Home Telecare Research Articles

Leveraging User-Friendly Mobile Medical Devices to Facilitate Early Hospital Discharges in a Pediatric Setting: A Randomized Trial Study Protocol.

Mobile technology is increasingly prevalent in healthcare, serving various purposes, including remote health monitoring and patient self-management, which could prove beneficial to early hospital discharges. This study investigates the transitional care program experience facilitating early discharges in a pediatric setting through the use of an easy-to-use mobile medical device (TytoCare™, TytoCare Ltd., Natanya, Israel). This study aims to assess the effectiveness of telehomecare in achieving complete resolution of diseases without readmission, compare the length of stay between intervention and standard care groups, and gather user and professional experiences. A randomized open-label, controlled pilot study enrolled 102 children, randomly assigned to the telehomecare (TELE) group (n = 51, adopting early hospital discharge with continued home monitoring) or the standard-of-care (STAND) group (n = 51). Primary outcomes include complete disease resolution without readmission. Secondary objectives include recording a shorter length of stay in the intervention group. Surveys on user and professional experiences were conducted. A group of 51 children declining telemedicine services (NO-TELE) was also included. In the TELE group, 100% of children achieved complete disease resolution without readmission, with a median duration of stay of 4 days, significantly shorter than the 7 days in the STAND group (p = 0.01). The telemedicine system demonstrated efficient performance and high satisfaction levels. The NO-TELE group showed no significant differences in demographics or digital technology competence. Perceived benefits of telemedicine included time and cost savings, reduced hospital stays, and technology utility and usability. This study demonstrates that user-friendly mobile medical devices effectively facilitate early hospital discharges in a pediatric setting. These devices serve as a bridge between home and hospital, optimizing care pathways.

Cloud-Based Realtime Decision System for Severity Classification of COVID-19 Self-Isolation Patients using Machine Learning Algorithm

The global impact of the COVID-19 pandemic has been profound, affecting economies and societal structures worldwide. Indonesia, with a high caseload, has encountered significant challenges across various sectors. Virus transmission primarily occurs through physical contact, and the surge in active cases has strained hospital capacities, leading to the hospitalization of only severe cases. The remaining patients receive home telecare, but some experience sudden health deterioration with fatal consequences. To address this issue, this study proposes a remote outpatient care system utilizing Internet of Things (IoT) technology and medical electronics. This integrated system aims to provide an effective response to the COVID-19 pandemic. The research includes a comparative analysis of three machine-learning algorithms: decision tree, gradient tree boosting, and random forest for the classification of COVID-19 patients. The results reveal that the random forest algorithm outperforms the others with an accuracy rate of 70%, as compared to 67% for the decision tree and 62% for the gradient tree boosting algorithm. This integrated system not only addresses immediate healthcare delivery challenges but also offers data-driven insights for patient classification, thereby enhancing the effectiveness and reach of medical interventions

Challenges of Implemention and Developing of Telehomecare: A Qualitative Study

Background: Providing health services through telehomecare in addition to increasing community access to health care services, reduce the challenges of aging communities. Objectives: In this study, the implementation and development challenges of telehomecare are examined. Methods: This qualitative study was conducted with a content analysis in 2022 in Iran. Twenty-three participants were selected by purposive sampling. Semi-structured interviews were used to collect data. Data were analyzed by content analysis (conceptual analysis) method and MaxQDA-10 software. Results: Five categories including costs imposed, rules and standards, infrastructure, health information security, and sociocultural were identified as challenges to the implementation and development of telehomecare. These five categories were divided into 19 subcategories. Conclusions: The implementation and use of telehomecare is face with several challenges. It seems that the most important reason for these challenges is related to the lack of responsible organizations and weakness in the rules.

