Home-based Health Care Research Articles

A Real-Time Wearable Physiological Monitoring System for Home-Based Healthcare Applications

The acquisition of physiological data are essential to efficiently predict and treat cardiac patients before a heart attack occurs and effectively expedite motor recovery after a stroke. This goal can be achieved by using wearable wireless sensor network platforms for real-time healthcare monitoring. In this paper, we present a wireless physiological signal acquisition device and a smartphone-based software platform for real-time data processing and monitor and cloud server access for everyday ECG/EMG signal monitoring. The device is implemented in a compact size (diameter: 30 mm, thickness: 4.5 mm) where the biopotential is measured and wirelessly transmitted to a smartphone or a laptop for real-time monitoring, data recording and analysis. Adaptive digital filtering is applied to eliminate any interference noise that can occur during a regular at-home environment, while minimizing the data process time. The accuracy of ECG and EMG signal coverage is assessed using Bland–Altman analysis by comparing with a reference physiological signal acquisition instrument (RHS2116 Stim/Recording System, Intan). Signal coverage of R-R peak intervals showed almost identical outcome between this proposed work and the RHS2116, showing a mean difference in heart rate of 0.15 ± 4.65 bpm and a Wilcoxon’s p value of 0.133. A 24 h continuous recording session of ECG and EMG is conducted to demonstrate the robustness and stability of the device based on extended time wearability on a daily routine.

Home-Based Health Care Interventions for People Aged 75 Years and Above With Chronic, Noninflammatory Musculoskeletal Pain: A Scoping Review.

Chronic, noninflammatory musculoskeletal pain is common in the aged population and management can be challenging for older people due to multimorbidity, social isolation, and physical frailty. The aim of this scoping review is to summarize and discuss the evidence related to home-based health care interventions for older adults, with chronic, musculoskeletal pain. A review of the literature using 8 electronic databases (Embase, MEDLINE, CINAHL, PubMed, Cochrane Library, Physiotherapy Evidence Database [PEDro], Scopus, and Web of Science) was performed, following the PRISMA-ScR guidelines. English language published studies that assessed home-based health care intervention/s, in men and women 75 years and older, with chronic, noninflammatory musculoskeletal pain where included. Two authors independently reviewed the articles and extracted data into a preformulated chart. The database search identified 4722 studies of which 7 studies met the inclusion criteria. Six of the 7 studies were randomized controlled trials and 5 studies focused on a single-site pain. The type of home-based interventions in the included studies was physical therapy (n = 2), psychotherapy (n = 3), and multimodal therapy (combination of multiple therapies) (n = 2). Participation completion rate was more than 74% in 6 out of 7 studies. Most studies used pain and/or physical function as their primary outcome (n = 6). Music therapy showed a statistically significant reduction in visual analog scale score for pain, and there was a trend toward improvement of pain and function in the physical therapy studies. No significant differences in outcomes between intervention and control groups were observed in the multimodal studies. This review highlights the scarcity of evidence related to home-based health interventions in older people 75 years and older, living with chronic, noninflammatory musculoskeletal pain. The findings were that physical, psychotherapeutic, and multimodal interventions are usually well tolerated and can be delivered as a safe self-management option. There remains a substantial need for more high-quality research with wider range of home-based interventions and comprehensive assessment of outcomes for this age group.

Relationships between Kazakh elders' disability severity and informal care time in far north-western low-income areas in China: The mediating roles of caregiver health and home-based care quality.

Elders' disability severity and caregiver health could predict elders' informal care time, but the mechanism by which the degree of disability in the elderly affects informal care time is unclear. The aim of this works is to explore the mediating roles of caregiver health and home-based care quality between disability severity of elders and informal care time in far north-western low-income areas in China. From September 2017 to February 2018, three hundred fifty-two dyads of Kazakh disabled elders and informal caregivers in Xinjiang were interviewed. Structural equation modelling analyses were applied. Significant positive correlations were observed between elders' disability severity and informal care time, caregiver health and informal care time, elders' disability severity and caregiver health. Significant negative correlations were observed between home-based care quality and informal care time, elders' disability severity and home-based care quality, caregiver health and home-based care quality. Elders' disability severity had 71.94% direct effect on informal care time, 28.06% indirect effect on informal care time mediated by home-based care quality and caregiver health. Caregiver health and home-based care quality play mediating roles on the path relationship between the elders' disability severity and informal care time.

