Telehome Monitoring Research Articles

Predicting exacerbations in severe preschool wheezers.

Simple clinical indices, complex composite phenotyping/endotyping and telehome monitoring now allow us to evaluate the risk of preschool wheezing on a population or individual level. We herein discuss the usefulness of clinical markers which involve underlying issues such as in utero smoke exposure, the pathophysiology of viral-immunological-allergic interactions, and changes in airway epithelium, mesenchyme and smooth muscle cells. The most important unmet need in this age group remains disease-modifying interventions.

Sustaining e-health innovations in a complex hospital environment: learning through evidence.

Implementing and sustaining technological innovations in healthcare is a complex process. Commonly, innovations are abandoned due to unsuccessful attempts to sustain and scale-up post implementation. Limited information is available on what characterizes successful e-health innovations and the enabling factors that can lead to their sustainability in complex hospital environments. We present a successful implementation, sustainability and scale-up of a virtual care program consisting of three e-health applications (telemedicine, telehome monitoring, and interactive voice response) in a major cardiac care hospital in Canada. We describe their evolution and adaptation over time, present the innovative approach for their "business case" and funding that supported their implementation, and identify key factors that enabled their sustainability and success, which may inform future research and serve as a benchmark for other health care organizations. Despite resource constraints, e-health innovations can be deployed and successfully sustained in complex healthcare settings contingent key considerations: simplifying technology to make it intuitive for patients; providing significant value proposition that is research supported to influence policy changes; involving early supporters of adoption from administrative and clinical staff; engaging patients throughout the innovation cycle; and partnering with industry/technology providers.

Trust and Objects: Trust Building Capacities of Objects in Interorganizational Collaboration

Research has paid attention to individual dispositions of trust and the interpersonal trust relations among boundary spanners leaving little attention to objects in relation to trust building in interorganizational collaboration processes. This study explores the dynamic relation between trust and objects in interorganizational collaboration. A longitudinal study of an innovative tele-home monitoring service involving health professionals from hospitals, municipalities, and general practice clinics forms the empirical context for this study.
 This study demonstrates that trust is not alone a human feature but also a dimension of objects since objects mediate and build trust among actors by creating a focused communication and shared knowledge, improving predictalibility and transparency in behavior and decision-making, and creating visibility about work contexts and tasks. In the context of this paper these three features denote objects’ trust building capacities which support shared problem-solving and collaboration. The study, however, also show a flipside of objects where they may create mistrust and thereby act as barriers for collaboration. Overall, these insights contribute to the literature about trust in interorganizational collaboration processes by foregrounding the role of objects in trust building processes and exploring their trust building capacities.

Telehome Monitoring of Symptoms and Lung Function in Children with Asthma.

Background: The ability to perceive bronchial obstruction is variable in asthma. This is one of the main causes of inaccurate asthma control assessment, on which therapeutic strategies are based. Objective: Primary: To evaluate the ability of physicians to characterize the bronchial obstruction perception profile in asthmatic children using a clinical and spiro-metric telemonitoring device. Secondary: To evaluate its impact on asthma management (control, treatment, respiratory function variability) and the acceptability of this telemonitoring system. Methods: 26 asthmatic children aged 6–18 years equipped with a portable spirometer and a smartphone application were home-monitored remotely for 3 months. Clinical and spiro-metric data were automatically transmitted to a secure internet platform. By analyzing these data, three physicians blindly and independently classified the patients according to their perception profile. The impact of telemonitoring on the quantitative data was assessed at the beginning (T0) and end (T3 months) of telemonitoring, using matched statistical tests. Results: Patients could initially be classified according to their perception profile, with a concordance between the three observers of 64% (kappa coefficient: 0.55, 95%CI [0.39; 0.71]). After discussion among the observers, consensus was reached for all patients but one. There was a significant >40% decrease in FEV1 and PEF variability, with good acceptance of the device. Conclusions: Clinical and spiro-metric tele-home monitoring is applicable and can help define the perception profile of bronchial obstruction in asthmatic children. The device was generally well accepted.

Rural-Urban Comparison of Telehome Monitoring for Patients with Chronic Heart Failure.

