Cost-effective Care Research Articles

Titanium clips for vascular control of renal vessels during laparoscopic nephrectomy: a safe and cost effective tertiary care center experience

This study aimed to evaluate the safety and cost-effectiveness of practice of titanium clip application on renal vessels in laparoscopic nephrectomy (LN) in a tertiary care hospital. A total of 143 patients were included in our study undergoing laparoscopic nephrectomy from January 2018 to April 2023. In our study, 3 titanium clips were applied on each renal artery and vein 1-2 mm apart from each other in order to achieve vascular control of the renal pedicle. This data was obtained retrospectively through medical records. We reported 31 (22%) patients in our study with malignant conditions and 112 (88%) patients with benign diseases. Of these, 4 (3 %) patients required blood transfusion. There were four cases where laparoscopic nephrectomy was converted to open procedure. No incidence of slippage of titanium clips used for vascular ligation was reported in our study neither did we encounter any clip dislodgement during or after the surgery. No significant post-operative complications pertaining to clip application were seen. Cost analysis revealed that most cases required a total of 6 titanium clips costing around 8 USD (4 USD per cartridge of 6 titanium clips) in total for vascular control. Titanium clip application for securing renal vessels during laparoscopic nephrectomy is a safe and cost-effective approach.

Implementing e-Health initiatives in Zimbabwe’s public health sector

The Zimbabwean government has instigated various policies and strategies as part of e-government initiatives to provide members of the public with convenient access to health information and services. Efforts have been made to embrace ICTs in Zimbabwe’s public health sector. The performance of health institutions in Zimbabwe however continues to deteriorate at a time when the use of ICTs in health is gaining momentum in Africa. This paper therefore seeks to assess the implementation of the E-health strategy revealing the current state of e-health or digital technology systems in Zimbabwe’s public hospitals. The study adopted an exploratory research design. Participants in this study were selected using purposive sampling. Data were gathered through participant observations, in-depth interviews and documentary research. The study established that even though e-health is an indispensable tool in improving quality, timely and cost effective health care, its implementation in Zimbabwe has not been easy and it is still in its infancy stages. The study concluded that e-health is a reliable tool for promoting successful and effective public health service provision in Zimbabwe. The study therefore reflects and proposes elements necessary for the successful implementation of e-health in Zimbabwe’s public health sector.

AONN+ Navigation Metrics That Support the Oncology Navigation Standards of Professional Practice

ObjectivesTo offer a comprehensive overview of the critical elements contributing to the achievements of oncology navigation, address challenges in standardized implementation, and examine recent advancements influencing the acknowledgment and reimbursement of navigation services. Lastly, the AONN+ 35 evidence-based navigation metrics will be shared, emphasizing the five core metrics that should be utilized by all navigation models in all settings. MethodsEmployed in this review involves synthesizing information from established oncology organizations, documenting the development of navigator professional standards of practice and navigation metrics that measure patient experience, clinical outcomes, and return on investment, and analyzing outcomes from national studies and collaborations to present a summary of advancements in oncology navigation. ResultsThe key components vital for ensuring the enduring success of programs encompass the core competencies of navigators, adherence to standards of navigation practice set by the Professional Oncology Navigation Taskforce, and the establishment of well-defined metrics specific to oncology navigation. ConclusionsDespite these advancements, challenges persist in implementing and recognizing the newly defined standards and metrics. Effective solutions involve aligning navigation programs with leadership, integrating standards into daily practice, defining navigator roles, measuring navigation program outcomes through defined metrics, and leveraging certifications. Standardized measurement and practice are imperative for national policy development and reimbursement models, aligning with the Cancer Moonshot's goal of high-quality, patient-centered, and cost-effective cancer care. Implications for Nursing PracticeTo contribute to standardizing measurement and practice in oncology navigation for national policy development and reimbursement models.

