The aim of this study was to examine the satisfaction with telehealth technologies of all users-p... more The aim of this study was to examine the satisfaction with telehealth technologies of all users-patients, health care providers, and telehealth presenters. As the use of videoconferencing in health care is rapidly increasing to allow adequate and timely access to care for patients from rural areas, it is important to examine how these technologies are perceived and utilized. Three separate surveys were used to collect data: patient, provider, and telehealth coordinator. Patient surveys were collected in a paper format, while provider and coordinator surveys were done using REDCap (Research Electronic Data Capture) application. Findings indicate high satisfaction with telehealth, as well as confidence in providing care via distance. While this is encouraging for both patients and health care organizations, further studies should be done to include urban telehealth as well as other types of health care organizations utilizing videoconferencing for clinical appointments.
Perspectives in health information management / AHIMA, American Health Information Management Association, 2015
Robotic telepresence has been used for outsourcing of healthcare services for more than a decade;... more Robotic telepresence has been used for outsourcing of healthcare services for more than a decade; however, its use within an academic medical department is not yet widespread. Intensive care unit (ICU) robots can be used to increase access to off-site supervising physicians and other specialists, reducing possible wait time for difficult admissions and procedures. To study the use of ICU robots through a pilot program in an academic hospital and examine provider attitudes toward the usability and effectiveness of an ICU robot. The study was done as a postinterventional cross-sectional seven-question survey in a medical ICU in an urban academic hospital. Participants were attending physicians, fellows, residents, nurses, and respiratory therapists. Users of the ICU robot reported satisfaction with communication, and improved patient care. They also reported perceived improved quality of care with the use of the robot. Findings show the importance of a whole-team approach to the insta...
Cancer registry data collection involves, at a minimum, collecting data on demographics, tumor ch... more Cancer registry data collection involves, at a minimum, collecting data on demographics, tumor characteristics, and treatment. A common, identified, and standardized set of data elements is needed to share data quickly and efficiently with consumers of this data. This project highlights the fact that, there is a need to develop common data elements; Surveys were developed for central cancer registries (CCRs) and cancer researchers (CRs) at NCI-designated Cancer Centers, in order to understand data needs. Survey questions were developed based on the project focus, an evaluation of the research registries and database responses, and systematic review of the literature. Questions covered the following topics: 1) Research, 2) Data collection, 3) Database/ repository, 4) Use of data, 5) Additional data items, 6) Data requests, 7) New data fields, and 8) Cancer registry data set. A review of the surveys indicates that all cancer registries' data are used for public health surveillance, and 96% of the registries indicate the data are also used for research. Data are available online in interactive tables from over 50% of CRs and 87% of CCRs. Some other survey responses indicate that CCR treatment data are not complete for example treatment data, however cancer researchers are interested in treatment variables from CCRs. Cancer registries have many data available for review, but need to examine what data are needed and used by different entities. Cancer Registries can further enhance usage through collaborations and partnerships to connect common interests in the data by making registries visible and accessible.
The purpose of this project was to explore how persons with chronic heart failure (CHF) obtain an... more The purpose of this project was to explore how persons with chronic heart failure (CHF) obtain and use health information about their condition and how health literacy might have an impact. We interviewed 28 patients with CHF regarding their quality of life, chronic illness care, literacy level, and knowledge about self-management care for CHF.
Most countries in Europe and the USA are increasingly using an electronic medical record (EMR) to... more Most countries in Europe and the USA are increasingly using an electronic medical record (EMR) to help improve healthcare quality. Unfortunately, most developing countries face many challenges ranging from epidemics and civil wars to disasters: they also lack a robust healthcare infrastructure in the form of information and communications technology (ICT) to ensure continuity of patient health which many research studies consider a lifesaving resource. The aim of this systematic review is to examine the benefits of an EMR and its contribution to the development of healthcare delivery in developing countries. We searched MEDLINE, PubMed, CINAHL, COMPENDEX and Academic Search Premier as well as systematically searching the reference lists of included studies and relevant reviews. Inclusion criteria were that studies should relate to the importance and challenges of an EMR system, paper-based medical records, development and implementation of an EMR system in developing countries or EM...
