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Sample records for protocol home-based telehealth

  1. Study protocol: home-based telehealth stroke care: a randomized trial for veterans

    PubMed Central

    2010-01-01

    Background Stroke is one of the most disabling and costly impairments of adulthood in the United States. Stroke patients clearly benefit from intensive inpatient care, but due to the high cost, there is considerable interest in implementing interventions to reduce hospital lengths of stay. Early discharge rehabilitation programs require coordinated, well-organized home-based rehabilitation, yet lack of sufficient information about the home setting impedes successful rehabilitation. This trial examines a multifaceted telerehabilitation (TR) intervention that uses telehealth technology to simultaneously evaluate the home environment, assess the patient's mobility skills, initiate rehabilitative treatment, prescribe exercises tailored for stroke patients and provide periodic goal oriented reassessment, feedback and encouragement. Methods We describe an ongoing Phase II, 2-arm, 3-site randomized controlled trial (RCT) that determines primarily the effect of TR on physical function and secondarily the effect on disability, falls-related self-efficacy, and patient satisfaction. Fifty participants with a diagnosis of ischemic or hemorrhagic stroke will be randomly assigned to one of two groups: (a) TR; or (b) Usual Care. The TR intervention uses a combination of three videotaped visits and five telephone calls, an in-home messaging device, and additional telephonic contact as needed over a 3-month study period, to provide a progressive rehabilitative intervention with a treatment goal of safe functional mobility of the individual within an accessible home environment. Dependent variables will be measured at baseline, 3-, and 6-months and analyzed with a linear mixed-effects model across all time points. Discussion For patients recovering from stroke, the use of TR to provide home assessments and follow-up training in prescribed equipment has the potential to effectively supplement existing home health services, assist transition to home and increase efficiency. This may

  2. Integrating care coordination home telehealth and home based primary care in rural Oklahoma: a pilot study.

    PubMed

    Sorocco, Kristen H; Bratkovich, Kristi L; Wingo, Rita; Qureshi, Saleem M; Mason, Patrick J

    2013-08-01

    The purpose of this program was to evaluate the benefits of integrating VA Care Coordination Home Telehealth and Telemental health within HBPC. A case study design was used to determine quality assurance and quality improvement of incorporating additional home telehealth equipment within Home Based Primary Care (HBPC). Veterans with complex medical conditions and their caregivers living in rural Oklahoma were enrolled. Veterans received the same care other HBPC patients received with the addition of home telehealth equipment. Members from the interdisciplinary treatment team were certified to use the telehealth equipment. Veterans and their caregivers were trained on use of the equipment in their homes. Standard HBPC program measures were used to assess the program success. Assessments from all disciplines on the HBPC team were at baseline, 3, and 6 months, and participants provided satisfaction and interview data to assess the benefits of integrating technology into standard care delivery within an HBPC program. Six veterans were enrolled (mean age = 72 yrs) with a range of physical health conditions including: chronic obstructive pulmonary disease, cerebrovascular accident, spinal cord injury, diabetes, hypertension, and syncope. Primary mental health conditions included depression, dementia, anxiety, and PTSD. Scores on the Mini-Mental State Examination ranged from 18 to 30. Over a 6-month period, case studies indicated improvements in strength, social functioning, decreased caregiver burden, and compliance with treatment plan. This integration of CCHT and HBPC served previously underserved rural veterans having complex medical conditions and appears both feasible and clinically beneficial to veterans and their caregivers. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  3. The case for home based telehealth in pediatric palliative care: a systematic review

    PubMed Central

    2013-01-01

    Background Over the last decade technology has rapidly changed the ability to provide home telehealth services. At the same time, pediatric palliative care has developed as a small, but distinct speciality. Understanding the experiences of providing home telehealth services in pediatric palliative care is therefore important. Methods A literature review was undertaken to identify and critically appraise published work relevant to the area. Studies were identified by searching the electronic databases Medline, CINAHL and Google Scholar. The reference list of each paper was also inspected to identify any further studies. Results There were 33 studies that met the inclusion criteria of which only six were pediatric focussed. Outcome measures included effects on quality of life and anxiety, substitution of home visits, economic factors, barriers, feasibility, acceptability, satisfaction and readiness for telehealth. While studies generally identified benefits of using home telehealth in palliative care, the utilisation of home telehealth programs was limited by numerous challenges. Conclusion Research in this area is challenging; ethical issues and logistical factors such as recruitment and attrition because of patient death make determining effectiveness of telehealth interventions difficult. Future research in home telehealth for the pediatric palliative care population should focus on the factors that influence acceptance of telehealth applications, including goals of care, access to alternative modes of care, perceived need for care, and comfort with using technology. PMID:23374676

  4. The case for home based telehealth in pediatric palliative care: a systematic review.

    PubMed

    Bradford, Natalie; Armfield, Nigel R; Young, Jeanine; Smith, Anthony C

    2013-02-01

    Over the last decade technology has rapidly changed the ability to provide home telehealth services. At the same time, pediatric palliative care has developed as a small, but distinct speciality. Understanding the experiences of providing home telehealth services in pediatric palliative care is therefore important. A literature review was undertaken to identify and critically appraise published work relevant to the area. Studies were identified by searching the electronic databases Medline, CINAHL and Google Scholar. The reference list of each paper was also inspected to identify any further studies. There were 33 studies that met the inclusion criteria of which only six were pediatric focussed. Outcome measures included effects on quality of life and anxiety, substitution of home visits, economic factors, barriers, feasibility, acceptability, satisfaction and readiness for telehealth. While studies generally identified benefits of using home telehealth in palliative care, the utilisation of home telehealth programs was limited by numerous challenges. Research in this area is challenging; ethical issues and logistical factors such as recruitment and attrition because of patient death make determining effectiveness of telehealth interventions difficult. Future research in home telehealth for the pediatric palliative care population should focus on the factors that influence acceptance of telehealth applications, including goals of care, access to alternative modes of care, perceived need for care, and comfort with using technology.

  5. Treatment satisfaction of home-based telehealth versus in-person delivery of prolonged exposure for combat-related PTSD in veterans.

    PubMed

    Gros, Daniel F; Lancaster, Cynthia Luethcke; López, Cristina M; Acierno, Ron

    2016-09-26

    Although there is growing support that evidence-based psychotherapies (EBPs) delivered in-person and through telehealth are equivalent in terms of symptom reduction for posttraumatic stress disorder (PTSD), there has been far less investigation comparing these treatment modalities in terms of patient satisfaction. The present study investigated participant satisfaction and perception of the quality of service delivery within a clinical trial comparing the delivery of an EBP, Prolonged Exposure (PE) for PTSD, through home-based telehealth and in-person services. Veterans (N = 67) with PTSD were randomized to receive PE via video telehealth technology (n = 27) or via in-person delivery (n = 40). Participants completed service demographic questions, PTSD symptom assessments, and satisfaction and service delivery perception questionnaires. Analyses of covariance were used to investigate the influence of treatment modality on patient satisfaction and perceived quality of service delivery, while controlling for demographics and PTSD symptoms. No differences were observed on the majority of measures, with the exception of participants in the telehealth condition endorsing willingness to drive further for telehealth services as compared with participants in the in-person condition. Findings illustrate participant satisfaction and acceptance of EBPs delivered via telehealth at a level consistent with that of in-person services. Preliminary findings suggest that the experience of receiving telehealth services may be associated with increased willingness to participate in telehealth services again. Together, these findings of patient satisfaction and acceptance of telehealth services support the ongoing delivery of EBPs via telehealth as well as their future expansion. © The Author(s) 2016.

  6. A non-inferiority trial of Prolonged Exposure for posttraumatic stress disorder: In person versus home-based telehealth.

    PubMed

    Acierno, Ron; Knapp, Rebecca; Tuerk, Peter; Gilmore, Amanda K; Lejuez, Carl; Ruggiero, Kenneth; Muzzy, Wendy; Egede, Leonard; Hernandez-Tejada, Melba A; Foa, Edna B

    2017-02-01

    This is the first randomized controlled trial to evaluate non-inferiority of Prolonged Exposure (PE) delivered via home-based telehealth (HBT) compared to standard in-person (IP) PE. One-hundred thirty two Veterans recruited from a Southeastern Veterans Affairs Medical Center and affiliated University who met criteria for posttraumatic stress disorder (PTSD) were randomized to receive PE via HBT or PE via IP. Results indicated that PE-HBT was non-inferior to PE-IP in terms of reducing PTSD scores at post-treatment, 3 and 6 month follow-up. However, non-inferiority hypotheses for depression were only supported at 6 month follow-up. HBT has great potential to reduce patient burden associated with receiving treatment in terms of travel time, travel cost, lost work, and stigma without sacrificing efficacy. These findings indicate that telehealth treatment delivered directly into patients' homes may dramatically increase the reach of this evidence-based therapy for PTSD without diminishing effectiveness. Published by Elsevier Ltd.

  7. Protocol for a Systematic Review of Telehealth Privacy and Security Research to Identify Best Practices

    PubMed Central

    WATZLAF, VALERIE J.M.; DEALMEIDA, DILHARI R.; ZHOU, LEMING; HARTMAN, LINDA M.

    2015-01-01

    Healthcare professionals engaged in telehealth are faced with complex US federal regulations (e.g., HIPAA/HITECH) and could benefit from the guidance provided by best practices in Privacy and Security (P&S). This article describes a systematic review protocol to address this need. The protocol described herein uses the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The PRISMA-P contains 17 items that are considered essential, as well as minimum components to include in systematic reviews. PICOS (participants, interventions, comparisons, outcome(s) and study design of the systematic review) are also relevant to the development of best practices in P&S in telehealth systems. A systematic process can best determine what information should be included and how this information should be retrieved, condensed, analyzed, organized, and disseminated. PMID:27563383

  8. Induction of oral tolerance to peanut: a successful home-based protocol.

    PubMed

    Ojeda, P; Ojeda, I; Pineda, F; Alfaya, T; Ojeda, J A

    2010-01-01

    In Spain, peanut allergy is increasingly prevalent. Successful protocols for the induction of oral tolerance (LOT) with several foods have been reported. We aimed to induce clinical tolerance to peanut in a child with severe peanut allergy (age 4 years, facial urticaria and lip angioedema upon licking a peanut; peanut skin prick test, 13 x 10 mm; specific immunoglobulin (Ig) E > 100 kUA/L). At age 6, the threshold oral challenge dose was 62.5 mg. Several peanut solutions were prepared and sequentially administered at the patient's home. Over 138 days, the dose was increased from 0.625 to 5500 mg. There were 43 mild-to-moderate reactions (28% of the doses administered). Pre-LOT and post-LOT peanut IgE and IgG4 values were 265 vs 487 kUA/L, and 6.11 vs 14.8 mg/L. This is the first report of successful LOT to peanut in Spain. This home-based regimen is safe under permanent and close medical supervision by an allergist.

  9. Wildcat wellness coaching feasibility trial: protocol for home-based health behavior mentoring in girls.

    PubMed

    Cull, Brooke J; Rosenkranz, Sara K; Dzewaltowski, David A; Teeman, Colby S; Knutson, Cassandra K; Rosenkranz, Richard R

    2016-01-01

    Childhood obesity is a major public health problem, with one third of America's children classified as either overweight or obese. Obesity prevention and health promotion programs using components such as wellness coaching and home-based interventions have shown promise, but there is a lack of published research evaluating the impact of a combined home-based and wellness coaching intervention for obesity prevention and health promotion in young girls. The main objective of this study is to test the feasibility of such an intervention on metrics related to recruitment, intervention delivery, and health-related outcome assessments. The secondary outcome is to evaluate the possibility of change in health-related psychosocial, behavioral, and biomedical outcomes in our sample of participants. Forty girls who are overweight or obese (aged 8-13 years) will be recruited from a Midwestern college town. Participants will be recruited through posted flyers, newspaper advertisements, email, and social media. The volunteer convenience sample of girls will be randomized to one of two home-based wellness coaching interventions: a general health education condition or a healthy eating physical activity skills condition. Trained female wellness coaches will conduct weekly hour-long home visits for 12 consecutive weeks. Assessments will occur at baseline, post-intervention (3 months after baseline), and follow-up (6 months after baseline) and will include height, weight, waist circumference, body composition, pulmonary function, blood pressure, systemic inflammation, physical activity (Actical accelerometer), and self-reported survey measures (relevant to fruit and vegetable consumption, physical activity, and quality of life). This study will evaluate the feasibility of home-based wellness coaching interventions for overweight and obese girls and secondarily assess the preliminary impact on health-related psychosocial, behavioral, and biomedical outcomes. Results will provide

  10. Feasibility and effect of home-based therapy programmes for children with cerebral palsy: a protocol for a systematic review

    PubMed Central

    Beckers, L W M E; Schnackers, M L A P; Janssen-Potten, Y J; Kleijnen, J; Steenbergen, B

    2017-01-01

    Introduction Given the promising advantages of upper extremity home-based programmes in children with cerebral palsy (CP), a systematic review of the available literature on this topic is warranted. The purpose of the systematic review described in this protocol is to investigate currently available home-based occupational therapy and physiotherapy programmes regarding both their feasibility and effect. Methods and analysis This protocol describes a systematic review, developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015. Studies will be included in which primary data are collected, participants are children aged <18 years with any type of CP and the intervention of interest is a home-based occupational therapy or physiotherapy intervention. Comparators of interest are: no therapy, care as usual, centre-based occupational therapy or physiotherapy, an alternative home-based programme and a medical intervention. Studies will be included that report either on feasibility (ie, acceptability, demand, implementation, practicality, adaptation, expansion or integration) or on efficacy/effectiveness (ie, child-related upper extremity outcomes within all International Classification of Functioning, Disability and Health levels or parent-related/caregiver-related outcomes on the psychological and social domain). Relevant studies will be identified by searching the databases MEDLINE, EMBASE, CINAHL, PsycINFO, PEDro, OTSeeker and CPCI-S as well as the trial registers ICTRP and CENTRAL, the reference lists of included records and by circulating a bibliography of the included records to authors of included studies. There will be no restrictions on language or year of publication. The search strategy consists of terms related to the population and intervention. Data will be extracted in duplicate using a digital data extraction form. Ethics and dissemination The proposed study does not involve collection of

  11. Home-based oral immunotherapy (OIT) with an intermittent loading protocol in children unlikely to outgrow egg allergy

    PubMed Central

    2014-01-01

    Background Home based oral immunotherapy (OIT) for food allergy has often been used for young children in Japan, the majority of whom are believed to outgrow the allergy by the school age, therefore the true efficacy of the therapy has been controversial. The aim of this study was to evaluate the efficacy and safety of a newly developed slow- type home-based oral immunotherapy (OIT) regimen in children with hen’s egg (HE) allergy, who had low likelihood of outgrowing the allergy, with treatment involving only elimination diet. Method We retrospectively reviewed the medical records of 43 children with egg allergy (30 males; median age 6) who fulfilled Burks et al.’s criteria of being unlikely to outgrow the allergy. Thirty children who agreed to start OIT were assigned to the treatment group, and 13 who did not want to participate immediately were assigned to the untreated group; the patients underwent an elimination diet for 1 year, during which they were monitored. The OIT regimen involved the intake of the maximum tolerated dose 2 to 3 times a week at home, with initial dose introduction followed by dose build-ups with medical supervision. We statistically evaluated the rate of children who changed their threshold up to 32 g of egg – defined as, oral tolerance induction– in both the groups for 1 year and in the OIT group for 2 years, as well as the rate of children who fulfilled Savage et al.’s criteria of clinical tolerance after reaching the abovementioned remission stage. Results The rate of children who achieved oral tolerance induction to 32 g of egg after 1 year in the OIT group (9/30) was significantly higher than that in the untreated group (0/13). The total rate within the OIT group was significantly increased from 9/30 at 1 year to 17/30 at two years without any severe adverse reaction; of the above 17 children, we followed 14 children, and noted that 11 of these were able to obtain clinical tolerance. Conclusion The home-based OIT with

  12. Home-based oral immunotherapy (OIT) with an intermittent loading protocol in children unlikely to outgrow egg allergy.

    PubMed

    Sudo, Kyoko; Taniuchi, Shoichiro; Takahashi, Masaya; Soejima, Kazuhiko; Hatano, Yasuko; Nakano, Keiji; Shimo, Tomohiko; Koshino, Hayato; Kaneko, Kazunari

    2014-02-26

    Home based oral immunotherapy (OIT) for food allergy has often been used for young children in Japan, the majority of whom are believed to outgrow the allergy by the school age, therefore the true efficacy of the therapy has been controversial. The aim of this study was to evaluate the efficacy and safety of a newly developed slow- type home-based oral immunotherapy (OIT) regimen in children with hen's egg (HE) allergy, who had low likelihood of outgrowing the allergy, with treatment involving only elimination diet. We retrospectively reviewed the medical records of 43 children with egg allergy (30 males; median age 6) who fulfilled Burks et al.'s criteria of being unlikely to outgrow the allergy. Thirty children who agreed to start OIT were assigned to the treatment group, and 13 who did not want to participate immediately were assigned to the untreated group; the patients underwent an elimination diet for 1 year, during which they were monitored. The OIT regimen involved the intake of the maximum tolerated dose 2 to 3 times a week at home, with initial dose introduction followed by dose build-ups with medical supervision. We statistically evaluated the rate of children who changed their threshold up to 32 g of egg - defined as, oral tolerance induction- in both the groups for 1 year and in the OIT group for 2 years, as well as the rate of children who fulfilled Savage et al.'s criteria of clinical tolerance after reaching the abovementioned remission stage. The rate of children who achieved oral tolerance induction to 32 g of egg after 1 year in the OIT group (9/30) was significantly higher than that in the untreated group (0/13). The total rate within the OIT group was significantly increased from 9/30 at 1 year to 17/30 at two years without any severe adverse reaction; of the above 17 children, we followed 14 children, and noted that 11 of these were able to obtain clinical tolerance. The home-based OIT with an intermittent loading protocol was very safe

  13. Internet protocol television for personalized home-based health information: design-based research on a diabetes education system.

    PubMed

    Gray, Kathleen Mary; Clarke, Ken; Alzougool, Basil; Hines, Carolyn; Tidhar, Gil; Frukhtman, Feodor

    2014-03-10

    The use of Internet protocol television (IPTV) as a channel for consumer health information is a relatively under-explored area of medical Internet research. IPTV may afford new opportunities for health care service providers to provide health information and for consumers, patients, and caretakers to access health information. The technologies of Web 2.0 add a new and even less explored dimension to IPTV's potential. Our research explored an application of Web 2.0 integrated with IPTV for personalized home-based health information in diabetes education, particularly for people with diabetes who are not strong computer and Internet users, and thus may miss out on Web-based resources. We wanted to establish whether this system could enable diabetes educators to deliver personalized health information directly to people with diabetes in their homes; and whether this system could encourage people with diabetes who make little use of Web-based health information to build their health literacy via the interface of a home television screen and remote control. This project was undertaken as design-based research in two stages. Stage 1 comprised a feasibility study into the technical work required to integrate an existing Web 2.0 platform with an existing IPTV system, populated with content and implemented for user trials in a laboratory setting. Stage 2 comprised an evaluation of the system by consumers and providers of diabetes information. The project succeeded in developing a Web 2.0 IPTV system for people with diabetes and low literacies and their diabetes educators. The performance of the system in the laboratory setting gave them the confidence to engage seriously in thinking about the actual and potential features and benefits of a more widely-implemented system. In their feedback they pointed out a range of critical usability and usefulness issues related to Web 2.0 affordances and learning fundamentals. They also described their experiences with the system in

  14. Internet Protocol Television for Personalized Home-Based Health Information: Design-Based Research on a Diabetes Education System

    PubMed Central

    Clarke, Ken; Kwong, Mabel; Alzougool, Basil; Hines, Carolyn; Tidhar, Gil; Frukhtman, Feodor

    2014-01-01

    Background The use of Internet protocol television (IPTV) as a channel for consumer health information is a relatively under-explored area of medical Internet research. IPTV may afford new opportunities for health care service providers to provide health information and for consumers, patients, and caretakers to access health information. The technologies of Web 2.0 add a new and even less explored dimension to IPTV’s potential. Objective Our research explored an application of Web 2.0 integrated with IPTV for personalized home-based health information in diabetes education, particularly for people with diabetes who are not strong computer and Internet users, and thus may miss out on Web-based resources. We wanted to establish whether this system could enable diabetes educators to deliver personalized health information directly to people with diabetes in their homes; and whether this system could encourage people with diabetes who make little use of Web-based health information to build their health literacy via the interface of a home television screen and remote control. Methods This project was undertaken as design-based research in two stages. Stage 1 comprised a feasibility study into the technical work required to integrate an existing Web 2.0 platform with an existing IPTV system, populated with content and implemented for user trials in a laboratory setting. Stage 2 comprised an evaluation of the system by consumers and providers of diabetes information. Results The project succeeded in developing a Web 2.0 IPTV system for people with diabetes and low literacies and their diabetes educators. The performance of the system in the laboratory setting gave them the confidence to engage seriously in thinking about the actual and potential features and benefits of a more widely-implemented system. In their feedback they pointed out a range of critical usability and usefulness issues related to Web 2.0 affordances and learning fundamentals. They also described

  15. Effectiveness of the home-based alcohol prevention program "In control: no alcohol!": study protocol of a randomized controlled trial.

    PubMed

    Mares, Suzanne H W; van der Vorst, Haske; Lichtwarck-Aschoff, Anna; Schulten, Ingrid; Verdurmen, Jacqueline E E; Otten, Roy; Engels, Rutger C M E

    2011-08-04

    In the Netherlands, children start to drink at an early age; of the Dutch 12-year olds, 40% reports lifetime alcohol use, while 9.7% reports last-month drinking. Starting to drink at an early age puts youth at risk of developing several alcohol-related problems later in life. Recently, a home-based prevention program called "In control: No alcohol!" was developed to delay the age of alcohol onset in children. The main aim of this project is to conduct a Randomized Controlled Trial (RCT) to evaluate the effectiveness of the program. The prevention program will be tested with an RCT among mothers and their 6 grade primary school children (11-12 years old), randomly assigned to the prevention or control condition. The program consists of five printed magazines and an activity book designed to improve parental alcohol-specific socialization. Parent-child dyads in the control group receive a factsheet information brochure, which is the standard alcohol brochure of the Trimbos Institute (the Netherlands Institute for Mental Health and Addiction).Outcome measures are initiation of alcohol use (have been drinking at least one glass of alcohol), alcohol-specific parenting, susceptibility to drinking alcohol, alcohol expectancies, self-efficacy, and frequency and intensity of child alcohol use. Questionnaires will be administered online on secured Internet webpages, with personal login codes for both mothers and children. Mothers and children in both the experimental and control condition will be surveyed at baseline and after 6, 12, and 18 months (follow-ups). The present study protocol presents the design of an RCT evaluating the effectiveness of the home-based "In control: No alcohol!" program for 6 grade primary school children (11-12 years old). It is hypothesized that children in the prevention condition will be less likely to have their first glass of alcohol, compared to the control condition. When the prevention appears to be effective, it can easily and relatively

  16. Design and methodology of a randomized clinical trial of home-based telemental health treatment for U.S. military personnel and veterans with depression.

    PubMed

    Luxton, David D; Pruitt, Larry D; O'Brien, Karen; Stanfill, Katherine; Jenkins-Guarnieri, Michael A; Johnson, Kristine; Wagner, Amy; Thomas, Elissa; Gahm, Gregory A

    2014-05-01

    Home-based telemental health (TMH) treatments have the potential to address current and future health needs of military service members, veterans, and their families, especially for those who live in rural or underserved areas. The use of home-based TMH treatments to address the behavioral health care needs of U.S. military healthcare beneficiaries is not presently considered standard of care in the Military Health System. The feasibility, safety, and clinical efficacy of home-based TMH treatments must be established before broad dissemination of home-based treatment programs can be implemented. This paper describes the design, methodology, and protocol of a clinical trial that compares in-office to home-based Behavioral Activation for Depression (BATD) treatment delivered via web-based video technology for service members and veterans with depression. This grant funded three-year randomized clinical trial is being conducted at the National Center for Telehealth and Technology at Joint-base Lewis-McChord and at the Portland VA Medical Center. Best practice recommendations regarding the implementation of in-home telehealth in the military setting as well as the cultural and contextual factors of providing in-home care to active duty and veteran military populations are also discussed. Published by Elsevier Inc.

  17. An international landmine telehealth symposium between Hawaii and Thailand using an Internet2 and multi-protocol videoconferencing bridge.

    PubMed

    Soh, Eugene K; Vincent, Dale S; Berg, Benjamin W; Chitpatima, Suwicha T; Hudson, Donald H

    2004-10-01

    An international telehealth symposium was conducted between healthcare institutions in Hawaii and Thailand using a combination of Asynchronous Transfer Mode, and Internet2 connectivity. Military and civilian experts exchanged information on the acute and rehabilitative care of landmine victims in Southeast Asia. Videoconferencing can promote civil-military cooperation in healthcare fields that have multiple international stakeholders.

  18. A home-based comprehensive care model in patients with Multiple Sclerosis: A study pre-protocol.

    PubMed

    Young, Lufei; Healey, Kathleen; Charlton, Mary; Schmid, Kendra; Zabad, Rana; Wester, Rebecca

    2015-01-01

    Background Disability is prevalent in individuals with multiple sclerosis (MS), leading to difficulty in care access, significant caregiver burden, immense challenges in self-care and great societal burden.  Without highly coordinated, competent and accessible care, individuals living with progressive MS experience psychological distress, poor quality of life, suffer from life-threatening complications, and have frequent but avoidable healthcare utilizations. Unfortunately, current healthcare delivery models present severe limitations in providing easily accessible, patient-centered, coordinated comprehensive care to those with progressive MS. We propose a home-based comprehensive care model (MAHA) to address the unmet needs, challenges, and avoidable complications in individuals with progressive MS with disabling disease. Objective The article aims to describe the study design and methods used to implement and evaluate the proposed intervention.   Method The study will use a randomized controlled design to evaluate the feasibility of providing a 24-month, home-based, patient-centered comprehensive care program to improve quality of life, reduce complications and healthcare utilizations overtime (quarterly) for 24 months. A transdisciplinary team led by a MS-Comprehensivist will carry out this project. Fifty MS patients will be randomly assigned to the intervention and usual care program using block randomization procedures. We hypothesize that patients in the intervention group will have fewer complications, higher quality of life, greater satisfaction with care, and reduced healthcare utilization. The proposed project is also expected to be financially sustainable in fee-for-service models but best suited for and gain financial success in valued-based care systems.   Discussion This is the first study to examine the feasibility and effectiveness of a home-based comprehensive care management program in MS patients living with progressive disability. If

  19. Using Ontario's "Telehealth" health telephone helpline as an early-warning system: a study protocol.

    PubMed

    Rolland, Elizabeth; Moore, Kieran M; Robinson, Victoria A; McGuinness, Don

    2006-02-15

    The science of syndromic surveillance is still very much in its infancy. While a number of syndromic surveillance systems are being evaluated in the US, very few have had success thus far in predicting an infectious disease event. Furthermore, to date, the majority of syndromic surveillance systems have been based primarily in emergency department settings, with varying levels of enhancement from other data sources. While research has been done on the value of telephone helplines on health care use and patient satisfaction, very few projects have looked at using a telephone helpline as a source of data for syndromic surveillance, and none have been attempted in Canada. The notable exception to this statement has been in the UK where research using the national NHS Direct system as a syndromic surveillance tool has been conducted. The purpose of our proposed study is to evaluate the effectiveness of Ontario's telephone nursing helpline system as a real-time syndromic surveillance system, and how its implementation, if successful, would have an impact on outbreak event detection in Ontario. Using data collected retrospectively, all "reasons for call" and assigned algorithms will be linked to a syndrome category. Using different analytic methods, normal thresholds for the different syndromes will be ascertained. This will allow for the evaluation of the system's sensitivity, specificity and positive predictive value. The next step will include the prospective monitoring of syndromic activity, both temporally and spatially. As this is a study protocol, there are currently no results to report. However, this study has been granted ethical approval, and is now being implemented. It is our hope that this syndromic surveillance system will display high sensitivity and specificity in detecting true outbreaks within Ontario, before they are detected by conventional surveillance systems. Future results will be published in peer-reviewed journals so as to contribute to the

  20. Effect of a Home-based Balance Training Protocol on Dynamic Postural Control in Subjects with Chronic Ankle Instability.

    PubMed

    De Ridder, R; Willems, T M; Vanrenterghem, J; Roosen, P

    2015-06-01

    The aim of this study was to establish the presence of postural deficits in subjects with chronic ankle instability (CAI) and to assess the effect of an 8-week balance training program on dynamic postural control. A total of 43 subjects with CAI and 31 controls participated in this case-control study. Participants with CAI performed an 8-week home-based balance training, including 3 sessions a week. As main outcome measure, postural control was quantified after a vertical drop by means of the dynamic postural stability index (DPSI). Perceptual outcomes were documented using the FADI, FADI-Sport and VAS scales. At baseline, subjects with CAI displayed higher anterior/posterior and vertical postural instability, a poorer DPSI, and lower subjective stability scores compared to the control group. After balance training, all subjective stability scores improved significantly, although no changes were noted for the stability indices. In conclusion, subjects with CAI have an impaired postural control. As a treatment modality, balance training exhibits the capability of improving the subjective feeling of instability in subjects with CAI. However, there was no effect on dynamic postural control. Further research on the explanatory mechanisms of balance training is warranted, and other training modalities should be considered.

  1. Acceptance of Home-Based Telehealth Problem-Solving Therapy for Depressed, Low-Income Homebound Older Adults: Qualitative Interviews With the Participants and Aging-Service Case Managers

    PubMed Central

    Choi, Namkee G.; Wilson, Nancy L.; Sirrianni, Leslie; Marinucci, Mary Lynn; Hegel, Mark T.

    2014-01-01

    Purpose: To report low-income homebound older adults’ experience of telehealth problem-solving therapy (tele-PST) and aging-service case managers’ (CMs’) experience/perception of client-level personal barriers to accessing psychotherapy in general and PST specifically. Design and Methods: The study sample consisted of 42 homebound older adults who participated in the feasibility and efficacy trial of tele-PST and completed 36-week follow-up assessments and 12 CMs of a large home-delivered meals program who referred their clients to the tele-PST trial. In-depth interviews with the older adults and written feedback and focus group discussions with the CMs provided the data. Results: Older adults reported a high rate of approval of PST procedures and acknowledged its positive treatment effect. Tele-PST participants were satisfied with videoconferenced sessions because they were convenient and allowed them to see their therapist. However, CMs reported that only about 10%–20% of potentially eligible older adults gave oral consent for PST. Significant treatment engagement barriers were the older adults’ lack of motivation, denial of depression, perceived stigma, and other personal attitudinal factors. Implications: The real-world implementation of tele-PST or other psychotherapies needs to include educating and motivating depressed homebound elders to recognize their depression and accept treatment. PMID:23929664

  2. Acceptance of home-based telehealth problem-solving therapy for depressed, low-income homebound older adults: qualitative interviews with the participants and aging-service case managers.

    PubMed

    Choi, Namkee G; Wilson, Nancy L; Sirrianni, Leslie; Marinucci, Mary Lynn; Hegel, Mark T

    2014-08-01

    To report low-income homebound older adults' experience of telehealth problem-solving therapy (tele-PST) and aging-service case managers' (CMs') experience/perception of client-level personal barriers to accessing psychotherapy in general and PST specifically. The study sample consisted of 42 homebound older adults who participated in the feasibility and efficacy trial of tele-PST and completed 36-week follow-up assessments and 12 CMs of a large home-delivered meals program who referred their clients to the tele-PST trial. In-depth interviews with the older adults and written feedback and focus group discussions with the CMs provided the data. Older adults reported a high rate of approval of PST procedures and acknowledged its positive treatment effect. Tele-PST participants were satisfied with videoconferenced sessions because they were convenient and allowed them to see their therapist. However, CMs reported that only about 10%-20% of potentially eligible older adults gave oral consent for PST. Significant treatment engagement barriers were the older adults' lack of motivation, denial of depression, perceived stigma, and other personal attitudinal factors. The real-world implementation of tele-PST or other psychotherapies needs to include educating and motivating depressed homebound elders to recognize their depression and accept treatment. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. Home-based, early intervention with mechatronic toys for preterm infants at risk of neurodevelopmental disorders (CARETOY): a RCT protocol.

    PubMed

    Sgandurra, Giuseppina; Bartalena, Laura; Cioni, Giovanni; Greisen, Gorm; Herskind, Anna; Inguaggiato, Emanuela; Lorentzen, Jakob; Nielsen, Jens Bo; Sicola, Elisa

    2014-10-15

    Preterm infants are at risk for neurodevelopmental disorders, including motor, cognitive or behavioural problems, which may potentially be modified by early intervention. The EU CareToy Project Consortium (http://www.caretoy.eu) has developed a new modular system for intensive, individualized, home-based and family-centred early intervention, managed remotely by rehabilitation staff. A randomised controlled trial (RCT) has been designed to evaluate the efficacy of CareToy training in a first sample of low-risk preterm infants. The trial, randomised, multi-center, evaluator-blinded, parallel group controlled, is designed according to CONSORT Statement. Eligible subjects are infants born preterm without major complications, aged 3-9 months of corrected age with specific gross-motor abilities defined by Ages & Stages Questionnaire scores. Recruited infants, whose parents will sign a written informed consent for participation, will be randomized in CareToy training and control groups at baseline (T0). CareToy group will perform four weeks of personalized activities with the CareToy system, customized by the rehabilitation staff. The control group will continue standard care. Infant Motor Profile Scale is the primary outcome measure and a total sample size of 40 infants has been established. Bayley-Cognitive subscale, Alberta Infants Motor Scale and Teller Acuity Cards are secondary outcome measures. All measurements will be performed at T0 and at the end of training/control period (T1). For ethical reasons, after this first phase infants enrolled in the control group will perform the CareToy training, while the training group will continue standard care. At the end of open phase (T2) all infants will be assessed as at T1. Further assessment will be performed at 18 months corrected age (T3) to evaluate the long-term effects on neurodevelopmental outcome. Caregivers and rehabilitation staff will not be blinded whereas all the clinical assessments will be performed

  4. A multidisciplinary telehealth program in patients with combined chronic obstructive pulmonary disease and chronic heart failure: study protocol for a randomized controlled trial.

    PubMed

    Bernocchi, Palmira; Scalvini, Simonetta; Galli, Tiziana; Paneroni, Mara; Baratti, Doriana; Turla, Ottavia; La Rovere, Maria Teresa; Volterrani, Maurizio; Vitacca, Michele

    2016-09-22

    Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) frequently coexist, significantly reducing patients' quality of life and increasing morbidity and mortality. For either single disease, a multidisciplinary disease-management approach supported by telecommunication technologies offers the best outcome in terms of prolonged survival and reduced hospital readmissions. However, no data exist in patients with combined COPD/CHF. We planned a randomized controlled trial to investigate the feasibility and efficacy of an integrated, home-based, medical/nursing intervention plus a rehabilitation program versus conventional care in patients with coexisting COPD/CHF. The purpose of the paper is to describe the rationale and design of the trial. Patients, after inpatient rehabilitation, were randomly assigned to the intervention or control group, followed for 4 months at home, then assessed at 4 and 6 months. The intervention group followed a telesurveillance (telephone contacts by nurse and remote monitoring of cardiorespiratory parameters) and home-based rehabilitation program (at least three sessions/week of mini-ergometer exercises, callisthenic exercises and twice weekly pedometer-driven walking, plus telephone contacts by a physiotherapist). Telephone follow-up served to verify compliance to therapy, maintain exercise motivation, educate for early recognition of signs/symptoms, and verify the skills acquired. At baseline and 4 and 6 months, the 6-min Walk Test, dyspnea and fatigue at rest, oxygenation (PaO2/FiO2), physical activity profile (PASE questionnaire), and QoL (Minnesota and CAT questionnaires) were assessed. During the study, serious clinical events (hospitalizations or deaths) were recorded. Currently, no studies have assessed the impact of a telehealth program in patients with combined COPD and CHF. Our study will show whether this approach is effective in the management of such complex, frail patients who are at very high risk of

  5. Home-based neurologic music therapy for upper limb rehabilitation with stroke patients at community rehabilitation stage—a feasibility study protocol

    PubMed Central

    Street, Alexander J.; Magee, Wendy L.; Odell-Miller, Helen; Bateman, Andrew; Fachner, Jorg C.

    2015-01-01

    Background: Impairment of upper limb function following stroke is more common than lower limb impairment and is also more resistant to treatment. Several lab-based studies with stroke patients have produced statistically significant gains in upper limb function when using musical instrument playing and techniques where rhythm acts as an external time-keeper for the priming and timing of upper limb movements. Methods: For this feasibility study a small sample size of 14 participants (3–60 months post stroke) has been determined through clinical discussion between the researcher and study host in order to test for management, feasibility and effects, before planning a larger trial determined through power analysis. A cross-over design with five repeated measures will be used, whereby participants will be randomized into either a treatment (n = 7) or wait list control (n = 7) group. Intervention will take place twice weekly over 6 weeks. The ARAT and 9HPT will be used to measure for quantitative gains in arm function and finger dexterity, pre/post treatment interviews will serve to investigate treatment compliance and tolerance. A lab based EEG case comparison study will be undertaken to explore audio-motor coupling, brain connectivity and neural reorganization with this intervention, as evidenced in similar studies. Discussion: Before evaluating the effectiveness of a home-based intervention in a larger scale study, it is important to assess whether implementation of the trial methodology is feasible. This study investigates the feasibility, efficacy and patient experience of a music therapy treatment protocol comprising a chart of 12 different instrumental exercises and variations, which aims at promoting measurable changes in upper limb function in hemiparetic stroke patients. The study proposes to examine several new aspects including home-based treatment and dosage, and will provide data on recruitment, adherence and variability of outcomes. PMID:26441586

  6. The Online Parent Information and Support project, meeting parents' information and support needs for home-based management of childhood chronic kidney disease: research protocol.

    PubMed

    Swallow, Veronica; Knafl, Kathleen; Sanatacroce, Sheila; Hall, Andrew; Smith, Trish; Campbell, Malcolm; Webb, Nicholas J A

    2012-09-01

    This article is a report of a protocol for studying the development and evaluation of an online parent information and support package for home-based care of children with chronic kidney disease stages 3-5. The study is funded by a National Institute of Health Research, Research for Patient Benefit Grant awarded (December 2010). Approval to undetake the study was obtained from the Department of Health National Research Ethics Service (June 2011). Children with chronic kidney disease require skilled, home-based care by parents, supported by professionals. Parents have identified a need for continuously available online resources to supplement professional support, and structured resources tailored to parents' needs are highlighted by policy makers as key to optimizing care; yet, online resource provision is patchy with little evidence base. Using mixed methods, we will (i) conduct parent/child/young person/professional/patient and parent volunteer focus groups to explore views on existing resources, (ii) collaboratively define gaps in provision, identify desirable components, develop/test resources and conduct a feasibility randomized controlled trial, and (iii) of usual professional support versus usual support supplemented by the package. Eighty parents of children with chronic kidney disease will be randomized. Primary outcomes will assess parents' self-efficacy and views of resources, using standardized measures at entry and 24 weeks, and semi-structured interviews at 24 weeks. We will finalize trial components for a later definitive trial. By working collaboratively, we will derive a detailed insight into parents' information and support needs and experiences of using the package, and should see improved parental self-efficacy. © 2012 Blackwell Publishing Ltd.

  7. Increasing specialty care access through use of an innovative home telehealth-based spinal cord injury disease management protocol (SCI DMP).