Multimorbidity healthcare expenditure in Belgium: a 4-year analysis (COMORB study)

BackgroundThe complex management of health needs in multimorbid patients, alongside limited cost data, presents challenges in developing cost-effective patient-care pathways. We estimated the costs of managing 171 dyads and 969 triads in Belgium, taking into account the influence of morbidity interactions on costs.MethodsWe followed a retrospective longitudinal study design, using the linked Belgian Health Interview Survey 2018 and the administrative claim database 2017–2020 hosted by the Intermutualistic Agency. We included people aged 15 and older, who had complete profiles (N = 9753). Applying a system costing perspective, the average annual direct cost per person per dyad/triad was presented in 2022 Euro and comprised mainly direct medical costs. We developed mixed models to analyse the impact of single chronic conditions, dyads and triads on healthcare costs, considering two-/three-way interactions within dyads/triads, key cost determinants and clustering at the household level.ResultsPeople with multimorbidity constituted nearly half of the study population and their total healthcare cost constituted around three quarters of the healthcare cost of the study population. The most common dyad, arthropathies + dorsopathies, with a 14% prevalence rate, accounted for 11% of the total national health expenditure. The most frequent triad, arthropathies + dorsopathies + hypertension, with a 5% prevalence rate, contributed 5%. The average annual direct costs per person with dyad and triad were €3515 (95% CI 3093–3937) and €4592 (95% CI 3920–5264), respectively. Dyads and triads associated with cancer, diabetes, chronic fatigue, and genitourinary problems incurred the highest costs. In most cases, the cost associated with multimorbidity was lower or not substantially different from the combined cost of the same conditions observed in separate patients.ConclusionPrevalent morbidity combinations, rather than high-cost ones, made a greater contribution to total national health expenditure. Our study contributes to the sparse evidence on this topic globally and in Europe, with the aim of improving cost-effective care for patients with diverse needs.

Pediatric anesthesia in North America.

This educational review outlines the current landscape of pediatric anesthesia training, care delivery, and challenges across Canada, Barbados, and the United States. Approximately 5% of Canadian children undergo general anesthesia annually, administered by fellowship-trained pediatric anesthesiologists in children's hospitals, general anesthesiologists in community hospitals, or family practice anesthesiologists in underserved regions. In Canada, the focus is on national-level evaluation and accreditation of pediatric anesthesia fellowship training, addressing challenges arising from workforce shortages, particularly in remote areas. Barbados, a Caribbean nation, lacks dedicated pediatric hospitals but has provided pediatric anesthesia since 1972 through anesthetists with additional training. Challenges in its development, common to low-middle-income countries, include inadequate infrastructure and workforce shortages. Increased awareness of pediatric anesthesia as a sub-specialty could enhance perioperative care for Barbadian children. Pediatric anesthesia encompasses various specialties in the United States, with pediatric anesthesiologists playing a foundational role. Challenges faced include recruitment and retention difficulties, supply-chain shortages, and the proliferation of anesthesia sites, all impacting the delivery of modern, high-quality, and cost-effective patient care. Collaborative efforts at national and organizational levels strive to improve the quality and safety of pediatric anesthesia care in the United States.

An Intelligent Health Surveillance System: Predictive Modeling of Cardiovascular Parameters through Machine Learning Algorithms Using LoRa Communication and Internet of Medical Things (IoMT)

In several nations, the majority of heart attacks lead to fatality prior to patients receiving any kind of medical intervention. The traditional healthcare system is mostly passive, requiring patients to initiate contact with healthcare services independently. People often do not request the treatment if they are unconscious during a heart disease episode. The use of Internet of Medical Things (IoMT) methods offers significant advantages in addressing the issue of caring for patients with cardiac problems. These techniques may transform service delivery into ubiquitous and activate healthcare services. Low-cost remote monitoring systems are essential to implementing a widespread healthcare service. In this article, we proposed a cost-effective Personal Health Care Device(PHCD) based on the Internet of Things (IoT). The PHCD transmits user somatic signals to data acquisition devices using a LoRa (Long-range and low-power) wireless communication network. The received data is uploaded to the cloud using IoT platforms like Adafruit IO. Further, various Machine learning (ML) algorithms, Naïve Bayes, ANN, CNN, and LSTM, were applied to collected data to predict heart rate and SpO2 behavior. The performance results of different forecast models were compared to identify precise modeling and reliable forecasts to prevent emergency cardiovascular conditions.