The objective of this pilot study was to assess the accessibility of congestive heart failure con... more The objective of this pilot study was to assess the accessibility of congestive heart failure consumer information on the web. Twenty-seven education trials involving 5589 patients with congestive heart failure were analyzed. Education topics and outcomes were abstracted. Twenty education topics were linked to outcomes. A sample of 15 websites missed 56.7% of education topics and 61.8% of technical website characteristics that have suggested accuracy, reliability, and timeliness of content.
Several initiatives have addressed patient safety by enabling electronic voluntary reporting of a... more Several initiatives have addressed patient safety by enabling electronic voluntary reporting of adverse events within academic medical centres in urban settings. Such initiatives are lacking in the rural context, and it remains unknown whether the same challenges and solutions apply to rural hospitals. The purpose of this study is to provide insight into the organisational culture and level of readiness to adopt patient safety strategies in a rural setting, as well as to identify critical issues pertaining to the rural context that need to inform the design of such strategies. We conducted telephone interviews with administrators and healthcare providers of rural hospitals in one US state. Questions referred to the respondents' current reporting mechanism, its advantages and disadvantages, and organisational patient safety culture. A total of 16 administrators and 14 providers of eight rural hospitals in the state of Missouri were interviewed. Findings indicate that very few adm...
Veterans' health care has shifted towards outpatient treatment, and because of the high prevalenc... more Veterans' health care has shifted towards outpatient treatment, and because of the high prevalence of chronic illness in veterans, more caregiving has been required of their families. The purpose of this study was to identify predictors of caregiver (CG) strain and satisfaction associated with caring for veterans with chronic illness. Data were collected using telephone interviews of 120 dyads. Strain was associated with helping with instrumental activities of daily living, using counseling and prayer for coping, accompanying veteran to appointments, help/advice from friends, paid help, exercising, and depression. Satisfaction was associated with veteran health, CG social support, age, and depression. Innovative and easily accessible interventions are needed to mitigate sources of strain in CGs of chronically ill veterans. Published 2011.
Patients require education and information as they engage in self-help, self-care, and disease ma... more Patients require education and information as they engage in self-help, self-care, and disease management activities. The objective of this study was to explore the acceptance of voice technologies in diabetes patient education. Eighteen participants listened to a total of 324 diabetes educational messages and were provided the opportunity to rate the usefulness of each message. This study demonstrated that brief telephone-based education can be acceptable and useful.
The purpose of this study was to measure the efficiency of simple searches in retrieving controll... more The purpose of this study was to measure the efficiency of simple searches in retrieving controlled evidence about specific primary health care quality improvement interventions and their effects. Searches were conducted to retrieve evidence on seven interventions and seven effect variables. Specific words and the closest Medical Subject Headings (MeSH) recommended by professional librarians were used to search the MEDLINE database. Searches were restricted to the MeSH publication type "randomized controlled trial." Two reviewers independently judged retrieved citations for relevancy to the selected interventions and effects. In selecting MeSH terms, the average agreement among librarians was 64.3% (±26.1) for interventions and 57.1% (± 19.9) for effects. Analysis of the 755 retrieved reports showed that MeSH term searches had an overall recall rate of 58% while the same rate for textword searches was significantly lower (11%, p < .001). The difference in overall precision rates was nonsignificant (26% versus 33%, p = .15). In the group of MeSH searches, overall precision and recall was significantly lower for effects than for interventions (12% versus 52%, p < .001 and 41% versus 69%, p < .001). Two textwords appeared in more than 25% of the benchmark collection: reminder (25.7%) and cost (25.0%). The results of this study indicate that information needs for health care quality improvement cannot be met by simple literature searches. Certain MeSH terms and combinations of textwords yield moderately efficient recall and precision in literature searches for health care quality improvement. Clinicians and physician executives gaining direct access to bibliographic database could probably be better served by structured indexing of critical aspects of randomized controlled clinical trials: design, sample, interventions, and effects.