Clinical trials tranformation intiative-decentralized clinical trials: a review article

In clinical research, Decentralized clinical trials (DCTs) can provide opportunities to maximize efficiencies. Unlike the traditional clinical trial model, Decentralized Clinical Trials (DCTs) promote telemedicine, mobile/local healthcare providers (HCPs), mobile/web-based technology, and direct distribution of Investigational Medicinal Products (IMP) to patients, among other things. Hence, DCTs are in the spotlight as technology, infrastructure, and knowledge providing a backbone in clinical research.
 Background: Advances in electronic communication, data storage, emerging technologies, and biosensor development provides new opportunities to exchange information, such as the patient is tested from their home locations and are with locations distant from the investigator. Trials that take place at locations distant from the investigator (i.e., spectrum: CCTs → Hybrid Models → DCTs) in any or all study-related procedures and data is collected electronically fall in the category of the decentralized clinical trial. Trials should be designed to integrate the current healthcare system of the study subject, optimize convenience for study subjects and take advantage of existing programs and data sources including The study subjects themselves through the utilization of telecommunication, videoconferences, mobile or internet-based tools for patient reporting, mobile technology tools and biosensors. Local healthcare providers, home-based healthcare services, pharmacies, clinics, regional hospitals, their perceived obstacles have impeded the widespread use of mobile devices in clinical trials. To encourage solutions to these challenges, The Clinical Trial Transformation Initiative (CTTI) has released best practices and practical methods to advance solutions to these issues that clinical trial sponsors can now use.
 Conclusion: Decentralized clinical trials are not only operationally feasible and show high recruitment rates, have better compliance, lower dropout rates, and are conducted faster. DCT meets the goal of the industry in being low-risk, high returns trials and can offer a reliable, time-based, and cost-effective approach.

Family Caregiver and Provider Perspectives on Inclusive Care: Aligning Needs and Expectations.

Home-based and community-based health care for individuals with complex medical conditions is often provided by family caregivers. Yet caregivers often are not meaningfully included in interactions with clinical health care teams. Inclusive care means inviting the caregiver to participate in shared decision-making and treatment planning. For aging or medically vulnerable adults, caregiver inclusion is an important facet of patient-centered care. We apply a mixed-methods approach using a survey (n=50) and semistructured interview data (n=13) from a national sample of caregivers of veterans and semistructured interview data from (n=24) providers from 3 Veterans Affairs regional networks. We elicited data from caregivers about their experiences with inclusive care and how providers communicate with them and assess their capacity. We juxtaposed these data with provider perspectives to see where there was alignment. We determined that caregivers play important roles in trust-building, communications management, implementation of care plans at home or in the community, and improving the care of care recipients-while maintaining a balance between competing tensions. Our findings suggest that expanding inclusive care could improve care quality and health outcomes of individuals with complex health care needs. Further, our findings bolster recent policy efforts at the federal and state levels to increase recognition of caregivers as key members of the health care team.

Needs-led research: a way of employing user involvement when devising research questions on the trust model in community home-based health care services in Norway

BackgroundThis paper presents a user involvement process, called needs-led research, conducted as a part of a doctoral degree project aiming to explore research priorities and, ultimately, to develop a final top 10 list of questions relevant to the field of research. There is evidence of a mismatch between what user groups within a research field find relevant to study and what is actually being done. User involvement is a method that can accommodate this, and there is a growing attention and amount of research in this field based on an understanding that people who receive health care services, and their next of kin and clinicians, are uniquely positioned to contribute to research in order to understand their experiences better and improve the services. This paper presents a user involvement process in a small-scale study, referred to as needs-led research, which concerns the ‘performance of the trust model in community home-based health care services’. The process was conducted as part of a doctoral degree project.MethodThe needs-led research process is inspired by the James Lind Alliance (JLA), which focuses on bringing together service users, next of kin and clinicians on equal terms to explore research priorities. The process consisted of five-steps, each of which involved representatives from service users, next of kin and clinicians: 1) narrowing down the theme; 2) steering group meeting; 3) gathering input through a survey; 4) data processing and interim priority setting; and 5) final priority setting.ResultsAlmost 200 participants contributed during the five steps, 294 inputs were gathered, and 35 participants voted for the top 10 list. The top 10 list is presented.ConclusionThis paper provides an example of how user involvement can be employed to devise research questions that are relevant for clinicians, service users, next of kin and service providers concerning the ‘performance of the trust model in home-based health care’. It also outlines some strengths and limitations of the process. The needs-led research process shows that user involvement in research is feasible for developing research questions in small-scale studies. We hope that the top 10 list presented will encourage future research to address issues of importance regarding the performance of the trust model in community home-based health care services.