Expert consensus-based clinical recommendation for an integrative anthroposophic treatment approach to acute tonsillitis in childhood

BackgroundMedical guidelines are an important basis for qualitative and cost-effective patient care. However, there is a lack of clinical recommendations in anthroposophic medicine (AM), an integrative medicine approach frequently practised in Europe. Acute tonsillitis, which includes tonsillopharyngitis, is a common childhood disease. that is mostly caused by a viral infection. Symptomatic treatment is therefore of high importance, and AM can offer several therapy options. Methods53 physicians from Germany, Spain, Netherlands, Switzerland, Austria, and Hungary with at least one year of experience in anthroposophic paediatric medicine were invited to participate in an online Delphi process. The process comprises five survey rounds starting with open-ended questions and ending with final statements, which need 75% agreement of experts to reach consensus. Expert answers were evaluated by two independent reviewers using MAXQDA and Excel. ResultsResponse rate was between 28% and 45%. The developed recommendation included 15 subtopics. These covered clinical, diagnostic, therapeutic and psychosocial aspects of acute tonsillitis. Six subtopics achieved a high consensus (>90%) and nine subtopics achieved consensus (75–90%). ConclusionThe clinical recommendation for acute tonsillitis in children aims to simplify everyday patient care and provide decision-making support when considering and prescribing anthroposophic therapies. Moreover, the recommendation makes AM more transparent for physicians, parents, and maybe political stakeholders as well.

Aging populations and perspectives of geriatric medicine in Japan.

It is well known that Japan's population is aging, and the number of people older than 75 years is increasing significantly. Since older people, especially old individuals, are often multimorbid and cannot be always successfully treated and cared for by individual organ-specific treatment, it is essential to utilize knowledge of geriatrics when treating such older patients. Therefore, it is indisputable that education on geriatric medicine is extremely important in Japan, which is the country with the largest aging population. However, the number of universities in Japan that offer geriatrics courses is decreasing. This means that many medical students become doctors without learning the essential characteristics of medical care for older patients despite the need for prompt treatment of older patients in clinical practice in Japan, which is a major obstacle to the development of geriatric medicine in Japan. Here, we review the current status of geriatrics in Japan and overseas and consider the future of geriatrics education to provide holistic and cost-effective medical care for older patients and improve their quality of life and well-being.

Reviewing healthcare financial management: Strategies for cost-effective care

This research investigates the dynamic interplay between healthcare financial management and the pursuit of cost-effective care. The study explores operational efficiency strategies, value-based care models, and technological innovations. It explores their impact on economic outcomes and regulatory compliance. Governed by acts like the Affordable Care Act and initiatives like MACRA, the regulatory landscape significantly shapes financial strategies. Technology, including data analytics and electronic health records, emerges as a critical enabler for optimizing financial efficiency. Evaluating financial outcomes, emphasizing return on investment and cost-effectiveness ratios, reveals the intricate link between fiscal responsibility and enhanced patient care. While challenges persist, including resistance to change and limited resources, the study underscores the imperative for a balanced approach, recommending continued research into long-term financial impacts and innovative financial models aligned with value-based care.

Virtual first: implementation of a novel sleep telehealth platform in the United States military