To determine if home-centered monitoring through telemedicine has an impact on clinical character... more To determine if home-centered monitoring through telemedicine has an impact on clinical characteristics, metabolic profile and quality of life in overweight and obese patients. Randomized controlled trial, 6-month duration. Tertiary care academic hospital. A total of 122 patients were eligible to participate as they met the inclusion criteria of increased body mass index (BMI&gt;25 kg/m(2)), age&gt;18 and &lt;70 y and ability to operate electronic microdevices. All patients in the control group (n=77) received standard hospital care. Patients in the intervention group (n=45), additionally, measured three times a week, for 6 months, their blood pressure and body weight and transmitted them to an automated call center. These values were not shared with the patients&#39; physician or dietician. Clinical (body weight, BMI, blood pressure), laboratory (fasting plasma glucose, triglycerides, HDL-cholesterol, total cholesterol) and quality of life parameters (SF-36((R)), Visual Analog Scale of European Quality-5 Dimensions, Obesity Assessment Survey). Data were analyzed in an intention-to-treat-way (last observation carried forward). Drop-out rate was similar in the control and intervention groups: 12 vs 11 percent, respectively, P=NS. There were no significant differences at baseline between intervention and control groups in all main outcome parameters. There were significant decreases for patients in the intervention group in body weight (from 101.6+/-22.4 to 89.2+/-14.7 kg, P=0.002, P=0.05 vs controls at 6 months), total cholesterol (from 247.6+/-42.0 to 220.7+/-42.6 mg/dl, P=0.002, P=0.05 vs controls at 6 months) and triglycerides (from 148.4+/-35.0 to 122.3+/-31.4 mg/dl, P=0.001, P=0.01 vs controls at 6 months). Intervention group patients made a total of 1997 phone contacts. The number of phone contacts was correlated positively with Social Functioning (SF), Vitality (VT) and Mental Health (MH) scores of SF-36((R)) at baseline (r=0.48, r=0.41, r=0.41, respectively, P=0.05) but not with weight loss. Home-centered, intense treatment through the use of telemedicine can be effective in improving short-term obesity outcomes.
People with diabetes are at risk of developing complications that contribute to substantial morbi... more People with diabetes are at risk of developing complications that contribute to substantial morbidity and mortality. In 2011, the American Association of Diabetes Educators convened an invitational Reducing Risks Symposium, during which an interdisciplinary panel of 11 thought leaders examined current knowledge about the reduction and prevention of diabetes-related risks and translated evidence into diabetes care and self-management education. Symposium participants reviewed findings from the literature and engaged in a moderated roundtable discussion. This report summarizes the discussion and presents recommendations to incorporate into practice to improve outcomes. The objective of the symposium was to develop practical advice for diabetes educators and other members of the diabetes care team regarding the reduction of diabetes-related risks. Optimal diabetes management requires patients to actively participate in their care, which occurs most effectively with a multidisciplinary team. Diabetes education is an integral part of this team approach because it not only helps the patient understand diabetes, its progression, and possible complications, but also provides guidance and encouragement to the patient to engage in proactive risk-reduction decisions for optimal health. A variety of tools are available to help the diabetes educator develop an individualized, patient-centered plan for risk reduction. More research is needed regarding intervention efficacy, best practices to improve adherence, and quantification of benefits from ongoing diabetes support in risk reduction. Diabetes educators are urged to stay abreast of evolving models of care and to build relationships with health care providers both within and beyond the diabetes care team.
The 1999 Institute of Medicine (IOM) report To Err is Human alerted the healthcare industry and t... more The 1999 Institute of Medicine (IOM) report To Err is Human alerted the healthcare industry and the public to the lack of consistency in the delivery of quality care to the US population. Clinical decision support systems (CDSS) have become a leading response to this report, and to the growing demand for the promotion of standards-based care delivery. The objective of this paper is to evaluate the recent literature for both the types and effectiveness of electronic CDSS in the primary care setting. An electronic search of the literature was conducted utilising MEDLINE (1996-2006), CINAHL (1982-2006) and all EBM Reviews--Cochrane DSR, ACP Journal Club, DARE and CCTR. The search included various combinations of the MeSH search terms 'clinical decision support systems', 'primary health care', 'ambulatory care' and 'practice guidelines' and was limited to articles published from 2000 to 2006. Studies were selected for review if they involved either non-ra...