    PubMed

    Woo, Christine; Seton, Jacinta M; Washington, Monique; Tomlinson, Suk C; Phrasavath, Douangmala; Farrell, Karen R; Goldstein, Barry

    2016-01-01

    A spinal cord injury disease management protocol (SCI DMP) was developed to address the unique medical, physical, functional, and psychosocial needs of those living with spinal cord injuries and disorders (SCI/D). The SCI DMP was piloted to evaluate DMP clinical content and to identify issues for broader implementation across the Veterans Affairs (VA) SCI System of Care. Thirty-three patients with SCI/D from four VA SCI centers participated in a 6-month pilot. Patients received customized SCI DMP questions through a data messaging device (DMD). Nurse home telehealth care coordinators (HTCC) monitored responses and addressed clinical alerts daily. One site administered the Duke Severity of Illness (DUSOI) Checklist and Short Form-8 (SF-8™) to evaluate the changes in comorbidity severity and health-related quality of life while on the SCI DMP. Patients remained enrolled an average of 116 days, with a mean response rate of 56%. The average distance between patient's home and their VA SCI center was 59 miles. Feedback on SCI DMP content and the DMD included requests for additional clinical topics, changes in administration frequency, and adapting the DMD for functional impairments. Improvement in clinical outcomes was seen in a subset of patients enrolled on the SCI DMP. SCI HTCCs and patients reported that the program was most beneficial for newly injured patients recently discharged from acute rehabilitation that live far from specialty SCI care facilities. SCI DMP content changes and broader implementation strategies are currently being evaluated based on lessons learned from the pilot.

  8. An evaluation of the telehealth facilitation of diabetes and cardiovascular care in remote Australian Indigenous communities: - protocol for the telehealth eye and associated medical services network [TEAMSnet] project, a pre-post study design.

    PubMed

    Brazionis, Laima; Jenkins, Alicia; Keech, Anthony; Ryan, Chris; Bursell, Sven-Erik

    2017-01-05

    Despite substantial investment in detection, early intervention and evidence-based treatments, current management strategies for diabetes-associated retinopathy and cardiovascular disease are largely based on real-time and face-to-face approaches. There are limited data re telehealth facilitation in type 2 diabetes management. Therefore, we aim to investigate efficacy of telehealth facilitation of diabetes and cardiovascular disease care in high-risk vulnerable Aboriginal and Torres Strait Islanders in remote/very remote Australia. Using a pre-post intervention design, 600 Indigenous Australians with type 2 diabetes will be recruited from three primary-care health-services in the Northern Territory. Diabetes status will be based on clinical records. There will be four technological interventions: 1. Baseline retinal imaging [as a real-time patient education/engagement tool and telehealth screening strategy]. 2. A lifestyle survey tool administered at ≈ 6-months. 3. At ≈ 6- and 18-months, an electronic cardiovascular disease and diabetes decision-support tool based on current guidelines in the Standard Treatment Manual of the Central Australian Rural Practitioner's Association to generate clinical recommendations. 4. Mobile tablet technology developed to enhance participant engagement in self-management. Data will include: Pre-intervention clinical and encounter-history data, baseline retinopathy status, decision-support and survey data/opportunistic mobile tablet encounter data. The primary outcome is increased participant adherence to clinical appointments, a marker of engagement and self-management. A cost-benefit analysis will be performed. Remoteness is a major barrier to provision and uptake of best-practice chronic disease management. Telehealth, beyond videoconferencing of consultations, could facilitate evidence-based management of diabetes and cardiovascular disease in Indigenous Australians and serve as a model for other conditions. Australia

  9. A home-based exercise program for children with congenital heart disease following interventional cardiac catheterization: study protocol for a randomized controlled trial.

    PubMed

    Du, Qing; Salem, Yasser; Liu, Hao Howe; Zhou, Xuan; Chen, Sun; Chen, Nan; Yang, Xiaoyan; Liang, Juping; Sun, Kun

    2017-01-23

    Cardiac catheterization has opened an innovative treatment field for cardiac disease; this treatment is becoming the most popular approach for pediatric congenital heart disease (CHD) and has led to a significant growth in the number of children with cardiac catheterization. Unfortunately, based on evidence, it has been demonstrated that the majority of children with CHD are at an increased risk of "non-cardiac" problems. Effective exercise therapy could improve their functional status significantly. As studies identifying the efficacy of exercise therapy are rare in this field, the aims of this study are to (1) identify the efficacy of a home-based exercise program to improve the motor function of children with CHD with cardiac catheterization, (2) reduce parental anxiety and parenting burden, and (3) improve the quality of life for parents whose children are diagnosed with CHD with cardiac catheterization through the program. A total of 300 children who will perform a cardiac catheterization will be randomly assigned to two groups: a home-based intervention group and a control group. The home-based intervention group will carry out a home-based exercise program, and the control group will receive only home-based exercise education. Assessments will be undertaken before catheterization and at 1, 3, and 6 months after catheterization. Motor ability quotients will be assessed as the primary outcomes. The modified Ross score, cardiac function, speed of sound at the tibia, functional independence of the children, anxiety, quality of life, and caregiver burden of their parents or the main caregivers will be the secondary outcome measurements. The proposed prospective randomized controlled trial will evaluate the efficiency of a home-based exercise program for children with CHD with cardiac catheterization. We anticipate that the home-based exercise program may represent a valuable and efficient intervention for children with CHD and their families. http

  10. Home Telehealth Video Conferencing: Perceptions and Performance.

    PubMed

    Taylor, Alan; Morris, Greg; Pech, Joanne; Rechter, Stuart; Carati, Colin; Kidd, Michael R

    2015-09-17

    The Flinders Telehealth in the Home trial (FTH trial), conducted in South Australia, was an action research initiative to test and evaluate the inclusion of telehealth services and broadband access technologies for palliative care patients living in the community and home-based rehabilitation services for the elderly at home. Telehealth services at home were supported by video conferencing between a therapist, nurse or doctor, and a patient using the iPad tablet. The aims of this study are to identify which technical factors influence the quality of video conferencing in the home setting and to assess the impact of these factors on the clinical perceptions and acceptance of video conferencing for health care delivery into the home. Finally, we aim to identify any relationships between technical factors and clinical acceptance of this technology. An action research process developed several quantitative and qualitative procedures during the FTH trial to investigate technology performance and users perceptions of the technology including measurements of signal power, data transmission throughput, objective assessment of user perceptions of videoconference quality, and questionnaires administered to clinical users. The effectiveness of telehealth was judged by clinicians as equivalent to or better than a home visit on 192 (71.6%, 192/268) occasions, and clinicians rated the experience of conducting a telehealth session compared with a home visit as equivalent or better in 90.3% (489/540) of the sessions. It was found that the quality of video conferencing when using a third generation mobile data service (3G) in comparison to broadband fiber-based services was concerning as 23.5% (220/936) of the calls failed during the telehealth sessions. The experimental field tests indicated that video conferencing audio and video quality was worse when using mobile data services compared with fiber to the home services. As well, statistically significant associations were found

  11. Home Telehealth Video Conferencing: Perceptions and Performance

    PubMed Central

    Morris, Greg; Pech, Joanne; Rechter, Stuart; Carati, Colin; Kidd, Michael R

    2015-01-01

    Background The Flinders Telehealth in the Home trial (FTH trial), conducted in South Australia, was an action research initiative to test and evaluate the inclusion of telehealth services and broadband access technologies for palliative care patients living in the community and home-based rehabilitation services for the elderly at home. Telehealth services at home were supported by video conferencing between a therapist, nurse or doctor, and a patient using the iPad tablet. Objective The aims of this study are to identify which technical factors influence the quality of video conferencing in the home setting and to assess the impact of these factors on the clinical perceptions and acceptance of video conferencing for health care delivery into the home. Finally, we aim to identify any relationships between technical factors and clinical acceptance of this technology. Methods An action research process developed several quantitative and qualitative procedures during the FTH trial to investigate technology performance and users perceptions of the technology including measurements of signal power, data transmission throughput, objective assessment of user perceptions of videoconference quality, and questionnaires administered to clinical users. Results The effectiveness of telehealth was judged by clinicians as equivalent to or better than a home visit on 192 (71.6%, 192/268) occasions, and clinicians rated the experience of conducting a telehealth session compared with a home visit as equivalent or better in 90.3% (489/540) of the sessions. It was found that the quality of video conferencing when using a third generation mobile data service (3G) in comparison to broadband fiber-based services was concerning as 23.5% (220/936) of the calls failed during the telehealth sessions. The experimental field tests indicated that video conferencing audio and video quality was worse when using mobile data services compared with fiber to the home services. As well, statistically

  12. Home-Based Intervention Program to Reduce Food Insecurity in Elderly Populations Using a TV App: Study Protocol of the Randomized Controlled Trial Saúde.Come Senior.

    PubMed

    Rodrigues, Ana Maria; Gregório, Maria João; Gein, Pierre; Eusébio, Mónica; Santos, Maria José; de Sousa, Rute Dinis; Coelho, Pedro S; Mendes, Jorge M; Graça, Pedro; Oliveira, Pedro; Branco, Jaime C; Canhão, Helena

    2017-03-13

    considering that 50% of the target individuals are food insecure (based on INFOFAMÍLIA Survey) (567) and about 50% of those will adhere to the study (282). The randomized controlled trial with the 12-week home-based intervention with a comprehensive program on healthy eating and physical activity delivery is planned to start recruiting participants at the end of 2017. This study will assess the efficacy of this innovative tool (Saúde.Come Senior) for disseminating relevant health information, modifying behaviors, and decreasing food insecurity in an easy, low-cost, and massive way.

  13. Home-Based Intervention Program to Reduce Food Insecurity in Elderly Populations Using a TV App: Study Protocol of the Randomized Controlled Trial Saúde.Come Senior

    PubMed Central

    Gregório, Maria João; Gein, Pierre; Eusébio, Mónica; Santos, Maria José; de Sousa, Rute Dinis; Coelho, Pedro S; Mendes, Jorge M; Graça, Pedro; Oliveira, Pedro; Branco, Jaime C; Canhão, Helena

    2017-01-01

    recruit a total of 1,128 subjects considering that 50% of the target individuals are food insecure (based on INFOFAMÍLIA Survey) (567) and about 50% of those will adhere to the study (282). Results The randomized controlled trial with the 12-week home-based intervention with a comprehensive program on healthy eating and physical activity delivery is planned to start recruiting participants at the end of 2017. Conclusions This study will assess the efficacy of this innovative tool (Saúde.Come Senior) for disseminating relevant health information, modifying behaviors, and decreasing food insecurity in an easy, low-cost, and massive way. PMID:28288956

  14. Technology support to a telehealth in the home service: Qualitative observations.

    PubMed

    Taylor, Alan; Wade, Victoria; Morris, Greg; Pech, Joanne; Rechter, Stuart; Kidd, Michael; Carati, Colin

    2016-07-01

    The Flinders University Telehealth in the Home (FTH) trial was an action research initiative that introduced and evaluated the impact of telehealth services on palliative care patients living in the community, home-based rehabilitation services for the elderly, and services to the elderly in residential aged care. The aim of this study was to understand the issues encountered during the provision of technology services that supported this trial. A mixed methods approach was undertaken to analyse the roles of information and communication technology (ICT) and clinical staff in design, technology management and training. The data sources were staff observations and documents including job logs, meetings, emails and technology descriptions. Use of consumer technology for telehealth required customisation of applications and services. Clinicians played a key role in definition of applications and the embedding of workflow into applications. Usability of applications was key to their subsequent use. Management of design creep and technology services, coupled with support and training for clinicians were important to maintenance of a telehealth service. In the setting described, an iterative approach to the development of telehealth services to the home using consumer technologies was needed. The efficient management of consumer devices in multiple settings will become critical as telehealth services grow in scale. Effective collaboration between clinical and technical stakeholders and further workforce education in telehealth can be key enablers for the transition of face-to-face care to a telehealth mode of delivery. © The Author(s) 2015.

  15. Effect of workplace- versus home-based physical exercise on pain in healthcare workers: study protocol for a single blinded cluster randomized controlled trial.

    PubMed

    Jakobsen, Markus D; Sundstrup, Emil; Brandt, Mikkel; Kristensen, Anne Zoëga; Jay, Kenneth; Stelter, Reinhard; Lavendt, Ebbe; Aagaard, Per; Andersen, Lars L

    2014-04-07

    The prevalence and consequences of musculoskeletal pain is considerable among healthcare workers, allegedly due to high physical work demands of healthcare work. Previous investigations have shown promising results of physical exercise for relieving pain among different occupational groups, but the question remains whether such physical exercise should be performed at the workplace or conducted as home-based exercise. Performing physical exercise at the workplace together with colleagues may be more motivating for some employees and thus increase adherence. On the other hand, physical exercise performed during working hours at the workplace may be costly for the employers in terms of time spend. Thus, it seems relevant to compare the efficacy of workplace- versus home-based training on musculoskeletal pain. This study is intended to investigate the effect of workplace-based versus home-based physical exercise on musculoskeletal pain among healthcare workers. This study was designed as a cluster randomized controlled trial performed at 3 hospitals in Copenhagen, Denmark. Clusters are hospital departments and hospital units. Cluster randomization was chosen to increase adherence and avoid contamination between interventions. Two hundred healthcare workers from 18 departments located at three different hospitals is allocated to 10 weeks of 1) workplace based physical exercise performed during working hours (using kettlebells, elastic bands and exercise balls) for 5 × 10 minutes per week and up to 5 group-based coaching sessions, or 2) home based physical exercise performed during leisure time (using elastic bands and body weight exercises) for 5 × 10 minutes per week. Both intervention groups will also receive ergonomic instructions on patient handling and use of lifting aides etc. Inclusion criteria are female healthcare workers working at a hospital. Average pain intensity (VAS scale 0-10) of the back, neck and shoulder (primary outcome) and physical

  16. Effect of workplace- versus home-based physical exercise on pain in healthcare workers: study protocol for a single blinded cluster randomized controlled trial

    PubMed Central

    2014-01-01

    Background The prevalence and consequences of musculoskeletal pain is considerable among healthcare workers, allegedly due to high physical work demands of healthcare work. Previous investigations have shown promising results of physical exercise for relieving pain among different occupational groups, but the question remains whether such physical exercise should be performed at the workplace or conducted as home-based exercise. Performing physical exercise at the workplace together with colleagues may be more motivating for some employees and thus increase adherence. On the other hand, physical exercise performed during working hours at the workplace may be costly for the employers in terms of time spend. Thus, it seems relevant to compare the efficacy of workplace- versus home-based training on musculoskeletal pain. This study is intended to investigate the effect of workplace-based versus home-based physical exercise on musculoskeletal pain among healthcare workers. Methods/Design This study was designed as a cluster randomized controlled trial performed at 3 hospitals in Copenhagen, Denmark. Clusters are hospital departments and hospital units. Cluster randomization was chosen to increase adherence and avoid contamination between interventions. Two hundred healthcare workers from 18 departments located at three different hospitals is allocated to 10 weeks of 1) workplace based physical exercise performed during working hours (using kettlebells, elastic bands and exercise balls) for 5 × 10 minutes per week and up to 5 group-based coaching sessions, or 2) home based physical exercise performed during leisure time (using elastic bands and body weight exercises) for 5 × 10 minutes per week. Both intervention groups will also receive ergonomic instructions on patient handling and use of lifting aides etc. Inclusion criteria are female healthcare workers working at a hospital. Average pain intensity (VAS scale 0-10) of the back, neck and shoulder

  17. Telehealth and telecare news.

    PubMed

    Birmingham, Karen

    2008-10-01

    Swindon Primary Care Trust (PCT) last month became the latest trust to make a substantial expansion to its telehealth service. It joins three other PCTs which have greatly increased their use of remote monitoring in the last six months.

  18. Telehealth and Autism: Treating Challenging Behavior at Lower Cost

    PubMed Central

    Wacker, David; Suess, Alyssa; Schieltz, Kelly; Pelzel, Kelly; Kopelman, Todd; Lee, John; Romani, Patrick; Waldron, Debra

    2016-01-01

    OBJECTIVE: To determine whether challenging behavior in young children with autism and other developmental disabilities can be treated successfully at lower cost by using telehealth to train parents to implement applied behavior analysis (ABA). METHODS: We compared data on the outcomes and costs for implementing evidence-based ABA procedures to reduce problem behavior by using 3 service delivery models: in-home therapy, clinic-based telehealth, and home-based telehealth. Participants were 107 young children diagnosed with autism or other neurodevelopmental disorders, and data analysis focused on the 94 children who completed treatment. RESULTS: All 3 service delivery models demonstrated successful reduction of problem behavior by training parents to conduct functional analysis and functional communication training. The mean percentage reduction in problem behavior was >90% in all 3 groups after treatment, and treatment acceptability based on parent ratings was high for all groups. Total costs for implementing treatment were lowest for home telehealth, but both telehealth models were significantly less costly than in-home therapy. CONCLUSIONS: This research demonstrated that parents can use ABA procedures to successfully treat behavior problems associated with autism spectrum disorders regardless of whether treatment is directed by behavior consultants in person or via remote video coaching. Because ABA telehealth can achieve similar outcomes at lower cost compared with in-home therapy, geographic barriers to providing access to ABA for treating problem behavior can be minimized. These findings support the potential for using telehealth to provide research-based behavioral treatment to any family that has access to the Internet. PMID:26908472

  19. Telehealth and Autism: Treating Challenging Behavior at Lower Cost.

    PubMed

    Lindgren, Scott; Wacker, David; Suess, Alyssa; Schieltz, Kelly; Pelzel, Kelly; Kopelman, Todd; Lee, John; Romani, Patrick; Waldron, Debra

    2016-02-01

    To determine whether challenging behavior in young children with autism and other developmental disabilities can be treated successfully at lower cost by using telehealth to train parents to implement applied behavior analysis (ABA). We compared data on the outcomes and costs for implementing evidence-based ABA procedures to reduce problem behavior by using 3 service delivery models: in-home therapy, clinic-based telehealth, and home-based telehealth. Participants were 107 young children diagnosed with autism or other neurodevelopmental disorders, and data analysis focused on the 94 children who completed treatment. All 3 service delivery models demonstrated successful reduction of problem behavior by training parents to conduct functional analysis and functional communication training. The mean percentage reduction in problem behavior was >90% in all 3 groups after treatment, and treatment acceptability based on parent ratings was high for all groups. Total costs for implementing treatment were lowest for home telehealth, but both telehealth models were significantly less costly than in-home therapy. This research demonstrated that parents can use ABA procedures to successfully treat behavior problems associated with autism spectrum disorders regardless of whether treatment is directed by behavior consultants in person or via remote video coaching. Because ABA telehealth can achieve similar outcomes at lower cost compared with in-home therapy, geographic barriers to providing access to ABA for treating problem behavior can be minimized. These findings support the potential for using telehealth to provide research-based behavioral treatment to any family that has access to the Internet. Copyright © 2016 by the American Academy of Pediatrics.

  20. Inclusion of Ethnic Minorities in Telehealth Trials for Type 2 Diabetes: Protocol for a Systematic Review Examining Prevalence and Language Issues

    PubMed Central

    Rooshenas, Leila

    2016-01-01

    Background Type 2 diabetes is common, on the rise, and disproportionately affects ethnic minority groups. Telehealth interventions may mitigate diabetes-related complications, but might under-recruit or even exclude ethnic minorities, in part because of English language requirements. The under-representation of minority patients in trials could threaten the generalizability of the findings, whereby the patients who might stand to benefit most from such interventions are not being included in their evaluation. Objective The aims of this systematic review are twofold: (1) to assess the reporting and prevalence of ethnic minorities in published telehealth trials for type 2 diabetes, including identifying trial features associated with successful patient recruitment; and (2) to determine the proportion of such trials that report English language proficiency as an inclusion/exclusion criterion, including how and why they do so. Methods Randomized controlled trials (RCTs) of adults with type 2 diabetes in Western, English-speaking countries that included telehealth interventions targeting diabetes as a primary condition, and those that did not specifically recruit minority groups will be included. Search strategies were devised for indexed and keyword terms capturing type 2 diabetes, telehealth/health technology, and RCTs in English language publications from 2000 to July 2015 in MEDLINE, PsycINFO, EMBASE, CINAHL, and CENTRAL. Reference lists of included studies will also be searched. Two reviewers will independently screen abstracts and full-text articles against inclusion criteria, mediated by a third reviewer if consensus cannot be reached. Data extracted from included studies will be checked by a second reviewer and will be summarized using narrative synthesis. Results This research is in progress, with findings expected by Spring 2016. Conclusions This review will address research reporting and recruitment practices of ethnic minorities in telehealth RCTs for type 2

  1. The effects of a home-based arm ergometry exercise programme on physical fitness, fatigue and activity in polio survivors: protocol for a randomised controlled trial

    PubMed Central

    2012-01-01

    Background Many Polio survivors have reduced mobility, pain and fatigue, which make access to conventional forms of aerobic exercise difficult. Inactivity leads to increased risk of health problems, many of which are prevalent among Polio survivors. Aerobic exercise programmes in Polio survivors should utilise stable muscle groups and should be designed to minimise exacerbation of pain and fatigue. A home-based arm ergometry aerobic exercise programme may represent an affordable and accessible exercise modality, incorporating exercise prescription principles in this group. Methods/design This is a prospective, single blinded, randomised controlled trial. There are two arms; exercise intervention using arm ergometers and control. Polio survivors meeting eligibility criteria will be recruited and randomly allocated to intervention or control groups. Participants allocated to the intervention group will receive a small arm ergometer and a polar heart rate monitor. They will carry out a home-based moderate intensity (50-70% HRMax) aerobic exercise programme for eight weeks, following instruction by the treating physiotherapist. Assessments will occur at baseline and after eight weeks and will include tests of physical fitness, activity, energy cost of walking, fatigue and quality of life. Clinically feasible assessment tools including the Six Minute Arm Test, the Physical Activity Scale for People with Physical Disabilities questionnaire, the Physiological Cost Index, Fatigue Severity Scale and the SF-36v2 will be utilised. Discussion The efficacy of a home-based arm ergometry programme in Polio survivors will be examined. No previous trial has examined such a programme using a wide range of outcome measures pertinent to Polio survivors. This study will provide new information on the impact of arm ergometry on physical fitness, activity, body composition, fatigue, pain, muscle strength, and health related quality of life. Also, the study will provide information, which

  2. Home-based exercise and support programme for people with dementia and their caregivers: study protocol of a randomised controlled trial

    PubMed Central

    2011-01-01

    Background Dementia affects the mood of people with dementia but also of their caregivers. In the coming years, the number of people with dementia will increase worldwide and most of them will continue to live in the community as long as possible. Home-based psychosocial interventions reducing the depressive symptoms of both people with dementia and their caregivers in their own home are highly needed. Methods/Design This manuscript describes the design of a Randomised Controlled Trial (RCT) of the effects of a home-based exercise and support programme for people with dementia and their caregivers. The aim is to randomly assign 156 dyads (caregiver and dementia diagnosed person) to an intervention group or a comparison group. The experimental group receives a home programme in which exercise and support for the people with dementia and their caregivers are combined and integrated. The comparison group receives a minimal intervention. Primary outcomes are physical health (people with dementia) and mood (people with dementia and caregivers). In addition, to get more insight in the working components of the intervention and the impact of the intervention on the relationship of the dyads a qualitative sub-study is carried out. Discussion This study aims to contribute to an evidence-based treatment to reduce depressive symptoms among people with dementia and their caregivers independently living in the community. Trial Registration The study has been registered at the Netherlands National Trial Register (NTR), which is connected to the International Clinical Trials Registry Platform of the WHO. Trial number: NTR1802. PMID:22117691

  3. Effectiveness and cost-effectiveness of a telehealth intervention to support the management of long-term conditions: study protocol for two linked randomized controlled trials

    PubMed Central

    2014-01-01

    Background As the population ages, more people are suffering from long-term health conditions (LTCs). Health services around the world are exploring new ways of supporting people with LTCs and there is great interest in the use of telehealth: technologies such as the Internet, telephone and home self-monitoring. Methods/Design This study aims to evaluate the effectiveness and cost-effectiveness of a telehealth intervention delivered by NHS Direct to support patients with LTCs. Two randomized controlled trials will be conducted in parallel, recruiting patients with two exemplar LTCs: depression or raised cardiovascular disease (CVD) risk. A total of 1,200 patients will be recruited from approximately 42 general practices near Bristol, Sheffield and Southampton, UK. Participants will be randomly allocated to either usual care (control group) or usual care plus the NHS Direct Healthlines Service (intervention group). The intervention is based on a conceptual model incorporating promotion of self-management, optimisation of treatment, coordination of care and engagement of patients and general practitioners. Participants will be provided with tailored help, combining telephone advice from health information advisors with support to use a range of online resources. Participants will access the service for 12 months. Outcomes will be collected at baseline, four, eight and 12 months for the depression trial and baseline, six and 12 months for the CVD risk trial. The primary outcome will be the proportion of patients responding to treatment, defined in the depression trial as a PHQ-9 score <10 and an absolute reduction in PHQ-9 ≥5 after 4 months, and in the CVD risk trial as maintenance or reduction of 10-year CVD risk after 12 months. The study will also assess whether the intervention is cost-effective from the perspective of the NHS and personal social services. An embedded qualitative interview study will explore healthcare professionals’ and patients’ views of

  4. Economic Modeling of Heart Failure Telehealth Programs: When Do They Become Cost Saving?

    PubMed Central

    Liu, Sheena Xin; Lagor, Charles; Liu, Nan; Sullivan, Kathleen

    2016-01-01

    Telehealth programs for congestive heart failure have been shown to be clinically effective. This study assesses clinical and economic consequences of providing telehealth programs for CHF patients. A Markov model was developed and presented in the context of a home-based telehealth program on CHF. Incremental life expectancy, hospital admissions, and total healthcare costs were examined at periods ranging up to five years. One-way and two-way sensitivity analyses were also conducted on clinical performance parameters. The base case analysis yielded cost savings ranging from $2832 to $5499 and 0.03 to 0.04 life year gain per patient over a 1-year period. Applying telehealth solution to a low-risk cohort with no prior admission history would result in $2502 cost increase per person over the 1-year time frame with 0.01 life year gain. Sensitivity analyses demonstrated that the cost savings were most sensitive to patient risk, baseline cost of hospital admission, and the length-of-stay reduction ratio affected by the telehealth programs. In sum, telehealth programs can be cost saving for intermediate and high risk patients over a 1- to 5-year window. The results suggested the economic viability of telehealth programs for managing CHF patients and illustrated the importance of risk stratification in such programs. PMID:27528868

  5. Economic Modeling of Heart Failure Telehealth Programs: When Do They Become Cost Saving?

    PubMed

    Liu, Sheena Xin; Xiang, Rui; Lagor, Charles; Liu, Nan; Sullivan, Kathleen

    2016-01-01

    Telehealth programs for congestive heart failure have been shown to be clinically effective. This study assesses clinical and economic consequences of providing telehealth programs for CHF patients. A Markov model was developed and presented in the context of a home-based telehealth program on CHF. Incremental life expectancy, hospital admissions, and total healthcare costs were examined at periods ranging up to five years. One-way and two-way sensitivity analyses were also conducted on clinical performance parameters. The base case analysis yielded cost savings ranging from $2832 to $5499 and 0.03 to 0.04 life year gain per patient over a 1-year period. Applying telehealth solution to a low-risk cohort with no prior admission history would result in $2502 cost increase per person over the 1-year time frame with 0.01 life year gain. Sensitivity analyses demonstrated that the cost savings were most sensitive to patient risk, baseline cost of hospital admission, and the length-of-stay reduction ratio affected by the telehealth programs. In sum, telehealth programs can be cost saving for intermediate and high risk patients over a 1- to 5-year window. The results suggested the economic viability of telehealth programs for managing CHF patients and illustrated the importance of risk stratification in such programs.

  6. Participatory and persuasive telehealth.

    PubMed

    Lee, Duckki; Helal, Sumi; Anton, Steve; De Deugd, Scott; Smith, Andy

    2012-01-01

    Technological advances in telehealth systems are primarily focused on sensing and monitoring. However, these systems are limited in that they only rely on sensors and medical devices to obtain vital signs. New research and development are urgently needed to offer more effective and meaningful interactions between patients, medical professionals and other individuals around the patients. Social networking with Web 2.0 technologies and methods can meet these demands, and help to develop a more complete view of the patient. Also many people, including the elderly, may be resistant to change, which can reduce the efficacy of telehealth systems. Persuasive technology and mechanisms are urgently needed to counter this resistance and promote healthy lifestyles. In this paper, we propose the participatory and persuasive telehealth system as a solution for these two limitations. By integrating connected health solutions with social networking and adding persuasive influence, we increase the chances for effective interventions and behavior alterations.

  7. Discovering untapped relationship potential with patients in telehealth: a qualitative interview study

    PubMed Central

    Wolf, Axel; Ali, Lilas; Sonntag, Steffen Mark; Ekman, Inger

    2016-01-01

    Objectives To explore factors that influence relationship building between telehealth professionals and patients with chronic illness over a distance, from a telehealth professional's perspective. Design 4 focus group interviews were conducted in June 2014. Digital recordings were transcribed verbatim and qualitative content analysis was performed using an iterative process of 3 coding rounds. Participants 20 telehealth professionals. Setting A telehealth service centre in the south of Germany that provided care for 12 000 patients with chronic heart failure across Germany. Results Non-video telehealth technology creates an atmosphere that fosters sharing of personal information and a non-judgemental attitude. This facilitates the delivery of fair and equal healthcare. A combination of a protocol-driven service structure along with shared team and organisational values provide a basis for establishing long-term healthcare relationships. However, each contact between a telehealth professional and a patient has an uncertain outcome and requires skilful negotiation of the relationship. Although care provision was personalised, there was scope to include the patients as ‘experts on their own illness’ to a greater extent as advocated by person-centred care. Currently, provision of person-centred care is not sufficiently addressed in telehealth professional training. Conclusions Telehealth offers a viable environment for the delivery of person-centred care for patients with long-standing disease. Current telehealth training programmes may be enhanced by teaching person-centred care skills. PMID:26936904

  8. Evolving telehealth reimbursement in Australia.

    PubMed

    Bursell, S-E; Zang, S; Keech, A C; Jenkins, A J

    2016-08-01

    Video-based consultation is the only telehealth service reimbursed by the Medicare Benefits Schedule in Australia, but the uptake of telehealth is still low and inconsistent. There is a clear need for the development of appropriate medical evidence to support implementation of telehealth services. With the ubiquitous use of mobile phones, mobile health becomes important in facilitating health services and impacting clinical outcomes anywhere.

  9. Effect of high-intensity home-based respiratory muscle training on strength of respiratory muscles following a stroke: a protocol for a randomized controlled trial.

    PubMed

    Menezes, Kênia Kiefer Parreiras De; Nascimento, Lucas Rodrigues; Polese, Janaine Cunha; Ada, Louise; Teixeira-Salmela, Luci Fuscaldi

    2017-07-03

    Respiratory muscle training has shown to increase strength of the respiratory muscles following a stroke. However, low duration and/or intensity of training may be responsible for the small effect size seen and/or absence of carry-over effects to an activity, e.g., walking. Therefore, an investigation of the effects of long-duration, high-intensity respiratory muscle training is warranted. This proposed protocol for a randomized clinical trial will examine the efficacy of high-intensity respiratory muscle training to increase strength and improve activity following a stroke. This study will be a two-arm, prospectively registered, randomized controlled trial, with blinded assessors. Thirty-eight individuals who have suffered a stroke will participate. The experimental group will undertake a 40-min of respiratory muscle training program, seven days/week, for eight weeks in their homes. Training loads will be increased weekly. The control group will undertake a sham respiratory muscle training program with equivalent duration and scheduling of training. The primary outcome will be the strength of the inspiratory muscles, measured as maximal inspiratory pressure. Secondary outcomes will include expiratory muscle strength, inspiratory muscle endurance, dyspnea, respiratory complications, and walking capacity. Outcomes will be collected by a researcher blinded to group allocation at baseline (Week 0), after intervention (Week 8), and one month beyond intervention (Week 12). High-intensity respiratory muscle training may have the potential to optimize the strength of the respiratory muscles following a stroke. If benefits are carried over to activity, the findings may have broader implications, since walking capacity has been shown to predict physical activity and community participation on this population. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  10. Telehealth coordinators in hospital based telehealth services: Who are they and what do they do?

    PubMed

    Edirippulige, Sisira; Armfield, Nigel R; Greenup, Phil; Bryett, Andrew

    2016-12-01

    Many studies have identified the importance of 'telehealth coordinators' for successful telehealth implementation and operation. However, little is known about the telehealth coordinators' functions, the skills and competencies required and the reasons for their influence. This study aimed to examine the key functions of telehealth coordinators in the Queensland public health system, their perceptions about their role, and the level of competencies to support this role. All telehealth coordinators within Queensland Health Telehealth Services were invited to complete a questionnaire. We collected: (i) demographic information; (ii) details of their telehealth work; and (iii) information about knowledge and skills relevant to their telehealth coordinator role. Eighteen of 20 (90%) participants completed and submitted the survey. Telehealth coordinators were responsible for a range of tasks relating to telehealth consultations, technical assistance, administration, research, promotion and marketing. Nearly all telehealth coordinators (n = 17, 94%) were confident in carrying out the tasks of their job. The majority of telehealth coordinators (n = 13, 72%) thought education and training relating to telehealth would help improve their job. The top three topics that telehealth coordinators were keen to learn about were: (i) examples of clinical use of telehealth; (ii) types of technologies used; and (iii) telehealth clinical and business models. Our participants were all hospital-based; as the use of telehealth is growing outside of the traditional hospital settings, the role of telehealth coordinators is likely to change. © The Author(s) 2016.

  11. Telehealth: voice therapy using telecommunications technology.

    PubMed

    Mashima, Pauline A; Birkmire-Peters, Deborah P; Syms, Mark J; Holtel, Michael R; Burgess, Lawrence P A; Peters, Leslie J

    2003-11-01

    Telehealth offers the potential to meet the needs of underserved populations in remote regions. The purpose of this study was a proof-of-concept to determine whether voice therapy can be delivered effectively remotely. Treatment outcomes were evaluated for a vocal rehabilitation protocol delivered under 2 conditions: with the patient and clinician interacting within the same room (conventional group) and with the patient and clinician in separate rooms, interacting in real time via a hard-wired video camera and monitor (video teleconference group). Seventy-two patients with voice disorders served as participants. Based on evaluation by otolaryngologists, 31 participants were diagnosed with vocal nodules, 29 were diagnosed with edema, 9 were diagnosed with unilateral vocal fold paralysis, and 3 presented with vocal hyperfunction with no laryngeal pathology. Fifty-one participants (71%) completed the vocal rehabilitation protocol. Outcome measures included perceptual judgments of voice quality, acoustic analyses of voice, patient satisfaction ratings, and fiber-optic laryngoscopy. There were no differences in outcome measures between the conventional group and the remote video teleconference group. Participants in both groups showed positive changes on all outcome measures after completing the vocal rehabilitation protocol. Reasons for participants discontinuing therapy prematurely provided support for the telehealth model of service delivery.

  12. Telehealth system (e-CUIDATE) to improve quality of life in breast cancer survivors: rationale and study protocol for a randomized clinical trial

    PubMed Central

    2013-01-01

    European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 version 3.0 and breast module called The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life questionnaire. The secondary outcomes: pain (algometry, Visual Analogue Scale, Brief Pain Inventory short form); body composition; physical measurement (abdominal test, handgrip strength, back muscle strength, and multiple sit-to-stand test); cardiorespiratory fitness (International Fitness Scale, 6-minute walk test, International Physical Activity Questionnaire-Short Form); fatigue (Piper Fatigue Scale and Borg Fatigue Scale); anxiety and depression (Hospital Anxiety and Depression Scale); cognitive function (Trail Making Test and Auditory Consonant Trigram); accelerometry; lymphedema; and anthropometric perimeters. Discussion This study investigates the feasibility and effectiveness of a telerehabilitation system during adjuvant treatment of patients with breast cancer. If this treatment option is effective, telehealth systems could offer a choice of supportive care to cancer patients during the survivorship phase. Trial registration ClinicalTrials.gov Identifier: NCT01801527 PMID:23799886

  13. Impact of telehealth on general practice contacts: findings from the whole systems demonstrator cluster randomised trial.

    PubMed

    Bardsley, Martin; Steventon, Adam; Doll, Helen

    2013-10-08

    Telehealth is increasingly used in the care of people with long term conditions. Whilst many studies look at the impacts of the technology on hospital use, few look at how it changes contacts with primary care professionals. The aim of this paper was to assess the impacts of home-based telehealth interventions on general practice contacts. Secondary analysis of data from a Department of Health funded cluster-randomised trial with 179 general practices in three areas of England randomly assigned to offer telehealth or usual care to eligible patients. Telehealth included remote exchange of vitals signs and symptoms data between patients and healthcare professionals as part of the continuing management of patients. Usual care reflected the range of services otherwise available in the sites, excluding telehealth. Anonymised data from GP systems were used to construct person level histories for control and intervention patients. We tested for differences in numbers of general practitioner and practice nurse contacts over twelve months and in the number of clinical readings recorded on general practice systems over twelve months. 3,230 people with diabetes, chronic obstructive pulmonary disease or heart failure were recruited in 2008 and 2009. 1219 intervention and 1098 control cases were available for analysis. No statistically significant differences were detected in the numbers of general practitioner or practice nurse contacts between intervention and control groups during the trial, or in the numbers of clinical readings recorded on the general practice systems. Telehealth did not appear associated with different levels of contact with general practitioners and practice nurses. We note that the way that telehealth impacts on primary care roles may be influenced by a number of other features in the health system. The challenge is to ensure that these systems lead to better integration of care than fragmentation. International Standard Randomised Controlled Trial

  14. Development of the Telehealth Usability Questionnaire (TUQ).

    PubMed

    Parmanto, Bambang; Lewis, Allen Nelson; Graham, Kristin M; Bertolet, Marnie H

    2016-01-01

    Current telehealth usability questionnaires are designed primarily for older technologies, where telehealth interaction is conducted over dedicated videoconferencing applications. However, telehealth services are increasingly conducted over computer-based systems that rely on commercial software and a user supplied computer interface. Therefore, a usability questionnaire that addresses the changes in telehealth service delivery and technology is needed. The Telehealth Usability Questionnaire (TUQ) was developed to evaluate the usability of telehealth implementation and services. This paper addresses: (1) the need for a new measure of telehealth usability, (2) the development of the TUQ, (3) intended uses for the TUQ, and (4) the reliability of the TUQ. Analyses indicate that the TUQ is a solid, robust, and versatile measure that can be used to measure the quality of the computer-based user interface and the quality of the telehealth interaction and services.

  15. Development of the Telehealth Usability Questionnaire (TUQ)

    PubMed Central

    PARMANTO, BAMBANG; LEWIS, ALLEN NELSON; GRAHAM, KRISTIN M.; BERTOLET, MARNIE H.

    2016-01-01

    Current telehealth usability questionnaires are designed primarily for older technologies, where telehealth interaction is conducted over dedicated videoconferencing applications. However, telehealth services are increasingly conducted over computer-based systems that rely on commercial software and a user supplied computer interface. Therefore, a usability questionnaire that addresses the changes in telehealth service delivery and technology is needed. The Telehealth Usability Questionnaire (TUQ) was developed to evaluate the usability of telehealth implementation and services. This paper addresses: (1) the need for a new measure of telehealth usability, (2) the development of the TUQ, (3) intended uses for the TUQ, and (4) the reliability of the TUQ. Analyses indicate that the TUQ is a solid, robust, and versatile measure that can be used to measure the quality of the computer-based user interface and the quality of the telehealth interaction and services. PMID:27563386

  16. Discovering untapped relationship potential with patients in telehealth: a qualitative interview study.

    PubMed

    Heckemann, Birgit; Wolf, Axel; Ali, Lilas; Sonntag, Steffen Mark; Ekman, Inger

    2016-03-02

    To explore factors that influence relationship building between telehealth professionals and patients with chronic illness over a distance, from a telehealth professional's perspective. 4 focus group interviews were conducted in June 2014. Digital recordings were transcribed verbatim and qualitative content analysis was performed using an iterative process of 3 coding rounds. 20 telehealth professionals. A telehealth service centre in the south of Germany that provided care for 12,000 patients with chronic heart failure across Germany. Non-video telehealth technology creates an atmosphere that fosters sharing of personal information and a non-judgemental attitude. This facilitates the delivery of fair and equal healthcare. A combination of a protocol-driven service structure along with shared team and organisational values provide a basis for establishing long-term healthcare relationships. However, each contact between a telehealth professional and a patient has an uncertain outcome and requires skillful negotiation of the relationship. Although care provision was personalised, there was scope to include the patients as 'experts on their own illness' to a greater extent as advocated by person-centred care. Currently, provision of person-centred care is not sufficiently addressed in telehealth professional training. Telehealth offers a viable environment for the delivery of person-centred care for patients with long-standing disease. Current telehealth training programmes may be enhanced by teaching person-centred care skills. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  17. Feasibility and cost-effectiveness of a multidisciplinary home-telehealth intervention programme to reduce falls among elderly discharged from hospital: study protocol for a randomized controlled trial.