BackgroundThere is a gross shortage of sleep specialist providers within the military health system. Telehealth and mobile health represent promising approaches to increase access to high quality, cost-effective care in the U.S military.ObjectivesThis paper reports findings from a mixed-methods clinical implementation study of a novel sleep telehealth platform at two military treatment facilities in the National Capitol Region. The platform includes a mobile app and integrated wearable sensors (i.e., a commercial off-the-shelf sleep tracker [Fitbit]). The primary purpose was to evaluate the implementation of a 10-day remote monitoring assessment and provision of evidence-based sleep treatment recommendations to patients and providers. In addition, we sought to observe, in an exploratory manner, subsequent engagement with the app during 5 days of personalized sleep education and training.MethodsPatients with sleep problems completed an intensive 10-day remote monitoring assessment that included a baseline intake questionnaire, daily sleep diaries, twice daily symptom surveys, and Fitbit. Based on this assessment, patients received personalized assessment results. Concurrently, a provider report was generated that included provisional diagnoses and evidence-based treatment recommendations. Next, participants gained access to personalized sleep education and trainings within the mobile app. Within an established implementation science framework, outcomes were assessed via behavioral adherence (engagement with the app) and separate questionnaires for patients and providers. Last, we conducted four focus groups with patients and 12 key informant interviews with primary care managers (PCMs) and economic stakeholders to seek feedback and recommendations for future directions.ResultsTwo hundred and seventy patients participated in the study. Using validated research questionnaires, participants reported high-risk for obstructive sleep apnea (65.6%), moderate to severe insomnia (38.2%), and moderate to severe daytime sleepiness (38.5%), and moderate to severe anxiety (14.1%) and depressive (20.4%) symptoms. Total sleep time was 6.6 (SD = 1.8) h based on sleep diaries and 6.1 (SD = 1.8) h based on Fitbit. Regarding implementation, reach, effectiveness, adoption, implementation, and maintenance were all notably high, based on quantitative and qualitative data from participants and PCMs.ConclusionsSleep telehealth and mobile health represent promising approaches to increase access to cost-effective, evidence-based care for sleep disorders in the U.S. military.

Transforming Value-Based Dementia Care—Implications for the GUIDE Model

This Viewpoint reviews the Guiding an Improved Dementia Experience (GUIDE) Model to assess its suitability in providing equitable and cost-effective dementia care and to compare it with previously introduced specialty care payment models to identify opportunities for refining payment innovation in dementia care.

Assessing the Role of and Building a Business Case for Technology in Healthcare.

As the healthcare market continues to evolve, technology plays a growing role in an integrated delivery system's ability to provide high-quality, cost-effective care. Healthcare leaders must be proactive and forward-thinking about their technology investments because the financial investment for technology innovation can be significant. Healthcare leaders must deliberately design the role of technology and develop a consistent method for evaluating, identifying, and prioritizing technology investments. The article describes technology's role in a healthcare organization as a window to the organization, a driver of business strategy, and a high-performance enabler. The article also develops a process for building a business case to ensure that an organization's technology investments are well-reasoned and will provide value. In addition, the article discusses the importance of combining people and process reengineering with new technology to exponentially increase the value of an organization. Healthcare leaders must understand the multiple roles of technology and consistently develop a business case when making technology investment decisions.

Nurses retrospective view on nursing education: A repeated cross-sectional study over three decades

BackgroundAs the healthcare landscape undergoes transformative shifts due to factors like ageing demographics, technological innovations, rapid global dissemination of infectious diseases, and imperatives for accessible, cost-effective care, a pressing need emerges for the contemporisation of nursing education. Notably, there is a paucity of research delving into nurses’ introspective evaluations of their educational experiences after their immersion in professional settings. ObjectiveThis study aimed to examine nurses’ evaluations of their educational background over 30 years and identify relationships between their assessments and their demographic. DesignThe study embraced a recurrent cross-sectional survey methodology, encompassing three distinct quantitative cross-sectional evaluations conducted in the years 1999, 2009, and 2021. Context/participantsThe cohort for this inquiry consisted of nurses stationed in Estonian general hospitals and inpatient departments of developmental plan institutions, each with at least one year of professional experience. Cumulatively, 832 nurses were engaged across three sequential evaluations: Study I (n = 463), Study II (n = 198), and Study III (n = 171). MethodsData procurement was executed via a structured survey, with subsequent analytical procedures encompassing descriptive and correlational methodologies. ResultsA discernible augmentation in the educational calibre of nurses was observed with each successive evaluation. This escalation concomitated enhanced positive assessments in areas like evidence-informed education, skill development, and autonomous operational capabilities. Yet, a critical appraisal persisted concerning their competencies in navigating complex patient interactions and addressing socio-religious dilemmas. ConclusionsThe merit of this investigation lies in its illumination of nursing education's evolution, as perceived retrospectively by nurses who have operationalized their academic learnings in real-world scenarios. Their vantage point, inherently informed by practice, uniquely positions them to earmark avenues of refinement. This exploration paves the way for enrichments in nursing education, spotlighting the imperative of equipping nurses to adeptly manage intricate situations.