When a clinical decision support system (CDSS) passes the test of accuracy and is ready for clini... more When a clinical decision support system (CDSS) passes the test of accuracy and is ready for clinical implementation, the need for replicable and generalizable measurement of practical impact emerges. It is increasingly acknowledged that measurement of system ...
The purpose of this study was to evaluate the impact of diabetes self-management education/traini... more The purpose of this study was to evaluate the impact of diabetes self-management education/training (DSME/T) on financial outcomes (cost of patient care). Commercial and Medicare claims payer-derived datasets were used to assess whether patients who participate in diabetes education are more likely to follow recommendations for care than similar patients who do not participate in diabetes education, and if claims of patients who participate in diabetes education are lower than those of similar patients who do not. Patients using diabetes education have lower average costs than patients who do not use diabetes education. Physicians exhibit high variation in their referral rates to diabetes education. The collaboration between diabetes educators and physicians yields positive clinical quality and cost savings. The analysis indicates that quality can be improved, and cost reduced, by increasing referral rates to diabetes education among low-referring physicians, specifically among men and people in disadvantaged areas. More needs to be done to inform physicians about ways to increase access to diabetes education for underserved populations.
The purpose of this systematic review was to review published literature on risk-reducing interve... more The purpose of this systematic review was to review published literature on risk-reducing interventions as part of diabetes self-management. Medline (1990Medline ( -2007, CINAHL (1990CINAHL ( -2007, and Cochrane Central Register of Controlled Trials (first quarter 2007) databases were searched. Reference lists from included studies were reviewed to identify additional studies.
A Review of the Literature Purpose The purpose of this article was to review the published litera... more A Review of the Literature Purpose The purpose of this article was to review the published literature and evaluate the economic benefits and costs associated with diabetes education.
Regular care and informational support are helpful in improving disease-related health outcomes. ... more Regular care and informational support are helpful in improving disease-related health outcomes. Communication technologies can help in providing such care and support. The purpose of this study was to evaluate the empirical evidence related to the role of cell phones and text messaging interventions in improving health outcomes and processes of care. Scientific literature was searched to identify controlled studies evaluating cell phone voice and text message interventions to provide care and disease management support. Searches identified 25 studies that evaluated cell phone voice and text messaging interventions, with 20 randomized controlled trials and 5 controlled studies. Nineteen studies assessed outcomes of care and six assessed processes of care. Selected studies included 38,060 participants with 10,374 adults and 27,686 children. They covered 12 clinical areas and took place in 13 countries. Frequency of message delivery ranged from 5 times per day for diabetes and smoking cessation support to once a week for advice on how to overcome barriers and maintain regular physical activity. Significant improvements were noted in compliance with medicine taking, asthma symptoms, HbA1C, stress levels, smoking quit rates, and self-efficacy. Process improvements were reported in lower failed appointments, quicker diagnosis and treatment, and improved teaching and training. Cost per text message was provided by two studies. The findings that enhancing standard care with reminders, disease monitoring and management, and education through cell phone voice and short message service can help improve health outcomes and care processes have implications for both patients and providers.
Patients require education and information as they engage in self-help, self-care, and disease ma... more Patients require education and information as they engage in self-help, self-care, and disease management activities. The purpose of this study was to determine how effective voice technologies are in diabetes patient education. A pretest-posttest study was conducted to evaluate the effectiveness of prerecorded educational messages delivered via the telephone to participants with diabetes. The intervention consisted of 24 four-minute messages on the topics of knowledge and prevention, glucose level, diet and activity, and management and coping. Eighteen persons with diabetes participated in the pretest-posttest trial. A total of 324 educational messages were listened to over a 12-week intervention period. The pretest-posttest trial demonstrated that a brief telephone-based diabetes education intervention can have a significant impact on increasing frequency of checking blood for glucose (p = 0.017), improving general diabetes knowledge (p = 0.048), and improving insulin-specific knowledge (p = 0.020). Automated educational interventions should be based on scientifically sound evidence and can be effectively delivered by telephone. Automated telephone-based diabetes education may be used alone or as a supplement to existing diabetes education. Automated education is a viable solution when healthcare organizations and regions that as a result of a lack of human and financial resources cannot afford a diabetes educator.