    PubMed

    Giordano, Alessandro; Bonometti, Gian Pietro; Vanoglio, Fabio; Paneroni, Mara; Bernocchi, Palmira; Comini, Laura; Giordano, Amerigo

    2016-12-07

    Fall incidents are the third cause of chronic disablement in elderly according to the World Health Organization (WHO). Recent meta-analyses shows that a multifactorial falls risk assessment and management programmes are effective in all older population studied. However, the application of these programmes may not be the same in all National health care setting and, consequently, needs to be evaluated by cost-effectiveness studies before to plan this intervention in regular care. In Italy structured collaboration between hospital staff and primary care is generally lacking and the role of Information and Communication Technologies (ICT) in a fall prevention programme at home has never been explored. This will be a two-group randomised controlled trial aiming to evaluate the effects of a home-based intervention programme delivered by a multidisciplinary health team. The home tele-management programme, previously adopted in our Institute for chronic patients, will be proposed to elderly people affected by chronic diseases at high risk of falling at hospital discharge. The programme will involve the hospital staff and will be managed thanks to the collaboration between hospital and primary care setting. Patients will be followed for 6 months after hospital discharge. A nurse-tutor telephone support and tele-exercise will characterize the intervention programme. People in the control group will receive usual care. The main outcome measure of the study will be the percentage of patients sustaining a fall during the 6-months follow-up period. An economic evaluation will be performed from a societal perspective and will involve calculating cost-effectiveness and cost utility ratios. To date, no adequately powered studies have investigated the effect of the Information and Communication Technologies (ICT) in a home fall prevention program. We aim the program will be feasible in terms of intensity and characteristics, but particularly in terms of patient and provider

  18. Marketing telehealth to align with strategy.

    PubMed

    Dansky, Kathryn H; Ajello, Jeffrey

    2005-01-01

    Telehealth is a twenty-first century solution to an old problem-how to deliver quality health services with shrinking resources. Telehealth enables healthcare providers to interact with and monitor patients remotely, thus adding value to service delivery models. On occasion, telehealth can substitute for live encounters, saving time and resources. Furthermore, as the geriatric population increases, telehealth will support independent living by supplementing the existing network of care. To be used most effectively, however, telehealth services must be carefully planned and executed. This study investigated management practices used to promote telehealth services, focusing on strategic goals for adopting telehealth. Interviews with senior managers from 19 home health agencies identified three strategic goals for adopting telehealth: (1) clinical excellence, (2) technological preeminence, and (3) cost containment. Organizational documents were analyzed to determine the extent to which the telehealth program was featured in marketing materials. Documents included the organization's brochure, newspaper ads and articles, and each home health agency's web site. Results showed that marketing practices vary widely but are correlated with motivations to adopt telehealth. The organizations with the highest marketing scores emphasize clinical excellence as a major reason for using telehealth, whereas those with the lowest marketing scores tend to focus on cost containment. Although this study focused on management practices in home health agencies, results are applicable to hospital and outpatient services as well as to other community-based programs. Using a strategic management framework, the authors offer recommendations to help organizations develop effective marketing approaches for telehealth programs.

  19. The Patient Remote Intervention and Symptom Management System (PRISMS) - a Telehealth- mediated intervention enabling real-time monitoring of chemotherapy side-effects in patients with haematological malignancies: study protocol for a randomised controlled trial.

    PubMed

    Breen, Sibilah; Ritchie, David; Schofield, Penelope; Hsueh, Ya-Seng; Gough, Karla; Santamaria, Nick; Kamateros, Rose; Maguire, Roma; Kearney, Nora; Aranda, Sanchia

    2015-10-19

    Outpatient chemotherapy is a core treatment for haematological malignancies; however, its toxicities frequently lead to distressing/potentially life-threatening side-effects (neutropenia/infection, nausea/vomiting, mucositis, constipation/diarrhoea, fatigue). Early detection/management of side-effects is vital to improve patient outcomes, decrease morbidity and limit lengthy/costly hospital admissions. The ability to capture patient-reported health data in real-time, is regarded as the 'gold-standard' to allow rapid clinical decision-making/intervention. This paper presents the protocol for a Phase 3 multi-site randomised controlled trial evaluating a novel nurse-led Telehealth intervention for remote monitoring/management of chemotherapy side-effects in Australian haematological cancer patients. Two hundred and twenty-two patients will be recruited from two hospitals. Eligibility criteria include: diagnosis of chronic lymphocytic leukaemia/Hodgkin's/non-Hodgkin's lymphoma; aged ≥ 18 years; receiving ≥ 2 cycles chemotherapy. Patients will be randomised 1:1 to either the control or intervention arm with stratification by diagnosis, chemotherapy toxicity (high versus low), receipt of previous chemotherapy and hospital. Patients allocated to the control arm will receive 'Usual Care' whilst those allocated to the intervention will receive the intervention in addition to 'Usual Care'. Intervention patients will be provided with a computer tablet and software prompting twice-daily completion of physical/emotional scales for up to four chemotherapy cycles. Should patient data exceed pre-determined limits an Email alert is delivered to the treatment team, prompting nurses to view patient data, and contact the patient to provide clinical intervention. In addition, six scheduled nursing interventions will be completed to educate/support patients in use of the software. Patient outcomes will be measured cyclically (midpoint and end of cycles) via pen

  20. The effectiveness of the use of a digital activity coaching system in addition to a two-week home-based exercise program in patients after total knee arthroplasty: study protocol for a randomized controlled trial.

    PubMed

    Harmelink, Karen E M; Zeegers, A V C M; Tönis, Thijs M; Hullegie, Wim; Nijhuis-van der Sanden, Maria W G; Staal, J Bart

    2017-07-05

    There is consistent evidence that supervised programs are not superior to home-based programs after total knee arthroplasty (TKA), especially in patients without complications. Home-based exercise programs are effective, but we hypothesize that their effectiveness can be improved by increasing the adherence to physical therapy advice to reach an adequate exercise level during the program and thereafter. Our hypothesis is that an activity coaching system (accelerometer-based activity sensor), alongside a home-based exercise program, will increase adherence to exercises and the activity level, thereby improving physical functioning and recovery. The objective of this study is to determine the effectiveness of an activity coaching system in addition to a home-based exercise program after a TKA compared to only the home-based exercise program with physical functioning as outcome. This study is a single-blind randomized controlled trial. Both the intervention (n = 55) and the control group (n = 55) receive a two-week home-based exercise program, and the intervention group receives an additional activity coaching system. This is a hand-held electronic device together with an app on a smartphone providing information and advice on exercise behavior during the day. The primary outcome is physical functioning, measured with the Timed Up and Go test (TUG) after two weeks, six weeks and three months. Secondary outcomes are 1) adherence to the activity level (activity diary); 2) physical functioning, measured with the 2-Minute Walk Test (2MWT) and the Knee Osteoarthritis Outcome Score; 3) quality of life (SF-36); 4) healthcare use up to one year postoperatively and 5) cost-effectiveness. Data are collected preoperatively, three days, two and six weeks, three months and one year postoperatively. The strengths of the study are the use of both performance-based tests and self-reported questionnaires and the personalized tailored program after TKA given by specialized physical

  1. What's happening now! Telehealth management of spinal cord injury/disorders

    PubMed Central

    Woo, Christine; Guihan, Marylou; Frick, Christine; Gill, Carol M.; Ho, Chester H.

    2011-01-01

    Context Spinal cord injury and/or disorders (SCI/D) is a costly chronic condition. Impaired mobility, and lengthy travel distances to access specialty providers are barriers that can have adverse impact on expenses and quality of care. Although ample opportunities for use of telehealth technologies exist between medical facilities, and from clinical to home settings, field experience has largely been focused on home telehealth services to promote better patient self-management skills and improve clinical outcomes. Findings This paper provides an overview of published literature on use of telehealth technologies with the SCI/D population. Presentation of case studies describe telehealth as a potential strategy for addressing disparities in providing quality care, and explore comprehensive management of multiple health issues in individuals with SCI/D. Experiences of providers in both private sector health-care systems and VHA medical facilities are described. Development of telehealth clinical protocols and adaptive devices that can be integrated with equipment to accommodate for the functional limitations in the SCI/D population are discussed as necessary for expansion of use of telehealth services. Rigorous research studies are lacking. As use of this technology spreads and issues surrounding implementation are addressed, we look forward to increased research to assess and evaluate its efficacy in the SCI/D population. Conclusion/clinical relevance Telehealth in the home setting appears to be able to help persons with SCI/D remain in the community. As the use of telehealth increases, research will be necessary in both clinical and home settings to assess its efficacy in improving outcomes in the SCI/D population. PMID:21756573

  2. Categorizing the telehealth policy response of countries and their implications for complementarity of telehealth policy.

    PubMed

    Varghese, Sunil; Scott, Richard E

    2004-01-01

    Developing countries are exploring the role of telehealth to overcome the challenges of providing adequate health care services. However, this process faces disparities, and no complementarity in telehealth policy development. Telehealth has the potential to transcend geopolitical boundaries, yet telehealth policy developed in one jurisdiction may hamper applications in another. Understanding such policy complexities is essential for telehealth to realize its full global potential. This study investigated 12 East Asian countries that may represent a microcosm of the world, to determine if the telehealth policy response of countries could be categorized, and whether any implications could be identified for the development of complementary telehealth policy. The countries were Cambodia, China, Hong Kong, Indonesia, Japan, Malaysia, Myanmar, Singapore, South Korea, Taiwan, Thailand, and Vietnam. Three categories of country response were identified in regard to national policy support and development. The first category was "None" (Cambodia, Myanmar, and Vietnam) where international partners, driven by humanitarian concerns, lead telehealth activity. The second category was "Proactive" (China, Indonesia, Malaysia, Singapore, South Korea, Taiwan, and Thailand) where national policies were designed with the view that telehealth initiatives are a component of larger development objectives. The third was "Reactive" (Hong Kong and Japan), where policies were only proffered after telehealth activities were sustainable. It is concluded that although complementarity of telehealth policy development is not occurring, increased interjurisdictional telehealth activity, regional clusters, and concerted and coordinated effort amongst researchers, practitioners, and policy makers may alter this trend.

  3. Integrating Telehealth Instruction into the Graduate Nursing Curriculum

    ERIC Educational Resources Information Center

    Erickson, Christie

    2015-01-01

    Telehealth can be effective for those who use it; however, very few educational programs prepare their students to utilize telehealth. The goal of this project was to integrate telehealth into the graduate nursing curriculum. This was done by providing a 1-hour classroom educational demonstration and lecture on telehealth along with 4-hour…

  4. Integrating Telehealth Instruction into the Graduate Nursing Curriculum

    ERIC Educational Resources Information Center

    Erickson, Christie

    2015-01-01

    Telehealth can be effective for those who use it; however, very few educational programs prepare their students to utilize telehealth. The goal of this project was to integrate telehealth into the graduate nursing curriculum. This was done by providing a 1-hour classroom educational demonstration and lecture on telehealth along with 4-hour…

  5. Evaluating the effectiveness of a home-based exercise programme delivered through a tablet computer for preventing falls in older community-dwelling people over 2 years: study protocol for the Standing Tall randomised controlled trial

    PubMed Central

    Delbaere, K; Valenzuela, T; Woodbury, A; Davies, T; Yeong, J; Steffens, D; Miles, L; Pickett, L; Zijlstra, G A R; Clemson, L; Close, J C T; Howard, K; Lord, S R

    2015-01-01

    Introduction In order to prevent falls, older people should exercise for at least 2 h per week for 6 months, with a strong focus on balance exercises. This article describes the design of a randomised controlled trial to evaluate the effectiveness of a home-based exercise programme delivered through a tablet computer to prevent falls in older people. Methods and analysis Participants aged 70 years or older, living in the community in Sydney will be recruited and randomly allocated to an intervention or control group. The intervention consists of a tailored, home-based balance training delivered through a tablet computer. Intervention participants will be asked to complete 2 h of exercises per week for 2 years. Both groups will receive an education programme focused on health-related information relevant to older adults, delivered through the tablet computer via weekly fact sheets. Primary outcome measures include number of fallers and falls rate recorded in weekly fall diaries at 12 months. A sample size of 500 will be necessary to see an effect on falls rate. Secondary outcome measures include concern about falling, depressive symptoms, health-related quality of life and physical activity levels (in all 500 participants); and physiological fall risk, balance, functional mobility, gait, stepping and cognitive performance (in a subsample of 200 participants). Adherence, acceptability, usability and enjoyment will be recorded in intervention group participants over 2 years. Data will be analysed using the intention-to-treat principle. Secondary analyses are planned in people with greater adherence. Economic analyses will be assessed from a health and community care provider perspective. Ethics and dissemination Ethical approval was obtained from UNSW Ethics Committee in December 2014 (ref number HC#14/266). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conferences. Trial registration number

  6. Visioning technology for the future of telehealth.

    PubMed

    Brennan, David M; Holtz, Bree E; Chumbler, Neale R; Kobb, Rita; Rabinowitz, Terry

    2008-11-01

    By its very nature, telehealth relies on technology. Throughout history, as new technologies emerged and afforded people the ability to send information across distances, it was not long before this capability was applied to the most basic need of all: maintaining health. While much of the early work in telehealth was driven by technology (e.g., making opportunistic use of the systems and devices that were available at the time), recent trends are beginning to push the demand for and the development of new technologies specific to the individual needs of telehealth applications. The future of telehealth will benefit greatly from this technology innovation, in particular, in areas such as home telehealth and remote monitoring, e-health and patient portal applications, personal health records, interactive Internet technologies, and robotics. Telehealth, while not a panacea for all of the challenges facing modern healthcare systems, has a substantial and ever-expanding potential to revolutionize the ways in which people receive medical care while offering the possibility to contain costs, manage chronic diseases, and prevent secondary complications. By demanding innovative solutions and speaking out in support of the field, the telehealth community can and should be leading the charge for greater attention to human factors in technology development, interoperable medical records, staff training and competencies, standards and guidelines, and support for expanded telehealth coverage at the national, state, and local levels.

  7. Mixed Methods Approach for Measuring the Impact of Video Telehealth on Outpatient Clinic Triage Nurse Workflow

    PubMed Central

    Cady, Rhonda G.; Finkelstein, Stanley M.

    2015-01-01

    Nurse-delivered telephone triage is a common component of outpatient clinic settings. Adding new communication technology to clinic triage has the potential to not only transform the triage process, but also alter triage workflow. Evaluating the impact of new technology on an existing workflow is paramount to maximizing efficiency of the delivery system. This study investigated triage nurse workflow before and after the implementation of video telehealth using a sequential mixed methods protocol that combined ethnography and time-motion study to provide a robust analysis of the implementation environment. Outpatient clinic triage using video telehealth required significantly more time than telephone triage, indicating a reduction in nurse efficiency. Despite the increased time needed to conduct video telehealth, nurses consistently rated it useful in providing triage. Interpretive analysis of the qualitative and quantitative data suggests the increased depth and breadth of data available during video triage alters the assessment triage nurses provide physicians. This in turn could impact the time physicians spend formulating a diagnosis and treatment plan. While the immediate impact of video telehealth is a reduction in triage nurse efficiency, what is unknown is the impact of video telehealth on physician and overall clinic efficiency. Future studies should address this area. PMID:24080753

  8. Assessing home care agencies' readiness for telehealth.

    PubMed

    Demiris, George; Patrick, Timothy; Khatri, Naresh

    2003-01-01

    Home healthcare is facing a set of challenging new realities in the 21st century such as funding limitations and increased life expectancy. Many believe that the use of telehealth enabling patients at home to interact with nurses at the clinical site using videoconferencing technology, will be a cost-effective solution to providing quality care services. Many agencies have adopted or are planning on implementing a telehealth solution. Level of agencies' readiness can lead to a lower level of risk, and a more successful innovation outcome. We developed a framework for assessing home care agencies' readiness for telehealth consisting of 35 items. This instrument can be used as a decision support tool for agencies that are about to implement a telehealth system as well as a formative or summative evaluation tool for agencies already utilizing telehealth.

  9. Telehealth technology in case/disease management.

    PubMed

    Park, Eun-Jun

    2006-01-01

    Case managers can better coordinate and facilitate chronic illness care by adopting telehealth technology. This article overviews four major categories of telehealth technology based on patients' roles in self-management: surveillance, testing peripherals and messaging, decision support aids, and online support groups related to patients' subordinate, structured, collaborative, and autonomous roles, respectively. These various telehealth technologies should be selected on the basis of patients' care needs and preferences. Moreover, when they are integrated with other clinical information systems, case management practice can be better performed. However, the specific role functions and skill sets needed to be competent in telehealth environments have not yet been clearly identified. Considering role ambiguity and stress among telehealth clinicians, clarifying relevant roles is an urgent task.

  10. Effectiveness of personalised, home-based nutritional counselling on infant feeding practices, morbidity and nutritional outcomes among infants in Nairobi slums: study protocol for a cluster randomised controlled trial

    PubMed Central

    2013-01-01

    Background Nutrition in the first 1,000 days of life (during pregnancy and the first two years) is critical for child growth and survival. Poor maternal, infant and young child nutrition (MIYCN) practices are widely documented in Kenya, with potential detrimental effects on child growth and survival. This is particularly a problem in slums, where most urban residents live. For example, exclusive breastfeeding for the first six months is only about two per cent. Innovative strategies to reach slum residents are therefore needed. Strategies like the Baby Friendly Hospital Initiative have proven effective in some settings but their effectiveness in resource-limited settings, including slums where many women do not deliver in hospital, is questionable. We propose to test the effectiveness of a home-based intervention on infant feeding practices, nutrition and health outcomes of infants born in two slums in Nairobi, Kenya. Methods/Design The study, employing a cluster-randomised study design, will be conducted in two slums in Nairobi: Korogocho and Viwandani where 14 community units (defined by the Government’s health care system) will form the unit of randomization. A total of 780 pregnant women and their respective child will be recruited into the study. The mother-child pair will be followed up until the child is one year old. Recruitment will last approximately one year and three months from September 2012 to December 2013. The mothers will receive regular, personalised, home-based counselling by trained Community Health Workers on MIYCN. Regular assessment of knowledge, attitudes and practices on MIYCN will be done, coupled with assessments of nutritional status of the mother-child pairs and diarrhea morbidity for the children. Statistical methods will include analysis of covariance and multinomial logistic regression. Additionally, cost-effectiveness analysis will be done. The study is funded by the Wellcome Trust and will run from March 2012 to February 2015

  11. Effectiveness of personalised, home-based nutritional counselling on infant feeding practices, morbidity and nutritional outcomes among infants in Nairobi slums: study protocol for a cluster randomised controlled trial.

    PubMed

    Kimani-Murage, Elizabeth W; Kyobutungi, Catherine; Ezeh, Alex C; Wekesah, Frederick; Wanjohi, Milka; Muriuki, Peterrock; Musoke, Rachel N; Norris, Shane A; Griffiths, Paula; Madise, Nyovani J

    2013-12-27

    Nutrition in the first 1,000 days of life (during pregnancy and the first two years) is critical for child growth and survival. Poor maternal, infant and young child nutrition (MIYCN) practices are widely documented in Kenya, with potential detrimental effects on child growth and survival. This is particularly a problem in slums, where most urban residents live. For example, exclusive breastfeeding for the first six months is only about two per cent. Innovative strategies to reach slum residents are therefore needed. Strategies like the Baby Friendly Hospital Initiative have proven effective in some settings but their effectiveness in resource-limited settings, including slums where many women do not deliver in hospital, is questionable. We propose to test the effectiveness of a home-based intervention on infant feeding practices, nutrition and health outcomes of infants born in two slums in Nairobi, Kenya. The study, employing a cluster-randomised study design, will be conducted in two slums in Nairobi: Korogocho and Viwandani where 14 community units (defined by the Government's health care system) will form the unit of randomization. A total of 780 pregnant women and their respective child will be recruited into the study. The mother-child pair will be followed up until the child is one year old. Recruitment will last approximately one year and three months from September 2012 to December 2013. The mothers will receive regular, personalised, home-based counselling by trained Community Health Workers on MIYCN. Regular assessment of knowledge, attitudes and practices on MIYCN will be done, coupled with assessments of nutritional status of the mother-child pairs and diarrhea morbidity for the children. Statistical methods will include analysis of covariance and multinomial logistic regression. Additionally, cost-effectiveness analysis will be done. The study is funded by the Wellcome Trust and will run from March 2012 to February 2015. Interventions aimed at

  12. Standing up in multiple sclerosis (SUMS): protocol for a multi-centre randomised controlled trial evaluating the clinical and cost effectiveness of a home-based self-management standing frame programme in people with progressive multiple sclerosis.

    PubMed

    Freeman, J A; Hendrie, W; Creanor, S; Jarrett, L; Barton, A; Green, C; Marsden, J; Rogers, E; Zajicek, J

    2016-05-05

    Multiple sclerosis (MS) is an incurable, unpredictable but typically progressive neurological condition. It is the most common cause of neurological disability in young adults. Within 15 years of diagnosis, approximately 50 % of affected people are unable to walk unaided, and over time an estimated 25 % depend on a wheelchair. Typically, people with such limited mobility are excluded from clinical trials. Severely impaired people with MS spend much of their day sitting, often with limited ability to change position. In response, secondary complications can occur including: muscle wasting, pain, reduced skin integrity, spasms, limb stiffness, constipation, and associated psychosocial problems such as depression and lowered self-esteem. Effective self-management strategies, which can be implemented relatively easily and cheaply within people's homes, are needed to improve or maintain mobility and reduce sedentary behaviour. However this is challenging, particularly in the latter stages of disease. Regular supported standing using standing frames is one potential option. SUMS is a pragmatic multi-centre randomised controlled trial evaluating use of Oswestry standing frames with blinded outcome assessment and full economic evaluation. Participants will be randomly allocated (1:1) to either a home-based, self-management standing programme (with advice and support) along with their usual care or to usual care alone. Those in the intervention group will be asked to stand for a minimum of 30 min three times weekly over 20 weeks. Each participant will be followed-up at 20 and 36 weeks post baseline. The primary clinical outcome is motor function, assessed using the Amended Motor Club Assessment. The primary economic endpoint is quality-adjusted life years. The secondary outcomes include measures of explanatory physical impairments, key clinical outcomes, and health-related quality of life. An embedded qualitative component will explore participant's and carer

  13. Reimbursements for telehealth services are likely to be lower than non-telehealth services in the United States.

    PubMed

    Wilson, Fernando A; Rampa, Sankeerth; Trout, Kate E; Stimpson, Jim P

    2016-06-03

    Telehealth technologies promise to increase access to care, particularly in underserved communities. However, little is known about how private payer reimbursements vary between telehealth and non-telehealth services. We use the largest private claims database in the United States provided by the Health Care Cost Institute to identify telehealth claims and compare average reimbursements to non-telehealth claims. We find average reimbursements for telehealth services are significantly lower than those for non-telehealth for seven of the ten most common services. For example, telehealth reimbursements for office visits for evaluation and management of established patients with low complexity were 30% lower than the corresponding non-telehealth service. Reimbursements by clinical diagnosis code also tended to be lower for telehealth than non-telehealth claims. Widespread adoption of telehealth may be hampered by lower reimbursements for telehealth services relative to face-to-face services. This may result in lower incentives for providers to invest in telehealth technologies that do not result in significant cost savings to their practice, even if telehealth improves patient outcomes.

  14. Multi-centre cluster randomised trial comparing a community group exercise programme with home based exercise with usual care for people aged 65 and over in primary care: protocol of the ProAct 65+ trial

    PubMed Central

    2010-01-01

    Background Regular physical activity reduces the risk of mortality from all causes, with a powerful beneficial effect on risk of falls and hip fractures. However, physical activity levels are low in the older population and previous studies have demonstrated only modest, short-term improvements in activity levels with intervention. Design/Methods Pragmatic 3 arm parallel design cluster controlled trial of class-based exercise (FAME), home-based exercise (OEP) and usual care amongst older people (aged 65 years and over) in primary care. The primary outcome is the achievement of recommended physical activity targets 12 months after cessation of intervention. Secondary outcomes include functional assessments, predictors of exercise adherence, the incidence of falls, fear of falling, quality of life and continuation of physical activity after intervention, over a two-year follow up. An economic evaluation including participant and NHS costs will be embedded in the clinical trial. Discussion The ProAct65 trial will explore and evaluate the potential for increasing physical activity among older people recruited through general practice. The trial will be conducted in a relatively unselected population, and will address problems of selective recruitment, potentially low retention rates, variable quality of interventions and falls risk. Trial Registration Trial Registration: ISRCTN43453770 PMID:20082696

  15. Head Start Home-Based Resource Directory.

    ERIC Educational Resources Information Center

    Trans-Management Systems, Inc.

    A revision of the 1989 publication, this directory was compiled in order to help parents and professionals involved with Head Start home-based programming in meeting the needs of young children and families. The directory lists a broad range of guides and resources on topics related to Head Start home-based programs. Each listing provides the…

  16. Self-Delivered Home-Based Mirror Therapy for Lower Limb Phantom Pain

    PubMed Central

    Darnall, Beth D.

    2016-01-01

    Home-based patient-delivered mirror therapy is a promising approach in the treatment of phantom limb pain. Previous studies and case reports of mirror therapy have used a therapist-guided, structured protocol of exercises. No case report has described treatment for either upper or lower limb phantom pain by using home-based patient-delivered mirror therapy. The success of this case demonstrates that home-based patient-delivered mirror therapy may be an efficacious, low-cost treatment option that would eliminate many traditional barriers to care. PMID:19096290

  17. Considerations for the Telehealth Systems of Tomorrow: An Analysis of Student Perceptions of Telehealth Technologies

    PubMed Central

    Bull, Tyler Preston; Malvey, Donna M; Szalma, James Leo

    2016-01-01

    Background While much is known about factors that facilitate telehealth adoption, less is known about why adoption does or does not occur in specific populations, such as students. Objective This study aims to examine the perceptions of telehealth systems within a large student sample. Methods Undergraduate students (N=315) participated in a survey of the perceived advantages and disadvantages of telehealth technologies. The responses to the survey were analyzed using thematic analysis. Results We found that students were likely to adopt telehealth systems for the following reasons: (1) the system worked efficiently, (2) the convenience of telehealth, and (3) to gain access to health services. Students also perceived several disadvantages to telehealth systems, such as issues of trust (ie, security, privacy), the impersonal nature of telehealth systems, and they were concerned about the potential for major system errors. Conclusion By understanding the current barriers to telehealth adoption in a cohort of students, we can not only better anticipate the future needs of this group, but also incorporate such needs into the design of future telehealth systems. PMID:27731865

  18. Feasibility of a multidimensional home-based exercise programme for the elderly with structured support given by the general practitioner's surgery: Study protocol of a single arm trial preparing an RCT [ISRCTN58562962

    PubMed Central

    2009-01-01

    Background Physical activity programmes can help to prevent functional decline in the elderly. Until now, such programmes use to target either on healthy community-dwelling seniors or on elderly living in special residences or care institutions. Sedentary or frail people, however, are difficult to reach when they live in their own homes. The general practitioner's (GP) practice offers a unique opportunity to acquire these people for participation in activity programmes. We conceptualised a multidimensional home-based exercise programme that shall be delivered to the target group through cooperation between GPs and exercise therapists. In order to prepare a randomised controlled trial (RCT), a feasibility study is being conducted. Methods The study is designed as a single arm interventional trial. We plan to recruit 90 patients aged 70 years and above through their GPs. The intervention lasts 12 weeks and consists of physical activity counselling, a home-exercise programme, and exercise consultations provided by an exercise therapist in the GP's practice and via telephone. The exercise programme consists of two main components: 1. a combination of home-exercises to improve strength, flexibility and balance, 2. walking for exercise to improve aerobic capacity. Primary outcome measures are: appraisal by GP, undesirable events, drop-outs, adherence. Secondary outcome measures are: effects (a. motor tests: timed-up-and-go, chair rising, grip strength, tandem stand, tandem walk, sit-and-reach; b. telephone interview: PRISCUS-Physical Activity Questionnaire, Short Form-8 Health Survey, three month recall of frequency of falls, Falls Efficacy Scale), appraisal by participant, exercise performance, focus group discussion. Data analyses will focus on: 1. decision-making concerning the conduction of a RCT, 2. estimation of the effects of the programme, detection of shortcomings and identification of subgroups with contrary results, 3. feedback to participants and to GPs

  19. Telehealth: An Assessment of Growth and Distribution.

    ERIC Educational Resources Information Center

    Grigsby, William J.

    2002-01-01

    National surveys of telehealth networks, 1994-99, examined program characteristics; clinical activities (telemedicine); nonclinical activities related to continuing medical education, paraprofessional training, health promotion, administration, and research; technology; and barriers to growth and sustainability. Despite growing utilization,…

  20. Telehealth: An Assessment of Growth and Distribution.

    ERIC Educational Resources Information Center

    Grigsby, William J.

    2002-01-01

    National surveys of telehealth networks, 1994-99, examined program characteristics; clinical activities (telemedicine); nonclinical activities related to continuing medical education, paraprofessional training, health promotion, administration, and research; technology; and barriers to growth and sustainability. Despite growing utilization,…

  1. Optimizing Telehealth Strategies for Subspecialty Care: Recommendations from Rural Pediatricians.

    PubMed

    Ray, Kristin N; Demirci, Jill R; Bogen, Debra L; Mehrotra, Ateev; Miller, Elizabeth

    2015-08-01

    Telehealth offers strategies to improve access to subspecialty care for children in rural communities. Rural pediatrician experiences and preferences regarding the use of these telehealth strategies for children's subspecialty care needs are not known. We elicited rural pediatrician experiences and preferences regarding different pediatric subspecialty telehealth strategies. Seventeen semistructured telephone interviews were conducted with rural pediatricians from 17 states within the United States. Interviewees were recruited by e-mails to a pediatric rural health listserv and to rural pediatricians identified through snowball sampling. Themes were identified through thematic analysis of interview transcripts. Institutional Review Board approval was obtained. Rural pediatricians identified several telehealth strategies to improve access to subspecialty care, including physician access hotlines, remote electronic medical record access, electronic messaging systems, live video telemedicine, and telehealth triage systems. Rural pediatricians provided recommendations for optimizing the utility of each of these strategies based on their experiences with different systems. Rural pediatricians preferred specific telehealth strategies for specific clinical contexts, resulting in a proposed framework describing the complementary role of different telehealth strategies for pediatric subspecialty care. Finally, rural pediatricians identified additional benefits associated with the use of telehealth strategies and described a desire for telehealth systems that enhanced (rather than replaced) personal relationships between rural pediatricians and subspecialists. Rural pediatricians described complementary roles for different subspecialty care telehealth strategies. Additionally, rural pediatricians provided recommendations for optimizing individual telehealth strategies. Input from rural pediatricians will be crucial for optimizing specific telehealth strategies and designing

  2. Optimizing Telehealth Strategies for Subspecialty Care: Recommendations from Rural Pediatricians

    PubMed Central

    Demirci, Jill R.; Bogen, Debra L.; Mehrotra, Ateev; Miller, Elizabeth

    2015-01-01

    Abstract Background: Telehealth offers strategies to improve access to subspecialty care for children in rural communities. Rural pediatrician experiences and preferences regarding the use of these telehealth strategies for children's subspecialty care needs are not known. We elicited rural pediatrician experiences and preferences regarding different pediatric subspecialty telehealth strategies. Materials and Methods: Seventeen semistructured telephone interviews were conducted with rural pediatricians from 17 states within the United States. Interviewees were recruited by e-mails to a pediatric rural health listserv and to rural pediatricians identified through snowball sampling. Themes were identified through thematic analysis of interview transcripts. Institutional Review Board approval was obtained. Results: Rural pediatricians identified several telehealth strategies to improve access to subspecialty care, including physician access hotlines, remote electronic medical record access, electronic messaging systems, live video telemedicine, and telehealth triage systems. Rural pediatricians provided recommendations for optimizing the utility of each of these strategies based on their experiences with different systems. Rural pediatricians preferred specific telehealth strategies for specific clinical contexts, resulting in a proposed framework describing the complementary role of different telehealth strategies for pediatric subspecialty care. Finally, rural pediatricians identified additional benefits associated with the use of telehealth strategies and described a desire for telehealth systems that enhanced (rather than replaced) personal relationships between rural pediatricians and subspecialists. Conclusions: Rural pediatricians described complementary roles for different subspecialty care telehealth strategies. Additionally, rural pediatricians provided recommendations for optimizing individual telehealth strategies. Input from rural pediatricians will be

  3. A Telehealth Intervention Using Nintendo Wii Fit Balance Boards and iPads to Improve Walking in Older Adults With Lower Limb Amputation (Wii.n.Walk): Study Protocol for a Randomized Controlled Trial

    PubMed Central

    Imam, Bita; Finlayson, Heather C; Eng, Janice J; Payne, Michael WC; Jarus, Tal; Goldsmith, Charles H; Mitchell, Ian M

    2014-01-01

    Background The number of older adults living with lower limb amputation (LLA) who require rehabilitation for improving their walking capacity and mobility is growing. Existing rehabilitation practices frequently fail to meet this demand. Nintendo Wii Fit may be a valuable tool to enable rehabilitation interventions. Based on pilot studies, we have developed “Wii.n.Walk”, an in-home telehealth Wii Fit intervention targeted to improve walking capacity in older adults with LLA. Objective The objective of this study is to determine whether the Wii.n.Walk intervention enhances walking capacity compared to an attention control group. Methods This project is a multi-site (Vancouver BC, London ON), parallel, evaluator-blind randomized controlled trial. Participants include community-dwelling older adults over the age of 50 years with unilateral transtibial or transfemoral amputation. Participants will be stratified by site and block randomized in triplets to either the Wii.n.Walk intervention or an attention control group employing the Wii Big Brain cognitive software. This trial will include both supervised and unsupervised phases. During the supervised phase, both groups will receive 40-minute sessions of supervised group training three times per week for a duration of 4 weeks. Participants will complete the first week of the intervention in groups of three at their local rehabilitation center with a trainer. The remaining 3 weeks will take place at participants’ homes using remote supervision by the trainer using Apple iPad technology. At the end of 4 weeks, the supervised period will end and the unsupervised period will begin. Participants will retain the Wii console and be encouraged to continue using the program for an additional 4 weeks’ duration. The primary outcome measure will be the “Two-Minute Walk Test” to measure walking capacity. Outcome measures will be evaluated for all participants at baseline, after the end of both the supervised and

  4. [An overview of telehealth initiatives in Latin America].

    PubMed

    dos Santos, Alaneir de Fátima; D'Agostino, Marcelo; Bouskela, Maurício Simon; Fernandéz, Andrés; Messina, Luiz Ary; Alves, Humberto José

    2014-01-01

    This article aimed to systematize the views on telehealth in Latin America and to present the experience of building an instrument for monitoring the development of telehealth initiatives based on the reality of this region. A group was structured to coordinate telehealth efforts in Latin America, with members appointed by the ministries of health of 16 countries. Five thematic groups were also set up. Based on international experiences and focusing on the reality of telehealth in the continent, an instrument was created to monitor the development of telehealth in Latin America. Several countries have national telehealth projects: Brazil, Colombia, Ecuador, Mexico, Panama. Others are in the process of development and early deployment: Bolivia, Costa Rica, Cuba, El Salvador, Guatemala, Peru, Venezuela. The instrument described in the article, which is still being tested, proposes a characterization of countries according to their telehealth development stage: nonexistent, nascent, intermediate, advanced, and exemplary. Currently, important telehealth initiatives are already underway in Latin America.

  5. WebRTC: delivering telehealth in the browser

    PubMed Central

    2016-01-01

    WebRTC is enabling a new generation of Telehealth applications and will be an important part of the future of Telehealth. WebRTC allows for web applications to control a user's microphone and video camera from the browser. In this viewpoint, the author presents the pros and cons of WebRTC for Telehealth applications. PMID:28293589

  6. Health Insurance Portability and Accountability Act-Compliant Ocular Telehealth Network for the Remote Diagnosis and Management of Diabetic Retinopathy

    SciTech Connect

    Li, Yaquin; Karnowski, Thomas Paul; Tobin Jr, Kenneth William; Giancardo, Luca; Garg, Seema; Fox, Karen; Chaum, Edward

    2011-01-01

    In this article, we present the design and implementation of a regional ocular telehealth network for remote assessment and management of diabetic retinopathy (DR), including the design requirements, network topology, protocol design, system work flow, graphics user interfaces, and performance evaluation. The Telemedical Retinal Image Analysis and Diagnosis Network is a computer-aided, image analysis telehealth paradigm for the diagnosis of DR and other retinal diseases using fundus images acquired from primary care end users delivering care to underserved patient populations in the mid-South and southeastern United States.

  7. QRS Detection Algorithm for Telehealth Electrocardiogram Recordings.

    PubMed

    Khamis, Heba; Weiss, Robert; Xie, Yang; Chang, Chan-Wei; Lovell, Nigel H; Redmond, Stephen J

    2016-07-01

    QRS detection algorithms are needed to analyze electrocardiogram (ECG) recordings generated in telehealth environments. However, the numerous published QRS detectors focus on clean clinical data. Here, a "UNSW" QRS detection algorithm is described that is suitable for clinical ECG and also poorer quality telehealth ECG. The UNSW algorithm generates a feature signal containing information about ECG amplitude and derivative, which is filtered according to its frequency content and an adaptive threshold is applied. The algorithm was tested on clinical and telehealth ECG and the QRS detection performance is compared to the Pan-Tompkins (PT) and Gutiérrez-Rivas (GR) algorithm. For the MIT-BIH Arrhythmia database (virtually artifact free, clinical ECG), the overall sensitivity (Se) and positive predictivity (+P) of the UNSW algorithm was >99%, which was comparable to PT and GR. When applied to the MIT-BIH noise stress test database (clinical ECG with added calibrated noise) after artifact masking, all three algorithms had overall Se >99%, and the UNSW algorithm had higher +P (98%, p < 0.05) than PT and GR. For 250 telehealth ECG records (unsupervised recordings; dry metal electrodes), the UNSW algorithm had 98% Se and 95% +P which was superior to PT (+P: p < 0.001) and GR (Se and +P: p < 0.001). This is the first study to describe a QRS detection algorithm for telehealth data and evaluate it on clinical and telehealth ECG with superior results to published algorithms. The UNSW algorithm could be used to manage increasing telehealth ECG analysis workloads.

  8. Theory of use behind telehealth applications.

    PubMed

    Lehoux, P; Sicotte, C; Lacroix, A

    1999-01-01

    A variety of telehealth applications have been implemented throughout the industrialized world. Given that telehealth has yet to become routine in the practices of physicians, the impact of such applications on health care management remains difficult to identify. Only by becoming integrated into the 'normal practice' of clinicians can telehealth facilitate smooth communications in health care delivery processes. In this paper we demonstrate the importance of developing a 'theory of use', describing how clinicians are expected to use teleconsultation in their daily activities. By employing Giddens' Structuration Theory, we can develop a clear vision of the utilization of telehealth, and a better framework with which to assess its added value for health care delivery. We illustrate this claim by referring to our research on the Quebec Inter-Regional Telemedicine Network. In this study we compare the 'theory of use' behind the telemedicine network with the perceptions of physicians regarding their needs in terms of communications and access to expert advice. The breach between the theory and the perceptions of physicians may help to explain how the utilization of telehealth could be enhanced, and how new and sustainable routines for its integration into the health care system might be created.

  9. Study protocol of the CHOiCE trial: a three-armed, randomized, controlled trial of home-based HPV self-sampling for non-participants in an organized cervical cancer screening program.