Tele Homecare in Premature Infants’ Post-Discharge Early Follow-Up: A Narrative Review

The study was conducted to review, categorize and organize early tele-homecare follow-up research in premature infants based on research type, the focus of tele-homecare, and measured outcomes. This narrative review was conducted in 2021 through international databases, including PubMed, Scopus, ProQuest, and Web of Science databases. Studies selected for this purpose included original articles on premature infants. We reviewed 16 out of 267 identified articles. These studies were analyzed according to general characteristics, elements, and characteristics of tele-homecare intervention. Based on the obtained data, most studies had been conducted in Nordic countries as the pioneer in tele homecare. Also, most of them were on the psychological status of premature infants’ parents. Phone calls, video consultation, and applications were considered dominant tele-homecare communication tools. Overall, the qualitative studies on parents’ and health providers’ views about tele homecare revealed its hidden aspects as a supportive tool. The tele-homecare studies were distributed across different fields and countries, resulting in positive outcomes for infants and parents. However, further studies in the long-term periods are recommended to follow up on premature infants.

Evaluation of telehomecare Studies in Patients with Chronic Heart Failure: A health Technology Assessment Study

Background: Heart failure (HF) is a major complication resulting from a variety of heart diseases. HF is an increasingly important issue, whose prevalence has doubled in the last two decades. This is due to increased life expectancy, treatment and prevention of other heart diseases, and increased life expectancy. Promoting self-care through tele homecare is an emerging strategy for managing chronic diseases.
 Objectives: The purpose of this study is to evaluate tele-care studies in patients with chronic heart failure (CHF). This is based evaluating the types of technologies used for patients in this method, effectiveness, cost-effectiveness and safety of these technologies based on the aspects of health technology assessment.
 Methods: PubMed, Scopus, Web of Science, Cochrane databases, HTA (Health Technology Assessment), NHS EED (National Health System Economic Evaluation Database), DARE (Database of Abstract of Reviews of Effects), Embase, and (Society for Information Display) SID were searched using medical subject heading (Mesh) keywords. Then, studies were evaluated by two people and disputed by a third party. The quality of the extracted studies was evaluated based on the (Risk of Bias) RoB 2.0 checklist. The difference between the mean and its standard deviation was calculated (which was used as the effect size). To analyze the results, meta-analysis of random effects was performed. In addition, the subgroup and meta-regression analysis were performed to discover possible sources of heterogeneity. Finally, studies were evaluated in terms of Health Problem and Current Use of the Technology (CUR), Description and technical characteristics of technology (TEC), safety (SAF), Clinical effectiveness (EFF), Costs and economic evaluation (ECO) of 9 Aspects of Health Technology Assessment (HTA). Studies were evaluated with respect to the long-distance care in patients with CHF. We approach the method through systematic review and meta-analysis based on the principles of PRISMA-P. This systematic review examined the effectiveness of long-distance care interventions in patients with CHF, compared with conventional care methods. In general, evaluation of studies extracted in this systematic review will try to identify, evaluate and combine the effects of tele-care in patients with HF using meta-analytical methods in the evidence. Evaluating studies conducted in the field of tele-care in patients with CHF will help us to better understand how these methods work in the management of chronic heart disease [effectiveness, safety and cost reduction] and determine which care interventions Distance is more effective in patients with HF based on their characteristics according to clinical outcomes and resource use.
 Conclusion: The results of this study can be used as a guide to provide valid evidence for the decision of senior managers of the Ministry of Health and large hospitals to use common technologies used in distance care for patients with CHF and other chronic diseases. This study will also provide a new understanding of the various studies that have been conducted to help patients with chronic failure by different types of remote care technologies in terms of effectiveness, safety, technology, and economic costs.

Review of Systematic Reviews in the Field of Telemedicine.