The aim of this study was to examine the satisfaction with telehealth technologies of all users-p... more The aim of this study was to examine the satisfaction with telehealth technologies of all users-patients, health care providers, and telehealth presenters. As the use of videoconferencing in health care is rapidly increasing to allow adequate and timely access to care for patients from rural areas, it is important to examine how these technologies are perceived and utilized. Three separate surveys were used to collect data: patient, provider, and telehealth coordinator. Patient surveys were collected in a paper format, while provider and coordinator surveys were done using REDCap (Research Electronic Data Capture) application. Findings indicate high satisfaction with telehealth, as well as confidence in providing care via distance. While this is encouraging for both patients and health care organizations, further studies should be done to include urban telehealth as well as other types of health care organizations utilizing videoconferencing for clinical appointments.
Perspectives in health information management / AHIMA, American Health Information Management Association, 2015
Robotic telepresence has been used for outsourcing of healthcare services for more than a decade;... more Robotic telepresence has been used for outsourcing of healthcare services for more than a decade; however, its use within an academic medical department is not yet widespread. Intensive care unit (ICU) robots can be used to increase access to off-site supervising physicians and other specialists, reducing possible wait time for difficult admissions and procedures. To study the use of ICU robots through a pilot program in an academic hospital and examine provider attitudes toward the usability and effectiveness of an ICU robot. The study was done as a postinterventional cross-sectional seven-question survey in a medical ICU in an urban academic hospital. Participants were attending physicians, fellows, residents, nurses, and respiratory therapists. Users of the ICU robot reported satisfaction with communication, and improved patient care. They also reported perceived improved quality of care with the use of the robot. Findings show the importance of a whole-team approach to the insta...
Cancer registry data collection involves, at a minimum, collecting data on demographics, tumor ch... more Cancer registry data collection involves, at a minimum, collecting data on demographics, tumor characteristics, and treatment. A common, identified, and standardized set of data elements is needed to share data quickly and efficiently with consumers of this data. This project highlights the fact that, there is a need to develop common data elements; Surveys were developed for central cancer registries (CCRs) and cancer researchers (CRs) at NCI-designated Cancer Centers, in order to understand data needs. Survey questions were developed based on the project focus, an evaluation of the research registries and database responses, and systematic review of the literature. Questions covered the following topics: 1) Research, 2) Data collection, 3) Database/ repository, 4) Use of data, 5) Additional data items, 6) Data requests, 7) New data fields, and 8) Cancer registry data set. A review of the surveys indicates that all cancer registries&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; data are used for public health surveillance, and 96% of the registries indicate the data are also used for research. Data are available online in interactive tables from over 50% of CRs and 87% of CCRs. Some other survey responses indicate that CCR treatment data are not complete for example treatment data, however cancer researchers are interested in treatment variables from CCRs. Cancer registries have many data available for review, but need to examine what data are needed and used by different entities. Cancer Registries can further enhance usage through collaborations and partnerships to connect common interests in the data by making registries visible and accessible.
The purpose of this project was to explore how persons with chronic heart failure (CHF) obtain an... more The purpose of this project was to explore how persons with chronic heart failure (CHF) obtain and use health information about their condition and how health literacy might have an impact. We interviewed 28 patients with CHF regarding their quality of life, chronic illness care, literacy level, and knowledge about self-management care for CHF.
Most countries in Europe and the USA are increasingly using an electronic medical record (EMR) to... more Most countries in Europe and the USA are increasingly using an electronic medical record (EMR) to help improve healthcare quality. Unfortunately, most developing countries face many challenges ranging from epidemics and civil wars to disasters: they also lack a robust healthcare infrastructure in the form of information and communications technology (ICT) to ensure continuity of patient health which many research studies consider a lifesaving resource. The aim of this systematic review is to examine the benefits of an EMR and its contribution to the development of healthcare delivery in developing countries. We searched MEDLINE, PubMed, CINAHL, COMPENDEX and Academic Search Premier as well as systematically searching the reference lists of included studies and relevant reviews. Inclusion criteria were that studies should relate to the importance and challenges of an EMR system, paper-based medical records, development and implementation of an EMR system in developing countries or EM...