    PubMed

    Tranberg, Mette; Bech, Bodil Hammer; Blaakær, Jan; Jensen, Jørgen Skov; Svanholm, Hans; Andersen, Berit

    2016-11-03

    The effectiveness of cervical cancer screening programs is challenged by suboptimal participation and coverage. Offering cervico-vaginal self-sampling for human papillomavirus testing (HPV self-sampling) to non-participants can increase screening participation. However, the effect varies substantially among studies, especially depending on the approach used to offer HPV self-sampling. The present trial evaluates the effect on participation in an organized screening program of a HPV self-sampling kit mailed directly to the home of the woman or mailed to the woman's home on demand only, compared with the standard second reminder for regular screening. The CHOiCE trial is a parallel, randomized, controlled, open-label trial. It will include 9327 women aged 30-64 years who are living in the Central Denmark Region and who have not participated in cervical cancer screening after an invitation and one reminder. The women will be equally randomized into three arms: 1) Directly mailed a second reminder including a HPV self-sampling kit; 2) Mailed a second reminder offering a HPV self-sampling kit, to be ordered by e-mail, text message, phone, or through a webpage; and 3) Mailed a second reminder for a practitioner-collected sample (control group). The primary outcome will be the proportion of women in the intervention groups who participate by returning their HPV self-sampling kit or have a practitioner-collected sample compared with the proportion of women who have a practitioner-collected sample in the control group at 90 and 180 days after mail out of the second reminders. Per-protocol and intention-to-treat analyses will be performed. The secondary outcome will be the proportion of women with a positive HPV self-collected sample who attend follow-up testing at 30, 60, or 90 days after mail out of the results. The CHOiCE trial will provide strong and important evidence allowing us to determine if and how HPV self-sampling can be used to increase participation in

  10. Telehealth

    MedlinePlus

    ... services. You can get health care using phones, computers, or mobile devices. You find health information or ... your health information remains private. Providers must use computer software that keeps your health records safe. BENEFITS ...

  11. Proposal for a telehealth concept in the translational research model

    PubMed Central

    Silva, Angélica Baptista; Morel, Carlos Médicis; de Moraes, Ilara Hämmerli Sozzi

    2014-01-01

    OBJECTIVE To review the conceptual relationship between telehealth and translational research. METHODS Bibliographical search on telehealth was conducted in the Scopus, Cochrane BVS, LILACS and MEDLINE databases to find experiences of telehealth in conjunction with discussion of translational research in health. The search retrieved eight studies based on analysis of models of the five stages of translational research and the multiple strands of public health policy in the context of telehealth in Brazil. The models were applied to telehealth activities concerning the Network of Human Milk Banks, in the Telemedicine University Network. RESULTS The translational research cycle of human milk collected, stored and distributed presents several integrated telehealth initiatives, such as video conferencing, and software and portals for synthesizing knowledge, composing elements of an information ecosystem, mediated by information and communication technologies in the health system. CONCLUSIONS Telehealth should be composed of a set of activities in a computer mediated network promoting the translation of knowledge between research and health services. PMID:24897057

  12. Telehealth Innovations in Health Education and Training

    PubMed Central

    De, Suvranu; Hall, Richard W.; Johansen, Edward; Meglan, Dwight; Peng, Grace C.Y.

    2010-01-01

    Abstract Telehealth applications are increasingly important in many areas of health education and training. In addition, they will play a vital role in biomedical research and research training by facilitating remote collaborations and providing access to expensive/remote instrumentation. In order to fulfill their true potential to leverage education, training, and research activities, innovations in telehealth applications should be fostered across a range of technology fronts, including online, on-demand computational models for simulation; simplified interfaces for software and hardware; software frameworks for simulations; portable telepresence systems; artificial intelligence applications to be applied when simulated human patients are not options; and the development of more simulator applications. This article presents the results of discussion on potential areas of future development, barries to overcome, and suggestions to translate the promise of telehealth applications into a transformed environment of training, education, and research in the health sciences. PMID:20155874

  13. Occupational Therapy Home Safety Intervention via Telehealth

    PubMed Central

    BREEDEN, LORI E.

    2016-01-01

    Photography can be an effective addition for education-based telehealth services delivered by an occupational therapist. In this study, photography was used as antecedent to telehealth sessions delivered by an occupational therapist focused on narrative learning about home safety. After taking photographs of past home safety challenges, six participants experienced three web-based occupational therapy sessions. Sessions were recorded and transcribed. Data were examined using content analysis. The content analysis identified the following themes: the value of photos to support learning; the value of narrative learning related to home safety education; and abstract versus concrete learners. Procedural findings are included to support future endeavors. Findings indicate that within a wellness context, home safety education for older adults can be delivered effectively via telehealth when using photography as a part of an occupational therapy intervention. PMID:27563389

  14. Telehealth innovations in health education and training.

    PubMed

    Conde, José G; De, Suvranu; Hall, Richard W; Johansen, Edward; Meglan, Dwight; Peng, Grace C Y

    2010-01-01

    Telehealth applications are increasingly important in many areas of health education and training. In addition, they will play a vital role in biomedical research and research training by facilitating remote collaborations and providing access to expensive/remote instrumentation. In order to fulfill their true potential to leverage education, training, and research activities, innovations in telehealth applications should be fostered across a range of technology fronts, including online, on-demand computational models for simulation; simplified interfaces for software and hardware; software frameworks for simulations; portable telepresence systems; artificial intelligence applications to be applied when simulated human patients are not options; and the development of more simulator applications. This article presents the results of discussion on potential areas of future development, barries to overcome, and suggestions to translate the promise of telehealth applications into a transformed environment of training, education, and research in the health sciences.

  15. Telehealth stroke education for rural elderly Virginians.

    PubMed

    Schweickert, Patricia A; Rutledge, Carolyn M; Cattell-Gordon, David C; Solenski, Nina J; Jensen, Mary E; Branson, Sheila; Gaughen, John R

    2011-12-01

    Stroke is a prevalent condition found in elderly, rural populations. However, stroke education, which can be effective in addressing the risks, is often difficult to provide in these remote regions. The objective of this study is to evaluate the effectiveness of delivering stroke education to elderly individuals through telehealth versus in-person stroke prevention education methods. A quasi-experimental nonequivalent control group design was used in this study. A convenience sample of 11 elderly adults (36% men, 64% women) with a mean age of 70 was selected from an Appalachian Program for All Inclusive Care for the Elderly (day care) facility. Subjects completed preintervention surveys, received a 20-min group in-person or telehealth delivered education session, and then completed the postintervention surveys. Satisfaction with delivery method and post-education knowledge was equivalent between the two groups. Knowledge increased in both groups after the educational programs. Likelihood of reducing risk factors showed no differences pre-posttest. However, there were significant improvements in the pre-post likelihood scores of the telehealth group in contrast to the in-person group. This project provided a rural, high-risk population access to telehealth stroke education, thus enabling these individuals to receive education at a distance from experts in the field. The telehealth program was found to be equivalent to in-person stroke education in regards to satisfaction, knowledge, and likelihood of making changes to decrease vascular risk factors. The study demonstrated feasibility in providing effective stroke education through telehealth, thus suggesting an often overlooked route for providing patient education at a distance.

  16. Telehealth: is it the silver bullet?

    PubMed

    Conrad, Carol; Fuller, Elizabeth; Kessler, Stephanie

    2007-07-01

    The focus of our CQI Investigation was to determine whether home telehealth is the "Silver Bullet" in reducing re-hospitalizations, managing visits per episode, implementing disease management strategies, and improving patient satisfaction. In this article, we will discuss the challenges of developing and implementing a telehealth program in a free standing non-profit agency, the program design and its components, and obstacles encountered including those presented by home care staff and area physicians. When we started this project, we had no idea what the results would be. There were some surprises along the way.

  17. The untapped potential of Telehealth.

    PubMed

    Suleiman, A B

    2001-05-01

    The people of Malaysia generally enjoy a high standard of health. This is largely attributed to the comprehensive range of health services provided by the Government and the private sector at affordable costs. However, there are changing trends that now seriously challenge this status quo. The changing population structure, lifestyle, disease patterns and globalization are causing healthcare costs to rise. New and innovative ways will have to be devised to further improve the health status and at the same time contain costs. Information and Communication Technology (ICT) presents unprecedented opportunities to help the health sector in Malaysia reinvent itself and transform the way health and healthcare is managed and delivered in the future. Malaysia's Telehealth initiative under the Multimedia Super Corridor (MSC) project is designed to realize Malaysia's health vision and goals and meet future health challenges. Multimedia and Internet technology will be fully harnessed to deploy services that will shift the emphasis from episodic management of illness to proactive promotion of lifelong wellness and disease prevention. Health information content and interactive applications will engage the people to work as partners of health with healthcare professionals in maintaining their own health or managing their illnesses.

  18. Personalized Telehealth in the Future: A Global Research Agenda.

    PubMed

    Dinesen, Birthe; Nonnecke, Brandie; Lindeman, David; Toft, Egon; Kidholm, Kristian; Jethwani, Kamal; Young, Heather M; Spindler, Helle; Oestergaard, Claus Ugilt; Southard, Jeffrey A; Gutierrez, Mario; Anderson, Nick; Albert, Nancy M; Han, Jay J; Nesbitt, Thomas

    2016-03-01

    As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that can lead to scalable and sustainable telehealth programs. This paper has two aims: (1) to describe the challenges of promoting telehealth implementation to advance adoption and (2) to present a global research agenda for personalized telehealth within chronic disease management. Using evidence from the United States and the European Union, this paper provides a global overview of the current state of telehealth services and benefits, presents fundamental principles that must be addressed to advance the status quo, and provides a framework for current and future research initiatives within telehealth for personalized care, treatment, and prevention. A broad, multinational research agenda can provide a uniform framework for identifying and rapidly replicating best practices, while concurrently fostering global collaboration in the development and rigorous testing of new and emerging telehealth technologies. In this paper, the members of the Transatlantic Telehealth Research Network offer a 12-point research agenda for future telehealth applications within chronic disease management.

  19. Personalized Telehealth in the Future: A Global Research Agenda

    PubMed Central

    2016-01-01

    As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that can lead to scalable and sustainable telehealth programs. This paper has two aims: (1) to describe the challenges of promoting telehealth implementation to advance adoption and (2) to present a global research agenda for personalized telehealth within chronic disease management. Using evidence from the United States and the European Union, this paper provides a global overview of the current state of telehealth services and benefits, presents fundamental principles that must be addressed to advance the status quo, and provides a framework for current and future research initiatives within telehealth for personalized care, treatment, and prevention. A broad, multinational research agenda can provide a uniform framework for identifying and rapidly replicating best practices, while concurrently fostering global collaboration in the development and rigorous testing of new and emerging telehealth technologies. In this paper, the members of the Transatlantic Telehealth Research Network offer a 12-point research agenda for future telehealth applications within chronic disease management. PMID:26932229

  20. Telehealth and the Deaf: A Comparison Study

    ERIC Educational Resources Information Center

    Wilson, Jaime A. B.; Wells, M. Gawain

    2009-01-01

    Within the deaf population, an extreme mental health professional shortage exists that may be alleviated with videoconferencing technology--also known as telehealth. Moreover, much needed mental health education within the deaf population remains largely inaccessible. Researchers have warned that the deaf population may remain underserved if…

  1. Managing congestive heart failure using home telehealth.

    PubMed

    Schneider, Nina M

    2004-10-01

    Congestive heart failure (CHF) is the leading cause of rehospitalization and loss of revenue for home care agencies and hospitals. This article outlines how an agency used telehealth to provide CHF patients quality care and improved outcomes while decreasing the number of skilled home nursing visits and reducing rehospitalization rates to 1.2%.

  2. Telehealth and the Deaf: A Comparison Study

    ERIC Educational Resources Information Center

    Wilson, Jaime A. B.; Wells, M. Gawain

    2009-01-01

    Within the deaf population, an extreme mental health professional shortage exists that may be alleviated with videoconferencing technology--also known as telehealth. Moreover, much needed mental health education within the deaf population remains largely inaccessible. Researchers have warned that the deaf population may remain underserved if…

  3. Quality management practices in telehealth programs: a stakeholder accountability framework.

    PubMed Central

    Dansky, Kathryn H.; Gamm, Larry D.

    2002-01-01

    Improved technologies, distances between providers and patients, and an emphasis on cost-containment have encouraged the use of telehealth as a method of service delivery. Despite the increased use of this technology, few studies have been conducted on management of telehealth programs. Research on quality management is essential for disseminating and generalizing information on best practices in telehealth programs. This study focused on quality management practices used in telehealth programs, using a Stakeholder Accountability Framework. We propose that different indicators of quality are employed to satisfy the expectations of different internal and external stakeholders. A national survey of telehealth programs (N=93) was conducted in January, 2001. Wide variations in practices were found, with the most notable differences between not-for-profit and proprietary programs. The dimensions illustrated in the Stakeholder Accountability Framework were supported empirically. Implications of differences are examined as they relate to advancing quality in telehealth. PMID:12463813

  4. RAPID HOME-BASED HIV TESTING TO REDUCE COSTS IN A LARGE TUBERCULOSIS COHORT STUDY.

    PubMed

    Galea, Jerome T; Contreras, Carmen; Lecca, Leonid; Shin, Sonya; Lobatón, Raúl; Zhang, Zibiao; Calderón, Roger; Murray, Megan; Becerra, Mercedes C

    2013-06-21

    To reduce costs in a large tuberculosis household contact cohort study in Lima, Peru, we replaced laboratory-based HIV testing with home-based rapid testing. We developed a protocol and training course to prepare staff for the new strategy; these included role playing for home-based deployment of the Determine® HIV 1/2 Ag/Ac Combo HIV test. Though the rapid HIV test produced more false-positives, the overall cost per participant tested, refusal rate and time to confirmatory HIV testing were lower with the home-based rapid testing strategy compared to the original approach. Rapid testing could be used in similar research or routine care settings.

  5. Telehealth technology applications in speech-language pathology.

    PubMed

    Keck, Casey Stewart; Doarn, Charles R

    2014-07-01

    Speech-language pathologists are anxious to adopt telehealth technologies but have encountered barriers such as limited reimbursement, state licensure laws, and medical information privacy laws. Moreover, speech-language pathologists are confronted with the hurdle of evolving face-to-face clinical practices into effective telehealth practice adapted to the current national infrastructure. Factors such as costs, availability of resources, and diagnostic/intervention and patient needs should be considered when selecting the telehealth infrastructure for service delivery. Understanding the new role of technology in the diagnosis and treatment of communication disorders is vital for the expansion of telehealth as a standard of care. The purpose of this article is to overview the current technologic infrastructure and procedures for telehealth applications in speech-language pathology (SLP) and the innate challenges and opportunities. A literature search was conducted for telehealth publications in the field of SLP. Given the rapid rate at which technology advances, only peer-reviewed articles published over the past 5 years (2008-2013) were included. The majority of articles reviewed used hybrid methodologies to maintain traditional SLP service standards. General technological components for telehealth activities included computers, Web cameras, headsets with an embedded microphone, and Internet connectivity. Advanced technology has limitations in the application of telehealth. Technological adversities were not reported as the cause of discontinuation of telehealth services by the practitioner or the individual. Audio and visual disturbances were primarily associated with videoconferencing. Supplemental asynchronous technology was widely reported as a solution to real-time instabilities.

  6. Factors relating to home telehealth acceptance and usage compliance

    PubMed Central

    Wade, Rachael; Cartwright, Colleen; Shaw, Kelly

    2012-01-01

    Aim This paper investigates the acceptance of in-home telehealth by frail older adults and carers of the Transition Care Program (TCP), and evaluates telehealth acceptance as a predictor for usage compliance. Method A stratified random sample of participants was allocated to one of five groups: either a control group or to receive telehealth monitoring of their vital signs for a period of 12 or 24 weeks; with or without a medical alarm pendant. Results Before being trained in and using telehealth, the majority of participants and carers demonstrated acceptance of the technology by reporting that they perceived it would be “useful” and “easy to use.” This acceptance was also reported post-TCP (up to 12 weeks of usage). The “perceived ease of use” of the telehealth equipment increased significantly from pre-telehealth training and usage to post-TCP (up to 12 weeks of usage) (P = 0.001). There was no change, (pre-training and usage to post-TCP) in the “perceived usefulness” of the telehealth equipment. The telehealth acceptance constructs of “ease of use” and “usefulness,” at pre-telehealth training and usage, approached statistical significance as a predictor of future compliance (P = 0.06). “Perceived ease of use,” at pre-training and usage, had a positive relationship with future compliance (P = 0.02). Conclusion There is currently limited knowledge about the influences and determinants of home telehealth compliance in frail older people and their carers, potentially a significant user group for the technology into the future. This study’s finding that frail older people and their carers perceive that home telehealth is useful and easy to use demonstrates their acceptance of home telehealth as a therapeutic tool. Further, perceived ease of use of home telehealth is a significant predictor of compliance with frail older people and their carers’ use of home telehealth. Additional research is required in order to identify other

  7. Implementing a telehealth service: nurses' perceptions and experiences.

    PubMed

    Odeh, Bassel; Kayyali, Reem; Nabhani-Gebara, Shereen; Philip, Nada

    Telehealth is defined as the remote surveillance of a patient's health to aid early diagnosis and timely intervention. Understanding how the stakeholders perceive telehealth can influence its acceptability and diffusion. A primary care trust (PCT) in south London has been providing telehealth services for chronic obstructive pulmonary disease (COPD) and heart-failure patients for the past 22 months. The aim of this study was to elicit practice nurses' perceptions of the telehealth service provided by this PCT. A descriptive qualitative design was chosen to elicit practice nurses' perceptions. A semi-structured email interview was used to investigate their experiences of the service to date and their views about the future of the service. Seven nurses, working on telehealth for an average of 15 months and providing the service to 34 patients, were interviewed. Overall, the nurses described their experience with telehealth to be positive. Lack of resources, organisational support, patient selection criteria and technical support were identified as barriers to effective implementation of telehealth. Additional team members, more input and training, and expanded patient selection criteria were suggested by the nurses to enhance and ensure the success of telehealth. The challenges and barriers to the implementation of telehealth identified by the practice nurses need to be addressed by health services to ensure its continuity and success.

  8. A Review of Telehealth Service Implementation Frameworks

    PubMed Central

    van Dyk, Liezl

    2014-01-01

    Despite the potential of telehealth services to increase the quality and accessibility of healthcare, the success rate of such services has been disappointing. The purpose of this paper is to find and compare existing frameworks for the implementation of telehealth services that can contribute to the success rate of future endeavors. After a thorough discussion of these frameworks, this paper outlines the development methodologies in terms of theoretical background, methodology and validation. Finally, the common themes and formats are identified for consideration in future implementation. It was confirmed that a holistic implementation approach is needed, which includes technology, organizational structures, change management, economic feasibility, societal impacts, perceptions, user-friendliness, evaluation and evidence, legislation, policy and governance. Furthermore, there is some scope for scientifically rigorous framework development and validation approaches. PMID:24464237

  9. A health insurance portability and accountability act-compliant ocular telehealth network for the remote diagnosis and management of diabetic retinopathy.

    PubMed

    Li, Yaqin; Karnowski, Thomas P; Tobin, Kenneth W; Giancardo, Luca; Morris, Scott; Sparrow, Sylvia E; Garg, Seema; Fox, Karen; Chaum, Edward

    2011-10-01

    In this article, we present the design and implementation of a regional ocular telehealth network for remote assessment and management of diabetic retinopathy (DR), including the design requirements, network topology, protocol design, system work flow, graphics user interfaces, and performance evaluation. The Telemedical Retinal Image Analysis and Diagnosis Network is a computer-aided, image analysis telehealth paradigm for the diagnosis of DR and other retinal diseases using fundus images acquired from primary care end users delivering care to underserved patient populations in the mid-South and southeastern United States.

  10. A Health Insurance Portability and Accountability Act–Compliant Ocular Telehealth Network for the Remote Diagnosis and Management of Diabetic Retinopathy

    PubMed Central

    Li, Yaqin; Karnowski, Thomas P.; Tobin, Kenneth W.; Giancardo, Luca; Morris, Scott; Sparrow, Sylvia E.; Garg, Seema; Fox, Karen

    2011-01-01

    Abstract In this article, we present the design and implementation of a regional ocular telehealth network for remote assessment and management of diabetic retinopathy (DR), including the design requirements, network topology, protocol design, system work flow, graphics user interfaces, and performance evaluation. The Telemedical Retinal Image Analysis and Diagnosis Network is a computer-aided, image analysis telehealth paradigm for the diagnosis of DR and other retinal diseases using fundus images acquired from primary care end users delivering care to underserved patient populations in the mid-South and southeastern United States. PMID:21819244

  11. Capabilities of proprietary intermediate telehealth devices.

    PubMed

    Adeogun, Oluseun; Tiwari, Ashutosh; Alcock, Jeffrey R

    2011-11-01

    Proprietary intermediate telehealth devices are those which are specifically designed as connectors between the entities of telehealth systems. This article seeks to understand what are the capabilities of such devices and then to investigate how these are clustered on the current generation of devices. Fourteen current-generation devices available from 12 device providers were selected and analyzed. Four categories of questions were composed to evaluate the devices: setup/configuration, available features, inputs, and outputs. Data were collected and synthesized on the following capabilities: availability from suppliers, setup, environments of use, multiple-condition monitoring, multiuser capabilities, prompts, reminders and alerts, interaction with the health professional, access to historical data, device inputs, and their transfer technology. There are three main roles for proprietary intermediate devices in telehealth systems: displaying information to the patient; receiving data manually/automatically; forwarding results and questionnaire responses to another entity. Provider Perspective: Intermediate devices are usually part of closed proprietary systems. Providers produce disease-customisable devices. Connectivity is considerably ahead of the current generation of point-of-care devices. However, little data are available on connection to rest of the proprietary system. Patient Perspective: It shows clear benefit that one intermediate device can be potentially used with several chronic conditions. Simple setup, authentication procedures, and automatic data transfer are key design aspects. Health Professional Perspective: Little direct interaction with the health professional was observed. Payer Perspective: Details of costs of devices are generally unavailable; system providers indicate that cost variability is based on "user requirements."

  12. Telehealth in the School Setting: An Integrative Review

    ERIC Educational Resources Information Center

    Reynolds, Cori A.; Maughan, Erin D.

    2015-01-01

    Telehealth, the provision of health care through long-distance telecommunications technology, is a tool that can be used by school nurses to address and improve the health status of schoolchildren. The purpose of this literature review is to examine research related to implementation of telehealth in the school setting. A review of the literature…

  13. The Use of Telehealth in Schools. Position Statement. Revised

    ERIC Educational Resources Information Center

    Hoffmann, Susan; Dolatowski, Rosemary; McDowell, Bernadette; Mancuso, Patty; Rochkes, Laura L.; Wavra, Theresa Ernst; Selekman, Janice

    2012-01-01

    Telehealth has been defined as "the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration" (United States Department of Health and Human Services [USDHHS], n.d.). Telehealth enables collaboration of…

  14. Telehealth in the School Setting: An Integrative Review

    ERIC Educational Resources Information Center

    Reynolds, Cori A.; Maughan, Erin D.

    2015-01-01

    Telehealth, the provision of health care through long-distance telecommunications technology, is a tool that can be used by school nurses to address and improve the health status of schoolchildren. The purpose of this literature review is to examine research related to implementation of telehealth in the school setting. A review of the literature…

  15. Overview of telehealth activities in speech-language pathology.

    PubMed

    Mashima, Pauline A; Doarn, Charles R

    2008-12-01

    It is estimated that 10% of the world's population, approximately 650 million people, have some form of disability. Population growth, aging, and medical advances that preserve and prolong life have increased demands for health and rehabilitation services. Recent predictions indicate a shortage of speech-language pathologists and other rehabilitation specialists to provide care for individuals with disabilities. The application of telemedicine and telehealth technologies offers effective solutions to this challenge. An extensive literature review was conducted that included technical reports, websites, publications from the American Speech-Language-Hearing Association, and peer-reviewed journal articles of telehealth applications in speech-language pathology. Various applications of telehealth in speech-language pathology are described including types of technology, patient and clinician satisfaction, advantages of using telehealth, challenges and barriers to application, and future directions. This review provides a strong foundation for broader applications of telehealth technologies in this area of healthcare.

  16. Telehealth and the national health information technology strategic framework.

    PubMed

    Speedie, Stuart M; Davies, Diane

    2006-01-01

    Telehealth has a role in the federally sponsored plan for health information technology (HIT) that encompasses electronic health records (EHRs) and the National Health Information Network (NHIN). The goals of telehealth and the national plan are complementary. One focuses on improving access to high quality health-care services and the other on the information systems to support those services. Telehealth needs the fully realized EHR to provide the best possible care when patients are geographically and chronologically separated from their providers. Some current telehealth projects are natural examples of how a distributed, accessible EHR such as that envisaged by the plan can be used to provide better care. The experiences of telehealth in organizing large networks of heterogeneous health-care entities can provide useful lessons as the process of implementing HIT moves forward.

  17. Telehealth: important concepts for future nursing practice in space environments.

    PubMed

    Chonin, A

    1998-01-01

    The concept of telehealth has become a vital issue to healthcare providers in this day of instantaneous, varied, and technology-based communications. This article discusses the issues and implications of telehealth to nurses on Earth and in future space environments. Telehealth will be defined as currently implemented and the legal ramifications of practice across state lines, national borders, rural, and in remote and hazardous locations (space environments: orbital, Moon and Mars bases) will be delineated. The age of information is now here, and the age of communication is beginning. Telehealth is and will be an important means of providing communication links and healthcare to clients and providers alike. Healthcare professionals need to be aware of important concepts related to telehealth for their current and future practice.

  18. Competencies required for nursing telehealth activities: A Delphi-study.

    PubMed

    van Houwelingen, Cornelis T M; Moerman, Anna H; Ettema, Roelof G A; Kort, Helianthe S M; Ten Cate, Olle

    2016-04-01

    Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach full utilization. A better understanding of nursing telehealth entrustable professional activities (NT-EPAs) and the required competencies can contribute to the development of nursing telehealth education. In a four-round Delphi-study, a panel of experts discussed which NT-EPAs are relevant for nurses and which competencies nurses need to possess to execute these activities effectively. The 51 experts, including nurses, nursing faculty, clients and technicians all familiar with telehealth, were asked to select items from a list of 52 competencies based on the literature and on a previous study. Additionally, the panelists could add competencies based on their experience in practice. The threshold used for consensus was set at 80%. Consensus was achieved on the importance of fourteen NT-EPAs, requiring one or more of the following core competencies; coaching skills, the ability to combine clinical experience with telehealth, communication skills, clinical knowledge, ethical awareness, and a supportive attitude. Each NT-EPA requires a specific set of competencies (at least ten). In total, 52 competencies were identified as essential in telehealth. Many competencies for telehealth, including clinical knowledge and communication skills, are not novel competencies. They are fundamental to nursing care as a whole and therefore are also indispensable for telehealth. Additionally, the fourteen NT-EPAs appeared to require additional subject specific competencies, such as the ability to put patients at ease when they feel insecure about using technology. The NT-EPAs and related competencies presented in this study can be used by nursing schools that are considering including or expanding

  19. TEAhM-Technologies for Enhancing Access to Health Management: a pilot study of community-based telehealth.

    PubMed

    Resnick, Helaine E; Ilagan, Perla R; Kaylor, Mary Beth; Mehling, Diane; Alwan, Majd

    2012-04-01

    To explore implementation of nurse-mediated telehealth in community-based senior centers. Two senior centers had telehealth kiosks installed, and two other centers served as control sites. Participants with diagnosed hypertension were instructed to use the equipment at least once per week to measure blood pressure (BP). Nurses monitored BP data for 10 months and made referrals based on primary care physicians' protocols. Participants' mean age was 74.1 years, 75% were women, and mean baseline systolic BPs were 131 and 138 mm Hg in the intervention and control groups, respectively. At baseline, 64% and 85% of participants reported ever having owned a home computer and cell phone, respectively, and 84% reported having used an automated BP device outside of a doctor's office. At 10 months, mean systolic BP was 126 and 132 mm Hg in the intervention and control groups, respectively. Intervention participants used the telehealth station once per week during 69% of all follow-up weeks, and 71% of high readings received nurse follow-up within 24 h. Kiosk use increased steadily during the follow-up period, peaking at 80%, but declined over time to 47% at 10 months. Nearly all intervention group participants reported being "very comfortable" with the technology at study end, 81% reported it was "very easy" to use, and 89% would recommend it to friends. Senior center staff reported that the technology was consistent with their organizational mission and that clients and boards of directors were enthusiastic about it. This pilot study demonstrates that telehealth was embraced by clients and staff of community-based senior centers. A larger study is needed to determine the clinical impact and cost-effectiveness of using senior centers as a venue for telehealth-based management of hypertension and other common chronic conditions.

  20. Using the Australian and New Zealand Telehealth Committee framework to evaluate telehealth: identifying conceptual gaps.

    PubMed

    Hughes, Emma; King, Chris; Kitt, Sharon

    2002-01-01

    Telehealth is strongly supported in policy rhetoric as being economically significant to Australia, but evaluation standards have been insufficiently developed to ensure that this is the case. The use of one such evaluation standard, the Australian and New Zealand Telehealth Committee (ANZTC) framework, for telehealth evaluation in Australia makes good sense. However, that framework emphasizes economic and technical considerations at the expense of social contexts. Furthermore, there must be questions about the utility of a framework which, it appears, has been used to evaluate only a single telehealth project in Australia. The combination of the economic rationalism of health-care policy and the technological determinism of a tool model of information and communication technologies (ICTs) can result in evaluations that fail to match the complexities of the intersection of health-care and ICTs. Using the ANZTC framework while at the same time focusing on explaining, rather than just describing, the links between interventions and outcomes seems a reasonable compromise. This involves understanding complex socio-technical networks and relationships, and requires investigators to engage with the gulf between private opinions, public statements and actual behaviour.

  1. Telehealth Regulatory and Legal Considerations: Frequently Asked Questions

    PubMed Central

    Cason, Jana; Brannon, Janice A.

    2011-01-01

    As telehealth gains momentum as a service delivery model in the United States within the rehabilitation professions, regulatory and legal questions arise. This article examines the following questions: Is there a need to secure licenses in two states (i.e., where the practitioner resides, and where the client is located), before engaging in telehealth?Do state laws differ concerning if and how telehealth can occur?Do any states expressly disallow telehealth?Can services delivered through telehealth be billed the same way as services provided in-person?If practitioners fulfill the requirements to maintain licensure (e.g., continuing education obligations) in their state of residence, do they also need to fulfill the requirements to maintain licensure for the state in which the client resides?Will professional malpractice insurance cover services delivered through telehealth?Does a sole practitioner need to abide by HIPAA regulations?Responses to these questions are offered to raise awareness of the regulatory and legal implications associated with the use of a telehealth service delivery model within the professions of occupational therapy, physical therapy, speech-language pathology and audiology. PMID:25945185

  2. An Emergent Research and Policy Framework for Telehealth.

    PubMed

    Edmunds, Margo; Tuckson, Reed; Lewis, Joy; Atchinson, Brian; Rheuban, Karen; Fanberg, Hank; Olinger, Lois; Rosati, Robert; Austein-Casnoff, Cheryl; Capistrant, Gary; Thomas, Latoya

    2017-01-01

    Telehealth is a fast-growing sector in health care, using a variety of technologies to exchange information across locations and to improve access, quality, and outcomes across the continuum of care. Thousands of studies and hundreds of systematic reviews have been done, but their variability leaves many questions about telehealth's effectiveness, implementation priorities, and return on investment. There is an urgent need for a systematic, policy-relevant framework to integrate regulatory, operational, and clinical factors and to guide future investments in telehealth research and practice. An invited multidisciplinary group of 21 experts from AcademyHealth, the American Telemedicine Association (ATA), Kaiser Permanente Institute for Health Policy (KP), and the Physician Insurers Association of America (PIAA) met to review and discuss the components of a draft framework for policy-relevant telehealth research. The framework was revised and presented in a challenge workshop at Concordium 2016, and some additional refinements were made. The current framework encompasses the regulatory and payment policy context for telehealth, delivery system factors, and outcomes of telehealth interventions. Based on the feedback at Concordium 2016, the framework seems to have potential to help educate policymakers, payers, and health systems about the value of telehealth and to frame discussions about implementation barriers, including risk management concerns, technology costs, and organizational culture. However, questions remain about how to disseminate and use the framework to help coordinate policy, research, and implementation efforts in the delivery system.

  3. Post-disaster Gulf Coast Recovery Using Telehealth

    PubMed Central

    Kim, Thomas J.; Eastburn, Sasha L.; Icenogle, Marjorie L.; Slagle, Michelle; Nuriddin, Azizeh H.; Brantley, Katrina M.; Foreman, Rachel D.; Buckner, Ayanna V.

    2013-01-01

    Abstract Objective: The Gulf Coast continues to struggle with service need far outpacing available resources. Since 2005, the Regional Coordinating Center for Hurricane Response (RCC) at Morehouse School of Medicine, Atlanta, GA, has supported telehealth solutions designed to meet high service needs (e.g., psychiatry) within primary care and other healthcare organizations. The overall RCC vision is to support autonomous, useful, and sustainable telehealth programs towards mitigating unmet disaster-related needs. Subjects and Methods: To assess Gulf Coast telehealth experiences, we conducted semistructured interviews with both regional key informants and national organizations with Gulf Coast recovery interests. Using qualitative-descriptive analysis, interview transcripts were analyzed to identify shared development themes. Results: Thirty-eight key informants were interviewed, representing a 77.6% participation rate among organizations engaged by the RCC. Seven elements critical to telehealth success were identified: Funding, Regulatory, Workflow, Attitudes, Personnel, Technology, and Evaluation. These key informant accounts reveal shared insights with telehealth regarding successes, challenges, and recommendations. Conclusions: The seven elements critical to telehealth success both confirm and organize development principles from a diverse collective of healthcare stakeholders. The structured nature of these insights suggests a generalizable framework upon which other organizations might develop telehealth strategies toward addressing high service needs with limited resources. PMID:23427981

  4. Efficacy of home-based exercise programmes for people with chronic heart failure: a meta-analysis.

    PubMed

    Hwang, Rita; Marwick, Thomas

    2009-10-01

    Home-based programmes may offer an alternative to conventional programmes or as a means of maintaining physical fitness after graduating from centre-based programmes. We sought to examine the effectiveness of home-based exercise programmes on exercise capacity in patients with heart failure compared with usual medical care. Electronic databases were searched to identify randomized controlled trials. Protocols included an initial period of centre-based exercise followed by exercise at home, home-based exercise only and concurrent centre and home-based exercise. Outcome measures included peak oxygen consumption, exercise duration and the six-minute walk test. Nineteen relevant studies were identified for review. The mean improvement in peak oxygen consumption was 2.86 ml/kg per min [95% confidence interval (CI): 1.43-4.29]. Exercise duration increased by 1.94 min (95% CI: 0.89-2.98) and distance on the six-minute walk test was increased by 30.41 m (95% CI: 6.13-54.68). Other reported benefits of home-based programmes include increased quality of life and lowered hospital admission rates. In conclusion, home-based exercise programmes have been shown to benefit people with heart failure in the short term. Further research is required to investigate the long-term effects of home exercise and to determine the optimal strategies for improving exercise adherence in patients with heart failure.

  5. Positive Clinical Outcomes Are Synergistic With Positive Educational Outcomes When Using Telehealth Consulting in General Practice: A Mixed-Methods Study.

    PubMed

    Knight, Patricia; Bonney, Andrew; Teuss, Grigorijs; Guppy, Michelle; Lafferre, Danielle; Mullan, Judy; Barnett, Stephen

    2016-02-08

    The use of telehealth technology to enable real-time consultations between patients and specialist services (to whom travel may be an impediment to the patient's care) has recently been encouraged in Australia through financial incentives. However, the uptake has been both fragmented and inconsistent. The potential benefits for patients include access to a broader range of specialist referral services, cost and time saving, and more rapid access to specialist services and a continuum of care through the triangulation of interaction between patient, primary health care providers (general practitioners and nurses), and specialists. Enhanced broadband connectivity and higher-grade encryption present an opportunity to trial the use of telehealth consulting as an intrinsic element of medical education for both medical students and doctors-in-training within rural practices and Aboriginal Medical Services. This paper discusses the reported, and varied, benefits of telehealth consulting arising from a multisite trial in New South Wales, Australia. The purpose of this study is to encourage the use of selected telehealth consultations between patients in a primary care setting with a specialist service as an integral aspect of medical education. The trial closely followed the protocol developed for this complex and multiaspect intervention. This paper discusses one aspect of the research protocol--using telehealth consultations for medical education--in detail. Qualitative and quantitative analyses were conducted. In the quantitative analysis, free-text comments were made on aspects of Telehealth Consulting for the patient, concerning the quality of the interactions, and the time and cost saving, and also on the leaning opportunities. Students commented that their involvement enhanced their learning. All respondents agreed or strongly agreed that that the interpersonal aspects were satisfactory, with some brief comments supporting their views. In the analysis of the

  6. Telehealth: current practices and future directions

    NASA Astrophysics Data System (ADS)

    David, Yadin B.

    1996-02-01

    When we review the positive impact that the integration of ostensibly independent patient-care services have on the efficient management of quality care, education, and collaborative research, it is not surprising that telehealth deployment is on the rise. The forces that drive this phenomenon include: the need to manage the entire disease episode; the desire for wider geographically-distributed quality health care; the escalation of customer expectations; globalization of healthcare and its support services; an increase in patient and provider convenience; and the acceptance of the present technological community. At the Telehealth Center at the Texas Children's Hospital, current classifications of clinical applications are listed: (1) initial urgent evaluation of patients, (2) triage decisions and pretransfer arrangements, (3) medical and surgical follow-up and medication review, (4) consultation for primary care encounters, (5) real-time subspecialty care consultation and planning, (6) management of chronic diseases and conditions, (7) extended diagnostic work-ups, (8) review of diagnostic images, and (9) preventive medicine and patient education. The delivery of such services is associated with challenges and opportunities. As we move forward from limited data processing to an integrated communication system, from centralized main frame functions to personalized and location-independent workstations, and from hospitals to clinics and homecare, an increase in the minimum features provided by the equipment and the communication systems must accompany the widening variety of clinical applications. Future expansion of telehealth systems stands to revolutionize the delivery of services to the benefits of providers' networks, our economy, and patients through integration.

  7. Real-time telehealth for COPD self-management using Skype™.

    PubMed

    Nield, Margaret; Hoo, Guy W Soo

    2012-12-01

    The utility of real-time interactive voice and video telehealth for teaching pursed-lips breathing (PLB) in chronic obstructive pulmonary disease (COPD) is unknown. This was a pilot study to determine its feasibility and efficacy on the key variables of social support and dyspnea. A randomized control study design with repeated measures (baseline, 4 and 12 weeks) was used. All participants in the control and intervention groups received PLB instruction at baseline, but only the intervention group received one weekly PLB reinforcement session for 4 weeks via home computer and Skype™ software. Outcome measures were Medical Outcomes Study Social Support Survey and dyspnea assessment (visual analogue scales for intensity and distress, modified Borg after six-minute walk distance, and Shortness of Breath Questionnaire for activity-associated dyspnea). A total of 22 participants with COPD (mean FEV(1)% predicted = 56) were randomized; 16 (9 telehealth, 7 control) completed the protocol. Intent-to-treat analysis at week 4, but not week 12, demonstrated significantly improved total social support (P = 0.02) and emotional/informational subscale (P = 0.03) scores. Dyspnea intensity decreased (P = 0.08) for the intervention group with a minimal clinical important difference of 10.4 units. Analysis of only participants who completed the protocol demonstrated a significant decrease in dyspnea intensity (P = < 0.01) for the intervention group at both week 4 and 12. Real-time telehealth is a feasible, innovative approach for PLB instruction in the home with outcomes of improved social support and decreased dyspnea.

  8. A product-service system approach to telehealth application design.

    PubMed

    Flores-Vaquero, Paul; Tiwari, Ashutosh; Alcock, Jeffrey; Hutabarat, Windo; Turner, Chris

    2016-06-01

    A considerable proportion of current point-of-care devices do not offer a wide enough set of capabilities if they are to function in any telehealth system. There is a need for intermediate devices that lie between healthcare devices and service networks. The development of an application is suggested that allows for a smartphone to take the role of an intermediate device. This research seeks to identify the telehealth service requirements for long-term condition management using a product-service system approach. The use of product-service system has proven to be a suitable methodology for the design and development of telehealth smartphone applications.

  9. A nursing home telehealth system: keeping residents connected.

    PubMed

    Daly, Jeanette M; Jogerst, Gerald; Park, Jung-Yong; Kang, Yun-Deok; Bae, Taehee

    2005-08-01

    Live video and detailed images of nursing home residents can be transmitted in real time via the Internet. This telehealth system allows residents and long-term care health professionals to connect with experts not available on-site. Electronic stethoscope, otoscope, dermascope, dentalscope, and electrocardiogram are available for use via the Internet. Impediments to implementing telehealth systems in long-term care include costs and the lack of reimbursement for telehealth services. Reimbursement for telemedicine in nursing homes is limited by originating site, current procedural terminology codes, and facility location.