Prior authorization for diabetes medications: Clinical outcomes and health disparities

BackgroundPrior authorization (PA) is a utilization management strategy used by health plans to ensure affordable, cost-effective care; however, PA may lead to therapy delay/abandonment and exacerbate health disparities. The purpose of this observational study was to assess the clinical outcomes and any health disparities associated with PA for diabetes mellitus (DM) medications. Materials and methodsThis was a cohort study of US adult patients from health plans with integrated and non-integrated system providers who were prescribed a DM medication that required a PA. Patients were categorized into three groups: received the requested DM medication (PA Med) or a new, alternative DM medication (DM Med), or did not receive the requested or new DM medication (No Med). The primary outcome was change in hemoglobin A1c (HbA1c). Adjusted and unadjusted analyses were performed. Patient characteristics associated with the No Med group were identified, also, with multivariable logistic regression modeling. Results6305 patients were included: 2434, 1323, and 2548 in the PA Med, DM Med, and No Med groups, respectively. Patients in the PA Med (−0.9 %) and DM Med (−1.0 %) groups had statistically significantly greater reductions in HbA1c compared to the No Med group (−0.4 %) in both unadjusted and adjusted analyses (all p < 0.05). Patients who were Hispanic/Latino, had a non-integrated system prescriber, and had a higher burden of chronic disease were statistically significantly associated with the No Med group. ConclusionsReceiving a new DM medication following PA was associated with better clinical outcomes but health disparities were present in the PA process.

Cost-effectiveness of abobotulinumtoxinA plus best supportive care compared with best supportive care alone for early treatment of adult lower limb spasticity following an acute event.

Spasticity is an incurable chronic condition, and patients with spasticity frequently experience symptoms such as muscle stiffness, restricted mobility, fatigue, spasms, and pain. The study objective was to assess the cost-effectiveness of abobotulinumtoxinA plus best supportive care compared with best supportive care alone for the early treatment of adult lower limb spasticity following an acute event (e.g. stroke or traumatic brain injury), from an Australian payer perspective. Using clinical data from published pivotal trials, an economic model based on a Markov model was developed to capture changes in treatment costs, healthcare resource use costs, functional outcomes, and health-related quality of life over a lifetime horizon. Scenario analyses and a probabilistic sensitivity analysis were conducted to explore the uncertainty in the model parameters and assumptions used in the base case. AbobotulinumtoxinA plus best supportive care was cost-effective versus best supportive care, yielding an incremental cost-effectiveness ratio of $35,721 per quality-adjusted life year gained. Sensitivity analyses confirm the robustness of the base case, with most results remaining below the commonly acceptable cost-effectiveness willingness-to-pay threshold of $75,000 per quality-adjusted life year for cost-effectiveness in Australia. Inputs and assumptions that produced the top four highest incremental cost-effectiveness ratios include the application of different health resource utilisation source, short time horizon, unweighted regression analyses to determine regression probabilities, and no stopping rule. AbobotulinumtoxinA plus best supportive care has a 74% probability of being cost-effective compared with best supportive care alone at the willingness to pay threshold. AbobotulinumtoxinA plus best supportive care treatment is cost-effective in Australia for the management of adult lower limb spasticity in patients treated within 2 years of an acute event.

Abstract WP146: Critical Care After Thrombolytic Therapy in Acute Stroke: Who Really Needs the ICU?