Rural geographic isolation may act as a promoting or restraining variable to the diffusion of technology and healthy aging in the community. Telehome monitoring (TM) leverages technology to support seniors living in the community with chronic conditions. To date, limited research has investigated the utilization of TM in rural settings. This study assesses the comparative utilization of TM for patients with heart failure in rural versus urban environments. We conducted a cross-sectional study involving chart reviews of all patients enrolled in the TM program at the University of Ottawa Heart Institute during 2014. Data were extracted on urban/rural status, demographic characteristics, and process and outcomes of care. Descriptive, bivariate, and multivariate analyses were conducted. More rural patients did not have a documented reason for emergency room visits compared to urban patients. There was no significant association between the urban/rural status and the process and outcome measures at the multivariate level. Being followed-up regularly by a family physician and a specialist, as opposed to a specialist or general practitioner only, was associated with significantly longer TM period and a higher number of diuretic adjustments and calls made by nurses. Although more urban patients were older and living alone, their profile did not affect their utilization of TM. The difference in diagnosis between urban and rural patients also did not contribute to such differences. Hence, there is no variation in the process and outcome measures associated with the utilization of TM between urban and rural environments. Rural patients may not be perceived as extensive users of resources nor patients who represent challenges in terms of feasibility of TM use.

Economic outcomes from telecardiology services

ABSTRACT Background and Objectives: Owing to the scarcity of health-care financing and the pressure of aging with the associated increased incidence of chronic heart failure, new models of health-care delivery supported by technology solution require a social economic analysis. We aim to assess improvement of Kansas City Living with Cardiomyopathy Questionnaire (KCCQ) score with telehome monitoring in elderly patients affected with Chronic Heart Failure (CHF) and to estimate a probable cost saving for health-care provider and patient, by calculating a probability to reduce fatal events such as mortality and hospitalization associated with improved health status measured with the KCCQ questionnaire. Materials and Methods: An observational quasi-experimental trial was used. Eight patients affected with chronic heart failure aged 85-90 years of age who have been at least three times hospitalized within the last year were recruited for the study. These patients received an educational module to empower their self-management capacity and a medicine kit necessary for telehome monitoring. The KCCQ questionnaire was employed. The KCCQ questionnaire is an independent predictor of health-care resource utilization. The KCCQ score improvement is associated likely with rehospitalization and mortality reduction according to results from previous clinical trial, where KCCQ score has been demonstrated as a strong statistically independent predictor of mortality and rehospitalization after adjustment for other variables. Results: The KCCQ score improved for 15 points from baseline measurement, after 6 months of telehome monitoring. The improvement of KCCQ score of 15 points represents a reduction of probability of hospitalization and mortality for 18% and 16%, respectively. In addition, an individual's cost savings were calculated, using the individual's willingness to pay to avoid fatal event, individual's productivity gain by avoiding a travel to remote hospital facilities, and an improved probability of positive event with telehome monitoring. Conclusion: Analysis demonstrated a probability for an important economical saving with the use of telehome monitoring for the provider and patient. We can conclude that telehome monitoring represents an innovative service that provides clinical and economical value addition to the patient, health-care system, and society.

WebRTC-based video conferencing service for telehealth

Existing video conferencing systems that are often used in telehealth services have been criticized for a number of reasons: (a) they are often too expensive to purchase and maintain, (b) they use proprietary technologies that are incompatible to each other, and (c) they require fairly skilled IT personnel to maintain the system. There is a need for less expensive, compatible, and easy-to-use video conferencing system. The web real-time communication (WebRTC) promises to deliver such a solution by enabling web browsers with real-time communications capabilities via simple JavaScript APIs. Utilizing WebRTC, users can conduct video/audio calls and data sharing through web browsers without having to purchase or download extra software. Though the promise and prospective of WebRTC have been agreed on, there have not been many cases of real life applications (in particular in telehealth) that utilizes the WebRTC. In this paper, we present our practical experience in the design and implementation of a video conferencing system for telehealth based on WebRTC. Our video conferencing system is a part of a large tele-home monitoring project that is being carried out at six locations in five different states in Australia. One of the aims of the project is to evaluate whether high-bandwidth enabled telehealth services, delivered through tele-home monitoring, can be cost effective, and improve healthcare outcomes and access to care. This paper however focuses on WebRTC-based video conferencing system which allows online meetings between remotely located care coordinators and patients at their home. We discuss the underlying issues, detailed design and implementation, and current limitations of using WebRTC in a real life application.