  10. Telehealth: A Rapidly Developing Service Delivery Model For Occupational Therapy

    PubMed Central

    Cason, Jana

    2014-01-01

    Over the past decade, the practice of occupational therapy has been increasingly influenced by technological advances in the use of information and communication technologies (ICT) and associated changes in health care policy. Emergent from this evolution is the application of telehealth to deliver occupational therapy services to a client who is in a different physical location than the provider. This article furnishes an overview of the evidence for telehealth use in occupational therapy, discusses key policy considerations, and provides resources to guide practitioners in the ethical use of telehealth. PMID:25945220

  11. Experiences in home-based growth monitoring.

    PubMed

    Suelan, F; Briones, H

    1992-01-01

    A growth monitoring project (GMP) of child weighing was implemented by the Philippines' Department of Health (DOH) through the Integrated Provincial Health Office to monitor either children's nutritional progress or their faltering of growth. Weaknesses, however, were found in the GMP. For example, only 31% of preschoolers included in the Nutrition Center of the Philippines (NCP) survey had growth charts. An 1990 UNICEF-DOH survey also found that the growth chart was used primarily by mothers and service providers to record infant immunization. Mothers brought their children to well-baby clinics in barangay health centers only when their children were sick. Conducted only once per year, weighing was not perceived as a tool in detecting and preventing sickness, and ensuring normal growth. Asked to help improve the GMP, the NCP consulted intended beneficiaries and cooperators to develop a plan to pilot an intensive monitoring project in four towns of Negros Occidental, starting in January 1991 and ending in December 1992. The resultant Home-Based Growth Monitoring (HBGM) project would place emphasis upon enabling rural mothers to become self-sustaining agents for child growth monitoring. A key feature was the establishment of a weighing post in a strategic place for every 2-3 family clusters. The HBGM project was piloted in 1991 in Calatrava, Toboso, Cauayan, and Sipalay. This paper describes project implementation, problems and solutions, and results.

  12. Kinect system in home-based cardiovascular rehabilitation.

    PubMed

    Vieira, Ágata; Gabriel, Joaquim; Melo, Cristina; Machado, Jorge

    2017-01-01

    Cardiovascular diseases lead to a high consumption of financial resources. An important part of the recovery process is the cardiovascular rehabilitation. This study aimed to present a new cardiovascular rehabilitation system to 11 outpatients with coronary artery disease from a Hospital in Porto, Portugal, later collecting their opinions. This system is based on a virtual reality game system, using the Kinect sensor while performing an exercise protocol which is integrated in a home-based cardiovascular rehabilitation programme, with a duration of 6 months and at the maintenance phase. The participants responded to a questionnaire asking for their opinion about the system. The results demonstrated that 91% of the participants (n = 10) enjoyed the artwork, while 100% (n = 11) agreed on the importance and usefulness of the automatic counting of the number of repetitions, moreover 64% (n = 7) reported motivation to continue performing the programme after the end of the study, and 100% (n = 11) recognized Kinect as an instrument with potential to be an asset in cardiovascular rehabilitation. Criticisms included limitations in motion capture and gesture recognition, 91% (n = 10), and the lack of home space, 27% (n = 3). According to the participants' opinions, the Kinect has the potential to be used in cardiovascular rehabilitation; however, several technical details require improvement, particularly regarding the motion capture and gesture recognition.

  13. Home-Based Resistance Training: Predictors of Participation and Adherence.

    ERIC Educational Resources Information Center

    Jette, Alan M.; Rooks, Dan; Lachman, Margie; Lin, Ting H.; Levenson, Claudia; Heislein, Diane; Giorgetti, Marie M.; Harris, B. A.

    1998-01-01

    Identifies factors associated with exercise participation and adherence in a sample of sedentary, functionally limited, community-dwelling adults ages 60 to 94 who participated in a home-based resistance training program (N=102). Results show that psychological factors were most important to adherence to the home-based program. (Author/MKA)

  14. Canadian experiences in telehealth: equalizing access to quality care.

    PubMed

    Jennett, P A; Person, V L; Watson, M; Watanabe, M

    2000-01-01

    The Canadian Conference "TExpo'98: Interactive Health" focused on four telehealth themes: community needs, Canadian experiences, industry perspectives, and access/security/interoperability issues. Health and socioeconomic needs have been the driving force behind telehealth initiatives; telelearning is one of the major Canadian initiatives. To encourage Canadian telehealth initiatives, the federal government is building a national health infrastructure. One element in this framework is concerned with empowering the public, strengthening health care services, and ensuring accountability. Technological advancements and innovative partnerships among health communities, government, users, professional bodies, and industry are critical to continued growth. Key issues including access, evaluation, implementation, privacy, confidentiality, security, and interoperability are of universal concern to participants. Research that examines the benefits and costs of telehealth is needed.

  15. Diffusion of innovation: Telehealth for care at home.

    PubMed

    Levy, Sharon

    2015-01-01

    The 'care at home' study focused on a Scottish telehealth service, which was designed to support children with palliative and complex care needs. Using the diffusion of innovation theory, this poster highlights the differences between the way telehealth is used in the public sector and in a third sector or a voluntary organization. Analysis of the data, taken from interviews with key stakeholders, illuminate barriers and solutions as noted by clinicians who see the clear benefits and potential risks of telehealth use at home. In conclusion, it is argued that a strategic steer towards a culture of innovation is needed to support effective use of telehealth in clinical practice. Senior managers in the National Health Service in the United Kingdom need to 'unleash' the goodwill of staff who are eager to exploit innovation in clinical practice.

  16. Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial

    PubMed Central

    Mahal, Ajay; Hill, Catherine J; Lee, Annemarie L; Burge, Angela T; Cox, Narelle S; Moore, Rosemary; Nicolson, Caroline; O'Halloran, Paul; Lahham, Aroub; Gillies, Rebecca; McDonald, Christine F

    2017-01-01

    Background Pulmonary rehabilitation is a cornerstone of care for COPD but uptake of traditional centre-based programmes is poor. We assessed whether home-based pulmonary rehabilitation, delivered using minimal resources, had equivalent outcomes to centre-based pulmonary rehabilitation. Methods A randomised controlled equivalence trial with 12 months follow-up. Participants with stable COPD were randomly assigned to receive 8 weeks of pulmonary rehabilitation by either the standard outpatient centre-based model, or a new home-based model including one home visit and seven once-weekly telephone calls from a physiotherapist. The primary outcome was change in 6 min walk distance (6MWD). Results We enrolled 166 participants to receive centre-based rehabilitation (n=86) or home-based rehabilitation (n=80). Intention-to-treat analysis confirmed non-inferiority of home-based rehabilitation for 6MWD at end-rehabilitation and the confidence interval (CI) did not rule out superiority (mean difference favouring home group 18.6 m, 95% CI −3.3 to 40.7). At 12 months the CI did not exclude inferiority (−5.1 m, −29.2 to 18.9). Between-group differences for dyspnoea-related quality of life did not rule out superiority of home-based rehabilitation at programme completion (1.6 points, −0.3 to 3.5) and groups were equivalent at 12 months (0.05 points, −2.0 to 2.1). The per-protocol analysis showed the same pattern of findings. Neither group maintained postrehabilitation gains at 12 months. Conclusions This home-based pulmonary rehabilitation model, delivered with minimal resources, produced short-term clinical outcomes that were equivalent to centre-based pulmonary rehabilitation. Neither model was effective in maintaining gains at 12 months. Home-based pulmonary rehabilitation could be considered for people with COPD who cannot access centre-based pulmonary rehabilitation. Trial registration number NCT01423227, clinicaltrials.gov. PMID:27672116

  17. Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial.

    PubMed

    Holland, Anne E; Mahal, Ajay; Hill, Catherine J; Lee, Annemarie L; Burge, Angela T; Cox, Narelle S; Moore, Rosemary; Nicolson, Caroline; O'Halloran, Paul; Lahham, Aroub; Gillies, Rebecca; McDonald, Christine F

    2017-01-01

    Pulmonary rehabilitation is a cornerstone of care for COPD but uptake of traditional centre-based programmes is poor. We assessed whether home-based pulmonary rehabilitation, delivered using minimal resources, had equivalent outcomes to centre-based pulmonary rehabilitation. A randomised controlled equivalence trial with 12 months follow-up. Participants with stable COPD were randomly assigned to receive 8 weeks of pulmonary rehabilitation by either the standard outpatient centre-based model, or a new home-based model including one home visit and seven once-weekly telephone calls from a physiotherapist. The primary outcome was change in 6 min walk distance (6MWD). We enrolled 166 participants to receive centre-based rehabilitation (n=86) or home-based rehabilitation (n=80). Intention-to-treat analysis confirmed non-inferiority of home-based rehabilitation for 6MWD at end-rehabilitation and the confidence interval (CI) did not rule out superiority (mean difference favouring home group 18.6 m, 95% CI -3.3 to 40.7). At 12 months the CI did not exclude inferiority (-5.1 m, -29.2 to 18.9). Between-group differences for dyspnoea-related quality of life did not rule out superiority of home-based rehabilitation at programme completion (1.6 points, -0.3 to 3.5) and groups were equivalent at 12 months (0.05 points, -2.0 to 2.1). The per-protocol analysis showed the same pattern of findings. Neither group maintained postrehabilitation gains at 12 months. This home-based pulmonary rehabilitation model, delivered with minimal resources, produced short-term clinical outcomes that were equivalent to centre-based pulmonary rehabilitation. Neither model was effective in maintaining gains at 12 months. Home-based pulmonary rehabilitation could be considered for people with COPD who cannot access centre-based pulmonary rehabilitation. NCT01423227, clinicaltrials.gov. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted

  18. Home-based telemental healthcare safety planning: what you need to know.

    PubMed

    Luxton, David D; O'Brien, Karen; McCann, Russell A; Mishkind, Matthew C

    2012-10-01

    Telemental health (TMH) care provided directly to the home is an emerging area of care delivery. TMH care involves awareness of safety issues and adequate safety planning, although detailed practical recommendations for home-based TMH safety planning are absent in the literature. With this article we aim to increase awareness of safety issues associated with home-based synchronous TMH treatment and to discuss recommendations for consistent safety planning that can inform the development of standard operating procedures, emergency protocols, and overall good TMH practice. Specific areas discussed include consideration of state and local requirements, appropriateness of TMH care, technology and infrastructure, and emergency management and monitoring procedures. The topic of safety, as it relates to TMH policy, as well as the need for additional TMH research are also discussed.

  19. Effect of Telehealth Interventions on Hospitalization Indicators: A Systematic Review

    PubMed Central

    Kalankesh, Leila R.; Pourasghar, Faramarz; Nicholson, Lorraine; Ahmadi, Shamim; Hosseini, Mohsen

    2016-01-01

    Background Telehealth has been defined as the remote delivery of healthcare services using information and communication technology. Where resource-limited health systems face challenges caused by the increasing burden of chronic diseases and an aging global population, telehealth has been advocated as a solution for changing and improving the paradigm of healthcare delivery to cope with these issues. The aim of this systematic review is to investigate the effect of telehealth interventions on two indicators: hospitalization rate and length of stay. Materials and Methods The reviewers searched the PubMed, ScienceDirect, and Springer electronic databases from January 2005 to November 2013. A search strategy was developed using a combination of the following search keywords: impact, effect, telehealth, telemedicine, telecare, hospitalization, length of stay, and resource utilization. Both randomized controlled trials and observational studies were included in the review. To be included in the review, articles had to be written in English. The results of study were compiled, reviewed, and analyzed on the basis of the review aims. Results This systematic review examined 22 existing studies with a total population of 19,086 patients. The effect of telehealth on all-cause hospitalization was statistically significant in 40 percent of the related studies, whereas it was not statistically significant in 60 percent. Similarly, the effect of telehealth on the all-cause length of stay was statistically significant in 36 percent of the studies and nonsignificant in 64 percent. Conclusion Considering the fact that hospitalization rate and length of stay can be confounded by factors other than telehealth intervention, studies examining the effect of the intervention on these indicators must take into account all other factors influencing them. Otherwise any judgment on the effect of telehealth on these indicators cannot be valid. PMID:27843425

  20. Positive Clinical Outcomes Are Synergistic With Positive Educational Outcomes When Using Telehealth Consulting in General Practice: A Mixed-Methods Study

    PubMed Central

    Bonney, Andrew; Teuss, Grigorijs; Guppy, Michelle; Lafferre, Danielle; Mullan, Judy; Barnett, Stephen

    2016-01-01

    Background The use of telehealth technology to enable real-time consultations between patients and specialist services (to whom travel may be an impediment to the patient’s care) has recently been encouraged in Australia through financial incentives. However, the uptake has been both fragmented and inconsistent. The potential benefits for patients include access to a broader range of specialist referral services, cost and time saving, and more rapid access to specialist services and a continuum of care through the triangulation of interaction between patient, primary health care providers (general practitioners and nurses), and specialists. Enhanced broadband connectivity and higher-grade encryption present an opportunity to trial the use of telehealth consulting as an intrinsic element of medical education for both medical students and doctors-in-training within rural practices and Aboriginal Medical Services. Objective This paper discusses the reported, and varied, benefits of telehealth consulting arising from a multisite trial in New South Wales, Australia. The purpose of this study is to encourage the use of selected telehealth consultations between patients in a primary care setting with a specialist service as an integral aspect of medical education. Methods The trial closely followed the protocol developed for this complex and multiaspect intervention. This paper discuses one aspect of the research protocol—using telehealth consultations for medical education—in detail. Results Qualitative and quantitative analyses were conducted. In the quantitative analysis, free-text comments were made on aspects of Telehealth Consulting for the patient, concerning the quality of the interactions, and the time and cost saving, and also on the leaning opportunities. Students commented that their involvement enhanced their learning. All respondents agreed or strongly agreed that that the interpersonal aspects were satisfactory, with some brief comments supporting

  1. Legal Mapping Analysis of State Telehealth Reimbursement Policies.

    PubMed

    Trout, Kate E; Rampa, Sankeerth; Wilson, Fernando A; Stimpson, Jim P

    2017-04-21

    There exists rapid growth and inconsistency in the telehealth policy environment, which makes it difficult to quantitatively evaluate the impact of telehealth reimbursement and other policies without the availability of a legal mapping database. We describe the creation of a legal mapping database of state-level policies related to telehealth reimbursement of healthcare services. Trends and characteristics of these policies are presented. Information provided by the Center for Connected Health Policy was used to identify statewide laws and regulations regarding telehealth reimbursement. Other information was retrieved by using: (1) LexisNexis database, (2) Westlaw database, and (3) retrieval from legislative Web sites, historical documents, and contacting state officials. We examined policies for live video, store-and-forward, and remote patient monitoring (RPM). In the United States, there are 24 states with policies regarding reimbursement for live video transmission. Fourteen states have store-and-forward policies, and six states have RPM-related policies. Mississippi is the only state that requires reimbursement for all three types of telehealth transmission modes. Most states (47 states) have Medicaid policies regarding live video transmission, followed by 37 states for store-and-forward and 20 states for RPM. Only 13 states require that live video will be reimbursed "consistent with" or at the "same rate" as in-person services in their Medicaid program. There are no widely accepted telehealth reimbursement policies across states. They contain diverse restrictions and requirements that present complexities in policy evaluation and in determining policy effectiveness across states.

  2. Envisioning patient safety in Telehealth: a research perspective.

    PubMed

    Monteagudo, José Luis; Salvador, Carlos H; Kun, Luis

    2014-01-01

    This article explores the need for research into patient safety in large-scale Telehealth systems faced with the perspective of its development extended to healthcare systems. Telehealth systems give rise to significant advantages in improving the quality of healthcare services as well as bringing about the possibility of new types of risk. A theoretical framework is proposed for patient safety for its approach as an emerging property in complex socio-technical systems (CSTS) and their modelling in layers. As regards this framework, the differential characteristic Telehealth elements of the system have been identified, with a greater emphasis on the level of Telehealth system and its typical subsystems. The bases of the analysis are based on references in the literature and the experience accumulated by the researchers in the area. In particular, a case describing an example of Telehealth to control patients undergoing treatment with oral anticoagulants is used. As a result, a series of areas of research into and topics regarding Telehealth patient safety are proposed to cover the detectable gaps. Both the theoretical and practical implications of the study are discussed and future perspectives are reflected on.

  3. Telehealth monitoring: a smart investment for home care patients with heart failure?

    PubMed

    Browning, Sarah Via; Clark, Rebecca Culver; Poff, Renee M; Todd, Darren

    2011-06-01

    This telehealth project was positive overall. It was an agency goal to utilize telehealth to augment, not replace, SN visits while improving quality outcomes for the patient. The findings of this project supported that goal.

  4. 78 FR 53506 - Proposed Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-29

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Proposed Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction... forms of information technology. Titles: Care Coordination Home Telehealth (CCHT) Patient Satisfaction...

  5. Telehealth Implementation in a Skilled Nursing Facility: Case Report for Physical Therapist Practice in Washington.

    PubMed

    Lee, Alan Chong W; Billings, Michael

    2016-02-01

    Telehealth is defined as the delivery of health-related services and information via telecommunication technologies. The purposes of this case report are: (1) to describe the development, implementation, and evaluation of a telehealth approach for meeting physical therapist supervision requirements in a skilled nursing facility (SNF) in Washington and (2) to explore clinical and human factors of physical therapist practice in an SNF delivered via telehealth. In 2009, Infinity Rehab conducted a pilot program to determine whether telehealth could be used to meet physical therapist supervision requirements in an SNF. In 2011, language allowing telehealth physical therapy was approved by the Washington Board of Physical Therapy (Board). In 2014-2015, telehealth outcomes were evaluated in a 51-person sample at an Infinity Rehab SNF. Cost savings of telehealth implementation from 2011 to 2015 were estimated. The Board deemed the telehealth pilot program a success and subsequently established telehealth practice language for physical therapy. Both human factors and clinical outcomes were required to implement a successful telehealth practice. Clinical outcomes and user satisfaction in telehealth and nontelehealth groups were equivalent. Cost savings were identified. Human factors, such as the need for provider education in appropriate bedside manner with a telehealth session, were identified. Since 2011, more than 1,000 telehealth physical therapy sessions were conducted at Infinity Rehab SNFs in Washington State. In the future, alternative payment models focused on valued-based clinical outcomes may facilitate wider telehealth adoption in physical therapy. Future research on efficacy and cost-effectiveness is needed to promote broader adoption of telehealth physical therapy in SNFs. This experience demonstrates that telehealth implementation in an SNF for the purpose of physical therapy re-evaluation is a feasible alternative to in-person encounters. © 2016 American

  6. Rapid home-based human immunodeficiency virus testing to reduce costs in a large tuberculosis cohort study

    PubMed Central

    Contreras, C.; Lecca, L.; Shin, S.; Lobatón, R.; Zhang, Z.; Calderón, R.; Murray, M.; Becerra, M. C.

    2013-01-01

    To reduce costs in a large tuberculosis household contact cohort study in Lima, Peru, we replaced laboratory-based human immunodeficiency virus (HIV) testing with home-based rapid HIV testing. We developed a protocol and training course to prepare staff for the new strategy; these included role-playing for home-based deployment of the Determine® HIV 1/2 Ag/Ac Combo HIV test. Although the rapid HIV test produced more false-positives, the overall cost per participant tested, refusal rate and time to confirmatory HIV testing were lower with the home-based rapid testing strategy compared to the original approach. Rapid testing could be used in similar research or routine care settings. PMID:25580381

  7. Telehealth: the backbone of healthcare financing.

    PubMed

    Suleiman, Abu Bakar

    2004-01-01

    Malaysia, like many other countries faces major challenges in meeting increasing demands with limited resources. Changes in demography, life-style diseases, increasing consumer expectations, new medical technologies and rapid economic growth all fuel demand for more healthcare services. There are problems related to the distribution and delivery of healthcare services, and there is inadequate integration of healthcare delivery and continuity of care is a major concern. Resources tend to be concentrated in the very expensive hospital sector, although services would be cost-effectively and conveniently delivered at primary care level. There is no ideal healthcare system, and how healthcare is supported and organized for service delivery influences the country's social, economic and political well-being. Like many other countries, Malaysia is undergoing health reform in meeting these challenges, and is becoming more reliant on telemedicine and telehealth.

  8. Internet-Based Telehealth Assessment of Language Using the CELF-4

    ERIC Educational Resources Information Center

    Waite, Monique C.; Theodoros, Deborah G.; Russell, Trevor G.; Cahill, Louise M.

    2010-01-01

    Purpose: Telehealth has the potential to improve children's access to speech-language pathology services. Validation of telehealth applications, including the assessment of childhood language disorders, is necessary for telehealth to become an accepted alternative mode of service provision. The aim of this study was to validate an Internet-based…

  9. 77 FR 58952 - Exempting In-Home Video Telehealth From Copayments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-25

    ... AFFAIRS 38 CFR Part 17 RIN 2900-AO26 Exempting In-Home Video Telehealth From Copayments AGENCY: Department... care. Specifically, the regulation exempted in-home video telehealth care from having any required...-home video telehealth. VA published a companion substantially identical proposed rule at 77 FR 13236 on...

  10. Being Spontaneous: The Future of Telehealth Implementation?

    PubMed

    Mars, Maurice; Scott, Richard E

    2017-09-01

    The smartphone simplifies interprofessional communication, and smartphone applications can facilitate telemedicine activity. Much has been written about the steps that need to be followed to implement and establish a successful telemedicine service that is integrated into everyday clinical practice. A traditional and systematic approach has evolved incorporating activities such as strategy development, needs assessment, business cases and plans, readiness assessment, implementation plans, change management interventions, and ongoing monitoring and evaluation. This "best practice" has been promoted in the telehealth literature for many years. In contrast, several recent initiatives have arisen without any such formal undertakings. This article describes the strengths and weaknesses of two "spontaneous" telemedicine services in dermatology and burn management that have evolved in South Africa. Two spontaneous services were identified and reviewed. In one unsolicited service, doctors at rural referring hospitals have been taking photographs of skin lesions and sending them with a brief text message history to dermatologists using the instant messaging smartphone app, WhatsApp. In the other, burns service, admissions to the burns unit or the clinic were triaged by telephonic description of the case and completion of a preadmission questionnaire. More recently, management and referral decisions are made only after completion of the questionnaire and subsequent submission of photographs of the burn sent by WhatsApp, with the decision transmitted by text message. Although efficient and effective, potential legal and ethical shortcomings have been identified. These "spontaneous" telehealth services challenge traditional best practice, yet appear to lead to truly integrated practice and, therefore, are successful and warrant further study.

  11. High patient satisfaction with telehealth in Parkinson disease

    PubMed Central

    Spindler, Meredith; Wood, Stephanie M.; Marcus, Steven C.; Weintraub, Daniel; Morley, James F.; Stineman, Margaret G.; Duda, John E.

    2016-01-01

    Abstract Background: Parkinson disease (PD) is a complex neurodegenerative disorder that benefits from specialty care. Telehealth is an innovative resource that can enhance access to this care within a patient-centered framework. Research suggests that telehealth can lead to increased patient satisfaction, equal or better clinical outcomes, and cost savings, but these outcomes have not been well-studied in PD. Methods: We conducted a dual active-arm 12-month randomized controlled trial to assess patient satisfaction, clinical outcomes, travel burden, and health care utilization in PD using video telehealth for follow-up care with specialty providers. Telehealth visits took place either at a facility nearer to the patient (satellite clinic arm) or in the patient's home (home arm). Each control group received usual in-person care. Patient satisfaction, assessed by quantitative questionnaires, was the primary outcome. Results: Eighty-six men were enrolled (home arm: 18 active, 18 control; satellite clinic arm: 26 active, 24 control) with a mean age of 73 years (range 42–87). There were no differences in baseline characteristics between the active group and the controls in each arm (p > 0.05). A significant difference in overall patient satisfaction was not found; however, high levels of patient satisfaction were found in all groups. Greater satisfaction for the telehealth modality was found in assessments of convenience and accessibility/distance. Clinical outcomes were similar between groups, travel burden was reduced using telehealth, and health care utilization was largely similar in both groups. Conclusions: As the need for PD subspecialty care increases, innovative patient-centered solutions to overcoming barriers to access, such as video telehealth, will be invaluable to patients and may provide high patient satisfaction. PMID:27347441

  12. Clinician behaviors in telehealth care delivery: a systematic review.

    PubMed

    Henry, Beverly W; Block, Derryl E; Ciesla, James R; McGowan, Beth Ann; Vozenilek, John A

    2016-10-01

    Literature on telehealth care delivery often addresses clinical, cost, technological, system, and organizational impacts. Less is known about interpersonal behaviors such as communication patterns and therapeutic relationship-building, which may have workforce development considerations. The purpose of this study was to conduct a systematic literature review to identify interpersonal health care provider (HCP) behaviors and attributes related to provider-patient interaction during care in telehealth delivery. Electronic searches were conducted using five indexes/databases: CINAHL, ERIC, PsychInfo, ProQuest Dissertations, PubMed; with hand-searching of the immediate past 10 years of five journals. Search concepts included: communication, telehealth, education, and health care delivery. Of 5261 unique article abstracts initially identified, 338 full-text articles remained after exclusion criteria were applied and these were reviewed for eligibility. Finally, data were extracted from 45 articles. Through qualitative synthesis of the 45 articles, we noted that papers encompassed many disciplines and targeted care to people in many settings including: home care, primary and specialist care, mental health/counseling, and multi-site teams. Interpersonal behaviors were observed though not manipulated through study designs. Six themes were identified: HCP-based support for telehealth delivery; provider-patient interactions during the telehealth event; environmental attributes; and guidelines for education interventions or evaluation of HCP behaviors. Although unable to identify current best practices, important considerations for practice and education did emerge. These include: perceptions of the utility of telehealth; differences in communication patterns such as pace and type of discourse, reliance on visual cues by both provider and patient especially in communicating empathy and building rapport; and confidentiality and privacy in telehealth care delivery.

  13. Home Based Early Intervention: Dimensions of Current Practice.

    ERIC Educational Resources Information Center

    Halpern, Robert

    1986-01-01

    Questions whether home-based early intervention is an invasion of the family that inadvertently undermines its self-confidence or is a life-saving service to families whose children are at risk of abuse and neglect. (HOD)

  14. Rationing home-based nursing care: professional ethical implications.

    PubMed

    Tønnessen, Siri; Nortvedt, Per; Førde, Reidun

    2011-05-01

    The purpose of this study was to investigate nurses' decisions about priorities in home-based nursing care. Qualitative research interviews were conducted with 17 nurses in home-based care. The interviews were analyzed and interpreted according to a hermeneutic methodology. Nurses describe clinical priorities in home-based care as rationing care to mind the gap between an extensive workload and staff shortages. By organizing home-based care according to tight time schedules, the nurses' are able to provide care for as many patients as possible. Furthermore, legal norms set boundaries for clinical priority decisions, resulting in marginalized care. Hence, rationing care jeopardizes important values in the nurse-patient relationship, in particular the value of individualized and inclusive nursing care. The findings are highly relevant for clinical practice, since they have major implications for provision of nursing care. They revive debates about the protection of values and standards of care, and nurses' role and responsibility when resources are limited.

  15. A Home-Based Palliative Care Consult Service for Veterans.

    PubMed

    Golden, Adam G; Antoni, Charles; Gammonley, Denise

    2016-11-01

    We describe the development and implementation of a home-based palliative care consult service for Veterans with advanced illness. A retrospective chart review was performed on 73 Veterans who received a home-based palliative care consult. Nearly one-third were 80 years of age or older, and nearly one-third had a palliative diagnosis of cancer. The most common interventions of the consult team included discussion of advance directives, completion of a "do not resuscitate" form, reduction/stoppage of at least 1 medication, explanation of diagnosis, referral to home-based primary care program, referral to hospice, and assessment/support for caregiver stress. The home-based consult service was therefore able to address clinical and psychosocial issues that can demonstrate a direct benefit to Veterans, families, and referring clinicians.

  16. Home-based sourcing of tobacco among adolescents.

    PubMed

    Rainio, Susanna U; Rimpelä, Arja H

    2009-04-01

    To study home-based sources of tobacco and associated family factors among Finnish adolescents. Nationwide surveys (1999, 2003, 2007) of 14-16-year-old daily (n=2355), occasional (n=708), and experimental (n=2763) smokers. The main outcome measure was home-based sourcing of tobacco (parents, siblings, taking from home) during the past month. Logistic regression was used for statistical analysis. Home-based sources were used by 44% of daily, 11% of occasional, and 9% of experimental smokers; other social sources by 93%, 65%, and 51%; and commercial sources by 70%, 28%, and 10% respectively. Among daily smokers, home sources meant siblings (24%), parents (19%), and taking from home (19%). Parental smoking and absence of a home-smoking ban increased home-based sourcing. The odds ratio (OR) for obtaining tobacco from any home-based source was 6.96 (95% CI: 3.75-12.91) and from parents 7.44 (2.68-20.65) when both parents smoked versus nonsmoking parents. In the absence of a home-smoking ban, corresponding ORs were 2.21 (1.28-3.81) and 21.33 (2.84-60.30) versus those reporting having a ban. Obtaining tobacco from parents was more common in single-parent/reconstituted families than in families with two biological parents. Parents should be provided with guidance about the consequences of home-based sourcing in the persistence of children's smoking habit.

  17. Home-based vs supervised rehabilitation programs following knee surgery: a systematic review.

    PubMed

    Papalia, Rocco; Vasta, Sebastiano; Tecame, Andrea; D'Adamio, Stefano; Maffulli, Nicola; Denaro, Vincenzo

    2013-01-01

    Following knee surgery, rehabilitation can dramatically affect the postoperative course and the final outcomes of the procedure. We systematically reviewed the current literature comparing clinical outcomes of home-based and outpatient supervised rehabilitation protocols following knee surgery. We searched Medline, CINAHL, Embase, Google Scholar, The Cochrane Library and SPORTDiscus. The reference lists of the previously selected articles were then examined by hand. Only studies comparing clinical outcomes of patients who had undergone knee surgery followed by different rehabilitation programs were selected. Then the methodological quality of each article was evaluated using the Coleman methodology score (CMS), a 10-criterion scoring list assessing the methodological quality of the selected studies. Eighteen studies were evaluated in the present review. Three were retrospective studies. The remaining 15 studies were prospective randomized clinical trials. The supervised and home-based protocols did not show an overall significant difference in the outcomes achieved within the studies reviewed. The mean CMS was 77.2. The heterogeneity of the rehabilitation protocols used in the studies reviewed makes it difficult to draw definite conclusion on the subject. Supervision and location does not seem to directly determine the final outcomes. Numerous variables, including comorbidities and motivation, could influence the results and deserve to be accounted for in future investigations. Better designed studies are needed to show a clear superiority of one rehabilitation approach over another and its applicability to the various surgical procedures involving the knee.

  18. Home-based treadmill training improved seminal quality in adults with type 2 diabetes.

    PubMed

    Rosety-Rodriguez, M; Rosety, J M; Fornieles, G; Rosety, M A; Diaz, A J; Rosety, I; Rodríguez-Pareja, A; Rosety, M; Ordonez, F J; Elosegui, S

    2014-11-01

    This was the first study conducted to determine the influence of home-based treadmill training on seminal quality in adults with type 2 diabetes. Sixty sedentary adults with type 2 diabetes volunteered for the current study. Thirty were randomly allocated to the intervention group and performed a a 14-week, home-based, treadmill training program, 3 sessions per week, consisting of a warm-up (10-15min), 40min treadmill exercise at a work intensity of 55-70% of peak heart rate (increasing by 2.5% each two weeks) measured during a maximal treadmill test, and cooling-down (5-10min). The control group included 30, age and BMI matched adults with type 2 diabetes who did not take part in any training program. Seminal quality analysis included semen volume, sperm concentration, motility and normal morphologic features. Furthermore, total antioxidant status (TAS) as well as glutathione peroxidase (GPX) activity were assessed in seminal plasma. This protocol was approved by an Institutional Ethics Committee. The home-based treadmill training significantly increased sperm concentration as well as percentages of total sperm motility and normal spermatozoa. Furthermore, TAS and GPX activity were increased after the completion of the training program. No significant changes in any of the measured variables were found in the control group. Home-based treadmill training improved seminal quality in adults with type 2 diabetes. A secondary finding was that seminal antioxidant defense system was significantly increased after being exercised. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  19. Medicare Telehealth Services and Nephrology: Policies for Eligibility and Payment.

    PubMed

    Frilling, Stephanie

    2017-01-01

    The criteria for Medicare payment of telehealth nephrology services, and all other Medicare telehealth services, are set forth in section 1834(m) of the Social Security Act. There are just over 80 professional physician or practitioner services that may be furnished via telehealth and paid under Medicare Part B, when an interactive audio and video telecommunication system that permits real-time communication between a beneficiary at the originating site and the physician or practitioner at the distant site substitutes for an in-person encounter. These services include 16 nephrology billing codes for furnishing ESRD services for monthly monitoring and assessment and two billing codes for chronic kidney disease education. In recent years, many mobile health devices and other web-based tools have been developed in support of monitoring, observation, and collaboration for people living with chronic disease. This article reviews the statutory and program guidance that governs Medicare telehealth services, defines payment policy terms (e.g., originating site and distant site), and explains payment policies when telehealth services are furnished.

  20. Telehealth in New Zealand: current practice and future prospects.

    PubMed

    Kerr, Karolyn; Norris, Tony

    2004-01-01

    We have surveyed the current state of telehealth in New Zealand. The survey found 22 telehealth projects active in 2003, compared with 12 identified in a previous survey in 2000. Many projects were small, localized and led by enthusiasts. Sustainability was a problem and many projects had failed to enter routine operation. Teleradiology and telepsychiatry services focused on acute hospitals were the most frequent clinical applications. The majority of projects (9 of the 22) were on the North Island, concentrated around Auckland. Telehealth appears to have special potential for rural communities and for the remote treatment (telecare) of chronic disease. However, the provision of telehealth in New Zealand is patchy and meets the same barriers to success as have been identified elsewhere, which make it difficult to move telehealth into routine operation. The obstacles constitute not so much a failure of individual projects as a lack of a driving force to take advantage of the opportunities. It is to be hoped that a suggested strategic framework can help to harness the opportunities.

  1. Outcomes of an integrated telehealth network demonstration project.

    PubMed

    Dimmick, Susan L; Burgiss, Samuel G; Robbins, Sherry; Black, David; Jarnagin, Bertha; Anders, Mary

    2003-01-01

    An integrated telehealth network that linked three hospitals, a federally qualified health care clinic with six sites, a county dental clinic, and patient homes was developed and implemented using both private and federal funding. The goal of the network was to deliver 10 different medical, dental, and behavioral health services to a rural community. The network served patients from nine different counties and two states. Outcomes from the disease management programs for congestive heart failure and diabetes, as well as crisis telehealth and teledental health, were reported. Results for the diabetes disease management program increased the number of diabetics who brought their blood sugar under control. Additionally, based on hospital days per patient per year with and without intervention, and the cost of intervention by telehealth, it was projected that the national cost of care for CHF hospitalizations could be reduced from 8 billion dollars to 4.2 billion dollars. This telehealth network can serve as a model for integrating health services in each county of the state. Once each county had an integrated telehealth network, the county networks could be linked to provide regional services and coordination on a statewide basis.

  2. Home-Based Telemanagement in Advanced COPD: Who Uses it Most? Real-Life Study in Lombardy.

    PubMed

    Vitacca, Michele; Fumagalli, Lia Paola; Borghi, Gabriella; Colombo, Fausto; Castelli, Alberto; Scalvini, Simonetta; Masella, Cristina

    2016-08-01

    Current evidence indicates that the benefits of tele-health may not be uniform across all patients. Therefore, to understand what specific variables influence use of home-based telemanagement in COPD, we conducted this retrospective study.  A 6-month home-based telemanagement program (HTP) was offered to 1,074 COPD patients over a 4-year period. Multivarible linear regression analysis was used to identify predictors of HTP use/week (phone calls and specialist consultations) among all variables: clinical (body mass index, co-morbidities, HTP prescription not following an exacerbation, long-term oxygen therapy use, COPD severity, hospital readmissions, exacerbations and death), socio-demographic (sex, age, place of abode), smoking history, arterial blood gases (ABG), and specialist/general practitioner (GP) urgent need. Logistic regression was conducted to predict relapses/hospitalizations risk as well as the disease impact (COPD Assessment Test, CAT) at the end of the program.  Presence of relapses (p < 0.001), ABGs (p < 0.001) and GP request (p < 0.001) were significantly associated with higher HTP-use. Smoking history (OR 1.542 [IC 95% 1.069-2.217], p = 0.020), specialist (OR 2.895 [2.144-3.910], p < 0.001) and GP consultations (OR 6.575 [4.521-9.561], p < 0.001) were the only independent risk factors for relapse. No predictor of hospitalization was found. High final CAT score was inversely related to oxygen therapy use (p = 0.001) and HTP prescription (p < 0.001), and positively related to presence of co-morbidities (p = 0.001) and baseline CAT (p < 0.001).  This HTP in Lombardy shows that relapsers, people requiring several ABGs and urgent GP visits are the patient subgroup most likely to consume telemanagement services (scheduled and unscheduled). We propose a patient 'identikit' to improve prioritization for HTP prescriptions.

  3. Continuing education training focused on the development of behavioral telehealth competencies in behavioral healthcare providers.

    PubMed

    Gifford, V; Niles, B; Rivkin, I; Koverola, C; Polaha, J

    2012-01-01

    Telehealth allows behavioral health care and specialty services to be extended to rural residents. Telehealth is an important resource for the Alaskan healthcare system, which is tasked with providing services to culturally diverse populations living in remote areas. Training competent providers to deliver telehealth services is vital for the implementation of successful telehealth programs. Yet, the literature is lacking in the area of provider behavioral telehealth competency training. This study assessed the impact of a Behavioral Telehealth Ethical Competencies Training program on 16 behavioral health providers' development of behavioral telehealth competency. A total of 14 competencies were developed, which required participants to understand the roles and responsibilities of a behavioral telehealth coordinator working at the distal site as well as the roles and responsibilities of the therapist. Video vignettes evaluating the 14 competencies, self-reported competence surveys and follow-up surveys of progress on telehealth goals were utilized to assess effects of the training. Results indicated participants' behavioral telehealth competencies increased following training. Participants reported positive perceptions regarding their competency, and achieved progress on the majority of behavioral telehealth goals set during the training. This study provides a baseline for developing a best practice model for behavioral telehealth service delivery by identifying specific provider competencies for administering effective behavioral telehealth services. A unique continuing education training model, led by content experts including university professors and Alaska Native Elders, incorporating behavioral telehealth, rural ethics, cultural competency and vicarious trauma training is described. Lastly, this study details the use of an innovative video vignette assessment instrument for evaluating the effectiveness of continuing education training.

  4. CONDUCTING FUNCTIONAL ANALYSES OF PROBLEM BEHAVIOR VIA TELEHEALTH

    PubMed Central

    Wacker, David P.; Lee, John F.; Padilla Dalmau, Yaniz C.; Kopelman, Todd G.; Lindgren, Scott D.; Kuhle, Jennifer; Pelzel, Kelly E.; Waldron, Debra B.

    2017-01-01

    Behavior consultants conducted functional analyses (FAs) via telehealth with 20 young children with autism spectrum disorders between the ages of 29 and 80 months who displayed problem behavior and lived an average of 222 miles from the tertiary hospital that housed the behavior consultants. Participants’ parents conducted all procedures during weekly telehealth consultations in regional clinics located an average of 15 miles from the participants’ homes. Behavior consultants briefly trained parent assistants to provide on-site support for families during consultations. FAs completed within a multielement design identified environmental variables that maintained problem behavior for 18 of the 20 cases, and interrater agreement averaged over 90%. Results suggested that behavior analysts can conduct FAs effectively and efficiently via telehealth. PMID:24114083

  5. The effectiveness of telehealth care on caregiver burden, mastery of stress, and family function among family caregivers of heart failure patients: a quasi-experimental study.

