McKenzie Bedra

Defining patient-centered characteristics of a telerehabilitation system for patients with COPD.

Studies have shown that pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) can help to restore or enhance residual functional capacity and improve quality of life. Home-based telemedicine systems can promote comprehensive pulmonary rehabilitation in COPD patients. Successful acceptance of such systems depends on how well they reflect needs, values and preferences of older adults with COPD. However, patient-centered characteristics of pulmonary telerehabilitation systems were not systematically defined particularly in older adults. The goal of this pilot study was to assess older COPD patient acceptance of pulmonarytelerehabilitation and to develop patient-centered characteristics of computer technology to support pulmonary rehabilitation at homes of older adults with COPD based on their values, needs, and preferences. A prototype pulmonarytelerehabilitaton system was developed and demonstrated to patients. The system feasibility and acceptance was assessed by identifying patient ability to operate the system independently and by collecting open-ended feedback via semi-structured qualitative interview and attitudinal surveys. Older adults found this technology easy to operate and potentially useful personal rehabilitation. Patient-centered specifications of a comprehensive pulmonary telerehabilitation system in older adults with COPD were identified.

Feasibility of a mobile blood pressure telemanagement system in children with hypertension

Telemedicine interventions are being increasingly used in the care of adults with hypertension however application of these technologies in children with high BP has not been systematically studied. The goal of this project was to develop a mobile BP telemanagement system for children with hypertension and to evaluate its feasibility. The prototype system consisted of a home unit, decision support server, and care management site. The home unit was based on a wireless netbook and automated BP monitor. The home unit was designed to complete a symptom diary, assess medication side effects, obtain BP, undergo hypertension education, and communicate with the decision support server. Feasibility of the BP telemanagement system was assessed in 8 children ≤21 years of age with essential hypertension. The study participants were asked to review the system functionality and provide their feedback by completing attitudinal survey and semi-structured qualitative interview. Attitudinal survey results were as follows: 88% reported that working with the computer was not difficult; 100% reported that self-testing procedures were not complicated; 75% felt the self-testing procedure took little time and did not interfere with their usual activities; 63% felt safer while being monitored by the BP telemanagement system; 63% felt it was important to know that the self-testing results can be immediately reviewed in the medical center; 88% would like to use the home telemonitoring system in the future. Qualitative interview results showed consistently positive comments for content, interface and process components and provided suggestions for improvements. We concluded that BP telemanagement in children may be feasible means for hypertension care delivery, and that further development and evaluation of the system is warranted.

Exploring three perspectives on feasibility of a patient portal for older adults.

INTRODUCTION It is not clear whether older adults with chronic disease and their caregivers are likely to use patient portals. METHODS Older adults with a diagnosis of chronic obstructive pulmonary disease or congestive heart failure were evaluated as well as their caregivers. We explored whether these patients and/or their caregivers were able to use common portal elements. The perspective of informatics experts was ascertained using cognitive walkthrough methodology. RESULTS Fourteen patients and nineteen caregivers were evaluated. Patients required more time on all tasks than caregivers. Patient comments included a request for written instructions for using the system and a guide for interpreting lab results. Caregiver suggestions included improving color contrast and presentation of the current medication list. In the cognitive walkthrough, numerous problems were identified. CONCLUSIONS Older adults with chronic illness and caregivers were interested in using a patient portal however multiple barriers were identified.

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.

Avatar-based interactive ileostomy education in hospitalized patients

Computer-assisted education can be an effective means for patient engagement and empowerment however the feasibility of postoperative computer-assisted ileostomy education has not been studied systematically. The purpose of this study was to assess feasibility and patient acceptance of tablet-based interactive ileostomy education in patients with new stomas, and to evaluate the impact of this education modality on knowledge and self-efficacy. An interactive multimedia education for ileostomy management guided by adult learning theories was tested in 15 hospitalized patients with new ileostomies. After using the avatar-based education, the ileostomy knowledge score improved from 27.8±3.4 to 31.3±1.5 (p<0.002) and stoma care self-efficacy improved from 78.4±22.7 to 92.7±14.1 (p<0.05). Attitudinal surveys and qualitative interviews demonstrated high level of acceptance and provided valuable feedback for future improvements. We concluded that avatar-based interactive instruction can potentially be an effective means to deliver health education to hospitalized patients.

Feasibility of post-acute hip fracture telerehabilitation in older adults.

Recent studies demonstrated potential of home-based telerehabilitation in older adults and individuals with mobility impairment. However limited evidence exists on feasibility of home-based telerehabilitation in older adults after hip fracture. The aims of this study were: (1) to assess impact of home-based telerehabilitation of community dwelling older adults in post-acute phase of recovery after hip fracture on mobility, psycho-behavioral factors, quality of life, and satisfaction with care; (2) to estimate acceptance of the telerehabilitation system and adherence to the exercise program. We found statistically significant improvements in exercise self-efficacy, mobility, quality of life, and patient satisfaction after 30-day hip fracture telerehabilitation. Home telerehabilitation may be a viable model for post-acute hip fracture recovery and it is warranted for further evaluation in clinical trials.

Introducing Home Blood Pressure Telemonitoring for Children with Hypertension

The goal of this study was to introduce home blood pressure (BP) telemonitoring in children with hypertension and to assess the feasibility of this approach. Acceptance of the system was assessed by attitudinal survey and semi-structured qualitative interview. Qualitative interview results showed consistently positive comments for content, interface and process components. BP measurements obtained by self-testing were as reliable as Dinamap measurements. The home telemonitoring system was positively accepted, easy to use and found to be helpful by participants. Home-based BP telemonitoring has significant potential to improve patient-centered delivery in children with hypertension.

Is Internet search better than structured instruction for web-based health education?

Internet provides access to vast amounts of comprehensive information regarding any health-related subject. Patients increasingly use this information for health education using a search engine to identify education materials. An alternative approach of health education via Internet is based on utilizing a verified web site which provides structured interactive education guided by adult learning theories. Comparison of these two approaches in older patients was not performed systematically. The aim of this study was to compare the efficacy of a web-based computer-assisted education (CO-ED) system versus searching the Internet for learning about hypertension. Sixty hypertensive older adults (age 45+) were randomized into control or intervention groups. The control patients spent 30 to 40 minutes searching the Internet using a search engine for information about hypertension. The intervention patients spent 30 to 40 minutes using the CO-ED system, which provided computer-assisted instruction about major hypertension topics. Analysis of pre- and post- knowledge scores indicated a significant improvement among CO-ED users (14.6%) as opposed to Internet users (2%). Additionally, patients using the CO-ED program rated their learning experience more positively than those using the Internet.

A critical review of consumer health devices for stress self-management.

A number of consumer health devices have been advertised as effective means to manage individual stress. However, objective evidence of their efficacy is not readily available. We present a critical analysis of evidence related to efficacy of stress management devices based on comprehensive literature review and information provided by the vendors. The analysis was conducted along four dimensions: metrics, theoretical frameworks, evaluation, and FDA clearance. The review resulted in identification of critical issues including limited information on operational characteristics, controversial theoretical underpinnings, and lack of systematic evaluation. Efficacy of these consumer devices has yet to be established.