The objective of this pilot study was to assess the accessibility of congestive heart failure con... more The objective of this pilot study was to assess the accessibility of congestive heart failure consumer information on the web. Twenty-seven education trials involving 5589 patients with congestive heart failure were analyzed. Education topics and outcomes were abstracted. Twenty education topics were linked to outcomes. A sample of 15 websites missed 56.7% of education topics and 61.8% of technical website characteristics that have suggested accuracy, reliability, and timeliness of content.
Several initiatives have addressed patient safety by enabling electronic voluntary reporting of a... more Several initiatives have addressed patient safety by enabling electronic voluntary reporting of adverse events within academic medical centres in urban settings. Such initiatives are lacking in the rural context, and it remains unknown whether the same challenges and solutions apply to rural hospitals. The purpose of this study is to provide insight into the organisational culture and level of readiness to adopt patient safety strategies in a rural setting, as well as to identify critical issues pertaining to the rural context that need to inform the design of such strategies. We conducted telephone interviews with administrators and healthcare providers of rural hospitals in one US state. Questions referred to the respondents' current reporting mechanism, its advantages and disadvantages, and organisational patient safety culture. A total of 16 administrators and 14 providers of eight rural hospitals in the state of Missouri were interviewed. Findings indicate that very few adm...
Veterans' health care has shifted towards outpatient treatment, and because of the high prevalenc... more Veterans' health care has shifted towards outpatient treatment, and because of the high prevalence of chronic illness in veterans, more caregiving has been required of their families. The purpose of this study was to identify predictors of caregiver (CG) strain and satisfaction associated with caring for veterans with chronic illness. Data were collected using telephone interviews of 120 dyads. Strain was associated with helping with instrumental activities of daily living, using counseling and prayer for coping, accompanying veteran to appointments, help/advice from friends, paid help, exercising, and depression. Satisfaction was associated with veteran health, CG social support, age, and depression. Innovative and easily accessible interventions are needed to mitigate sources of strain in CGs of chronically ill veterans. Published 2011.
Patients require education and information as they engage in self-help, self-care, and disease ma... more Patients require education and information as they engage in self-help, self-care, and disease management activities. The objective of this study was to explore the acceptance of voice technologies in diabetes patient education. Eighteen participants listened to a total of 324 diabetes educational messages and were provided the opportunity to rate the usefulness of each message. This study demonstrated that brief telephone-based education can be acceptable and useful.
The purpose of this study was to measure the efficiency of simple searches in retrieving controll... more The purpose of this study was to measure the efficiency of simple searches in retrieving controlled evidence about specific primary health care quality improvement interventions and their effects. Searches were conducted to retrieve evidence on seven interventions and seven effect variables. Specific words and the closest Medical Subject Headings (MeSH) recommended by professional librarians were used to search the MEDLINE database. Searches were restricted to the MeSH publication type "randomized controlled trial." Two reviewers independently judged retrieved citations for relevancy to the selected interventions and effects. In selecting MeSH terms, the average agreement among librarians was 64.3% (±26.1) for interventions and 57.1% (± 19.9) for effects. Analysis of the 755 retrieved reports showed that MeSH term searches had an overall recall rate of 58% while the same rate for textword searches was significantly lower (11%, p < .001). The difference in overall precision rates was nonsignificant (26% versus 33%, p = .15). In the group of MeSH searches, overall precision and recall was significantly lower for effects than for interventions (12% versus 52%, p < .001 and 41% versus 69%, p < .001). Two textwords appeared in more than 25% of the benchmark collection: reminder (25.7%) and cost (25.0%). The results of this study indicate that information needs for health care quality improvement cannot be met by simple literature searches. Certain MeSH terms and combinations of textwords yield moderately efficient recall and precision in literature searches for health care quality improvement. Clinicians and physician executives gaining direct access to bibliographic database could probably be better served by structured indexing of critical aspects of randomized controlled clinical trials: design, sample, interventions, and effects.