N060 A Pilot Trial of a Coaching Intervention Desgined to Increase Woman's Attendance at Cardiac Rehabilitation Intake

BACKGROUND/RATIONALE: Cardiovascular disease (CVD) continues to be the leading cause of death of Canadian women and while treatment for CVD has improved dramatically, women typically fare worse than men. Cardiac rehabilitation (CR) is well established as a key intervention in the treatment of coronary artery disease and has been shown to be effective in both men and women. CR remains largely underutilized, especially in women who comprise only 1224% of contemporary CR programs, even though the prevalence of CVD in men and women is similar(American Heart Association, 2009). OBJECTIVES/RESEARCH QUESTIONS: The objectives of this pilot trial were to test the feasibility of all procedures, specifically to determine: 1) an estimate of patient recruitment rates, 2) acceptability and feasibility of the intervention and 3) barriers to CR attendance and resources required. Additionally, exploratory research questions were used to determine the effects of telephone coaching on womens’ attendance at CR intake appointment, self-efficacy for cardiac exercise and self-efficacy to attend CR. METHODS: A RCT design enrolled women with CVD referred for CR at a single site in Ontario. Patients were randomized, stratified for age, to either a usual care group or an intervention group. Participants allocated to usual care received a referral to CR. In addition to usual care, women randomly assigned to the intervention group received individualized telephone coaching, designed to support self-management. RESULTS: Eighty-four patients were approached and 70 consented to participate (usual care n 36, intervention n 34). Participants were highly satisfied with their coaching experience; they found the information provided to be helpful with goal setting, action planning and assisted them in their interactions with their health care providers. Participants received three to five calls prior to CR intake appointment and the telephone calls were generally less than 28 minutes in duration (n 118, 99%). Barriers to attendance identified included transportation, health concerns, timing and lack of physician endorsement. Most common resources identified included problem solving support, assistance with communication with physicians and information concerning CR. Participants in the intervention group were significantly more likely to attend CR intake (p 0.048). SIGNIFICANCE/IMPLICATIONS: The evidence obtained from this pilot trial suggests that a telephone coaching intervention designed to enhance self-management is feasible and may improve attendance at CR intake for women following hospital discharge with a cardiac event. N061 DO ALL TAVI PATIENTS REQUIRE TELEHOME MONITORING FOLLOW-UP AFTER DISCHARGE FROM HOSPITAL?

Utilisation of Telehome Monitoring in Patients over the Age of 75 with Complex Heart Failure; Does Age Make Any Difference?

TeleHome monitoring (THM) is a program designed for home monitoring of patients by nurses, based on direct transmission of clinical data to a central station. THM provides personalized health care derived from daily access to data with better record keeping and empowers patients to get involved with their care. Past research has shown benefits in the reduction of hospitalizations and costs, decrease in mortality, improved quality of life (QOL) and functional class. Data on the elderly population (>75 years of age) undergoing THM is more limited.

The Impact of Telehome Care on Health Status and Quality of Life Among Patients with Diabetes in a Primary Care Setting in Poland

Telehome care has been proposed as a solution to the challenges of providing effective and affordable care for patients with diabetes. A total of 100 adult patients with type 2 diabetes-divided between insulin and noninsulin requiring-was enrolled in a randomized, controlled trial aimed at investigating the effects of telehome monitoring. The experimental group (n = 50) received an in-home wireless glucose monitor and transmitter, whereas the control group (n = 50) was instructed to follow the conventional arrangement. There was an overall reduction in HbA1c values in both experimental and control groups after 6 months. A significant difference in HbA1c values between the groups was observed only among the noninsulin-requiring patients (decline from 6.95% ± 0.82% to 6.66% ± 0.86% in IB vs. 7.21% ± 2.02% to 7.2% ± 1.86% in IIB; p = 0.02). The experimental group reported considerably less hyperglycemic and hypoglycemic events. The profile of the patient who benefited the most from telemonitoring consisted of older, more educated patient who had acquired the disease relatively recently, and who spends most of the time at home. The experimental group had higher overall scores on quality of life measures and sense of control over diabetes. There was a positive association between educational attainment and ability to use the telemonitoring system without help (p = 0.045). Although not conclusive because of the small sample and short observation period, the study suggests that telehome monitoring is an effective tool in controlling type 2 diabetes in a primary care setting.