    PubMed

    Chiang, Li-Chi; Chen, Wan-Chou; Dai, Yu-Tzu; Ho, Yi-Lwun

    2012-10-01

    Telehealth care was developed to provide home-based monitoring and support for patients with chronic disease. The positive effects on physical outcome have been reported; however, more evidence is required concerning the effects on family caregivers and family function for heart failure patients transitioning from the hospital to home. To evaluate the effectiveness of nursing-led transitional care combining discharge plans and telehealth care on family caregiver burden, stress mastery and family function in family caregivers of heart failure patients compared to those receiving traditional discharge planning only. This is a quasi-experimental study design. Sixty-three patients with heart failure were assessed for eligibility and invited to participate in either telehealth care or standard care in a medical centre from May to October 2010. Three families refused to participate in data collection. Thirty families who chose telehealth care after discharge from the hospital to home comprised the experimental group; the others families receiving discharge planning only comprised the comparison group. Telenursing specialist provided the necessary family nursing interventions by 24-h remote monitoring of patients' health condition and counselling by telephone, helping the family caregivers successfully transition from hospital to home. Data on caregiver burden, stress mastery and family function were collected before discharge from the hospital and one month later at home. Effects of group, time, and group×time interaction were analysed using Mixed Model in SPSS (17.0). Family caregivers in both groups had significantly lower burden, higher stress mastery, and better family function at one-month follow-up compared to before discharge. The total score of caregiver burden, stress mastery and family function was significantly improved for the family caregivers in the experimental group compared to the comparison group at posttest. Two subscales of family function

  6. Telehealth at UC Davis--a 20-year experience.

    PubMed

    Nesbitt, Thomas S; Dharmar, Madan; Katz-Bell, Jana; Hartvigsen, Gunnar; Marcin, James P

    2013-05-01

    Telehealth at the University of California Health System began as a telefetal monitoring connection with a rural hospital in 1992 and evolved to become the Center for Health and Technology (CHT) in 2000. The Center supports the vision of the University of California Davis (UC Davis) Health System-a healthier world through bold innovation. The CHT focuses on the four pillars of the academic health center: clinical services, research and scholarly work, education, and public service. Since 1996, the Center has provided more than 33,000 telemedicine consultation (excluding teleradiology, telepathology, and phone consultations) in over 30 clinical specialties and at more than 90 locations across California. Research and continuous evaluation have played an integral role in shaping the telehealth program, as well as strategic collaborations and partnerships. In an effort to expand the field of telehealth the CHT provides telehealth training for health professionals, technical specialists, and administrators. Furthermore, it also plays an integral role in workforce development through the education of the next generation of community primary care physicians through Rural Programs In Medical Education (Rural PRIME) and continuing educational programs for working health professionals through videoconferencing and Web-based modalities. The Center is supported through a variety of funding sources, and its sustainability comes from a mix of fee-for-service payment, contracts, grants, gifts, and institutional funding. Together with key partners, UC Davis has educated and informed initiatives resulting in legislation and policies that advance telehealth. Looking toward the future, UC Davis is focused on technology-enabled healthcare and supporting synergy among electronic health records, health information exchange, mobile health, informatics, and telehealth.

  7. Usability testing of a prototype multi-user telehealth kiosk.

    PubMed

    Courtney, Karen L; Matthews, Judith T; McMillan, Julie M; Person Mecca, Laurel; Smailagic, Asim; Siewiorek, Daniel

    2015-01-01

    The overall purpose of this study was to learn how community-dwelling older adults would interact with our prototype multi-user telehealth kiosk and their views about its usability. Seven subjects participated in laboratory-based usability sessions to evaluate the physical design, appearance, functionality and perceived ease of use of a multi-user telehealth kiosk prototype. During usability testing participants recommended 18 new features (29% of comments), identified 15 software errors (23% of comments) and 29 user interface errors (47% of comments).

  8. Telehealth Business: Boom Times, but Profits May Wait.

    PubMed

    Calandra, Robert

    2017-04-01

    What we have here is irrational telehealth exuberance. Investors are plowing millions into startups. And even though millennials could be eager adopters, these are still early days for the industry. It may take years-and some regulatory changes-for profits to materialize.

  9. Attitudes toward Telehealth Use among Rural Residents: A Danish Survey

    ERIC Educational Resources Information Center

    Sorensen, Jens F. L.

    2008-01-01

    Context: Rural communities tend to be underserved by medical services. Low access to medical services affects quality of life and may also affect settlement decisions. The use of telehealth has often been mentioned as an alternative way to provide health care services in remote, underserved areas. One prerequisite for successful delivery of health…

  10. TeleCITE: Telehealth--A Cochlear Implant Therapy Exchange

    ERIC Educational Resources Information Center

    Stith, Joanna; Stredler-Brown, Arlene; Greenway, Pat; Kahn, Gary

    2012-01-01

    What might bring the efforts of a physician, a speech-language pathologist, a teacher of the deaf and hard of hearing, and a nurse together? The answer is the innovative use of telepractice to deliver high quality, family-centered early intervention to infants and toddlers with hearing loss. TeleCITE: Telehealth--A Cochlear Implant Therapy…

  11. Bridging the Gap: Telehealth in Profoundly Rural America.

    ERIC Educational Resources Information Center

    Holderegger, John; Fortune, Jon; Fortune, Barbara

    This report describes the activities and outcomes of a pioneering Telehealth project in which clinical psychologists use state of the art satellite technology to consult with paraprofessionals who live and provide treatment settings to persons with the dual diagnosis of developmental disabilities and mental illnesses. The goal is to provide early…

  12. Telehealth: Families Finding Ways to Connect in Rural Colorado

    ERIC Educational Resources Information Center

    Kaiser, Kristen

    2011-01-01

    JFK Partners, at the University of Colorado Denver, School of Medicine, is currently implementing a study on the use of telehealth (receiving treatment or services using videoconferencing technology, such as Skype) and youth with autism spectrum disorder (ASD) and anxiety. The study is an exploratory grant from Health Resources and Services…

  13. Attitudes toward Telehealth Use among Rural Residents: A Danish Survey

    ERIC Educational Resources Information Center

    Sorensen, Jens F. L.

    2008-01-01

    Context: Rural communities tend to be underserved by medical services. Low access to medical services affects quality of life and may also affect settlement decisions. The use of telehealth has often been mentioned as an alternative way to provide health care services in remote, underserved areas. One prerequisite for successful delivery of health…

  14. Video telehealth for weight maintenance of African-American women.

    PubMed

    Gerber, Ben S; Schiffer, Linda; Brown, Allison A; Berbaum, Michael L; Rimmer, James H; Braunschweig, Carol L; Fitzgibbon, Marian L

    2013-07-01

    We evaluated the effect of home telehealth on weight maintenance after a group-based weight loss programme. The home telehealth intervention comprised telephone counselling and home Internet-enabled digital video recorders (DVRs) with three channels of video programmes. The video content provided reinforcement and support to promote problem solving, prevent relapse and sustain motivation. Eighty-eight obese or overweight African-American women were randomized to receive monthly telephone counselling (control) or the home telehealth intervention. The weight change during maintenance was not significant in either group (0.6 kg in the intervention group, 0.0 kg in the control group), and there was no significant difference between them. Changes in diet, physical activity, social support and self-efficacy during the maintenance period did not differ significantly between groups. DVR use was low: during the intervention, the number of valid DVR viewings ranged from zero to 42 per person. DVR use was positively associated with previous attendance at the weight loss classes. Home video-based telehealth is a new method of delivering a weight loss maintenance intervention to African-American women. It had no effect on weight maintenance in the present study.

  15. Sustainable Rural Telehealth Innovation: A Public Health Case Study

    PubMed Central

    Singh, Rajendra; Mathiassen, Lars; Stachura, Max E; Astapova, Elena V

    2010-01-01

    Objective To examine adoption of telehealth in a rural public health district and to explain how the innovation became sustainable. Study Setting Longitudinal, qualitative study (1988–2008) of the largest public health district in Georgia. Study Design Case study design provided deep insights into the innovation's social dynamics. Punctuated equilibrium theory helped present and make sense of the process. We identified antecedent conditions and outcomes, and we distinguished between episodes and encounters based on the disruptive effects of events. Data Collection Twenty-five semistructured interviews with 19 decision makers and professionals, direct observations, published papers, grant proposals, technical specifications, and other written materials. Principal Findings Strong collaboration within the district, with local community, and with external partners energized the process. Well-functioning outreach clinics made telehealth desirable. Local champions cultivated participation and generative capability, and overcame barriers through opportunistic exploitation of technological and financial options. Telehealth usage fluctuated between medical and administrative operations in response to internal needs and contextual dynamics. External agencies provided initial funding and supported later expansion. Conclusions Extensive internal and external collaboration, and a combination of technology push and opportunistic exploitation, can enable sustainable rural telehealth innovation. PMID:20459449

  16. Experience of Home Telehealth Technology in Older Patients With Diabetes.

    PubMed

    Chang, Chi-Ping; Lee, Ting-Ting; Mills, Mary Etta

    2017-10-01

    The incidence of diabetes, a common chronic disease among older adults, is increasing annually. The lack of blood glucose regulation can result in severe diabetes-related complications and substantial healthcare costs, making self-care programs specific to this population especially important. Combined with reduced numbers of healthcare professionals, the integration of healthcare and information technology and the older adults' adoption of telehealth services have become increasingly important. This study used a qualitative method to interview 18 older study participants who used a telehealth service. Subject perceptions and suggestions regarding using such a service for diabetes management were investigated. Content analysis was used to examine the interview data and determine the older patients' acceptance and perceived benefits of telehealth service. Four main themes emerged: (1) initial trial encouragement from the doctors, nurses, and financial incentives; (2) enhanced self-management capability through continuous device use for better outcomes; (3) ambivalent feelings regarding dependence on others for problem solving; and (4) consideration for continual technology use for an uncertain future. These results serve as a reference for promoting, assessing, and verifying telehealth models for older patients with diabetes.

  17. Telehealth: Families Finding Ways to Connect in Rural Colorado

    ERIC Educational Resources Information Center

    Kaiser, Kristen

    2011-01-01

    JFK Partners, at the University of Colorado Denver, School of Medicine, is currently implementing a study on the use of telehealth (receiving treatment or services using videoconferencing technology, such as Skype) and youth with autism spectrum disorder (ASD) and anxiety. The study is an exploratory grant from Health Resources and Services…

  18. Video telehealth for weight maintenance of African-American women

    PubMed Central

    Gerber, Ben S; Schiffer, Linda; Brown, Allison A; Berbaum, Michael L; Rimmer, James H; Braunschweig, Carol L; Fitzgibbon, Marian L

    2013-01-01

    Summary We evaluated the effect of home telehealth on weight maintenance after a group-based weight loss programme. The home telehealth intervention comprised telephone counselling and home Internet-enabled digital video recorders (DVRs) with three channels of video programmes. The video content provided reinforcement and support to promote problem solving, prevent relapse, and sustain motivation. Eighty-eight obese or overweight African-American women were randomized to receive monthly telephone counselling (control) or the home telehealth intervention. The weight change during maintenance was not significant in either group (0.6 kg in the intervention group, 0.0 kg in the control group), and there was no significant difference between them. Changes in diet, physical activity, social support and self-efficacy during the maintenance period did not differ significantly between groups. DVR use was low: during the intervention, the number of valid DVR viewings ranged from zero to 42 per person. DVR use was positively associated with previous attendance at the weight loss classes. Home video-based telehealth is a new method of delivering a weight loss maintenance intervention to African-American women. It had no effect on weight maintenance in the present study. PMID:24163236

  19. TeleCITE: Telehealth--A Cochlear Implant Therapy Exchange

    ERIC Educational Resources Information Center

    Stith, Joanna; Stredler-Brown, Arlene; Greenway, Pat; Kahn, Gary

    2012-01-01

    What might bring the efforts of a physician, a speech-language pathologist, a teacher of the deaf and hard of hearing, and a nurse together? The answer is the innovative use of telepractice to deliver high quality, family-centered early intervention to infants and toddlers with hearing loss. TeleCITE: Telehealth--A Cochlear Implant Therapy…

  20. Clinician Behaviors in Telehealth Care Delivery: A Systematic Review

    ERIC Educational Resources Information Center

    Henry, Beverly W.; Block, Derryl E.; Ciesla, James R.; McGowan, Beth Ann; Vozenilek, John A.

    2017-01-01

    Literature on telehealth care delivery often addresses clinical, cost, technological, system, and organizational impacts. Less is known about interpersonal behaviors such as communication patterns and therapeutic relationship-building, which may have workforce development considerations. The purpose of this study was to conduct a systematic…

  1. 42 CFR 414.65 - Payment for telehealth services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Payment for telehealth services. 414.65 Section 414.65 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Physicians and Other...

  2. 42 CFR 414.65 - Payment for telehealth services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Payment for telehealth services. 414.65 Section 414.65 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Physicians and Other...

  3. Asynchronous telehealth: a scoping review of analytic studies.

    PubMed

    Deshpande, Amol; Khoja, Shariq; Lorca, Julio; McKibbon, Ann; Rizo, Carlos; Husereau, Donald; Jadad, Alejandro R

    2009-06-02

    Asynchronous telehealth captures clinically important digital samples (e.g., still images, video, audio, text files) and relevant data in one location and subsequently transmits these files for interpretation at a remote site by health professionals without requiring the simultaneous presence of the patient involved and his or her health care provider. Its utility in the health care system, however, still remains poorly defined. We conducted this scoping review to determine the impact of asynchronous telehealth on health outcomes, process of care, access to health services, and health resources. A search was performed up to December 2006 of MEDLINE, CINAHL, HealthSTAR, the Database of Abstracts of Reviews of Effectiveness, and The Cochrane Library. Studies were included if they contained original data on the use of asynchronous telehealth and were published in English in a peer-reviewed journal. Two independent reviewers screened all articles and extracted data, reaching consensus on the articles and data identified. Data were extracted on general study characteristics, clinical domain, technology, setting, category of outcome, and results. Study quality (internal validity) was assessed using the Jadad scale for randomized controlled trials and the Downs and Black index for non-randomized studies. Summary data were categorized by medical specialty and presented qualitatively. The scoping review included 52 original studies from 238 citations identified; of these 52, almost half focused on the use of telehealth in dermatology. Included studies were characterized by diverse designs, interventions, and outcomes. Only 16 studies were judged to be of high quality. Most studies showed beneficial effects in terms of diagnostic accuracy, wait times, referral management, and satisfaction with services. Evidence on the impact of asynchronous telehealth on resource use in dermatology suggests a reduction in the number of, or avoidance of, in-person visits. Reports from other

  4. Asynchronous telehealth: a scoping review of analytic studies

    PubMed Central

    Deshpande, Amol; Khoja, Shariq; Lorca, Julio; McKibbon, Ann; Rizo, Carlos; Husereau, Donald; Jadad, Alejandro R

    2009-01-01

    Background Asynchronous telehealth captures clinically important digital samples (e.g., still images, video, audio, text files) and relevant data in one location and subsequently transmits these files for interpretation at a remote site by health professionals without requiring the simultaneous presence of the patient involved and his or her health care provider. Its utility in the health care system, however, still remains poorly defined. We conducted this scoping review to determine the impact of asynchronous telehealth on health outcomes, process of care, access to health services, and health resources. Methods A search was performed up to December 2006 of MEDLINE, CINAHL, HealthSTAR, the Database of Abstracts of Reviews of Effectiveness, and The Cochrane Library. Studies were included if they contained original data on the use of asynchronous telehealth and were published in English in a peer-reviewed journal. Two independent reviewers screened all articles and extracted data, reaching consensus on the articles and data identified. Data were extracted on general study characteristics, clinical domain, technology, setting, category of outcome, and results. Study quality (internal validity) was assessed using the Jadad scale for randomized controlled trials and the Downs and Black index for non-randomized studies. Summary data were categorized by medical specialty and presented qualitatively. Results The scoping review included 52 original studies from 238 citations identified; of these 52, almost half focused on the use of telehealth in dermatology. Included studies were characterized by diverse designs, interventions, and outcomes. Only 16 studies were judged to be of high quality. Most studies showed beneficial effects in terms of diagnostic accuracy, wait times, referral management, and satisfaction with services. Evidence on the impact of asynchronous telehealth on resource use in dermatology suggests a reduction in the number of, or avoidance of, in

  5. Encounters in Home-Based Nursing Care - Registered Nurses’ Experiences

    PubMed Central

    Wälivaara, Britt-Marie; Sävenstedt, Stefan; Axelsson, Karin

    2013-01-01

    The encounter between registered nurses and persons in need of healthcare has been described as fundamental in nursing care. This encounter can take place face-to-face in physical meetings and through meetings via distance-spanning technology. A strong view expressed in the literature is that the face-to-face encounter is important and cannot entirely be replaced by remote encounters. The encounter has been studied in various healthcare contexts but there is a lack of studies with specific focus on the encounter in home-based nursing care. The aim of this study was to explore the encounter in home-based nursing care based on registered nurses’ experiences. Individual interviews were performed with 24 nurses working in home-based nursing care. The transcribed interviews were analyzed using thematic content analysis and six themes were identified: Follows special rules, Needs some doing, Provides unique information and understanding, Facilitates by being known, Brings energy and relieves anxiety, and Can reach a spirit of community. The encounter includes dimensions of being private, being personal and being professional. A good encounter contains dimensions of being personal and being professional and that there is a good balance between these. This is an encounter between two human beings, where the nurse faces the person with herself and the profession steadily and securely in the back. Being personal and professional at the same time could encourage nurses to focus on doing and being during the encounter in home-based nursing care. PMID:23847697

  6. Encounters in home-based nursing care - registered nurses' experiences.

    PubMed

    Wälivaara, Britt-Marie; Sävenstedt, Stefan; Axelsson, Karin

    2013-01-01

    The encounter between registered nurses and persons in need of healthcare has been described as fundamental in nursing care. This encounter can take place face-to-face in physical meetings and through meetings via distance-spanning technology. A strong view expressed in the literature is that the face-to-face encounter is important and cannot entirely be replaced by remote encounters. The encounter has been studied in various healthcare contexts but there is a lack of studies with specific focus on the encounter in home-based nursing care. The aim of this study was to explore the encounter in home-based nursing care based on registered nurses' experiences. Individual interviews were performed with 24 nurses working in home-based nursing care. The transcribed interviews were analyzed using thematic content analysis and six themes were identified: Follows special rules, Needs some doing, Provides unique information and understanding, Facilitates by being known, Brings energy and relieves anxiety, and Can reach a spirit of community. The encounter includes dimensions of being private, being personal and being professional. A good encounter contains dimensions of being personal and being professional and that there is a good balance between these. This is an encounter between two human beings, where the nurse faces the person with herself and the profession steadily and securely in the back. Being personal and professional at the same time could encourage nurses to focus on doing and being during the encounter in home-based nursing care.

  7. Home Based Care: Direction for the 80s.

    ERIC Educational Resources Information Center

    Bryce, Marvin E.

    Home based family centered (HBFC) service programs have been developed as alternatives to out-of-home placement. These programs have reported relatively high service success rates at costs signficantly lower than foster home and institutional care while, at the same time, avoiding the social and psychological risks of out-of-home placement.…

  8. Home-Based Crisis Therapy: A Comparative Outcome Study.

    ERIC Educational Resources Information Center

    Rowland, Charity; And Others

    Substitute care for a child at risk has been been associated with psychological distress in the child and his family and a drain on public finances. To investigate the cost effectiveness and ultimate influence on family intactness of home-based family crisis intervention, 77 low income, inner city families with an adolescent child at risk of…

  9. Washington State's Laws Regulating Home-Based Instruction. Revised.

    ERIC Educational Resources Information Center

    Bergeson, Terry; Kelly, Thomas J.; Riggers, Marcia L.; Dyer, Melinda

    This publication was put together by the Washington State Office of Superintendent of Public Instruction in response to questions about laws concerning home-based instruction passed in 1985. Part 1 contains responses to questions relating to Chapter 28A.225 RCW and Chapter 28A.200 RCW; topics covered include regulations governing compulsory school…

  10. Home Based Early Intervention: The Story of Susan.

    ERIC Educational Resources Information Center

    Gray, Davon

    1980-01-01

    Case of a severely handicapped preschooler illustrates advantages of home-based infant stimulation program. Initial goals were: work toward physical separation of mother and child, shape and reinforce child's behavior to extinguish crying, shape and reinforce mother's behavior to enrich home environment, and stimulate and reinforce a developmental…

  11. Status of the Home-Based Effort Within Head Start.

    ERIC Educational Resources Information Center

    Children First, Inc., Washington, DC.

    This status report is an attempt to provide a comprehensive picture of Head Start home-based programs which aimed at helping parents provide children with the same kinds of activities and support in their own homes that children would receive in any quality child development center. Data was collected through: (1) Children (1st) First, Inc.'s…

  12. Integrating telemedicine and telehealth: putting it all together.

    PubMed

    Weinstein, Ronald S; Lopez, Ana Maria; Krupinski, Elizabeth A; Beinar, Sandra J; Holcomb, Michael; McNeely, Richard A; Latifi, Rifat; Barker, Gail

    2008-01-01

    Telemedicine and telehealth programs are inherently complex compared with their traditional on-site health care delivery counterparts. Relatively few organizations have developed sustainable, multi-specialty telemedicine programs, although single service programs, such as teleradiology and telepsychiatry programs, are common. A number of factors are barriers to the development of sustainable telemedicine and telehealth programs. First, starting programs is often challenging since relatively few organizations have, in house, a critical mass of individuals with the skill sets required to organize and manage a telemedicine program. Therefore, it is necessary to "boot strap" many of the start-up activities using available personnel. Another challenge is to assemble a management team that has time to champion telemedicine and telehealth while dealing with the broad range of issues that often confront telemedicine programs. Telemedicine programs housed within a single health care delivery system have advantages over programs that serve as umbrella telehealth organizations for multiple health care systems. Planning a telemedicine program can involve developing a shared vision among the participants, including the parent organizations, management, customers and the public. Developing shared visions can be a time-consuming, iterative process. Part of planning includes having the partnering organizations and their management teams reach a consensus on the initial program goals, priorities, strategies, and implementation plans. Staffing requirements of telemedicine and telehealth programs may be met by sharing existent resources, hiring additional personnel, or outsourcing activities. Business models, such as the Application Service Provider (ASP) model used by the Arizona Telemedicine Program, are designed to provide staffing flexibility by offering a combination of in-house and out-sourced services, depending on the needs of the individual participating health care

  13. Social acceptance and population confidence in telehealth in Quebec.

    PubMed

    Poder, Thomas G; Bellemare, Christian A; Bédard, Suzanne K; Lemieux, Renald

    2015-02-21

    Access to healthcare in remote areas is difficult and telehealth could be a promising avenue if accepted by the population. The aim of this study is to assess social acceptance and population confidence in telehealth in the Province of Quebec. We conducted a survey using a questionnaire assessing the social acceptance of and confidence level in telehealth. Two strategies were used: 1) paper questionnaires were sent to two hospitals in Quebec; and 2) online questionnaires were randomly sent by a firm specialized in online survey to a representative sample of the population of the Province of Quebec. Respondents were all residents of the Province of Quebec and 18 years and older. Questions were scored with a four-level Likert scale. A total of 1816 questionnaires were analyzed (229 written and 1,587 online questionnaires). The socio-demographic variables in our samples, especially the online questionnaires, were fairly representative of Quebec's population. Overall, social acceptance scored at 77.71% and confidence level at 65.76%. Both scores were higher in the case of treatment (3 scenarios were proposed) vs. diagnosis (p < 0.05). No difference was found when respondents were asked to respond for themselves and for a member of their family, which demonstrates a true interest in telehealth in Quebec. In addition, we found a significant difference (p < 0.05) between written and online questionnaires regarding social acceptance (80.75% vs. 77.33%) and confidence level (74.84% vs. 64.55%). These differences may be due to social desirability or avidity bias in the written questionnaires. Our results suggest that the population in Quebec encourages the development of telehealth for real time diagnosis and long distance treatment for regions deprived of healthcare professionals.

  14. The organising vision for telehealth and telecare: discourse analysis

    PubMed Central

    Procter, Rob; Wherton, Joe; Sugarhood, Paul; Shaw, Sara

    2012-01-01

    Objective To (1) map how different stakeholders understand telehealth and telecare technologies and (2) explore the implications for development and implementation of telehealth and telecare services. Design Discourse analysis. Sample 68 publications representing diverse perspectives (academic, policy, service, commercial and lay) on telehealth and telecare plus field notes from 10 knowledge-sharing events. Method Following a familiarisation phase (browsing and informal interviews), we studied a systematic sample of texts in detail. Through repeated close reading, we identified assumptions, metaphors, storylines, scenarios, practices and rhetorical positions. We added successive findings to an emerging picture of the whole. Main findings Telehealth and telecare technologies featured prominently in texts on chronic illness and ageing. There was no coherent organising vision. Rather, four conflicting discourses were evident and engaged only minimally with one another's arguments. Modernist discourse presented a futuristic utopian vision in which assistive technologies, implemented at scale, would enable society to meet its moral obligations to older people by creating a safe ‘smart’ home environment where help was always at hand, while generating efficiency savings. Humanist discourse emphasised the uniqueness and moral worth of the individual and tailoring to personal and family context; it considered that technologies were only sometimes fit for purpose and could create as well as solve problems. Political economy discourse envisaged a techno-economic complex of powerful vested interests driving commodification of healthcare and diversion of public funds into private business. Change management discourse recognised the complicatedness of large-scale technology programmes and emphasised good project management and organisational processes. Conclusion Introduction of telehealth and telecare is hampered because different stakeholders hold different assumptions

  15. The organising vision for telehealth and telecare: discourse analysis.

    PubMed

    Greenhalgh, Trisha; Procter, Rob; Wherton, Joe; Sugarhood, Paul; Shaw, Sara

    2012-01-01

    To (1) map how different stakeholders understand telehealth and telecare technologies and (2) explore the implications for development and implementation of telehealth and telecare services. Discourse analysis. 68 publications representing diverse perspectives (academic, policy, service, commercial and lay) on telehealth and telecare plus field notes from 10 knowledge-sharing events. Following a familiarisation phase (browsing and informal interviews), we studied a systematic sample of texts in detail. Through repeated close reading, we identified assumptions, metaphors, storylines, scenarios, practices and rhetorical positions. We added successive findings to an emerging picture of the whole. Telehealth and telecare technologies featured prominently in texts on chronic illness and ageing. There was no coherent organising vision. Rather, four conflicting discourses were evident and engaged only minimally with one another's arguments. Modernist discourse presented a futuristic utopian vision in which assistive technologies, implemented at scale, would enable society to meet its moral obligations to older people by creating a safe 'smart' home environment where help was always at hand, while generating efficiency savings. Humanist discourse emphasised the uniqueness and moral worth of the individual and tailoring to personal and family context; it considered that technologies were only sometimes fit for purpose and could create as well as solve problems. Political economy discourse envisaged a techno-economic complex of powerful vested interests driving commodification of healthcare and diversion of public funds into private business. Change management discourse recognised the complicatedness of large-scale technology programmes and emphasised good project management and organisational processes. Introduction of telehealth and telecare is hampered because different stakeholders hold different assumptions, values and world views, 'talk past' each other and compete for

  16. 3D visualization environment for analysis of telehealth indicators in public health.

    PubMed

    Filho, Amadeu S Campos; Novaes, Magdala A; Gomes, Alex S

    2013-01-01

    With the growth of telehealth applications and the need for public health managers to have tools that facilitate visualization of indicators produced by telehealth services arose the need to have simple systems to better planning the interventions. Furthermore, Health systems are considers difficult in order to visualize the right information by many health professionals [1] because of the complexity of its Graphical User Interface (GUI) and the high cognitive load needed to handle it. To overcome this problem, we have proposed a 3D environment for the analysis of telehealth indicators in public health by managers of public health sites. Users who will use the environment are part of public health manager of family health sites that participate of Network of Telehealth Centers of Pernambuco (RedeNUTES) [2] that is part of Brazil telehealth program. This paper aims to present a 3D environment for analysis of telehealth indicators by public health manager.

  17. Home-based intermediate care program vs hospitalization

    PubMed Central

    Armstrong, Catherine Deri; Hogg, William E.; Lemelin, Jacques; Dahrouge, Simone; Martin, Carmel; Viner, Gary S.; Saginur, Raphael

    2008-01-01

    OBJECTIVE To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. DESIGN Single-arm study with historical controls. SETTING Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. PARTICIPANTS Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. INTERVENTIONS Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. MAIN OUTCOME MEASURES Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. RESULTS The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P < .001), used more community care services following discharge (coefficient $729, P = .007), and were more likely to be readmitted to hospital within 3 months of discharge (coefficient 17%, P = .012) than patients treated in hospital. Total substituted costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). CONCLUSION While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to

  18. Narrative as a Means of Understanding the Multi-Dimensional Benefits of Telehealth: An Exploration of Telehealth Stories

    ERIC Educational Resources Information Center

    Carter, Lorraine Mary; Muir, Linda; McLean, Doris

    2011-01-01

    Telehealth is a wide range of health services delivered across distance through technology. In this technology-supported health world, sometimes, the client and his or her family can get lost as clinical consultations are counted for reporting purposes and new technologies are implemented. As a response to this situation and building on the…

  19. Narrative as a Means of Understanding the Multi-Dimensional Benefits of Telehealth: An Exploration of Telehealth Stories

    ERIC Educational Resources Information Center

    Carter, Lorraine Mary; Muir, Linda; McLean, Doris

    2011-01-01

    Telehealth is a wide range of health services delivered across distance through technology. In this technology-supported health world, sometimes, the client and his or her family can get lost as clinical consultations are counted for reporting purposes and new technologies are implemented. As a response to this situation and building on the…

  20. Home-based isometric exercise training induced reductions resting blood pressure.

    PubMed

    Wiles, Jonathan D; Goldring, Natalie; Coleman, Damian

    2017-01-01

    Isometric exercise training (IET) reduces resting blood pressure (BP). Most previous protocols impose exercise barriers which undermine its effectiveness as a potential physical therapy for altering BP. An inexpensive, home-based programme would promote IET as a valuable tool in the fight against hypertension. The aims of this study were: (a) to investigate whether home-based wall squat training could successfully reduce resting BP and (b) to explore the physiological variables that might mediate a change in resting BP. Twenty-eight healthy normotensive males were randomly assigned to a control and a 4 week home-based IET intervention using a crossover design with a 4 week 'washout' period in-between. Wall squat training was completed 3 × weekly over 4 weeks with 48 h between sessions. Each session comprised 4 × 2 min bouts of wall squat exercise performed at a participant-specific knee joint angle relative to a target HR of 95% HRpeak, with 2 min rest between bouts. Resting heart rate, BP, cardiac output, total peripheral resistance, and stroke volume were taken at baseline and post each condition. Resting BP (systolic -4 ± 5, diastolic -3 ± 3 and mean arterial -3 ± 3 mmHg), cardiac output (-0.54 ± 0.66 L min(-1)) and heart rate (-5 ± 7 beats min(-1)) were all reduced following IET, with no change in total peripheral resistance or stroke volume compared to the control. These findings suggest that the wall squat provides an effective method for reducing resting BP in the home resulting primarily from a reduction in resting heart rate.

  1. Trials and tribulations: a small pilot telehealth home care program for medicare patients.

    PubMed

    Walsh, Maureen; Coleman, John R

    2005-01-01

    This article describes a home care agency's experience initiating the technology of a telehealth program for a selected view of its home care patients. The goal of the telehealth program was to improve patient outcomes by augmenting patients' regularly scheduled in-home skilled nursing visits with video-conferencing encounters. Patient selection, costs, projected savings, patient satisfaction, and the technical, clinical, and patient problems with the telehealth system are discussed.

  2. Awareness, experiences and perceptions of telehealth in a rural Queensland community.

    PubMed

    Bradford, Natalie K; Caffery, Liam J; Smith, Anthony C

    2015-09-28

    Telehealth can offer alternative options for receiving healthcare services in rural locations, improving access and reducing costs associated with traveling for services. However, the full potential of telehealth has not been realised with slow and fragmented uptake. This study describes the awareness, experiences and perceptions of telehealth in an Australian rural community. Semi-structured interviews were undertaken with 47 participants from three rural towns in the Darling Downs region of Queensland. Content analysis was used to abstract themes and core concepts from the interviews. Three participants were healthcare providers who had all previously used telehealth in their clinical practice. Twenty-seven (57 %) participants regularly travelled to access specialist healthcare. While 28 (60 %) participants were aware of telehealth, only six (13 %) had actually used telehealth services; three as patients and three as healthcare providers. Major themes evident included: acceptance of the need to travel; paternalism and empowerment; and trust and misconceptions. For telehealth initiatives to be successful, there needs to be greater public awareness and understanding of the potential benefits of telehealth. Empowering patients as partners in the delivery of healthcare may be an important factor in the growth of telehealth services.

  3. The Church as a Bridge to Deliver Health Resources Via Telehealth

    ClinicalTrials.gov

    2016-05-11

    Obesity; Diet, Food, and Nutrition; Church; Healthcare Disparities; Minority Health; Mobile Health; Telehealth; Community-based Participatory Research; Primary Health Care; Weight Loss Programs; Health Behavior

  4. Telehealth and Medicare: Payment Policy, Current Use, and Prospects for Growth

    PubMed Central

    Gilman, Matlin; Stensland, Jeff

    2013-01-01

    Objective Evaluate the growth in various types of Medicare-paid telehealth services. Background There has been a long-standing hope that telehealth could be used to reduce rural patients’ travel times to specialty physicians. Medicare covers telehealth services provided through live, interactive videoconferencing between a beneficiary located at a certified rural site and a distant practitioner. Methods We analyzed 100% of telehealth Medicare claims for 2009 matched to individual patient ZIP codes and individual provider characteristics. Results Despite increases in Medicare payment rates for telehealth services, expansions of covered services, reductions in provider requirements, and provisions of federal grants to encourage telehealth, growth in adoption of telehealth among providers has been modest. Medicare claims indicate that only 369 providers had 10 or more Medicare telehealth consultations in 2009. Roughly half of the 369 were mental health professionals, and about one-in-five of the 369 were non-physician professionals (e.g., physician assistants and nurse practitioners). On balance, the strong areas of telehealth are mental health and, surprisingly, nonphysician professionals. The comparative advantage of mental health could be the verbal (rather than physical contact) nature of mental health care, and the comparative advantage of non-physician professionals could be their lower labor costs. PMID:24834368

  5. Telehealth and Medicare: payment policy, current use, and prospects for growth.

    PubMed

    Gilman, Matlin; Stensland, Jeff

    2013-01-01

    Evaluate the growth in various types of Medicare-paid telehealth services. There has been a long-standing hope that telehealth could be used to reduce rural patients' travel times to specialty physicians. Medicare covers telehealth services provided through live, interactive videoconferencing between a beneficiary located at a certified rural site and a distant practitioner. We analyzed 100% of telehealth Medicare claims for 2009 matched to individual patient ZIP codes and individual provider characteristics. Despite increases in Medicare payment rates for telehealth services, expansions of covered services, reductions in provider requirements, and provisions of federal grants to encourage telehealth, growth in adoption of telehealth among providers has been modest. Medicare claims indicate that only 369 providers had 10 or more Medicare telehealth consultations in 2009. Roughly half of the 369 were mental health professionals, and about one-in-five of the 369 were non-physician professionals (e.g., physician assistants and nurse practitioners). On balance, the strong areas of telehealth are mental health and, surprisingly, nonphysician professionals. The comparative advantage of mental health could be the verbal (rather than physical contact) nature of mental health care, and the comparative advantage of non-physician professionals could be their lower labor costs.

  6. Use of telehealth for health care of Indigenous peoples with chronic conditions: a systematic review.

    PubMed

    Fraser, Sarah; Mackean, Tamara; Grant, Julian; Hunter, Kate; Towers, Kurt; Ivers, Rebecca

    2017-01-01

    Telehealth may be a cost effective modality in healthcare delivery, but how well used or how appropriate it is for the care of Indigenous peoples is unclear. This review examines the evidence for telehealth in facilitating chronic conditions management with Indigenous peoples. Databases were systematically searched for qualitative or quantitative primary research studies that investigated telehealth use for chronic conditions management with Indigenous peoples worldwide. Evidence of effectiveness was by consumer health outcomes, evidence of acceptability was through consumer and user perception, and health service feasibility was evident by service impact. Data were assessed for quality and data extracted using pre-defined tools. Articles (n=32) examined effectiveness (n=11), critiqued telehealth from the perspectives of the client (n=10) and healthcare professionals (n=8), and examined feasibility (n=12). Studies reported Indigenous people tend to be satisfied with telehealth, but are sceptical about its cultural safety. Evidence for the effectiveness of telehealth from a western biomedical perspective was found. Telehealth is promising; however, a lack of robust studies in this review make tangible conclusions difficult. A better overall understanding of telehealth use with Indigenous peoples, including delivery of culturally competent health care, true consultation and cultural competency of the professionals involved, would be helpful. Telehealth may have the potential to improve health care for Indigenous people, however the modality needs to be culturally competent and the care received must be culturally safe.

  7. Telehealth and eHealth in nurse practitioner training: current perspectives

    PubMed Central

    Rutledge, Carolyn M; Kott, Karen; Schweickert, Patty A; Poston, Rebecca; Fowler, Christianne; Haney, Tina S

    2017-01-01

    Telehealth is becoming a vital process for providing access to cost-effective quality care to patients at a distance. As such, it is important for nurse practitioners, often the primary providers for rural and disadvantaged populations, to develop the knowledge, skills, and attitudes needed to utilize telehealth technologies in practice. In reviewing the literature, very little information was found on programs that addressed nurse practitioner training in telehealth. This article provides an overview of both the topics and the techniques that have been utilized for training nurse practitioners and nurse practitioner students in the delivery of care utilizing telehealth. Specifically, this article focuses on topics including 1) defining telehealth, 2) telehealth etiquette, 3) interprofessional collaboration, 4) regulations, 5) reimbursement, 6) security/Health Insurance Portability and Accountability Act (HIPAA), 7) ethical practice in telehealth, and 8) satisfaction of patients and providers. A multimodal approach based on a review of the literature is presented for providing the training: 1) didactics, 2) simulations including standardized patient encounters, 3) practice immersions, and 4) telehealth projects. Studies found that training using the multimodal approach allowed the students to develop comfort, knowledge, and skills needed to embrace the utilization of telehealth in health care. PMID:28721113

  8. Telehealth and eHealth in nurse practitioner training: current perspectives.

    PubMed

    Rutledge, Carolyn M; Kott, Karen; Schweickert, Patty A; Poston, Rebecca; Fowler, Christianne; Haney, Tina S

    2017-01-01

    Telehealth is becoming a vital process for providing access to cost-effective quality care to patients at a distance. As such, it is important for nurse practitioners, often the primary providers for rural and disadvantaged populations, to develop the knowledge, skills, and attitudes needed to utilize telehealth technologies in practice. In reviewing the literature, very little information was found on programs that addressed nurse practitioner training in telehealth. This article provides an overview of both the topics and the techniques that have been utilized for training nurse practitioners and nurse practitioner students in the delivery of care utilizing telehealth. Specifically, this article focuses on topics including 1) defining telehealth, 2) telehealth etiquette, 3) interprofessional collaboration, 4) regulations, 5) reimbursement, 6) security/Health Insurance Portability and Accountability Act (HIPAA), 7) ethical practice in telehealth, and 8) satisfaction of patients and providers. A multimodal approach based on a review of the literature is presented for providing the training: 1) didactics, 2) simulations including standardized patient encounters, 3) practice immersions, and 4) telehealth projects. Studies found that training using the multimodal approach allowed the students to develop comfort, knowledge, and skills needed to embrace the utilization of telehealth in health care.

  9. Home-based rehabilitation in the postoperative treatment of flexor tendon repair.

    PubMed

    Sanmartín-Fernández, M; Fernández-Bran, B; Couceiro-Otero, J

    To evaluate the results and complications of flexor tendon repair in which a home-based rehabilitation program was utilized without the assistance of a hand therapist during the first 4postoperative weeks. Between July 2009 and July 2014, a total of 21 digits in 15 patients were treated in our institution for complete laceration of the flexor tendons within the flexor pulley system (zone 1 and 2). Passive and active exercises performed by the patients themselves were started the morning after the operation. Data, as range-of-motion and complications, were collected 6months after the surgery. Fifteen digits had full recovery of flexion. One patient suffered a rupture in the fifth postoperative week. Ten of the 21 digits developed a flexion contracture of the proximal interphalangeal joint; in 5 the contracture was less or equal to 10° without impairment of function or aesthetics. Over recent decades, specialized hand therapy has been of great importance in the postoperative treatment of hand diseases. Unfortunately, these professionals are not always available in our area in the first days after surgery. With this protocol, the patient is in charge of carrying out the postoperative exercises, which could lead to a worse final result and a higher rate of complications. The home-based rehabilitation program yielded complete recovery of joint mobility in most cases with a low complication rate. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Home-based video CBT for comorbid geriatric insomnia: a pilot study using secondary data analyses.