Background: Although the systematic reviews regarding telemedicine have increased in recent decades, no comprehensive studies have been conducted to review these systematic reviews. The present study aimed to review the published systematic reviews regarding telemedicine applications for the report and appraisal of several aspects. Methods: The literature search was performed in the PubMed database for the systematic reviews published during January 2010-June 2020 in the field of telemedicine using “telemedicine” Mesh terms. The extracted data from the selected articles were the year of publication, telemedicine specialty, clinical outcomes, cost evaluation, and satisfaction assessment. Data analysis was performed using descriptive statistics. Results: Among 746 retrieved articles, 191 cases were selected and reviewed. Most of the studies were focused on telemedicine (n=35; 18.3%), followed by telerehabilitation (n=22; 11.5%), tele-diabetes (n=18; 9.4%), telecardiology (n=16; 8.3%), home telecare (n=13; 6.8%), telepsychiatry (n=12; 6.3%), teledermatology (n=11; 5.7%), and teleneurology (n=9; 4.7%). The selected studies were primarily focused on clinical outcomes (72.7%), followed by cost-effectiveness (32.4%) and user satisfaction (29.3%). In addition, they mostly indicated that telemedicine services yielded acceptable clinical outcomes (72.5%), cost-effectiveness (67.7%), and healthcare provider/patient satisfaction (83.9%). Conclusion: Although telerehabilitation, tele-diabetes, telecardiology, home telecare, and telepsychiatry were studied further, there are still some specific specialties such as teleradiology, telepathology, and telepediatric that should be considered more. Moreover, investigation of various outcomes could result in a more comprehensive view of this field. Therefore, further investigations in this regard would improve telemedicine applications and encourage potential telemedicine providers to initiate these applications.

Comparison of Telehomecare Interventions in Controlling Chronic Obstructive Pulmonary Disease (COPD): Protocol for a Systematic Review and Meta-analysis

Background: Chronic obstructive pulmonary disease (COPD) is considered the fourth main cause of mortality worldwide, affecting 10% of adults aged up to 40 years. Due to the growing elderly population and smoking, the global burden of COPD is expected to increase in the general population. Telemedicine may help patients with COPD to decrease exacerbation episodes and the associated costs. Moreover, Telehomecare (THC) may be considered as an alternative to cut down hospitalization costs and increase the patients’ comfort.
 Objectives: This study explains the methodology of a systematic review and meta-analysis designed to evaluate the impact of THC interventions on the control and management of COPD and its complications.
 Methods: To review all published studies comparing THC interventions in controlling COPD and its complications, all studies published in PubMed, Google Scholar, Scopus, ISI Web of Science, Cochrane databases, HTA EED, DARE, Embase, SID, Magiran will be searched until the end of 2021. Randomized controlled trials (RCTs), cluster RCTs, controlled clinical trials comparing telehealth with standard monitoring of COPD patients were included. Independent reviewers will review the abstracts and full-texts of all relevant studies for eligibility, risk of bias, and data extraction using structured forms. The meta-analysis will be performed for adequately homogenous studies regarding their populations, interventions, and objectives.
 Conclusion: The results of this systematic review and meta-analysis will provide useful information on the impacts of THC on COPD control. The evidence provided by this systematic review can be helpful for clinical specialists, public health policymakers, and the general population.

THE IMPACT OF TELEHOMECARE ON HEART FAILURE PATIENTS, NURSES, AND INFORMAL CAREGIVERS: A LONGITUDINAL COHORT STUDY

THE IMPACT OF TELEHOMECARE ON HEART FAILURE PATIENTS, NURSES, AND INFORMAL CAREGIVERS: A LONGITUDINAL COHORT STUDY

ASSESSING THE EFFECTIVENESS AND COST-EFFECTIVENESS OF TELEHOMECARE (THC) PROGRAM IN PATIENTS WITH HEART FAILURE

In 2007 Ontario Telemedicine Network (OTN) launched pilot of telehomecare (THC) for HF patients residing in Central West (CW), Toronto Central (TC) and North East (NE) local health integration networks (LHINs). Following the successful pilot, program expansion was initiated in 2012 across 3 LHINs. The quasi experimental pre-post study aimed to assess effectiveness and cost effectiveness of THC in HF patients enrolled in THC across 3 LHINs.