A qualitative study of home health care experiences among Chinese homebound adults

BackgroundHome health care services (HHC) are emerging in China to meet increased healthcare needs among the homebound population, but there is a lack of research examining the efficiency and effectiveness of this new care model. This study aimed to investigate care recipients’ experiences with HHC and areas for improvement in China.MethodsThis research was a qualitative study based on semi-structured interviews. Qualitative data were collected from homebound adults living in Jinan, Zhangqiu, and Shanghai, China. A sample of 17 homebound participants aged 45 or older (mean age = 76) who have received home-based health care were recruited. Conceptual content analysis and Colaizzi’s method was used to generate qualitative codes and identify themes.ResultsThe evaluations of participants’ experiences with HHC yielded both positive and negative aspects. Positive experiences included: 1) the healthcare delivery method was convenient for homebound older adults; 2) health problems could be detected in a timely manner because clinicians visited regularly; 3) home care providers had better bedside manners and technical skills than did hospital-based providers; 4) medical insurance typically covered the cost of home care services. Areas that could potentially be improved included: 1) the scope of HHC services was too limited to meet all the needs of homebound older adults; 2) the visit time was too short; 3) healthcare providers’ technical skills varied greatly.ConclusionsFindings from this study suggested that the HHC model benefited Chinese older adults—primarily homebound adults—in terms of convenience and affordability. There are opportunities to expand the scope of home health care services and improve the quality of care. Policymakers should consider providing more resources and incentives to enhance HHC in China. Educational programs may be created to train more HHC providers and improve their technical skills.

Mediating Effects of Smartphone Utilization between Attitude and Willingness to Use Home-Based Healthcare ICT among Older Adults.

ObjectivesThis study explored the direct and indirect effects of knowledge of new technology (e.g., artificial intelligence, the Internet of Things, and the Fourth Industrial Revolution), attitudes towards technology use, and smartphone utilization skills on older adults’ willingness to use home-based information and communication technology (ICT) for self-health management.MethodsA phone survey was conducted among 300 older adults aged 65 or older in Gangwon Province, Republic of Korea. A path analysis was performed to identify the direct and indirect effects of knowledge of new technology, attitudes towards technology use, and smartphone utilization skills on willingness to use home-based healthcare ICT. Socioeconomic variables were used as control variables.ResultsKnowledge of new technology, but not attitudes towards technology use, had a direct impact on smartphone utilization skills. Attitude towards technology use and smartphone utilization skills showed significant effects on willingness to use home-based healthcare ICT. One standard unit change in attitudes towards technology use contributed to a 0.172 unit change in willingness (p = 0.001), and one standard unit change in smartphone utilization skills changed willingness by 0.246 units (p < 0.001). In addition, older adults with a higher education level and economic status, and lower self-related health status, were more willing to use home-based healthcare ICT.ConclusionsThese findings underscore the necessity of enhancing the smartphone utilization skills of older adults and attitudes towards technology use. Providing more user-friendly services and increasing smartphone utilization skills among older adults would contribute to willingness to use home-based ICT for healthcare management.

Use of social determinants of health codes in home-based primary care.