Introduction: Intravenous thrombolytic therapy remains the cornerstone of management in acute ischemic stroke (AIS) patients. Given the potential adverse effects of thrombolysis, patients are admitted to an intensive care unit (ICU) for close monitoring following administration. Alternative post-thrombolytic pathways may provide for safe cost-effective care in certain populations. We aimed to determine the proportion of patients treated with thrombolytics who required ICU care for reasons other than frequent neurologic monitoring and define their characteristics. Methods: We retrospectively reviewed patients ≥ 18 years of age who received TNK/ tPA for AIS at our community-based stroke center between May 2020 and August 2022. Patients were classified as requiring ICU care if they required intubation within 24 hours of admission or neurosurgical intervention, had symptomatic hemorrhagic conversion or brain compression, required a continuous infusion for hemodynamic management, or were in status epilepticus. Univariate and multivariate statistical analysis was performed. The study protocol was deemed exempt by our institutional IRB. Results: 262 patients met inclusion criteria. 54 (20.6%) required ICU level of care. Characteristics of those requiring ICU level of care are described in Table 1. Multivariate analysis showed that patients on antiplatelet or anticoagulant therapies prior to arrival (AOR: 2.205, p= 0.021) or who presented with higher initial NIH stroke scale (AOR: 1.108, p &lt; 0.001) had significantly higher likelihood of requiring ICU level of care. Conclusions: In our cohort, approximately 21% of patients required critical care. Anticoagulant or antiplatelet therapy prior to admission and greater NIH stroke scale on arrival were associated with an increased likelihood of requiring ICU level of care. Further prospective studies are indicated to assess the efficacy of alternative settings for post-thrombolytic care in selected AIS patients.

Optimization of medical care in regional health care: perspectives and barriers

The perspectives of Russian health care in the transition to personalized medicine are realized in the formation of an innovative digital health care system. Forming with the use of digital technologies the accessibility of health care provides enormous social advantages in regional conditions and assumes a qualitatively new level of regional health care system.&#x0D; The problems of the COVID-19 pandemic, requiring isolation, quarantine and social distancing and characterized by the formation of trends of social “atomization”, accelerated the dependence on digital health care, and served as a “catalyst for the development and implementation of a wide range of remote monitoring technologies in health care delivery”. However, the digitalization process is “objectively slow” in Russia. The research establishes a high differentiation of digitalization of regional health care systems in the Russian Federation.&#x0D; The implementation in regional health care of digital technologies, which have a high potential for improving the efficiency of the health care system, is limited by institutional barriers.&#x0D; The article presents a typology of institutional barriers to the digitalization of the regional health care system: on federal level [legal barriers, organizational and managerial (logistical) and technological barriers], regional level (financial barriers), level of medical organizations and users (medical staff and patients) [behavioral barriers, organizational and managerial (logistic) and technological barriers].&#x0D; Modern health care is experiencing large-scale digital technology inclusion, which can radically change the health care system by determining the accessibility and quality of medical care. However, the provision of cost-effective and quality health care initiated by the regional health care digitalization process is limited by institutional barriers at the federal, regional, medical organization and user levels.

Curriculum and Competency Guidelines for the Advanced Care Practitioner in Infectious Disease.

Changes in the health care delivery system have altered the way internal medicine (IM) is practiced, with inclusion of subspecialty advanced care practitioners (ACPs) as vital members of the health care team. ACPs are provided the clinical settings and educational resources within an academic center to become competent in recognizing and managing common and complicated infectious diseases (ID). The ID ACP will be given progressive responsibility with expectations for achievement of milestones as they develop into competent practitioners. We seek to ensure quality, cost-effective, and comprehensive patient-centered care on the ID service in the inpatient and ambulatory settings in compliance with national standards and scope of practice recommendations and regulations. In recognition of the expanding role of ACPs, we developed a curriculum and guidelines in the subspecialty of ID. Our proposal greatly adds to the available literature for ACPs to provide the full spectrum of ID practice.

Commentary on the Volume-Outcome Relationship in CRS/HIPEC for Peritoneal Carcinomatosis