IMPACT OF TELEHOMECARE ON HEALTH SYSTEM UTILIZATION IN PATIENTS WITH HEART FAILURE

In 2007 Ontario Telemedicine Network (OTN) launched pilot of telehomecare (THC) for HF patients residing in Central West (CW), Toronto Central (TC) and North East (NE) local health integration networks (LHINs). Phase 1 program expansion was initiated in 2012, based on pilot results indicating that THC may improve quality and access to care among HF population. The quasi experimental pre-post study aimed to assess impact of THC on health system utilization in HF patients enrolled in THC across 3 LHINs. Primary research data was linked to National Ambulatory Care Reporting System (NACRS) and Discharge Abstract Database (DAD) between July 26th, 2012 and up to March 31, 2014. THC impact on composite outcome (ED visits and hospitalizations); and disease specific ED visits and hospitalizations was assessed for a period of 30 days and 180 days pre and post THC enrollment. Data was analyzed based on intention to treat approach using generalized linear mixed model procedures in SAS. Subgroup analysis assessed impact of THC on gender and whether the impact varied by LHIN. In cohort of N=783 HF patients, average 76.93 ± 10.97 years of age; 51% were females; whereas N=257 (33%); N=155 (20%); and N=371 (47%) were recruited from CW, NE and TC LHINs respectively. Results indicate significant decrease in: composite outcome (95% CI: -0.70 to -0.44)/ (95% CI interval: -0.44 to -0.31); disease specific ED visits (95% CI: -1.55 to -0.87)/ (95% CI interval: -1.02 to -0.66) and hospitalizations (95% CI: -1.90 to -1.13)/ (95% CI interval: -1.20 to -0.82) in 30 days and 180 days post-THC. NE and TC LHINs patients experienced significant reductions in disease specific ED visits (95% CI interval: -1.09 to -0.12) (95% CI interval: -0.74 to -0.04) and hospitalizations (95% CI interval: -2.61 to -1.07) (95% CI interval: -0.83 to -0.22) in 30 days post-THC. Compared with women, men experienced higher rates of composite outcome (95% CI interval: 0.05 to 0.29) and all cause hospitalizations (95% CI interval: 0.08 to 0.33) 180 days post-THC. High system users experienced increased rates of system utilization 30 and 180 days post-THC. Results indicate that THC may impact health system utilization of HF patients. The impact may differ between genders; and program may be of benefit to patients residing in particular LHINs. Findings of the study merit further investigation on impact of THC.

HealthBand for Dementia Patients: Fall and Scream Detector and Caretaker Helper

The ratio of dementia patients is escalating with time and requires proper attention to help the people suffering from it to continue their activities of daily living (ADL). Such patients suffer from the symptoms like irregular sleep patterns, restlessness, wandering, screaming, falling, sadness and depression. Assistive Technology facilitates caretaker to aid the patient efficiently with minimum effort. Advances in technology have made possible state of the art and innovative methods of health care delivery. Home telecare; in which the patient’s health is monitored remotely at home, is one such method. This paper is proposing a cost effective and user friendly wearable product based solution (i.e. HealthBand) that monitors patient’s activities (specifically fall and scream) and notifies the caretaker in case of emergency to take appropriate action(s). These notifications are sent to the caretaker on the basis of predefined threshold and time span over Bluetooth and GSM mediums to android based application. The android app also keeps patient’s medicines’ intake record and reminds caretaker regarding medicine dosage and timings.