    PubMed

    Rybarczyk, Bruce; Lopez, Martita; Schelble, Kathy; Stepanski, Edward

    2005-01-01

    Two recent studies showed that cognitive-behavioral treatment (CBT) is efficacious in treating insomnia in older adults with comorbid medical conditions. The authors extended these findings by comparing 12 older adults with comorbid insomnia who received a home-based video CBT program to the authors' previously published data on 24 participants who received classroom CBT or no treatment. All 36 participants were initially randomized within the same protocol, but the video arm was conducted 7 months after completion of the other two study arms. Compared to controls, the video CBT group demonstrated significant changes in five of eight self-report measures of sleep at posttreatment, including sleep latency, time awake after sleep onset, total time in bed, overall sleep quality, and dysfunctional beliefs and attitudes about sleep. Compared to controls, the video CBT group also had posttreatment improvements in daytime functioning, including mood, pain perception, social functioning, and energy-vitality. Although video CBT was not significantly different from classroom CBT on self-report measures, the attrition rate was higher (27% vs. 19%) and the number of participants who achieved clinically significant change was lower (50% vs. 73%). These preliminary findings suggest that delivering CBT in a home-based video format has the potential to serve as a first-line, cost-effective treatment for comorbid insomnia.

  11. The challenges of a home-based nursing consultation business.

    PubMed

    Schulmeister, L

    1999-03-01

    The transition from working in a traditional setting to working at home alone can be challenging for new nurse consultants. Home-based consultants can use a variety of strategies to stay focused and connected, such as having a designated work area, limiting distractions, and networking. Nurse consultants can obtain information about business management from community resources, and computer on-line services offer a means of contacting other small-business owners. Ongoing business evaluations, which include professional accomplishments as well as an examination of income and expenses, help in planning. Home-based nurse consultants can increase the likelihood of business success by setting objectives, working diligently, and networking with others in the business community.

  12. A Retrospective Comparison of Home Telehealth and Nursing Care With or Without Rehabilitation Therapy on Rehospitalization Rates of Individuals With Heart Failure.

    PubMed

    Martin, Stacy; Anderson, Bill; Vincenzo, Jennifer L; Zai, Sajid Yousuf

    2017-05-01

    Congestive heart failure (CHF) is the most common reason for rehospitalization among the aging population, accounting for one-fifth of all hospital admissions. To date, there is no research comparing the rehospitalization rates between patients with CHF (PWCHF) who receive telehealth and home health nursing care versus a multidisciplinary team consisting of telehealth, home nursing, physical therapy (PT), and/or occupational therapy (OT). A retrospective analysis was performed with 132 Medicare Part A home health patients discharged from an inpatient setting with a primary or secondary diagnosis of CHF receiving daily telehealth over the course of 1 year. Allscripts Home Care and Lifestream software was used to query data from patient records. Rehospitalization rates were analyzed using Cochran-Mantel-Haenszel tests. Patients were divided into 3 groups: (1) nursing only; (2) nursing and PT or OT; or (3) nursing, PT, and OT. A total of 41 of the 132 patients (31.06%) were rehospitalized during their home health 60-day episode of care. This percentage includes all-cause rehospitalizations. Cochran-Mantel-Haenszel tests indicated there were no differences in rehospitalization rates between the 3 groups after controlling for the confounding variables: (1) multiple hospitalizations (P = .15); (2) history of falls (P = .16); or (3) depression (P = .18). There was no statistically significant difference between the 3 groups for all-cause rehospitalization rates. Further prospective research is required to determine best practices and multidisciplinary protocols to further reduce rehospitalization rates in this population.

  13. Measuring Knowledge, Acceptance, and Perceptions of Telehealth in an Interprofessional Curriculum for Student Nurse Practitioners, Occupational Therapists, and Physical Therapists

    ERIC Educational Resources Information Center

    Randall, Ken; Steinheider, Brigitte; Isaacson, Mary; Shortridge, Ann; Bird, Stephanie; Crio, Carrie; Ross, Heather; Loving, Gary

    2016-01-01

    Introduction: The use of telehealth in service delivery is both challenging and beneficial. This paper describes the results of a three semester-long interprofessional education program in team-based care using telehealth technology. The study assessed telehealth knowledge acquisition, practice in a structured environment with a simulated patient,…

  14. Measuring Knowledge, Acceptance, and Perceptions of Telehealth in an Interprofessional Curriculum for Student Nurse Practitioners, Occupational Therapists, and Physical Therapists

    ERIC Educational Resources Information Center

    Randall, Ken; Steinheider, Brigitte; Isaacson, Mary; Shortridge, Ann; Bird, Stephanie; Crio, Carrie; Ross, Heather; Loving, Gary

    2016-01-01

    Introduction: The use of telehealth in service delivery is both challenging and beneficial. This paper describes the results of a three semester-long interprofessional education program in team-based care using telehealth technology. The study assessed telehealth knowledge acquisition, practice in a structured environment with a simulated patient,…

  15. Success factors for telehealth--a case study.

    PubMed

    Moehr, J R; Schaafsma, J; Anglin, C; Pantazi, S V; Grimm, N A; Anglin, S

    2006-01-01

    To present the lessons learned from an evaluation of a comprehensive telehealth project regarding success factors and evaluation methodology for such projects. A recent experience with the evaluation of new telehealth services in BC, Canada, is summarized. Two domains of clinical applications, as well as educational and administrative uses, and the project environment were evaluated. In order to contribute to the success of the project, the evaluation included formative and summative approaches employing qualitative and quantitative methods with data collection from telehealth events, participants and existing databases. The evaluation had to be carried out under severe budgetary and time constraints. We therefore deliberately chose a broad ranging exploratory approach within a framework provided, and generated questions to be answered on the basis of initial observations and participant driven interviews with progressively more focused and detailed data gathering, including perusal of a variety of existing data sources. A unique feature was an economic evaluation using static simulation models. The evaluation yielded rich and detailed data, which were able to explain a number of unanticipated findings. One clinical application domain was cancelled after 6 months, the other continues. The factors contributing to success include: Focus on chronic conditions which require visual information for proper management. Involvement of established teams in regular scheduled visits or in sessions scheduled well in advance. Problems arose with: Ad hoc applications, in particular under emergency conditions. Applications that disregard established referral patterns. Applications that support only part of a unit's services. The latter leads to the service mismatch dilemma (SMMD) with the end result that even those e-health services provided are not used. The problems encountered were compounded by issues arising from the manner in which the telehealth services had been introduced

  16. Tablet PC Enabled Body Sensor System for Rural Telehealth Applications

    PubMed Central

    Panicker, Nitha V.; Kumar, A. Sukesh

    2016-01-01

    Telehealth systems benefit from the rapid growth of mobile communication technology for measuring physiological signals. Development and validation of a tablet PC enabled noninvasive body sensor system for rural telehealth application are discussed in this paper. This system includes real time continuous collection of physiological parameters (blood pressure, pulse rate, and temperature) and fall detection of a patient with the help of a body sensor unit and wireless transmission of the acquired information to a tablet PC handled by the medical staff in a Primary Health Center (PHC). Abnormal conditions are automatically identified and alert messages are given to the medical officer in real time. Clinical validation is performed in a real environment and found to be successful. Bland-Altman analysis is carried out to validate the wrist blood pressure sensor used. The system works well for all measurements. PMID:26884757

  17. Exploring challenges to telehealth communication by specialists in poison information.

    PubMed

    Rothwell, Erin; Ellington, Lee; Planalp, Sally; Crouch, Barbara

    2012-01-01

    The use of the telephone for providing health care is growing. A significant amount of social meaning is derived from visual information, and the absence of visual stimuli provides unique barriers to communication and increases the risks for misunderstandings and distractions. Understanding challenges to telephone communication can provide insight into training opportunities for overcoming these difficulties and improving patient care. The purpose of this research was to explore through focus groups the challenges of phone communication perceived by specialists in poison information. General types of challenges to effective phone communication included developing new communication skills to compensate for lack of visual information, difficulty assessing caller understanding, difficulty managing caller misunderstandings, maintaining distinctive assessments for routine calls, and managing the multifaceted aspects of job stress. The desire for training to enhance telehealth and cultural competency skills was also mentioned, and these findings might provide guidance for the development of training opportunities for telehealth professionals.

  18. Satisfaction and Improvements in Peritoneal Dialysis Outcomes Associated with Telehealth.

    PubMed

    Magnus, Manya; Sikka, Neal; Cherian, Teena; Lew, Susie Q

    2017-03-01

    End stage renal disease (ESRD) affects approximately 660,000 persons in the US each year, representing a significant financial burden to the health care system and affected individuals. Telehealth approaches to care offer an important means of reducing costs as well as increasing autonomy for patients. Understanding patient satisfaction with telehealth provides a key towards eventual scalability. Quarterly surveys were conducted to characterize satisfaction with remote biometric monitoring (RBM) for blood pressure, weight, glucose and peritoneal dialysis (PD)-specific educational online videos for ESRD patients using PD. Of 300 participants, 67% participated in the surveys and provided baseline and at least one follow-up assessment. The majority were 45 to 64 years of age (50.5%), Black (64.5%), married or living with significant other (52.0%), and had more than a high school degree (73.0%). RBM was associated with perceived autonomy and confidence in health care activities and decreased negative perceptions of PD care and ESRD. The majority of participants (80.1%) indicated that they were satisfied or completely satisfied with the system. Participants found that the interface increased confidence, reduced frustration, and related perceptions were significantly and positively altered (p<0.05) for each of the separate telehealth components. Educational videos were well utilized with nearly half of the participants (42.5%) reporting that they watched at least one of the videos, and the majority reporting that the videos seen had an overall positive impact on health. Supplementing PD with telehealth has the potential to have a positive impact on patient perceptions of PD care and consequently improve clinical outcomes.

  19. The Same Language Speak We Do - Consensus Terminology for Telehealth.

    PubMed

    Scott, Richard E; Mars, Maurice

    2016-01-01

    e-Health has grown to become interjurisdictional in scope and in practice. Central to successful implementation and scaling of e-heath solutions is clear and concise communication of ideas and principles, and instructions during construction. This paper addresses the need for an agreed taxonomy and terminology and focuses on explaining, proposing, and recommending terms and action for an international consensus-based terminology for telehealth.

  20. Down to the fundamentals of telehealth and home healthcare nursing.

    PubMed

    Vasquez, Monica S

    2008-05-01

    Many changes have taken place in the field of home healthcare. Because of these changes, home health agencies must be creative and implement various tools that help improve quality of care for their patients. Starting with the most basic intervention definitely can lend a hand in improving patient outcomes. Phone monitoring, the most basic form of telehealth, can be an important aspect in a patient's plan of care.

  1. E-learning and telehealth: measuring your success.

    PubMed

    Kobb, Rita F; Lane, Robert J; Stallings, Deidre

    2008-08-01

    Organizations that provide training for their employees are interested in translating training expenditures into benefits. Even though there are several common methodologies that are used to train employees, finding the right methodology to stimulate learning and develop a competent workforce while reducing fiscal burdens can be challenging. One such method that continues to grow in popularity is e-learning. For the purpose of this discussion, e-learning refers to Internet-based or online training. The Veterans Health Administration's (VHA's) Office of Care Coordination (OCC) was established in July 2003 to oversee the national implementation of its telehealth initiatives. As part of this implementation, the OCC created a national center, the Sunshine Training Center, to work directly with the VHA's Employees Education System (EES) to develop a home telehealth Web-based curriculum. After 3 years, the Sunshine Training Center and EES initiated an Impact Evaluation Process. Over five hundred staff completed the online impact survey. This number represented a 74% response rate. Staff responded overwhelmingly in the positive on the benefits of e-learning for building telehealth skills.

  2. Telehealth application on the rehabilitation of children and adolescents

    PubMed Central

    dos Santos, Maria Tereza N.; Moura, Sarah Costa D. O.; Gomes, Ludmila Mourão X.; Lima, Ana Henriques; Moreira, Rafaela Silva; Silva, Caroline Duarte; Guimarães, Eliane Marina P.

    2014-01-01

    Objective: To systematically review the literature on the telehealth initiatives in telerehabilitation practices in children and adolescents from zero to 18 years old. Data sources: Randomized and controlled clinical trials published in the past ten years (January 2002 to February 2012) in Medline/PubMed, Medline/BVS, PEDro and Cochrane Library databases. The descriptors "telemedicine", "rehabilitation" and "telehealth" were used in three different languages (English, Portuguese and Spanish). Data synthesis: From the 20 studies found in the literature, nine were included in this review. Most of the studies showed that telerehabilitation is able to produce better results in the treatment when compared to the traditional methods, providing less frequency of symptoms, better disease control, better quality of life and greater adherence to treatment. Conclusions: Telerehabilitation is a viable and effective strategy in the treatment of common diseases in children and adolescents. However, there are few studies on the subject in this age group. Although telehealth is already consolidated worldwide, there are no studies in Brazil that used the telerehabilitation in children and adolescents, which reinforces the need for more research and investments. PMID:24676201

  3. Building a multicenter telehealth network to advance chronic disease management.

    PubMed

    Khairat, Saif; Wijesinghe, Namal; Wolfson, Julian; Scott, Rob; Simkus, Ray

    2014-01-01

    The use of telehealth solutions has proved to improve clinical management of chronic diseases, expand access to healthcare services and clinicians, and reduce healthcare-related costs. The project aims at improving Heart Failure (HF) management through the utilization of a Telemedicine and Personal Health Records systems that will assist HF specialist in Colombo, Sri Lanka to monitor and consult with remote HF patients. A telehealth network will be built at an international site that connects five remote telehealth clinics to a central clinic at a major University Hospital in Sri Lanka where HF specialists are located. In this study, 200 HF patients will be recruited for nine months, 100 patients will be randomly selected for the treatment group and the other 100 will be selected for the control group. Pre, mid, and post study surveys will be conducted to assess the efficacy and satisfaction levels of patients with both care models. Moreover, clinical outcomes will be collected to evaluate the impact of the intervention on the treatment patients compared to control patients. The research aims at enhancing Heart Failure management through eliminating current health challenges and healthcare-related financial burdens.

  4. Leveraging Telehealth to Bring Volunteer Physicians Into Underserved Communities.

    PubMed

    Uscher-Pines, Lori; Rudin, Robert; Mehrotra, Ateev

    2016-11-28

    Many disadvantaged communities lack sufficient numbers of local primary care and specialty physicians. Yet tens of thousands of physicians, in particular those who are retired or semiretired, desire meaningful volunteer opportunities. Multiple programs have begun to use telehealth to bridge the gap between volunteer physicians and underserved patients. In this brief, we describe programs that are using this model and discuss the promise and pitfalls. Physician volunteers in these programs report that the work can be fulfilling and exciting, a cutting-edge yet convenient way to remain engaged and contribute. Given the projected shortfall of physicians in the United States, recruiting retired and semiretired physicians to provide care through telehealth increases the total supply of active physicians and the capacity of the existing workforce. However, programs typically use volunteers in a limited capacity because of uncertainty about the level and duration of commitment. Acknowledging this reality, most programs only use volunteer physicians for curbside consults rather than fully integrating them into longitudinal patient care. The part-time availability of volunteers may also be difficult to incorporate into the workflow of busy safety net clinics. As more physicians volunteer in a growing number of telehealth programs, the dual benefits of enriching the professional lives of volunteers and improving care for underserved communities will make further development of these programs worthwhile.

  5. Telehealth interventions to improve clinical nursing of elders.

    PubMed

    Jones, Josette F; Brennan, Patricia Flatley

    2002-01-01

    This chapter reviews reports of research conducted worldwide from 1966 to January 2001 on telehealth interventions in clinical nursing for elders. Reports were identified through a systematic search of MEDLINE, CINAHL, PsychInfo, ERIC, and ACM using the search terms Telemedicine or Health Information Networks, Nursing, and Research, and were restricted to those published in English. Reports of research using interactive computer technology to assess or intervene with nursing problems commonly observed in persons age 65 and older were sought. Only published reports presenting the findings of an exploratory or experimental study and exploring the association between one intervention variable and technology were included. The search resulted in 18 research reports describing eight research projects. Due to the preponderance of demonstrations and feasibility reports, the dearth of experimental investigations, and the heterogeneous nature of the few studies identified, statistical summarization was not attempted. Telehealth interventions have the potential to improve the clinical nursing care of elders because they provide alternative, equivalent approaches to assess key indicators of the physical and psychological state of elders; are acceptable to nurses, elders, and family caregivers; and may prove less costly than face-to-face interventions. Telehealth approaches provide not only acceptable substitutes for discrete nursing actions but also can serve as a context within which a large range of professional gerontological nursing services can be delivered in a manner that is timely and convenient for elders.

  6. Developing Initiatives for Home-Based Child Care: Current Research and Future Directions

    ERIC Educational Resources Information Center

    Porter, Toni; Paulsell, Diane

    2011-01-01

    Home-based child care accounts for a significant share of the child care supply in the United States, especially for infants and toddlers. A synthesis of the home-based care research literature and information about recent home-based care quality initiatives points to a critical need for more systematic efforts to develop and test quality…

  7. For telehealth to succeed, privacy and security risks must be identified and addressed.

    PubMed

    Hall, Joseph L; McGraw, Deven

    2014-02-01

    The success of telehealth could be undermined if serious privacy and security risks are not addressed. For example, sensors that are located in a patient's home or that interface with the patient's body to detect safety issues or medical emergencies may inadvertently transmit sensitive information about household activities. Similarly, routine data transmissions from an app or medical device, such as an insulin pump, may be shared with third-party advertisers. Without adequate security and privacy protections for underlying telehealth data and systems, providers and patients will lack trust in the use of telehealth solutions. Although some federal and state guidelines for telehealth security and privacy have been established, many gaps remain. No federal agency currently has authority to enact privacy and security requirements to cover the telehealth ecosystem. This article examines privacy risks and security threats to telehealth applications and summarizes the extent to which technical controls and federal law adequately address these risks. We argue for a comprehensive federal regulatory framework for telehealth, developed and enforced by a single federal entity, the Federal Trade Commission, to bolster trust and fully realize the benefits of telehealth.

  8. Pediatric Obesity Management in Rural Clinics in California and the Role of Telehealth in Distance Education

    ERIC Educational Resources Information Center

    Shaikh, Ulfat; Nettiksimmons, Jasmine; Romano, Patrick

    2011-01-01

    Objective: To determine health care provider needs related to pediatric obesity management in rural California and to explore strategies to improve care through telehealth. Methods: Cross-sectional survey of health care providers who treated children and adolescents at 41 rural clinics with existing telehealth connectivity. Results: Most of the…

  9. Increasing Access to an ASD Imitation Intervention via a Telehealth Parent Training Program

    ERIC Educational Resources Information Center

    Wainer, Allison L.; Ingersoll, Brooke R.

    2015-01-01

    Systematic research focused on developing and improving strategies for the dissemination and implementation of effective ASD services is essential. An innovative and promising area of research is the use of telehealth programs to train parents of children with ASD in intervention techniques. A hybrid telehealth program, combining self-directed…

  10. A Phase II Trial of Telehealth Delivery of the Lidcombe Program of Early Stuttering Intervention

    ERIC Educational Resources Information Center

    Lewis, Christine; Packman, Ann; Onslow, Mark; Simpson, Judy M.; Jones, Mark

    2008-01-01

    Purpose: The aims of this study were to evaluate the efficacy of telehealth delivery of the Lidcombe Program of Early Stuttering Intervention, compared with a control group, and to determine the number of children who could be regarded as "responders." Method: A speech-language pathologist provided telehealth delivery of the Lidcombe…

  11. Pediatric Obesity Management in Rural Clinics in California and the Role of Telehealth in Distance Education

    ERIC Educational Resources Information Center

    Shaikh, Ulfat; Nettiksimmons, Jasmine; Romano, Patrick

    2011-01-01

    Objective: To determine health care provider needs related to pediatric obesity management in rural California and to explore strategies to improve care through telehealth. Methods: Cross-sectional survey of health care providers who treated children and adolescents at 41 rural clinics with existing telehealth connectivity. Results: Most of the…

  12. Using home telehealth to empower patients to monitor and manage long term conditions.

    PubMed

    Paget, Tony; Jones, Craig; Davies, Michelle; Evered, Caroline; Lewis, Clare

    This article describes a pilot telehealth project in Swansea where patients with heart failure and chronic obstructive pulmonary disease were provided with telehealth monitoring equipment. While early evaluation points to some potential economic benefits, supporting patient empowerment was a significant outcome.

  13. Telehealth, disease management, home care and the future--part 2.

    PubMed

    Fazzi, Robert; Ashe, Tim; Doak, Lindsay

    2008-01-01

    In October CARING, Part I of the Phillips Study gave information on the background of the study along with insights into the major technologies studied. Part II will focus on what was clearly the area of greatest interest in the web survey--the impact of telehealth on quality and cost, especially the impact of telehealth on disease management.

  14. The Evolution of a Distance Education Initiative into a Major Telehealth Project.

    ERIC Educational Resources Information Center

    Green, Alexia; Esperat, Christina; Seale, Deborah; Chalambaga, Michael; Smith, Sheila; Walker, Glenda; Ellison, Patty; Berg, Bobbye; Robinson, Sally

    2000-01-01

    Three Texas nursing schools collaborated in establishing a telehealth clinic to provide services for chronically ill children. Expanded into public schools, the project provides distance learning and telehealth services to school nurses, teachers, administrators, and families involved in the care of these children. (SK)

  15. Increasing Access to an ASD Imitation Intervention via a Telehealth Parent Training Program

    ERIC Educational Resources Information Center

    Wainer, Allison L.; Ingersoll, Brooke R.

    2015-01-01

    Systematic research focused on developing and improving strategies for the dissemination and implementation of effective ASD services is essential. An innovative and promising area of research is the use of telehealth programs to train parents of children with ASD in intervention techniques. A hybrid telehealth program, combining self-directed…

  16. 77 FR 58977 - Exempting In-Home Video Telehealth From Copayments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-25

    ... AFFAIRS 38 CFR Part 17 RIN 2900-AO27 Exempting In-Home Video Telehealth From Copayments AGENCY: Department... inpatient hospital care or outpatient medical care. Specifically, the regulation exempted in-home video... video telehealth. Additionally, VA published a companion substantially identical direct final rule at 77...

  17. Home telehealth for chronic disease management: selected findings of a narrative synthesis.

    PubMed

    Jones, Alison; Hedges-Chou, Jessica; Bates, Joanna; Loyola, Margarita; Lear, Scott A; Jarvis-Selinger, Sandra

    2014-04-01

    Chronic disease has become an increasingly important issue for individuals and healthcare organizations across Canada. Home telehealth may have the potential to alleviate the economic and social challenges associated with rising rates of chronic disease. An aim of this review was to gather and synthesize the evidence on the effectiveness of home telehealth in chronic disease management. We searched the Medline, EMBASE, Web of Science, CINAHL, and PAIS databases for studies published in English from January 1, 2005, and December 31, 2010. Academic publications, white papers, and gray literature were all considered eligible for inclusion, provided an original research element was present. Articles were screened for relevance. One hundred one articles on quantitative or mixed-methods studies reported the effects of home telehealth on disease state, symptoms, and quality of life in chronic disease patients. Studies were consistent in finding that home telehealth was equivalent or superior to usual care. The literature strongly supports the use of home telehealth as an equally effective alternative to usual care. The circumstances under which home telehealth emerges as significantly better than usual care have not been extensively researched. Further research into factors affecting the effectiveness of home telehealth would support more widespread realization of telehealth's potential benefits.

  18. An evaluation of telehealth websites for design, literacy, information and content.

    PubMed

    Whitten, Pamela; Holtz, Bree; Cornacchione, Jennifer; Wirth, Christina

    2011-01-01

    We examined 62 telehealth websites using four assessment criteria: design, literacy, information and telehealth content. The websites came from the member list of the American Telemedicine Association and the Office for the Advancement of Telehealth and partner sites, and were included if they were currently active and at least three clicks deep. Approximately 130 variables were examined for each website by two independent researchers. The websites reviewed contained most of the design variables (mean 74%, SD 6), but fewer of those relating to literacy (mean 26%, SD 6), website information (mean 35%, SD 16) and telehealth content (mean 37%, SD 18). Only 29% of websites encouraged users to ask about telehealth, and 19% contained information on overcoming telehealth barriers. Nonetheless, 84% promoted awareness of telehealth. All evaluation assessments were significantly correlated with each other except for literacy and information. The present study identified various matters that should be addressed when developing telehealth websites. Although much of this represents simple common sense in website design, our evaluation demonstrates that there is still much room for improvement.

  19. Family and Practitioner Perspectives on Telehealth for Services to Young Children with Autism.

    PubMed

    Iacono, Teresa; Dissanayake, Cheryl; Trembath, David; Hudry, Kristelle; Erickson, Shane; Spong, Jo

    2016-01-01

    Telehealth offers the potential to address inequalities in autism service access for young children living in regional and rural areas with limited access to autism specialists. Our aim was to explore parent and practitioner uses of technology, and views about telehealth, including perceived barriers, for autism early intervention service delivery in a regional town in Australia. Fifteen mothers and 19 front-line autism practitioners completed surveys distributed by local autism service and support providers in the regional town; eight front-line practitioners from one service participated in interviews. Mothers and practitioners had access to technology that could be used for video-communication, but had little or no experience with telehealth. Mothers appeared more willing to try telehealth for receiving autism services than practitioners appeared to believe, and practitioners preferred to use it for consulting with other professionals and professional development. Barriers to telehealth included limited experience and practitioners not knowing what a telehealth service would look like, poor access to reliable and high speed internet, lack of skill and technical supports, and practitioners believing families preferred face-to-face services. The success of telehealth in this regional town will rely on better infrastructure, and upskilling practitioners in evidence-based autism interventions so they can provide the required support remotely. Use of telehealth to upskill practitioners in evidence-based practice could provide a first step in ensuring equitable access to expert autism services to regional and rural families.

  20. Overview of States' Use of Telehealth for the Delivery of Early Intervention (IDEA Part C) Services.

    PubMed

    Cason, Jana; Behl, Diane; Ringwalt, Sharon

    2012-01-01

    Early intervention (EI) services are designed to promote the development of skills and enhance the quality of life of infants and toddlers who have been identified as having a disability or developmental delay, enhance capacity of families to care for their child with special needs, reduce future educational costs, and promote independent living (NECTAC, 2011). EI services are regulated by Part C of the Individuals with Disabilities Education Improvement Act (IDEA); however, personnel shortages, particularly in rural areas, limit access for children who qualify. Telehealth is an emerging delivery model demonstrating potential to deliver EI services effectively and efficiently, thereby improving access and ameliorating the impact of provider shortages in underserved areas. The use of a telehealth delivery model facilitates inter-disciplinary collaboration, coordinated care, and consultation with specialists not available within a local community. A survey sent by the National Early Childhood Technical Assistance Center (NECTAC) to IDEA Part C coordinators assessed their utilization of telehealth within states' IDEA Part C programs. Reimbursement for provider type and services and barriers to implement a telehealth service delivery model were identified. Representatives from 26 states and one jurisdiction responded to the NECTAC telehealth survey. Of these, 30% (n=9) indicated that they are either currently using telehealth as an adjunct service delivery model (n=6) or plan to incorporate telehealth within the next 1-2 years (n=3). Identified telehealth providers included developmental specialists, teachers of the Deaf/Hard of Hearing (DHH), speech-language pathologists, occupational therapists, physical therapists, behavior specialists, audiologists, and interpreters. Reimbursement was variable and included use of IDEA Part C funding, Medicaid, and private insurance. Expressed barriers and concerns for the implementation of telehealth as a delivery model within Part

  1. Telehealth: seven strategies to successfully implement disruptive technology and transform health care.

    PubMed

    Schwamm, Lee H

    2014-02-01

    "Telehealth" refers to the use of electronic services to support a broad range of remote services, such as patient care, education, and monitoring. Telehealth must be integrated into traditional ambulatory and hospital-based practices if it is to achieve its full potential, including addressing the six domains of care quality defined by the Institute of Medicine: safe, effective, patient-centered, timely, efficient, and equitable. Telehealth is a disruptive technology that appears to threaten traditional health care delivery but has the potential to reform and transform the industry by reducing costs and increasing quality and patient satisfaction. This article outlines seven strategies critical to successful telehealth implementation: understanding patients' and providers' expectations, untethering telehealth from traditional revenue expectations, deconstructing the traditional health care encounter, being open to discovery, being mindful of the importance of space, redesigning care to improve value in health care, and being bold and visionary.

  2. The Process for the Formulation of the International Telehealth Position Statement for Occupational Therapy

    PubMed Central

    JACOBS, KAREN; CASON, JANA; MCCULLOUGH, ANN

    2015-01-01

    The World Federation of Occupational Therapists (WFOT) consists of 84 member organizations representing over 420,000 occupational therapists internationally (WFOT, 2014). In 2014, WFOT published the WFOT Telehealth Position Statement on the use of telehealth in occupational therapy. The process for the formulation of the official document involved reviewing WFOT member organizations’ telehealth position statements and data collected from a survey sent to member organizations’ delegates in April 2014. Qualitative data from 39 countries yielded factors to consider in five key areas: licensure/registration requirements, the cost of technology, privacy and security, reimbursement/payment models, and other issues (e.g., need for collaboration/transfer of knowledge, client selection, provider competencies, standard of care). The WFOT Telehealth Position Statement addressed each of these areas. The collaborative effort resulting in the development of the WFOT Telehealth Position Statement serves as a model for other international organizations. PMID:27563380

  3. The Process for the Formulation of the International Telehealth Position Statement for Occupational Therapy.

    PubMed

    Jacobs, Karen; Cason, Jana; McCullough, Ann

    2015-01-01

    The World Federation of Occupational Therapists (WFOT) consists of 84 member organizations representing over 420,000 occupational therapists internationally (WFOT, 2014). In 2014, WFOT published the WFOT Telehealth Position Statement on the use of telehealth in occupational therapy. The process for the formulation of the official document involved reviewing WFOT member organizations' telehealth position statements and data collected from a survey sent to member organizations' delegates in April 2014. Qualitative data from 39 countries yielded factors to consider in five key areas: licensure/registration requirements, the cost of technology, privacy and security, reimbursement/payment models, and other issues (e.g., need for collaboration/transfer of knowledge, client selection, provider competencies, standard of care). The WFOT Telehealth Position Statement addressed each of these areas. The collaborative effort resulting in the development of the WFOT Telehealth Position Statement serves as a model for other international organizations.

  4. Indoor location-aware medical systems for smart homecare and telehealth monitoring: state-of-the-art.

    PubMed

    Santoso, Fendy; Redmond, Stephen J

    2015-10-01

    This paper presents a comprehensive literature review of current progress in the application of state-of-the-art indoor positioning systems for telecare and telehealth monitoring. This review is the first in the literature that provides a comprehensive discussion on how existing wireless indoor positioning systems can benefit the development of home-based care systems. More specifically, this review provides an in-depth comparative study of how both system users and medical practitioners can get benefit from indoor positioning technologies; e.g. for real-time monitoring of patients suffering chronic cardiovascular conditions, general monitoring of activities of daily living (ADLs), fall detection systems for the elderly as well as indoor navigation systems for those suffering from visual impairments. Furthermore, it also details various aspects worth considering when choosing a certain technology for a specific healthcare application; e.g. the spatial precision demanded by the application, trade-offs between unobtrusiveness and complexity, and issues surrounding compliance and adherence with the use of wearable tags. Beyond the current state-of-the-art, this review also rigorously discusses several research opportunities and the challenges associated with each.

  5. Understanding heart failure; explaining telehealth - a hermeneutic systematic review.

    PubMed

    Greenhalgh, Trisha; A'Court, Christine; Shaw, Sara

    2017-06-14

    Enthusiasts for telehealth extol its potential for supporting heart failure management. But randomised trials have been slow to recruit and produced conflicting findings; real-world roll-out has been slow. We sought to inform policy by making sense of a complex literature on heart failure and its remote management. Through database searching and citation tracking, we identified 7 systematic reviews of systematic reviews, 32 systematic reviews (including 17 meta-analyses and 8 qualitative reviews); six mega-trials and over 60 additional relevant empirical studies and commentaries. We synthesised these using Boell's hermeneutic methodology for systematic review, which emphasises the quest for understanding. Heart failure is a complex and serious condition with frequent co-morbidity and diverse manifestations including severe tiredness. Patients are often frightened, bewildered, socially isolated and variably able to self-manage. Remote monitoring technologies are many and varied; they create new forms of knowledge and new possibilities for care but require fundamental changes to clinical roles and service models and place substantial burdens on patients, carers and staff. The policy innovation of remote biomarker monitoring enabling timely adjustment of medication, mediated by "activated" patients, is based on a modernist vision of efficient, rational, technology-mediated and guideline-driven ("cold") care. It contrasts with relationship-based ("warm") care valued by some clinicians and by patients who are older, sicker and less technically savvy. Limited uptake of telehealth can be analysed in terms of key tensions: between tidy, "textbook" heart failure and the reality of multiple comorbidities; between basic and intensive telehealth; between activated, well-supported patients and vulnerable, unsupported ones; between "cold" and "warm" telehealth; and between fixed and agile care programmes. The limited adoption of telehealth for heart failure has complex clinical

  6. Audit of primary care electrocardiograms sent as emergency to a telehealth service - the Telehealth Network of Minas Gerais, Brazil.

    PubMed

    Marcolino, Milena S; Carvalho, Bárbara C; Lucena, Aline M; França, Ana Luiza N; Pessoa, Cristiane G; Neves, Daniel S; Alkmim, Maria Beatriz M

    2015-01-01

    The Telehealth Network of Minas Gerais (TNMG) is a public telehealth service in Brazil that has performed electrocardiogram (ECG) analysis since 2005. From February to March 2014, 28% of ECGs were classified as "emergency" by the primary care tele-health sites. This quasi-experimental study aimed to investigate the reasons behind the high number of emergency ECGs being sent in, the implementation of corrective actions, and an assessment of the impact of these actions. In the 1st phase, primary care units that sent >70% of ECGs as emergency from February to March 2014 were selected. The 2nd phase consisted of the intervention. In the 3rd phase, the proportion of ECGs sent as an emergency during the 1st and 2nd months post intervention were assessed. Of the 63 cities selected during the 1st phase, 50% of the practitioners did not know the proper definition of emergency. After the intervention, 67% of the cities had a significant reduction in the proportion of ECGs sent as an emergency during the 1st month, and 17% had a significant reduction during the 2nd month.

  7. Home-based versus centre-based cardiac rehabilitation.

    PubMed

    Anderson, Lindsey; Sharp, Georgina A; Norton, Rebecca J; Dalal, Hasnain; Dean, Sarah G; Jolly, Kate; Cowie, Aynsley; Zawada, Anna; Taylor, Rod S

    2017-06-30

    Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. This is an update of a review previously published in 2009 and 2015. To compare the effect of home-based and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease. We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 21 September 2016. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. We included randomised controlled trials, including parallel group, cross-over or quasi-randomised designs) that compared centre-based cardiac rehabilitation (e.g. hospital, gymnasium, sports centre) with home-based programmes in adults with myocardial infarction, angina, heart failure or who had undergone revascularisation. Two review authors independently screened all identified references for inclusion based on pre-defined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Quality of evidence was assessed using GRADE principles and a Summary of findings table was created. We included six new studies (624 participants) for this update, which now includes a total of 23 trials that randomised a total of 2890 participants undergoing cardiac rehabilitation. Participants had an acute myocardial

  8. Exploring pharmacy and home-based sexually transmissible infection testing

    PubMed Central

    Habel, Melissa A.; Scheinmann, Roberta; Verdesoto, Elizabeth; Gaydos, Charlotte; Bertisch, Maggie; Chiasson, Mary Ann

    2015-01-01

    Background This study assessed the feasibility and acceptability of pharmacy and home-based sexually transmissible infection (STI) screening as alternate testing venues among emergency contraception (EC) users. Methods The study included two phases in February 2011–July 2012. In Phase I, customers purchasing EC from eight pharmacies in Manhattan received vouchers for free STI testing at onsite medical clinics. In Phase II, three Facebook ads targeted EC users to connect them with free home-based STI test kits ordered online. Participants completed a self-administered survey. Results Only 38 participants enrolled in Phase I: 90% female, ≤29 years (74%), 45% White non-Hispanic and 75% college graduates; 71% were not tested for STIs in the past year and 68% reported a new partner in the past 3 months. None tested positive for STIs. In Phase II, ads led to >45 000 click-throughs, 382 completed the survey and 290 requested kits; 28% were returned. Phase II participants were younger and less educated than Phase I participants; six tested positive for STIs. Challenges included recruitment, pharmacy staff participation, advertising with discretion and cost. Conclusions This study found low uptake of pharmacy and home-based testing among EC users; however, STI testing in these settings is feasible and the acceptability findings indicate an appeal among younger women for testing in non-traditional settings. Collaborating with and training pharmacy and medical staff are key elements of service provision. Future research should explore how different permutations of expanding screening in non-traditional settings could improve testing uptake and detect additional STI cases. PMID:26409484

  9. Developing and validating the French-Canadian version of the practitioner and organizational telehealth readiness assessment tools.

    PubMed

    Légaré, Emilie; Vincent, Claude; Lehoux, Pascale; Anderson, Donna; Kairy, Dahlia; Gagnon, Marie-Pierre; Jennett, Penny

    2010-01-01

    Only one telehealth readiness assessment tool, that of Jennett et al., covers all types of telehealth projects, regardless of health-care provision context. However, this instrument is only available in English and has not undergone psychometric evaluation. We developed a French-Canadian version of the Practitioner Telehealth Readiness Assessment Tool and the Organizational Telehealth Readiness Assessment Tool. Transcultural validity was assessed by nine practitioners and 12 clinical project co-ordinators or administrators. For practitioners and managers, there was no significant difference between the scores of the English and the French versions of the questionnaires. The results showed that the telehealth readiness of co-ordinators or administrators was greater than that of practitioners when the range in scores was taken into account. The French-Canadian versions of the two questionnaires make it possible to assess telehealth readiness among French speakers. However, other studies involving patients will be necessary to validate the Patient-Public Telehealth Readiness Assessment Tool.