The Affordable Care Act created funding for nurse practitioner education programs to transform the primary health care workforce through student awareness of how social, political, economic, and environmental factors influence individual and population health. Funding established Academic Clinical Partnerships (ACPs) that created value-based health care models, which improved patient outcomes and decreased hospital and emergency department admissions and health care costs. The ACP established a home-based primary health care (HBPC) program to deliver primary care and collect patient data. The purposes were to describe the incidence of chronic conditions for HBPC patients and determine associations between chronic conditions and presence of social determinants of health (SDoH). Nurse practitioner students were assigned to HBPC clinical placements. A convenience sample of 102 high-risk, homebound patients was identified. Nurse practitioners and students recorded deidentified patient data, including ICD-10-CM codes into a Health Insurance Portability and Accountability Act compliant platform. Secondary analysis of patient records assessed for SDoH through Z codes. Patients had high incidences of hypertension, diabetes, pulmonary disease, heart disease, chronic pain, mood, and substance abuse disorders. Secondary analysis revealed that 92% of patients had indications for the use of Z codes, but these were not recorded. Common Z codes were personal risk factors, housing/economic circumstances, care provider dependency, lifestyle, and family support. By coding for SDoH, providers and agencies can realize higher reimbursement rates in HBPC settings. Nurse practitioners can use this information to provide better treatment recommendations, more accurate diagnoses, and referrals to enhance primary care services to a patient population negatively affected by SDoH.

Wireless Wearable Electrochemical Sensors: A Review

The demand for wearable sensors has been grown rapidly over the past few years, mainly those related to monitor health, fitness and their surroundings. Consequently, wearable chemical sensing has become a crucial appliance area for wireless sensors and has proved to be a very challenging and multidisciplinary area. The great advantage of coupling wireless communication to different types of wearable sensors is the enhancement of the sensor’s scope for remote and resource-limited settings with the possibility of obtaining real-time data acquisition and application in different areas like homeland defense, home-based healthcare, and food logistics. Being the electrochemical sensors considered attractive and promising to use in the wireless chemical sensor field, due to its features such as simple structure, the possibility of miniaturization, comfort, simplicity of operation, high sensitivity, fast response, relatively low energy consumption and low manufacturing cost. Furthermore, wearable electrochemical sensors enable obtaining insights into individuals' health status through the noninvasive monitoring of clinically relevant biomarkers in different biofluids without complex sampling, manipulation and treatment steps. In this review, we present the main advances in technologies used in the development of fully integrated wireless wearable electrochemical devices, such as communication protocols, data collection and privacy concerns and power sources. We also discuss in a critical way the main challenges, trends, strategies and new technologies that will drive this research line in the future. Lastly, we highlight the progress in the last few years in healthcare, sports, security and defense, and forensic applications.

Effectiveness of Nurse-Driven Discharge Teaching Using Mobile Application for Home-Based Health Care Practices among Postoperative Neurosurgical Patients or Caregivers in a Tertiary Care Hospital, New Delhi: A Randomized Control Study

Abstract Introduction Considering the increased access to mobile use even in the remote areas, it may be feasible to utilize mobile application (App)-based education among neurosurgical patients and caregivers for home-based care. Objective This study was aimed to assess the effectiveness of nurse-driven discharge teaching using mobile App for home-based health care practices in terms of discharge advice compliances, revisits, and satisfaction among postoperative neurosurgical patients. Materials and Methods This randomized control trial was conducted among 100 (50 in each arm) postoperative neurosurgical patients admitted to Neurosurgery department, All India Institute of Medical Sciences (AIIMS), New Delhi. The experimental group received mobile App–based discharge teaching additional to the routine paper-based discharge teaching received by the control group. Data were collected at baseline, during first (within 30th day) and second (within 60th day) routine follow-up visits using adherence to refills and medications scale (ARMS) questionnaire (medication compliance), self-developed structured questionnaires (lifestyle practices like tracheostomy tube (TT) catheter care, exercises and diet changes, revisits, and satisfaction) and computerized log record from App. Data were analyzed using descriptive and inferential statistics. Results The demographic and clinical profiles of both groups were comparable. There was no statistically significant difference in medication compliance between the experimental group and control group (p = 0.35 and 0.53) in first and second posttests, respectively. The level of confidence to perform lifestyle practices was high among experimental group. The subgroup analysis showed that patients in experimental arm were more compliant to medications as compared with control group (p = 0.001). Both the groups were comparable in terms of revisits (p = 0.26). However, the overall satisfaction of experimental group was reported to be highly using mobile App based teaching than control group with routine paper-based discharge teaching (p = 0.001). Conclusion Nurse-driven discharge teaching using mobile App is an effective method for neurosurgical patients to adhere to home-based discharge teachings. Use of technology like mobile Apps in vernacular language can bridge the gap for improving home-based care and follow-up among patients in resource constrained settings.