EPS6.2 Feasibility of telehomecare (THC) in children with cystic fibrosis (CF)

EPS6.2 Feasibility of telehomecare (THC) in children with cystic fibrosis (CF)

Barriers and facilitators for sustainability of tele-homecare programs: a systematic review1)

Thuiszorg wordt in de Verenigde Staten geconfronteerd met bezuinigingen, terwijl er tegelijkertijd een groter beroep op wordt gedaan. Er is daarom behoefte aan innovaties die verpleegkundigen ondersteunen om effectieve en doelmatige zorg te verlenen aan chronisch zieken. De inzet van telezorg – of: zorg op afstand – wordt gezien als een mogelijke oplossing.

Simulation of an optimized technique based on DS-CDMA for simultaneous transmission of multichannel biosignals.

Telemedicine is becoming increasingly, with applications in many areas of healthcare, such as home telecare of the elderly, diagnosis at a distance and robotic surgery. The simultaneous transmission of several leads of biomedical signals should be considered in telemedicine, given the many benefits it brings. Code division multiple access (CDMA) is a multiple access technique that enables users to transmit independent information simultaneously within the same bandwidth. The direct sequence CDMA (DS-CDMA) is a variant of the CDMA technique in which a pseudorandom sequence having a higher bandwidth than the information signal is used to modulate the information signal directly. Biomedical signals are confidential; thus, their transmission must be secured. In this paper we propose a protocol similar to DS-CDMA for the simultaneous transmission of all of the leads of some multichannel biomedical signals. We assigned orthogonal codes to different leads of a signal. The convolution of each lead with the code gives a signal spread over a broad frequency band. All of the spread signals are then mixed to produce a single composite signal. This composite signal is frequency modulated, amplified and transmitted. At the reception, inverse functions to the previous are developed to perform demodulation, demultiplexing and extraction of the physiological signals transmitted. We used the discrete Walsh functions as codes. The results obtained are satisfactory, even in situations where the noise disturbances are significant.

Oral home telecare tutorials for the community-dwelling elderly.

The objectives of this empirical study were to evaluate the quantitative and qualitative alterations experienced by community-dwelling elderly and their families when employing oral home telecare (a care service system based on interactive motion-picture transmission between households and healthcare providers). The subjects were four community-dwelling elderly in Kuriyama-cho, Hokkaido. The tutorial programs were designed to provide health information and education, as well as to enhance life skills related to exercise and communication. The programs were provided to the elderly through a new oral healthcare interactive learning system disseminated via an ISDN-based network. Quantitative and qualitative observation data on oral home telecare were collected by videophone and subsequently discussed. Functional independence in daily activities, communication skills, and social cognition, independence in oral care, and oral hygiene status all improved. Clients and their families were able to acquire broader knowledge relating to oral and general health, practical oral homecare skills, and social life skills. The use of this home telecare system as a "preventive home visit" and as a "living environmental tool" incorporating broad social supports could help improve the quality of life of clients and become part of a community oral healthcare service.

Effectiveness of telehome-care in functional recovery after stroke: a randomized, controlled trial

Objective To investigate the influence of a multifaceted stroke telehome-care (THC) on extremities function, activities of daily living (ADL) and quality of life in stroke patients with hemiplegia. Methods A total of 52 stroke survivors in department of neurology were randomized to the THC intervention or usual care. The patients in the control group received conventional care, while those in the intervention group were additionally given a THC program over 3 months. The THC intervention includes motor imagery and adaptive strategies. Data collection was undertaken using the Fugl-Meyer Motor Assessment Scale (FMA), the Barthel Index (BI), the Stroke Impact Scale (SIS) at baseline, 3 months, and 6 months. Results At baseline, the scores of FMA, BI, and SIS in the intervention group were 53.62±23.52, 54.04±17.44, 179.96±28.51, and while the scores of the control group were 50.96±19.52, 49.46±15.09, 169.23±28.48. There were no pre-existing differences on any scale between the two groups (t=0.443, 1.012, 1.358, P > 0.05). At 3 months, the scores of FMA, BI, SIS in the control group were 53.54±17.45, 50.77±14.47, 76.19±27.78, and were significantly lower than 78.38±12.54, 74.62±11.22, 228.54±22.63 in the THC group (t=5.895, 6.641, 7.449, P < 0.01). At 6 months, the scores of FMA, BI, SIS in the control group were 57.88±17.89, 59.08±13.85, 183.92±26.56, and were significantly lower than 90.58±9.60, 86.54±9.88, 252.19±20.10 in the THC group (t=8.211, 8.233, 10.451, P < 0.01). Conclusions A telehome-care program that provide distance training and education of disabled persons resulted in greater improvements in physical functioning, ADL and quality of life. Key words: Stroke; Rehabilitation nursing; Telerehabilitation