Implementation of a Wireless Device for Real-Time Telemedical Assistance of Home-Ventilated Amyotrophic Lateral Sclerosis Patients: A Feasibility Study

Neuromuscular disorders encompass a wide category of illnesses with a significant burden on the patient, family, and society. Telehome monitoring presents an alternative for closer follow-up, by ensuring timely transmission of data and prompting medical support before deterioration occurs. We used telehome monitoring devices for amyotrophic lateral sclerosis patients with respiratory failure in a clinic. This instrument directly acts as a digital recorder of parameters received from an external instrument, such as the bi-level ventilator, and contains an internal modem for direct connection to the Internet, thereby allowing bidirectional flexibility in collecting data and parameter changes whenever needed. The use and acceptance of the system was investigated with patients and all therapists involved. The instrument was found to be user-friendly and effective by the researchers, being practical for both patients and therapists. Therefore, it can be integrated into a routine home care application based on a large respiratory rehabilitation center. The device was extensively tested, and in an ongoing randomized controlled study it is being investigated whether this management strategy is able to hasten the ventilator adaptation process and to diminish the overall utilization of health services, with concurrent economic viability. We conclude that home telemonitoring represents a positive contribution to the management of chronic patients and raised awareness of it should be considered in a near future. This portable telemonitoring device provides an opportune approach to better understand and recognize a ventilatory pattern through long-term ventilation monitoring in the home environment.

Telehome monitoring reduced readmissions and improved quality of life in heart failure or angina

A K Woodend Dr A K Woodend, University of Ottawa, Ottawa, Ontario, Canada; kwoodend@uottawa.ca In patients with heart failure (HF) or angina who are at high risk for hospital readmission,...

Telehome monitoring in patients with cardiac disease who are at high risk of readmission1

Chronische aandoeningen zoals cardiovasculaire aandoeningen vormen de grootste operationele en financiele uitdaging in het gezondheidszorgsysteem in de komende 10 jaar. Ongeveer 1 op de 100 in de totale bevolking en 1 op de 10 in de populatie ouderen hebben hartfalen (chronisch) waarbij herhaalde ziekenhuisopnames voor HF niet ongewoon zijn.2 Onderzoek onder steekproeven van patienten met HF rapporteren heropnamecijfers rond 47 procent in drie maanden en 54 procent in 6 maanden3- 4 hetgeen een betekenisvolle aanslag op de gezondheidszorgvoorzieningen met zich meebrengt.

A Tele-home Care System Exploiting the DVB-T Technology and MHP

The aim of this research work is the development of a low-cost system for telemedicine based on the DVB-T technology. The diffusion of DVB-T standard and the low cost of DVB-T set-top boxes bring the vision of a capillary distribution of tele-home care monitoring systems with easy-to-use patient's interface. Exploiting the potentiality of the DVB-T set-top box, we transformed it into an "on-demand tele-home care interface". The Xlet we developed is able to govern the functionality of an external microcontroller-based unit for the acquisition of the bio-signals of interest. The uplink connection is used to send the exam results to a remote care center. The Xlet providing the patient interface on the set-top box is uploaded by a DVB-T broadcaster without any intervention in the patient's home. A prototypal low-cost base station for the acquisition of the patient's signals (1-lead ECG) has been developed. It is able to be connected to the set-top box via an infrared link. A smart-card-based system is in charge for the customization of the Xlet for every patient. The proposed system, based on a currently widespread infrastructure, is able to allow the patients monitoring from home without any installation procedure. Even untrained (or elderly) people can easily use such system due to their practice with the basic DVB-T home-entertainment equipments.

Telehome monitoring in patients with cardiac disease who are at high risk of readmission

Patients with chronic conditions are heavy users of the health care system. There are opportunities for significant savings and improvements to patient care if patients can be maintained in their homes. A randomized control trial tested the impact of 3 months of telehome monitoring on hospital readmission, quality of life, and functional status in patients with heart failure or angina. The intervention consisted of video conferencing and phone line transmission of weight, blood pressure, and electrocardiograms. Telehome monitoring significantly reduced the number of hospital readmissions and days spent in the hospital for patients with angina and improved quality of life and functional status in patients with heart failure or angina. Patients found the technology easy to use and expressed high levels of satisfaction. Telehealth technologies are a viable means of providing home monitoring to patients with heart disease at high risk of hospital readmission to improve their self-care abilities.