CRBP-TS - evaluation of a home-based training and health care program for colorectal, breast, and prostate cancer using telemonitoring and self-management: study protocol for a randomized controlled trial

BackgroundPhysical training is recommended in various national and international guidelines for patients with cancer. Observational studies have shown that physical activity leads to reduced recurrence and mortality rates by 20–40% in colorectal, breast, and prostate cancer. Despite existing evidence, a systematic care structure is still lacking. The primary aim of this study is to implement and evaluate an online training platform to strengthen physical performance and patient empowerment after cancer surgery.MethodsThe evaluation will be conducted as a prospective multicenter randomized controlled trial with three subgroups (colorectal-, breast-, and prostate cancer). Each group will include 100 patients (total 300 patients including dropouts; clinical stages T1–3 and/or N+; M0 after surgery intervention) and the primary endpoint (13% increase in the maximal oxygen consumption during exercise) will be examined. The intervention group will receive a 6-month home-based online training (2–3 times per week strength-endurance training using video presentations), bidirectional activity feedback information, online communication, and online counseling. The control group (usual care) will be advised lifestyle improvement. In-hospital testing will be performed before, during, and after the intervention. In addition to cardiopulmonary capacity, tumor specific diagnostics (liquid biopsy, depression and fatigue assessment, metabolic and endothelial screening) will be applied.DiscussionDue to the increasing incidence of cancer, associated with considerable mortality, morbidity and impaired quality of life, there is an imperative requirement for improved cancer care, of which structured physical training may become an integral component.Trial registrationDRKS-ID: DRKS00020499; Registered 17 March 2020.

Impact of Economic Accessibility on Realized Utilization of Home-Based Healthcare Services for the Older Adults in China.

Home-based healthcare service has gradually become the most important model to cope with aging in China. However, the contradiction between oversupply and insufficient demand of healthcare services is becoming increasingly serious. How to effectively improve the realized utilization of healthcare resources has become a key issue in the development of healthcare services. Based on the social background of “getting old before getting rich”, this article explores the relationship between economic accessibility and realized utilization, and finds that the impact of economic accessibility on realized utilization is inverted U-shaped, not a linear positive effect. In addition, considering the moderating role of family support, it is found that family support can strengthen the inverted U-shaped effect of economic accessibility on realized utilization. Therefore, exerting the role of family and improving economic accessibility can effectively solve the dilemma of low utilization of healthcare services.

Home-based Art Therapy in Hong Kong

Creative Arts Educ Ther (2020) 6(2):200–208 DOI: 10.15212/CAET/2020/6/27 Home-based Art Therapy in Hong Kong 香港在家藝術治療發展 Abstract This article investigates the validity and impact of home-based art therapy practices in Hong Kong by highlighting the needs of the home environment, the unique structure of the therapeutic relationship, and the appropriate treatment planning. Additionally, general and culturally specific ethical concerns are examined within the context of home-based mental health care. A home-based art therapy case study is presented to illustrate the benefits and complexities of such a modality. The possibilities of further development in home-based art therapy in Hong Kong are examined. Keywords: Hong Kong, home-based art therapy, mobile art therapy 摘要 本文透過審視家庭環境的需求、治療關係的獨特結構以及適當的治療計劃，對香港居家藝術治療工作的認受性及效力進行探討。此外，在以移动心理治療為基礎的前提下，對一般及特定文化的道德考慮納入分析。運用居家為基礎的藝術治療案例，展示說明其好處及這形式包含的複雜度。對香港居家藝術治療進一步發展的可能性進行探討。 關鍵字：香港，居家藝術治療，移动藝術治療

Preoperative Risk Assessment for Loss of Independence after Hepatic Resection in Elderly Patients: A Prospective Multicenter Study