Background: Peritoneal carcinomatosis historically has a poor prognosis; however, Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) have shown improved outcomes. While a volume-outcome relationship is established in oncologic surgeries, its applicability to CRS/HIPEC remains unexplored. This study examines the impact of hospital volume on CRS/HIPEC outcomes. Methods: Using the national Vizient Clinical Database, this retrospective analysis evaluated 5,165 HIPEC cases from 149 hospitals between January 2020 and December 2022. Hospitals were stratified into tertiles based on procedural volume. Chi-squared analysis and one-way ANOVA assessed the associations between hospital volume and patient demographics, morbidity, mortality, ICU utilization, length of stay, readmission rates, and costs. Results: No significant differences were found in morbidity (low- 9.4% vs. medium- 7.1% vs. high- 9.0%, p = 0.71) or mortality rates across hospital volume tertiles (0.9% vs. 0.6% vs. 0.7%, p = 0.93). Postoperative ICU use was higher in low-volume hospitals, yet this factor did not affect the overall length of stay or costs. Hospitals with Magnet nursing status had lower observed mortality (0.5% vs 1.7%, p = 0.048), but Magnet status did not significantly affect post-operative complications. CMI was similar between low-, medium-, and high-volume hospitals. While Magnet status and CMI were influential, hospital volume alone was not indicative of patient outcomes. Costs remained consistent across all volumes, indicating a trend toward cost-effective care. Conclusion: The anticipated volume-outcome relationship for CRS/HIPEC is not supported by this study's findings. Outcomes were more closely related to institutional quality and case complexity rather than procedural volume. These results suggest a reconsideration of the current emphasis on regionalization, advocating for the expansion of high-quality CRS/HIPEC care beyond high-volume centers, potentially increasing accessibility for patients.

Exploring the Feasibility and Acceptability of Telehealth Qi Gong Shared Medical Appointments: A Novel Approach to Expand Access.

Research on Qi Gong (QG) supports promising health benefits. Both interest and use of QG in U.S. adults has increased over the past decade. Shared Medical Appointments (SMAs) are a novel, cost-effective, and time efficient health care delivery approach associated with patient and clinician satisfaction. A telehealth delivered QG SMA was pilot tested among a diverse demographic population within an integrative medicine practice at an academic medical center to assess feasibility and acceptability. This was a feasibility/acceptability pilot study conducted at a large New York City academic medical center's Integrative Health and Wellness center from January to July 2023. A QG instructor-acupuncturist and an integrative medicine physician-acupuncturist co-led 3 separate series (5 Element QG, Eight-Section Brocade, and Joint-Mobilizing/Sinew Strengthening exercises) of weekly 30-45-minute sessions of QG SMA on a weekday afternoon via telemedicine. The first session included an overview of QG and Traditional Chinese Medicine (TCM) research while follow-up sessions included a check-in, didactic demonstration followed by QG practice, and a debrief to answer questions. Video links were provided for home practice. Surveys assessing satisfaction were sent pre/post series. 18 sessions of QG SMA were offered over a 6-month period. A total of 40 unique participants from diverse demographics (gender, race/ethnicity, primary residence) attended, for a total of 197 virtual visits. A total of 20 participants enrolled in Series 1 (8weeks), 23 enrolled in Series 2 (7weeks), and 16 enrolled in Series 3 (3cweeks). For each session, group attendance ranged from 8-16 with an average of 11 participants. Attendance was high with participants attending an average of 72% of the sessions. Participants attended 88% of the first 8-week series, 54% of the second 7-week series, and 60% of the third series. Participant interest persisted over time with 35% of the 40 participants attending more than 1 series, and 12.5% attending all 3 series. Participants' diagnoses and health symptoms included pain (62.5%), cancer (45%) anxiety/depression (40%), cardiovascular disease (CVD) or metabolic conditions (32.5%), gastrointestinal (GI) symptoms/diagnoses (27.5%), stress (22.5%), osteopenia/osteoporosis (17.5%), and insomnia (17.5%). Pre-series [n = 27] participants endorsed symptoms including sleep disturbances, fatigue, pain, stress, weakness, GI symptoms, psychological symptoms, hot flashes, and brain fog. Post-program survey results [n = 11] suggested QG program addressed common symptoms including fatigue, insomnia, anxiety, stress, pain, weakness, and gastrointestinal symptoms. Participants reported incorporating QG, breathing techniques, and meditation into their daily routine. All participants reported their goals were met and that they would recommend the program to others. Regarding delivery preferences, 73% preferred telehealth, 27% hybrid, and none preferred in-person. Participants appreciated the format, new skills, community, and instructors. While the Virtual QG SMA series provided to diverse demographic population with mixed diagnoses is feasible, acceptable, and shows promising positive impact in this pilot, caution in interpreting the data is advised due to the low response rate of the post-program survey. Robust studies with longer follow-ups are recommended.