Morbidity and medication consumption among users of home telecare services.

Telecare is a healthcare resource based on new technologies that, through the services offered, attempt to help elderly people to continue living in their homes. In this sense, first-generation telecare services have quickly developed in Europe. The aim of this work was to define the profile, pattern of medication consumption and disease frequencies of elderly users of a telecare service. The cross-sectional study involved 742 Spanish community-dwelling elders (85.3% of the total users aged 65years and over who used a telecare service before the end of the data collection period). Data were collected between March and September 2012. Subjects' mean age was 83.3 (SD 6.6) years, and the majority lived alone (78.3%) and were female (85.8%). The mean Charlson comorbidity index score was 1.13 (SD 1.1), and the mean number of prescribed medications per day was 5.6 (SD 3.0). The most frequent diseases were hypertension (51.1%) and rheumatic disorders (44%); and the most consumed medications were those for the cardiovascular (75%) and nervous (65.2%) systems. For the total sample, the three main determinants of polymedication (five or more medications) were hypertension, anxiety-depressive symptoms and coronary heart disease. Regardless of the social elements contributing to the implementation of telecare services, specific health characteristics of potential users, such as morbidity and polypharmacy, should be carefully considered when implementing telecare services in the coming years.

Pressure Mapping Mat for Tele-Home Care Applications

In this paper we present the development of a mat-like pressure mapping system based on a single layer textile sensor and intended to be used in home environments for monitoring the physical condition of persons with limited mobility. The sensor is fabricated by embroidering silver-coated yarns on a light cotton fabric and creating pressure-sensitive resistive elements by stamping the conductive polymer poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate) (PEDOT:PSS) at the crossing points of conductive stitches. A battery-operated mat prototype was developed and includes the scanning circuitry and a wireless communication module. A functional description of the system is presented together with a preliminary experimental evaluation of the mat prototype in the extraction of plantar pressure parameters.

Specification of an integrated information architecture for a mobile teleoperated robot for home telecare

ABSTRACTObjective: The objective of this study was to design effectively integrated information architecture for a mobile teleoperated robot in remote assistance to the delivery of home health care. Methods: Three role classes were identified related to the deployment of a telerobot, namely, engineer, technology integrator, and health professional. Patients and natural caregivers were indirectly considered, this being a component of future field studies. Interviewing representatives of each class provided the functions, and information content and flows for each function. Interview transcripts enabled the formulation of UML (Universal Modeling Language) diagrams for feedback from participants. The proposed information architecture was validated with a use-case scenario. Results: The integrated information architecture incorporates progressive design, ergonomic integration, and the home care needs from medical specialist, nursing, physiotherapy, occupational therapy, and social worker care perspectives. The integrated architecture iterative process promoted insight among participants. The use-case scenario evaluation showed the design’s robustness. Conclusions: Complex innovation such as a telerobot must coherently mesh with health-care service delivery needs. The deployment of integrated information architecture bridging development, with specialist and home care applications, is necessary for home care technology innovation. It enables continuing evolution of robot and novel health information design in the same integrated architecture, while accounting for patient ecological need.

Medical Cyber-Physical System for Home Telecare of High-Risk Pregnancy: Design Challenges and Requirements

Medical Cyber-Physical System for Home Telecare of High-Risk Pregnancy: Design Challenges and Requirements