Backgrounds: Hepatic resection often results in loss of independence in preoperatively self-sufficient elderly people. Elderly patients should therefore be carefully selected for surgery. However, a preoperative risk assessment method for loss of independence after hepatic resection has not been established. Methods: In this prospective, multicenter study, 347 independently-living patients aged ≥65 years, scheduled for hepatic resection, were divided into study (n=232) and validation (n=115) cohorts. We investigated the risk factors for postoperative loss of independence in the study cohort and verified our findings with the validation cohort. Loss of independence was defined as transfer to a rehabilitation facility, discharge to residence with home-based healthcare, 30-day readmission for poor functionality, and 90-day mortality (except for cancer-related deaths). Results: In the study cohort, univariate and multivariate analyses indicated that frailty, age ≥ 76 years, and open surgery were independent risk factors for postoperative loss of independence. Proportions of patients with postoperative loss of independence in the study and validation cohorts were respectively 3.0% and 0% among those with no applicable risk factors, 8.1% and 12.5% among those with one applicable risk factor, 25.5% and 25.0% among those with two applicable risk factors, and 56.3% and 50.0% among those with all three factors applicable (P< 0.001 for both cohorts). Areas under the receiver operating characteristic curves for the study and validation groups were 0.777 and 0.783, respectively. Conclusions: Preoperative risk-assessments using these three factors may be effective in predicting and planning for postoperative loss of independence after hepatic resection in elderly patients.

Association between Regionally Organized, Collaborative Home-Based Palliative Care and Healthcare Outcomes in Adults Who Died with Chronic Heart Failure: A Matched Cohort Study

Association between Regionally Organized, Collaborative Home-Based Palliative Care and Healthcare Outcomes in Adults Who Died with Chronic Heart Failure: A Matched Cohort Study

Using AI to Implement O2O Home Health Care Program

With the continuous growth of China’s elderly population, the demand for elderly care services has increased dramatically. Due to the influence of Chinese people’s cultural concept of elderly care, most of the elderly are more inclined to home-based care, enjoy the happiness of children and grandchildren, and enjoy family happiness. At present, there are some problems in home-based health care services, such as lack of professional talents and single service mode. This entrepreneurial project which is proposed by Wish Magic has grasped the pain points of China’s elderly care problems, and brought about some problems. Efforts should be made to build a sharing platform for elderly care services, attract professionals to provide professional services for the elderly, and hold diversified activities to meet the material and spiritual needs of the elderly. The planned market strategy of the project is divided into three steps. Firstly, the project will be carried out in the first and second tier cities, and then expanded to the third tier cities. Later, the market will be expanded to the fourth tier cities. At the same time, the project will cooperate with government departments to strive for government funding and policy support, and provide accurate services in combination with online and offline ways, so as to meet the diversified pension needs of the elderly.

Smart real time health monitoring system using Arduino and Raspberry Pi

The common problem we face these days is the lack of accurate health care for the elderly. There are many home-based health care monitoring systems but they are limited due to various setbacks. This work proposes a design of a health care monitoring system by using Arduino and Raspberry PI, to monitor the parameters i.e., heartbeat, body temperature, heart rhythm, and electrical activity. GPS module is used for tracking the location and camera for capturing live feed and an alert notification system that will notify the hospital and family if the values are abnormal and we can also check the real-time data in an app or a website that is incorporated into this module.

Situation, Challenges, and Countermeasures of Home-Based Healthcare Service Supply and Demand in China.

Situation, Challenges, and Countermeasures of Home-Based Healthcare Service Supply and Demand in China.

Research Progress on the Home-based Healthcare Plan for the Elderly with Chronic Diseases

Objective: To develop a home-based care plan for the elderly person with chronic diseases based on the status of their home-based care needs and relevant literature. Methods: The clinical data consisted of 132 patients who were 60-year-old or older with chronic diseases from June 2019 to May 2020 were selected and categorized into control and treatment groups of 66 patients each. For the experimental group, a care team for chronically ill elderly receiving regular post-treatment home-based care. Meanwhile, a general clinical care team for chronically ill elderly receiving regular treatment for the control group. The effectiveness of these two healthcare models was evaluated and analyzed. Results: Results showed that satisfaction and effectiveness of home-based care among the elderly with chronic diseases were statistically better (P&lt;0.05) than those in the usual care group. Conclusion: Providing home-based care services to elderly patients with chronic illnesses helps them to improve their chronic disease condition, patients are more receptive to home care, and patients have higher rates of recovery and treatment satisfaction.