To determine if home-centered monitoring through telemedicine has an impact on clinical character... more To determine if home-centered monitoring through telemedicine has an impact on clinical characteristics, metabolic profile and quality of life in overweight and obese patients. Randomized controlled trial, 6-month duration. Tertiary care academic hospital. A total of 122 patients were eligible to participate as they met the inclusion criteria of increased body mass index (BMI&gt;25 kg/m(2)), age&gt;18 and &lt;70 y and ability to operate electronic microdevices. All patients in the control group (n=77) received standard hospital care. Patients in the intervention group (n=45), additionally, measured three times a week, for 6 months, their blood pressure and body weight and transmitted them to an automated call center. These values were not shared with the patients&#39; physician or dietician. Clinical (body weight, BMI, blood pressure), laboratory (fasting plasma glucose, triglycerides, HDL-cholesterol, total cholesterol) and quality of life parameters (SF-36((R)), Visual Analog Scale of European Quality-5 Dimensions, Obesity Assessment Survey). Data were analyzed in an intention-to-treat-way (last observation carried forward). Drop-out rate was similar in the control and intervention groups: 12 vs 11 percent, respectively, P=NS. There were no significant differences at baseline between intervention and control groups in all main outcome parameters. There were significant decreases for patients in the intervention group in body weight (from 101.6+/-22.4 to 89.2+/-14.7 kg, P=0.002, P=0.05 vs controls at 6 months), total cholesterol (from 247.6+/-42.0 to 220.7+/-42.6 mg/dl, P=0.002, P=0.05 vs controls at 6 months) and triglycerides (from 148.4+/-35.0 to 122.3+/-31.4 mg/dl, P=0.001, P=0.01 vs controls at 6 months). Intervention group patients made a total of 1997 phone contacts. The number of phone contacts was correlated positively with Social Functioning (SF), Vitality (VT) and Mental Health (MH) scores of SF-36((R)) at baseline (r=0.48, r=0.41, r=0.41, respectively, P=0.05) but not with weight loss. Home-centered, intense treatment through the use of telemedicine can be effective in improving short-term obesity outcomes.
People with diabetes are at risk of developing complications that contribute to substantial morbi... more People with diabetes are at risk of developing complications that contribute to substantial morbidity and mortality. In 2011, the American Association of Diabetes Educators convened an invitational Reducing Risks Symposium, during which an interdisciplinary panel of 11 thought leaders examined current knowledge about the reduction and prevention of diabetes-related risks and translated evidence into diabetes care and self-management education. Symposium participants reviewed findings from the literature and engaged in a moderated roundtable discussion. This report summarizes the discussion and presents recommendations to incorporate into practice to improve outcomes. The objective of the symposium was to develop practical advice for diabetes educators and other members of the diabetes care team regarding the reduction of diabetes-related risks. Optimal diabetes management requires patients to actively participate in their care, which occurs most effectively with a multidisciplinary team. Diabetes education is an integral part of this team approach because it not only helps the patient understand diabetes, its progression, and possible complications, but also provides guidance and encouragement to the patient to engage in proactive risk-reduction decisions for optimal health. A variety of tools are available to help the diabetes educator develop an individualized, patient-centered plan for risk reduction. More research is needed regarding intervention efficacy, best practices to improve adherence, and quantification of benefits from ongoing diabetes support in risk reduction. Diabetes educators are urged to stay abreast of evolving models of care and to build relationships with health care providers both within and beyond the diabetes care team.
The 1999 Institute of Medicine (IOM) report To Err is Human alerted the healthcare industry and t... more The 1999 Institute of Medicine (IOM) report To Err is Human alerted the healthcare industry and the public to the lack of consistency in the delivery of quality care to the US population. Clinical decision support systems (CDSS) have become a leading response to this report, and to the growing demand for the promotion of standards-based care delivery. The objective of this paper is to evaluate the recent literature for both the types and effectiveness of electronic CDSS in the primary care setting. An electronic search of the literature was conducted utilising MEDLINE (1996-2006), CINAHL (1982-2006) and all EBM Reviews--Cochrane DSR, ACP Journal Club, DARE and CCTR. The search included various combinations of the MeSH search terms 'clinical decision support systems', 'primary health care', 'ambulatory care' and 'practice guidelines' and was limited to articles published from 2000 to 2006. Studies were selected for review if they involved either non-ra...
