of computer-assisted diabetes education in hispanic seniors

This study is aimed to evaluate the feasibility of diabetes computer-assisted education model combining behavioral theories and interactive computer media among seniors in the Hispanic community.

Unanticipated consequences of hospital-based insulin management order sets

Recent studies demonstrated risks to patient safety associated with implementation of electronic applications for medication management in ambulatory care. This study was aimed at demonstrating similar phenomenon in a hospital setting. After introduction of computerized order set targeting hypoglycemia, the frequency of hypoglycemia significantly decreased from 1/1/07 to 12/31/08. In contrast, the frequency of hyperglycemia increased at the same time from 1/1/07 to 12/31/07. Only after subsequent introduction of a hospital-wide standardized insulin order set including hyperglycemia policies frequency of hyperglycemic episodes declined. Hypo/hyperglycemia is associated with adverse clinical outcomes in the inpatient setting. Retroactive analysis showed that if hypoglycemic and hyperglycemic policies were introduced simultaneously, unexpected increase in frequency of hyperglycemic episodes could have been avoided. These data are informative in identifying unanticipated consequences of an insulin management order sets focused entirely on hypoglycemia. A balanced approach in implementing insulin management guidelines concurrently addressing both hypoglycemia and hyperglycemia policies is warranted.