When a clinical decision support system (CDSS) passes the test of accuracy and is ready for clini... more When a clinical decision support system (CDSS) passes the test of accuracy and is ready for clinical implementation, the need for replicable and generalizable measurement of practical impact emerges. It is increasingly acknowledged that measurement of system ...
The purpose of this study was to evaluate the impact of diabetes self-management education/traini... more The purpose of this study was to evaluate the impact of diabetes self-management education/training (DSME/T) on financial outcomes (cost of patient care). Commercial and Medicare claims payer-derived datasets were used to assess whether patients who participate in diabetes education are more likely to follow recommendations for care than similar patients who do not participate in diabetes education, and if claims of patients who participate in diabetes education are lower than those of similar patients who do not. Patients using diabetes education have lower average costs than patients who do not use diabetes education. Physicians exhibit high variation in their referral rates to diabetes education. The collaboration between diabetes educators and physicians yields positive clinical quality and cost savings. The analysis indicates that quality can be improved, and cost reduced, by increasing referral rates to diabetes education among low-referring physicians, specifically among men and people in disadvantaged areas. More needs to be done to inform physicians about ways to increase access to diabetes education for underserved populations.
The purpose of this systematic review was to review published literature on risk-reducing interve... more The purpose of this systematic review was to review published literature on risk-reducing interventions as part of diabetes self-management. Medline (1990Medline ( -2007, CINAHL (1990CINAHL ( -2007, and Cochrane Central Register of Controlled Trials (first quarter 2007) databases were searched. Reference lists from included studies were reviewed to identify additional studies.
A Review of the Literature Purpose The purpose of this article was to review the published litera... more A Review of the Literature Purpose The purpose of this article was to review the published literature and evaluate the economic benefits and costs associated with diabetes education.
Regular care and informational support are helpful in improving disease-related health outcomes. ... more Regular care and informational support are helpful in improving disease-related health outcomes. Communication technologies can help in providing such care and support. The purpose of this study was to evaluate the empirical evidence related to the role of cell phones and text messaging interventions in improving health outcomes and processes of care. Scientific literature was searched to identify controlled studies evaluating cell phone voice and text message interventions to provide care and disease management support. Searches identified 25 studies that evaluated cell phone voice and text messaging interventions, with 20 randomized controlled trials and 5 controlled studies. Nineteen studies assessed outcomes of care and six assessed processes of care. Selected studies included 38,060 participants with 10,374 adults and 27,686 children. They covered 12 clinical areas and took place in 13 countries. Frequency of message delivery ranged from 5 times per day for diabetes and smoking cessation support to once a week for advice on how to overcome barriers and maintain regular physical activity. Significant improvements were noted in compliance with medicine taking, asthma symptoms, HbA1C, stress levels, smoking quit rates, and self-efficacy. Process improvements were reported in lower failed appointments, quicker diagnosis and treatment, and improved teaching and training. Cost per text message was provided by two studies. The findings that enhancing standard care with reminders, disease monitoring and management, and education through cell phone voice and short message service can help improve health outcomes and care processes have implications for both patients and providers.
Patients require education and information as they engage in self-help, self-care, and disease ma... more Patients require education and information as they engage in self-help, self-care, and disease management activities. The purpose of this study was to determine how effective voice technologies are in diabetes patient education. A pretest-posttest study was conducted to evaluate the effectiveness of prerecorded educational messages delivered via the telephone to participants with diabetes. The intervention consisted of 24 four-minute messages on the topics of knowledge and prevention, glucose level, diet and activity, and management and coping. Eighteen persons with diabetes participated in the pretest-posttest trial. A total of 324 educational messages were listened to over a 12-week intervention period. The pretest-posttest trial demonstrated that a brief telephone-based diabetes education intervention can have a significant impact on increasing frequency of checking blood for glucose (p = 0.017), improving general diabetes knowledge (p = 0.048), and improving insulin-specific knowledge (p = 0.020). Automated educational interventions should be based on scientifically sound evidence and can be effectively delivered by telephone. Automated telephone-based diabetes education may be used alone or as a supplement to existing diabetes education. Automated education is a viable solution when healthcare organizations and regions that as a result of a lack of human and financial resources cannot afford a diabetes educator.
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Papers by Suzanne Boren