  10. Home-based versus centre-based cardiac rehabilitation

    PubMed Central

    Taylor, Rod S; Dalal, Hayes; Jolly, Kate; Moxham, Tiffany; Zawada, Anna

    2014-01-01

    Background The burden of cardiovascular disease world-wide is one of great concern to patients and health care agencies alike. Traditionally centre-based cardiac rehabilitation (CR) programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. Objectives To determine the effectiveness of home-based cardiac rehabilitation programmes compared with supervised centre-based cardiac rehabilitation on mortality and morbidity, health-related quality of life and modifiable cardiac risk factors in patients with coronary heart disease. Search methods We updated the search of a previous review by searching the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2007, Issue 4), MEDLINE, EMBASE and CINAHL from 2001 to January 2008. We checked reference lists and sought advice from experts. No language restrictions were applied. Selection criteria Randomised controlled trials (RCTs) that compared centre-based cardiac rehabilitation (e.g. hospital, gymnasium, sports centre) with home-based programmes, in adults with myocardial infarction, angina, heart failure or who had undergone revascularisation. Data collection and analysis Studies were selected independently by two reviewers, and data extracted by a single reviewer and checked by a second one. Authors were contacted where possible to obtain missing information. Main results Twelve studies (1,938 participants) met the inclusion criteria. The majority of studies recruited a lower risk patient following an acute myocardial infarction (MI) and revascularisation. There was no difference in outcomes of home- versus centre-based cardiac rehabilitation in mortality risk ratio (RR) was 1.31 (95% confidence interval (C) 0.65 to 2.66), cardiac events, exercise capacity standardised mean difference (SMD) −0.11 (95% CI −0.35 to 0.13), as well

  11. WITHDRAWN: Home-based social support for socially disadvantaged mothers.

    PubMed

    Hodnett, E D; Roberts, I

    2007-07-18

    Epidemiologic studies indicate that babies born to socio-economically disadvantaged mothers are at higher risk of injury, abuse and neglect, health problems in infancy, and are less likely to have regular well-child care. Home visitation programs have long been advocated as a strategy for improving the health of disadvantaged children. Over the past two decades, a number of randomised trials have examined the effect of home visitation programs on a range of maternal and child health outcomes. The studies in this review evaluate programs which offer additional home based support for socially disadvantaged mothers and their children. Babies born in socio-economic disadvantage are likely to be at higher risk of injury, abuse and neglect, and to have health problems in infancy. The objective of this review was to assess the effects of programs offering additional home-based support for women who have recently given birth and who are socially disadvantaged. We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Date of last search: 26 October 1998. Randomised and quasi-randomised trials of one or more post-natal home visits with the aim of providing additional home based support for socially disadvantaged women who had recently given birth, compared to usual care. Trial quality was assessed. Study authors were contacted for additional information. Eleven studies, involving 2992 families, were included. Most of the trials had important methodological limitations. Seven trial reports are awaiting further assessment. There was a trend towards reduced child injury rates with additional support, although this was not statistically significant (odds ratio 0.74, 95% confidence interval 0.54 to 1.03). There appeared to be no difference for child abuse and neglect (odds ratio 1.12, 95% confidence interval 0.80 to 1.57), although differential surveillance between visited and non-visited families is an important

  12. Stem cell homing-based tissue engineering using bioactive materials

    NASA Astrophysics Data System (ADS)

    Yu, Yinxian; Sun, Binbin; Yi, Chengqing; Mo, Xiumei

    2017-06-01

    Tissue engineering focuses on repairing tissue and restoring tissue functions by employing three elements: scaffolds, cells and biochemical signals. In tissue engineering, bioactive material scaffolds have been used to cure tissue and organ defects with stem cell-based therapies being one of the best documented approaches. In the review, different biomaterials which are used in several methods to fabricate tissue engineering scaffolds were explained and show good properties (biocompatibility, biodegradability, and mechanical properties etc.) for cell migration and infiltration. Stem cell homing is a recruitment process for inducing the migration of the systemically transplanted cells, or host cells, to defect sites. The mechanisms and modes of stem cell homing-based tissue engineering can be divided into two types depending on the source of the stem cells: endogenous and exogenous. Exogenous stem cell-based bioactive scaffolds have the challenge of long-term culturing in vitro and for endogenous stem cells the biochemical signal homing recruitment mechanism is not clear yet. Although the stem cell homing-based bioactive scaffolds are attractive candidates for tissue defect therapies, based on in vitro studies and animal tests, there is still a long way before clinical application.

  13. Home-based care, technology, and the maintenance of selves.

    PubMed

    Parks, Jennifer A

    2015-06-01

    In this paper, I will argue that there is a deep connection between home-based care, technology, and the self. Providing the means for persons (especially older persons) to receive care at home is not merely a kindness that respects their preference to be at home: it is an important means of extending their selfhood and respecting the unique selves that they are. Home-based technologies like telemedicine and robotic care may certainly be useful tools in providing care for persons at home, but they also have important implications for sustaining selfhood in ways that are of value to individuals and those who care for them. I will argue, by appealing to Hilde Lindemann's notion of "holding" persons' identities in place, that technological interventions are not only useful tools for improving and sustaining health and good care at home, but that they may also help to extend our personal identities and relational capacities in ways that are practically and ethically good. Because of these important goods, I will claim that there is a prima facie moral duty to do this "holding" work and that it is best done by family members and loved ones who are well suited to the job because of their history and relationship with the individual that needs to be "held" in place.

  14. Dilemma of applying telehealth for overseas organ transplantation: comparison on perspectives of health professionals and e-health information and communication technologists in Taiwan.

    PubMed

    Shih, F Jin; Shih, F Jong; Pan, Y J; Chen, H M; Wang, S-S

    2014-05-01

    Telehealth is one of the avenues of e-health; it is a voice, image, or document delivery system via the internet and aims to assist patients to prevent disease and to promote health, diagnosis, self-care, and treatment. The purpose of using telehealth for overseas organ transplantation (OOT) was debated. This study aimed to explore the dilemma in applying telehealth for OOT patients from the perspectives of health professionals and e-health information and communication technologists (eh-ICTs) in Taiwan. An exploratory qualitative method was used, with a purposive sample of OT health professionals (OTHP) and eh-ICTs in Taiwan. Qualitative data were collected by face-to-face semistructured interviews, and were analyzed by content analysis. Fifty subjects including 10 OT surgeons (OTS), 30 registered nurses (RNs), and 10 eh-ICTs participated in this study. Five dilemmas were identified: (1) medical law violation (80%, n = 40 of 50; 100% OTS [n = 10 of 10], 67% RNs [n = 20 of 30], 100% eh-ICTs [n = 10 of 10]); (2) integrating telecommunication and medical systems for OOT (74%, n = 37 of 50; 90% OTS [n = 9 of 10], 73% RNs [n = 22 of 30], 60% eh-ICTs [n = 6 of 10]); (3) the inconsistent caring protocols among medical parties (68%, n = 34 of 50; 80% OTS [n = 8 of 10], 70% RNs [n = 21 of 30], 50% eh-ICTs [n = 5 of 10]); (4) the uncertainty in quality of care in overseas medical institutes (62%, n = 31 of 50; 80% OTS [n = 8 of 10], 60% RNs [n = 18 of 30], 50% eh-ICTs [n = 5 of 10]); and (5) the uncertainty in cost-effectiveness (36%, n = 18 of 50; 60% OTS [n = 6 of 10], 17% RNs [n = 5 of 30], 70% eh-ICTs [n = 7 of 10]). The use of telehealth for OOT is in its infancy. A systematic curriculum with advanced pilots targeted to develop telehealth for OOT will be needed for mutual communication between OTHPs and eh-ICTs in the near future. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Effectiveness of a home-based strengthening program for elderly males in Italy. A preliminary study.

    PubMed

    Capodaglio, P; Facioli, M; Burroni, E; Giordano, A; Ferri, A; Scaglioni, G

    2002-02-01

    The practice of regular physical exercise has been shown to be effective in slowing the age-related progressive functional deterioration. Most exercise trials have been conducted with supervised training programs. The purpose of this study was to investigate the effectiveness of a 4-month home-based strength training on strength, function and personal satisfaction. Ten elderly men (mean age 68.5 years) were enrolled for home-based training one month after completing a 4-month supervised program; 12 age-matched men served as the control group. Subjects were asked to perform 3 sessions a week consisting of six resistance exercises with elastic bands involving the major muscle groups of the upper and lower limbs. We had calculated the correlation between the elongation and resistance of the elastic bands. The subjects were instructed to keep a diary reporting the execution of the session. We measured dynamic concentric strength of the muscle groups involved in the resistance exercises and maximal isometric strength of the knee extensors and elbow flexors before and after the 4-month home training. The Satisfaction Profile (SAT-P) questionnaire was administered before and one month after the completion of the training program for assessing personal satisfaction. The final to baseline comparison showed a non-significant decrease in mean isometric maximal strength values for knee extensors and elbow flexors in the control group, while the exercise group significantly (p=0.001) improved the average baseline values. Maximal dynamic concentric strength values decreased significantly in the control group, while significant improvements were observed in the exercising subjects. The SAT-P questionnaire did not show any difference in either group from baseline. The adherence-to-protocol rate based on self-report was 78%. Home training with elastic bands appears to be an effective low-cost modality of maintaining strength and function in an elderly population.

  16. Are people with chronic diseases interested in using telehealth? A cross-sectional postal survey.

    PubMed

    Edwards, Louisa; Thomas, Clare; Gregory, Alison; Yardley, Lucy; O'Cathain, Alicia; Montgomery, Alan A; Salisbury, Chris

    2014-05-08

    There is growing interest in telehealth-the use of technology to support the remote delivery of health care and promote self-management-as a potential alternative to face-to-face care for patients with chronic diseases. However, little is known about what precipitates interest in the use of telehealth among these patients. This survey forms part of a research program to develop and evaluate a telehealth intervention for patients with two exemplar chronic diseases: depression and raised cardiovascular disease (CVD) risk. The survey was designed to explore the key factors that influence interest in using telehealth in these patient groups. Thirty-four general practices were recruited from two different regions within England. Practice records were searched for patients with (1) depression (aged 18+ years) or (2) 10-year risk of CVD ≥20% and at least one modifiable risk factor (aged 40-74 years). Within each general practice, 54 patients in each chronic disease group were randomly selected to receive a postal questionnaire. Questions assessed five key constructs: sociodemographics, health needs, difficulties accessing health care, technology-related factors (availability, confidence using technology, perceived benefits and drawbacks of telehealth), and satisfaction with prior use of telehealth. Respondents also rated their interest in using different technologies for telehealth (phone, email and Internet, or social media). Relationships between the key constructs and interest in using the three mediums of telehealth were examined using multivariable regression models. Of the 3329 patients who were sent a study questionnaire, 44.40% completed it (872/1740, 50.11% CVD risk; 606/1589, 38.14% depression). Overall, there was moderate interest in using phone-based (854/1423, 60.01%) and email/Internet-based (816/1425, 57.26%) telehealth, but very little interest in social media (243/1430, 16.99%). After adjusting for health needs, access difficulties, technology

  17. Integrating telehealth in to 'business as usual': Is it really possible?

    PubMed

    Jury, Susan C; Kornberg, Andrew J

    2016-12-01

    The Royal Children's Hospital, Melbourne, began offering web-based telehealth video consultation in 2011, with the principle being that telehealth should be integrated into 'business as usual'. In telehealth literature, key differences between telehealth and in-person consultations can make this hard to achieve, so an audit was performed that revealed many small gaps in the process.A total of 125 telehealth appointments were booked during the study period. Of these, 13% (n = 16) were rescheduled, cancelled or changed to face-to-face appointments, and up to two main issues were identified for the remaining appointments. Some 69% of the remaining 108 appointments (n = 75) were completed successfully, with 23% (n = 25) completely seamless end to end. Overall, 39 issues were administrative (40%), 34 technical (35%) and 24 scheduling (25%); nine (8%) required some minor troubleshooting.For long-term sustainability, integrating telehealth into business as usual needs to remain the target. Scheduling and technical glitches were the main barriers to seamless telehealth. Several issues have now been addressed with the introduction of an electronic medical record, and the development of standardised processes and staff training.

  18. Education and training to support the use of clinical telehealth: A review of the literature.

    PubMed

    Edirippulige, S; Armfield, N R

    2017-02-01

    Introduction Despite a growing literature base, substantial investment, and policy changes within governments, the integration of telehealth into routine clinical care has been limited. The availability of appropriate systematic education and training for practitioners has been highlighted as necessary for strong adoption. However, the availability and nature of telehealth-related education and training for practitioners is not understood. By reviewing the literature, we aimed to describe the delivery of education and training in telehealth, with particular focus on content, modes of delivery, types of institutions, and target clinician groups. Methods We performed searches using PubMed, Scopus, Embase, Web of Science, PsycINFO, the Cochrane Library, and ERIC. We included studies that were focused on the delivery of telehealth-related academic or vocational education and training. We extracted information pertaining to country, programs and their participants, and tabulated the results. Results Altogether 388 articles were identified, of which nine studies were selected for final review. Programs from five countries were represented and articles were spread across telemedicine and clinically oriented journals. Education and training in telehealth has been provided as both university level and vocational courses using conventional classroom based delivery methods and e-learning. Reported curriculum items included terminology, clinical applications, the evidence-base, and technological aspects. Conclusions Published evidence in peer-reviewed literature on telehealth education and training is limited. According to this review, a number of topics relating to telehealth have been covered by existing education programs both within tertiary and professional development levels.

  19. Telehealth in the trenches: reporting back from the frontlines in rural America.

    PubMed

    Alverson, Dale C; Shannon, Suzanne; Sullivan, Eileen; Prill, Amanda; Effertz, Glen; Helitzer, Deborah; Beffort, Steven; Preston, Alistair

    2004-01-01

    Access to appropriate healthcare services continues to be a major challenge in rural America. Telehealth technologies offer an opportunity to bridge gaps in health services in rural and remote areas and possibly support rural economic development. Lack of access to healthcare services to a growing population may create barriers to recruitment of businesses and economic growth. Several rural-oriented programs have attempted to leverage these emerging distance technologies, but success has varied despite the application of considerable federal, state governmental, and private resources. Barriers to adoption and sustainability of rural telehealth embody several factors that must be considered when planning, developing, implementing, and evaluating a rural telehealth program. New Mexico, the fifth largest state in the United States, represents many of the issues related to the potential benefits and challenges in developing a telehealth system to serve its rural communities. The Center for Telehealth at the University of New Mexico Health Sciences Center has been supported in large part by state and federal funding. Through our experiences, successes, failures, and lessons learned, we have developed approaches to overcoming barriers to adoption and sustainment of telehealth applications, including the establishment of partnerships with economic development projects in the state. This article describes these experiences and identifies and provides strategies for planning, development, implementation, and sustainment of telehealth in a rural program.

  20. A pilot study to engage and counsel HIV-positive African American youth via telehealth technology.

    PubMed

    Saberi, Parya; Yuan, Patrick; John, Malcolm; Sheon, Nicolas; Johnson, Mallory O

    2013-09-01

    Abstract Antiretroviral nonadherence is a strong determinant of virologic failure and is negatively correlated with survival. HIV-positive African American youth have lower antiretroviral adherence and treatment engagement than other populations. We assessed the feasibility and acceptability of a telehealth (remote videoconferencing) medication counseling intervention as an innovative approach to address these disparities. HIV-positive African American youth (18-29 years old) on antiretrovirals were enrolled in a telehealth medication counseling session, followed by a semi-structured qualitative interview to explore likes/dislikes of the format, modality, and content; potential impact on adherence; privacy issues; and interaction quality. Fourteen participants with a mean age of 24 years, who were 86% male, and had a mean self-reported adherence in the past month of 89%, were interviewed. Participants stated that they liked telehealth, would use it if offered in clinic/research settings, and indicated that their privacy was maintained. Participants described telehealth as convenient and efficient, with positive impact on their knowledge. Telehealth provided a modality to interact with providers that participants described as less intimidating than in-person visits. Telehealth is feasible and acceptable for delivering medication counseling to HIV-positive African American youth when conducted in a controlled clinical setting and may improve quality of patient-provider dialogue. Use of telehealth may lead to more disclosure of treatment difficulties, increased patient comfort, and improved health education.

  1. A systematic review of economic analyses of telehealth services using real time video communication

    PubMed Central

    2010-01-01

    Background Telehealth is the delivery of health care at a distance, using information and communication technology. The major rationales for its introduction have been to decrease costs, improve efficiency and increase access in health care delivery. This systematic review assesses the economic value of one type of telehealth delivery - synchronous or real time video communication - rather than examining a heterogeneous range of delivery modes as has been the case with previous reviews in this area. Methods A systematic search was undertaken for economic analyses of the clinical use of telehealth, ending in June 2009. Studies with patient outcome data and a non-telehealth comparator were included. Cost analyses, non-comparative studies and those where patient satisfaction was the only health outcome were excluded. Results 36 articles met the inclusion criteria. 22(61%) of the studies found telehealth to be less costly than the non-telehealth alternative, 11(31%) found greater costs and 3 (9%) gave the same or mixed results. 23 of the studies took the perspective of the health services, 12 were societal, and one was from the patient perspective. In three studies of telehealth to rural areas, the health services paid more for telehealth, but due to savings in patient travel, the societal perspective demonstrated cost savings. In regard to health outcomes, 12 (33%) of studies found improved health outcomes, 21 (58%) found outcomes were not significantly different, 2(6%) found that telehealth was less effective, and 1 (3%) found outcomes differed according to patient group. The organisational model of care was more important in determining the value of the service than the clinical discipline, the type of technology, or the date of the study. Conclusion Delivery of health services by real time video communication was cost-effective for home care and access to on-call hospital specialists, showed mixed results for rural service delivery, and was not cost-effective for

  2. A systematic review of economic analyses of telehealth services using real time video communication.

    PubMed

    Wade, Victoria A; Karnon, Jonathan; Elshaug, Adam G; Hiller, Janet E

    2010-08-10

    Telehealth is the delivery of health care at a distance, using information and communication technology. The major rationales for its introduction have been to decrease costs, improve efficiency and increase access in health care delivery. This systematic review assesses the economic value of one type of telehealth delivery--synchronous or real time video communication--rather than examining a heterogeneous range of delivery modes as has been the case with previous reviews in this area. A systematic search was undertaken for economic analyses of the clinical use of telehealth, ending in June 2009. Studies with patient outcome data and a non-telehealth comparator were included. Cost analyses, non-comparative studies and those where patient satisfaction was the only health outcome were excluded. 36 articles met the inclusion criteria. 22(61%) of the studies found telehealth to be less costly than the non-telehealth alternative, 11(31%) found greater costs and 3 (9%) gave the same or mixed results. 23 of the studies took the perspective of the health services, 12 were societal, and one was from the patient perspective. In three studies of telehealth to rural areas, the health services paid more for telehealth, but due to savings in patient travel, the societal perspective demonstrated cost savings. In regard to health outcomes, 12 (33%) of studies found improved health outcomes, 21 (58%) found outcomes were not significantly different, 2(6%) found that telehealth was less effective, and 1 (3%) found outcomes differed according to patient group. The organisational model of care was more important in determining the value of the service than the clinical discipline, the type of technology, or the date of the study. Delivery of health services by real time video communication was cost-effective for home care and access to on-call hospital specialists, showed mixed results for rural service delivery, and was not cost-effective for local delivery of services between

  3. The Experience of a Sustainable Large Scale Brazilian Telehealth Network.

    PubMed

    Soriano Marcolino, Milena; Minelli Figueira, Renato; Pereira Afonso Dos Santos, Julia; Silva Cardoso, Clareci; Luiz Ribeiro, Antonio; Alkmim, Maria Beatriz

    2016-11-01

    In Brazil, the majority of healthcare resources are concentrated in the largest cities, whereas most communities lack proper healthcare assistance in primary care and have difficulties accessing specialists and diagnostic examinations. Considering this, the Telehealth Network of Minas Gerais (TNMG) was created. It is a public telehealth initiative that provides support to primary healthcare (PHC), performing teleconsultation and telediagnosis (electrocardiogram [ECG], Holter, ambulatory blood pressure monitoring, spirometry, and retinography analysis) mainly for small and remote cities in the state of Minas Gerais, Brazil. To describe the successful experience of the TNMG in 10 years of activities. The TNMG was created in 2005 and supported PHC in 82 cities as a research project and was progressively expanded. A methodology for implementation and maintenance was developed, including quality control. Nowadays it provides support to 750 cities, 88.0% of Minas Gerais state. The examinations performed by the PHC team, with additional basic clinical data, are transmitted through the Internet to the TNMG specialists for remote interpretation. The TNMG teleconsultations system has been used by the PHC team to address written clinical questions to university staff. Until December 2015, 2,464,999 ECGs and 73,698 teleconsultations have already been performed: on average, 2,000 ECGs and 40 teleconsultations per day in 2015. More than 95% of users have declared to be satisfied or very satisfied with the service. A recent cost-benefit analysis of the project showed that for each dollar invested, 6.1 dollars are saved as a consequence of patient referral reduction. The TNMG is a successful example of a sustainable telehealth service, integrated to primary care centers of remote and small cities. It overcomes geographical barriers to provide specialized healthcare, reducing the number of unnecessary referrals, and contributing to improve the case-resolving capacity and the

  4. Plastic surgery telehealth consultation expedites Emergency Department treatment.

    PubMed

    Paik, Angie M; Granick, Mark S; Scott, Sandra

    2017-02-01

    Plastic surgery is a field that is particularly amenable to a telehealth milieu, as visual exam and radiographs guide proper diagnosis and management. The goals of this study were to evaluate telehealth feedback executed through an iPad app for plastic surgery-related consultations. A Quality Assurance/Quality Improvement (QA/QI) study was conducted over a 1-month period during which patients with hand injuries, facial injuries, or acute wounds presenting to the Emergency Department (ED) of a level-one trauma centre and university hospital were monitored. The study utilized a commercial iPad application through which up to four images and a brief history could be sent to a remote Plastic Surgery Educator (PSE) for evaluation. The PSE would respond with best practice information, references and videos to assist ED point-of-care providers. During the 1-month period of this study, there were 42 ED consultations for plastic surgical conditions. There was a highly significant difference in overall mean response time between consultants and PSEs (48.3 minutes vs. 8.9 minutes respectively, p < 0.001). The agreement between PSEs and consultants regarding patient assessment and care was 85.7% for in-person consultations and 100% for phone consultations. In four cases of telephone consultations, the ED providers placed splints incorrectly on hand-injured patients. Our results show that telehealth consultations to a remote plastic surgeon based on digital images and a brief history were able to produce timely and accurate responses in an emergency care facility. This design may have significant impact in rural areas, underserved populations, or regions abroad.

  5. Between ideals and reality in home-based rehabilitation

    PubMed Central

    Steihaug, Sissel; Lippestad, Jan-W.; Werner, Anne

    2016-01-01

    Setting and objective The growing elderly population and the rising number of people with chronic diseases indicate an increasing need for rehabilitation. Norwegian municipalities are required by law to offer rehabilitation. The aim of this study was to investigate how rehabilitation work is perceived and carried out by first-line service providers compared with the guidelines issued by Norway’s health authorities. Design and subjects In this action research project, qualitative data were collected through 24 individual interviews and seven group interviews with employees – service providers and managers – in the home-based service of two boroughs in Oslo, Norway. The data were analysed using a systematic text-condensation method. Results The results show that rehabilitation receives little attention in the boroughs and that patients are seldom rehabilitated at home. There is disagreement among professional staff as to what rehabilitation is and should be. The purchaser–provider organization, high speed of service delivery, and scarcity of resources are reported to hamper rehabilitation work. Conclusion and implications A discrepancy exists between the high level of ambitious goals of Norwegian health authorities and the possibilities that practitioners have to achieve them. This situation results in healthcare staff being squeezed by the increasing expectations and demands of the population and the promises and statutory rights coming from politicians and administrators. For the employees in the municipalities to place rehabilitation on the agenda, it is a requirement that authorities understand the clinical aspect of rehabilitation and provide the municipalities with adequate framework conditions for successful rehabilitation work. Key pointsHome-based rehabilitation is documented to be effective, and access to rehabilitation has been established in Norwegian law.The purchaser–provider organization, high rate of speed, and a scarcity of resources in

  6. The design, implementation, and operational management of a comprehensive quality management program to support national telehealth networks.

    PubMed

    Darkins, Adam; Foster, Linda; Anderson, Carla; Goldschmidt, Leonard; Selvin, Gerald

    2013-07-01

    The Veterans Health Administration (VHA) is a large integrated healthcare system with a mission to care for over 5.6 million Veteran patients annually. VHA, like other healthcare organizations, is challenged with providing access to care to those it serves when they live at a distance from a physical site of care. VHA has embraced telehealth as a way of delivering care at a distance and increase access to specialty care services. Since 2003 VHA has developed large national telehealth networks that provided care to 497,342 patients in fiscal year 2012, who received 1,429,424 episodes of care, and is recognized as a national leader in this field. To ensure the safety and effectiveness of its telehealth networks in their delivery of care VHA has implemented a dedicated quality management (QM) program for telehealth. QM data for telehealth are reviewed at 3-month intervals, and the procedures and processes in place to support telehealth in VHA are assessed biannually in an internal accreditation process called "Telehealth Conditions of Participation." This collegial, nonadversarial process has ensured that all designated telehealth programs meet minimal standards and disseminate best practice. As a result of VHA's QM program, telehealth services in VHA meet consistently high clinical outcomes and have received no adverse Joint Commission citations. The Joint Commission regularly assesses patients managed via telehealth under its tracer methodology reviews.

  7. Implementing solutions to improve and expand telehealth adoption: participatory action research in four community healthcare settings.

    PubMed

    Taylor, Johanna; Coates, Elizabeth; Wessels, Bridgette; Mountain, Gail; Hawley, Mark S

    2015-12-01

    Adoption of telehealth has been slower than anticipated, and little is known about the service improvements that help to embed telehealth into routine practice or the role of frontline staff in improving adoption. This paper reports on participatory action research carried out in four community health settings using telehealth for patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. To inform the action research, in-depth case studies of each telehealth service were conducted (May 2012-June 2013). Each service was then supported by researchers through two cycles of action research to implement changes to increase adoption of telehealth, completed over a seven month period (July 2013-April 2014). The action research was studied via observation of multi-stakeholder workshops, analysis of implementation plans, and focus groups. Action research participants included 57 staff and one patient, with between eight and 20 participants per site. The case study findings were identified as a key source of information for planning change, with sites addressing common challenges identified through this work. For example, refining referral criteria; standardizing how and when patients are monitored; improving data sharing; and establishing evaluation processes. Sites also focused on raising awareness of telehealth to increase adoption in other clinical teams and to help secure future financial investment for telehealth, which was required because of short-term funding arrangements. Specific solutions varied due to local infrastructures, resources, and opinion, as well as previous service developments. Local telehealth champions played an important role in engaging multiple stakeholders in the study. Action research enabled services to make planned changes to telehealth and share learning across multiple stakeholders about how and when to use telehealth. However, adoption was impeded by continual changes affecting telehealth and wider service provision

  8. “Real-World” Practical Evaluation Strategies: A Review of Telehealth Evaluation

    PubMed Central

    Masters, Caitlin; Kvedar, Joseph; Jethwani, Kamal

    2014-01-01

    Background Currently, the increasing interest in telehealth and significant technological breakthroughs of the past decade create favorable conditions for the widespread adoption of telehealth services. Therefore, expectations are high that telehealth can help alleviate prevailing challenges in health care delivery. However, in order to translate current research to policy and facilitate adoption by patients and health care providers, there is need for compelling evidence of the effectiveness of telehealth interventions. Such evidence is gathered from rigorously designed research studies, which may not always be practical in many real-world settings. Objective Our aim was to summarize current telehealth evaluation strategies and challenges and to outline practical approaches to conduct evaluation in real-world settings using one of our previously reported telehealth initiatives, the Diabetes Connect program, as a case study. Methods We reviewed commonly used current evaluation frameworks and strategies, as well as best practices based on successful evaluative efforts to date to address commonly encountered challenges in telehealth evaluation. These challenges in telehealth evaluation and commonly used frameworks are described relevant to the evaluation of Diabetes Connect, a 12-month Web-based blood glucose monitoring program. Results Designers of telehealth evaluation frameworks must give careful consideration to the elements of planning, implementation, and impact assessment of interventions. Evaluating performance at each of these phases is critical to the overall success of an intervention. Although impact assessment occurs at the end of a program, our review shows that it should begin at the point of problem definition. Critical to the success of an evaluative strategy is early planning that involves all stakeholders to identify the overall goals of the program and key measures of success at each phase of the program life cycle. This strategy should enable

  9. Information needs in home based healthcare in South Africa.

    PubMed

    de la Harpe, Retha; Barnes, Jay; Korpela, Mikko

    2010-01-01

    Home based health care (HBHC) is advocated by the WHO "to ensure better accessibility to effective and efficient health care in community and home-settings to improve health and well-being, and contribute to morbidity and mortality reduction". In South Africa the government and many other role players see an increasingly important role for HBHC. Many researchers believe that the evolution of HBHC will follow the socio-technical network evolution. There can be no doubt that the focus is on using information and communication technologies (ICT) to implement HBHC solutions. The objective of this paper is to provide a rich picture of the current situation and needs for improvement in HBHC in South Africa today through descriptive research in one specific case. The longer-term purpose is to identify pain-points that require socio-technical solutions, including but not exclusively ICT-supported solutions.

  10. Serious Games for Home-based Stroke Rehabilitation.

    PubMed

    Friedrich, Raoul; Hiesel, Patrick; Peters, Sebastian; Siewiorek, Daniel P; Smailagic, Asim; Brügge, Bernd

    2015-01-01

    On average, two thousand residents in the United States experience a stroke every day. These circumstances account for $28 billion direct costs annually and given the latest predictions, these costs will more than triple by 2030. In our research, we propose a portfolio of serious games for home-based stroke rehabilitation. The objective of the game approach is to enrich the training experience and establish a higher level of compliance to prescribed exercises, while maintaining a supportive training environment as found in common therapy sessions. Our system provides a collection of mini games based on rehabilitation exercises used in conventional physical therapy, monitors the patient's performance while exercising and provides clinicians with an interface to personalize the training. The clinician can set the current state of rehabilitation and change the playable games over time to drive diversification. While the system still has to be evaluated, an early stage case study with one patient offered positive indications towards this concept.

  11. User Interaction Design for a Home-Based Telecare System

    NASA Astrophysics Data System (ADS)

    Raptis, Spyros; Tsiakoulis, Pirros; Chalamandaris, Aimilios; Karabetsos, Sotiris

    This paper presents the design of the user-interaction component of a home-based telecare system for congestive heart failure patients. It provides a short overview of the overall system and offers details on the different interaction types supported by the system. Interacting with the user occurs either as part of a scheduled procedure or as a consequence of identifying or predicting a potentially hazardous deterioration of the patients' health state. The overall logic of the interaction is structured around event-scenario associations, where a scenario consists of concrete actions to be performed, some of which may involve the patient. A key objective in this type of interaction that it is very simple, intuitive and short, involving common everyday objects and familiar media such as speech.

  12. Are People With Chronic Diseases Interested in Using Telehealth? A Cross-Sectional Postal Survey

    PubMed Central

    Thomas, Clare; Gregory, Alison; Yardley, Lucy; O'Cathain, Alicia; Montgomery, Alan A; Salisbury, Chris

    2014-01-01

    Background There is growing interest in telehealth—the use of technology to support the remote delivery of health care and promote self-management—as a potential alternative to face-to-face care for patients with chronic diseases. However, little is known about what precipitates interest in the use of telehealth among these patients. Objective This survey forms part of a research program to develop and evaluate a telehealth intervention for patients with two exemplar chronic diseases: depression and raised cardiovascular disease (CVD) risk. The survey was designed to explore the key factors that influence interest in using telehealth in these patient groups. Methods Thirty-four general practices were recruited from two different regions within England. Practice records were searched for patients with (1) depression (aged 18+ years) or (2) 10-year risk of CVD ≥20% and at least one modifiable risk factor (aged 40-74 years). Within each general practice, 54 patients in each chronic disease group were randomly selected to receive a postal questionnaire. Questions assessed five key constructs: sociodemographics, health needs, difficulties accessing health care, technology-related factors (availability, confidence using technology, perceived benefits and drawbacks of telehealth), and satisfaction with prior use of telehealth. Respondents also rated their interest in using different technologies for telehealth (phone, email and Internet, or social media). Relationships between the key constructs and interest in using the three mediums of telehealth were examined using multivariable regression models. Results Of the 3329 patients who were sent a study questionnaire, 44.40% completed it (872/1740, 50.11% CVD risk; 606/1589, 38.14% depression). Overall, there was moderate interest in using phone-based (854/1423, 60.01%) and email/Internet-based (816/1425, 57.26%) telehealth, but very little interest in social media (243/1430, 16.99%). After adjusting for health needs

  13. Systematic home-based physical and functional therapy for older persons after hip fracture.

    PubMed

    Tinetti, M E; Baker, D I; Gottschalk, M; Garrett, P; McGeary, S; Pollack, D; Charpentier, P

    1997-11-01

    To describe the development, implementation, and results of a home-based rehabilitation protocol for older persons after hip fracture. Demonstration study. Community. One hundred forty-eight community-living, nondemented participants at least 65 years of age who underwent repair of a fractured hip at two local hospitals. A linked assessment-intervention, home-based rehabilitation strategy. The physical therapy (PT) component of the intervention was designed to identify and ameliorate impairments in balance, strength, transfers, gait, and stair climbing; the functional therapy (FT) component was designed to identify and improve unsafe and/or inefficient performance of specific activities of daily living (ADL). The percentage of participants able to complete each component and the extent of progress noted in strength, balance, transfers, gait, and daily functioning. A total of 104 of the 148 participants (70%) completed the 6-month PT and FT program; 4 completed only PT and 6 refused both PT and FT. The remaining 32 participants (22%) received partial PT and FT that was terminated by death, hospitalization, or institutionalization. Seventy-seven percent of participants reported performing at least half of the recommended daily exercise sessions. Ninety-four percent and 96% of participants progressed in upper and lower extremity conditioning respectively; 33% progressed to the highest level in the graduated resisted exercise program. All participants progressed in the competency-based graded balance program, with 55% progressing to the fifth (most difficult) level. Similarly, the majority progressed in transfer maneuvers, stair climbing, and outdoor gait. One repetition maximum (RM) elbow extension increased from a mean of 5.8 (SD 4.6) pounds at baseline to 7.2 (SD 3.8) pounds at 6mo (t 2.22; p < .02). One RM knee extension increased from 5.8 (SD 5.8) pounds to 10.8 (SD 5.4) pounds (t = 8.06; p < .0001). The number of gait deviations decreased from 2.1 (SD 1.3) to 0

  14. An evaluation of the routine use of amoxicillin as part of the home-based treatment of severe acute malnutrition

    PubMed Central

    Trehan, Indi; Amthor, Rachel E.; Maleta, Kenneth; Manary, Mark J.

    2010-01-01

    Objective To determine if the inclusion of amoxicillin correlates with better recovery rates in the home-based treatment of severe acute malnutrition with ready-to-use therapeutic food. Methods This retrospective cohort study compared data from the treatment of two groups of children in Malawi aged 6–59 months with uncomplicated severe acute malnutrition. The standard protocol group received a 7 day course of amoxicillin at the onset of treatment. The alternate protocol group received no antibiotics. All children were treated with the same ready-to-use therapeutic food. The primary outcome was nutritional recovery, defined as achieving a weight-for-height Z-score > −2 without edema. Results 498 children were treated according to the standard protocol with amoxicillin and 1955 were treated under the alternate protocol without antibiotics. The group of children treated with amoxicillin was slightly older and more stunted at baseline. The recovery rate for children who received amoxicillin was worse at 4 weeks (40% vs. 71%) but similar after up to 12 weeks of therapy (84% vs. 86%), compared to the children treated without antibiotics. Regression modeling indicated that this difference at 4 weeks was most strongly associated with the receipt of amoxicillin. Conclusions This review of two therapeutic feeding programs suggests that children with severe acute malnutrition who were treated without amoxicillin did not have an inferior rate of recovery. Given the limitations of this retrospective analysis, a prospective trial is warranted to determine the effect of antibiotics on recovery from uncomplicated malnutrition with home-based therapy. PMID:20545919

  15. Evaluation of a clinical video telehealth pain management clinic.

    PubMed

    Desko, Lauren; Nazario, Mitchell

    2014-12-01

    The objectives of this project were to evaluate patient satisfaction with the clinical video telehealth (CVT) pain management clinic, and to evaluate possible benefits of this clinic. Data collected included the distance from the patient's home to the main Department of Veterans Affairs (VA) medical center, the distance from the patient's home to the community based outpatient clinic (CBOC), travel distance saved for the patient, and travel pay status. Following CVT clinic appointments patients were asked to complete a written feedback assessment to evaluate patient satisfaction. All data were analyzed using descriptive statistics. Veterans saved 8,981 miles in travel distance, and the VA saved $2,317.51 due to averted travel reimbursement. There was a 90% satisfaction rate with the CVT pain management clinic services, and 90% of patients agreed that they would recommend telehealth to other veterans. Overall, patients are satisfied with the CVT pain management clinic. Furthermore, the substantial miles saved for the patients, as well as the cost savings for the VA, indicates that this service has tangible benefits. As this clinic continues to operate, it can be expected that miles saved for patients and cost savings for the VA will continue to grow.

  16. Increasing Access to an ASD Imitation Intervention Via a Telehealth Parent Training Program.

    PubMed

    Wainer, Allison L; Ingersoll, Brooke R

    2015-12-01

    Systematic research focused on developing and improving strategies for the dissemination and implementation of effective ASD services is essential. An innovative and promising area of research is the use of telehealth programs to train parents of children with ASD in intervention techniques. A hybrid telehealth program, combining self-directed internet-based instruction with remote coaching, was created to introduce parents of children with ASD to an imitation intervention. A single-subject multiple-baseline design study evaluated the effect of the program on changes in parent and child behavior. Parents improved in their use of the intervention techniques and their children demonstrated concurrent increases in spontaneous imitation skills. Parents also indicated that the intervention and telehealth service delivery model were acceptable, useable, and effective. Results suggest that this hybrid telehealth program has the potential to increase access to ASD services.

  17. Telemedicine, telehealth, and mobile health applications that work: opportunities and barriers.

    PubMed

    Weinstein, Ronald S; Lopez, Ana Maria; Joseph, Bellal A; Erps, Kristine A; Holcomb, Michael; Barker, Gail P; Krupinski, Elizabeth A

    2014-03-01

    There has been a spike in interest and use of telehealth, catalyzed recently by the anticipated implementation of the Affordable Care Act, which rewards efficiency in healthcare delivery. Advances in telehealth services are in many areas, including gap service coverage (eg, night-time radiology coverage), urgent services (eg, telestroke services and teleburn services), mandated services (eg, the delivery of health care services to prison inmates), and the proliferation of video-enabled multisite group chart rounds (eg, Extension for Community Healthcare Outcomes programs). Progress has been made in confronting traditional barriers to the proliferation of telehealth. Reimbursement by third-party payers has been addressed in 19 states that passed parity legislation to guarantee payment for telehealth services. Medicare lags behind Medicaid, in some states, in reimbursement. Interstate medical licensure rules remain problematic. Mobile health is currently undergoing explosive growth and could be a disruptive innovation that will change the face of healthcare in the future.

  18. Telehealth Applications to Enhance CKD Knowledge and Awareness Among Patients and Providers.

    PubMed

    Tuot, Delphine S; Boulware, L Ebony

    2017-01-01

    CKD affects 13% of the US adult population, causes excess mortality, and is associated with significant sociodemographic disparities. Optimal CKD management slows progression of disease and reduces cardiovascular-related outcomes. Resources for patients and primary care providers, major stakeholders in preventive CKD care, are critically needed to enhance understanding of the disease and to optimize CKD health, particularly because of the asymptomatic nature of kidney disease. Telehealth is defined as the use of electronic communication and telecommunications technology to support long-distance clinical health care, patient and professional health-related education, and public health and health administration. It provides new opportunities to enhance awareness and understanding among these important stakeholders. This review will examine the role of telehealth within existing educational theories, identify telehealth applications that can enhance CKD knowledge and behavior change among patients and primary care providers, and examine the advantages and disadvantages of telehealth vs usual modalities for education.

  19. A step-by-step guide to home telehealth program planning.

    PubMed

    Kinsella, Audrey

    2003-08-01

    Many home health providers have become familiar with the idea of home telehealth service, but planning its optimal delivery nevertheless presents a challenge. This article presents the first steps agencies need to take before the "televisiting" can begin.

  20. Home Clinical Video Telehealth Promotes Education and Communication with Caregivers of Veterans with TBI.

    PubMed

    Hernandez, Haniel; Scholten, Joel; Moore, Elsie

    2015-09-01

    Ongoing communication and care coordination are essential among patients, their family, and interdisciplinary rehabilitation team members to address the complex and changing rehabilitation needs of traumatic brain injuries. Family members of patients with traumatic brain injury commonly assume a caregiver role following discharge from inpatient rehabilitation. The Department of Veterans Affairs has adopted clinical video telehealth to promote access to care, and use of clinical video telehealth for rehabilitation is expanding. Recent implementation of home clinical video telehealth can assist with the ongoing management and treatment of patients in their home setting. This report demonstrates enhanced education and care coordination by using clinical video telehealth with a Veterans Affairs-eligible beneficiary receiving treatment for traumatic brain injury.

  1. [Nursing contributions to the development of the Brazilian Telehealth Lactation Support Program].

    PubMed

    Prado, Cláudia; Silva, Isília Aparecida; Soares, Alda Valéria Neves; Aragaki, Ilva Marico Mizumoto; Shimoda, Gilcéria Tochika; Zaniboni, Vanessa Forte; Padula, Camila Brolezzi; Muller, Fabiana Swain; Salve, Jeanine Maria; Daré, Sergio Junior; Wen, Chao Lung; Peres, Heloísa Helena Ciqueto; Leite, Maria Madalena Januário

    2013-08-01

    The National Telehealth Program was founded by the Ministry of Health, in partnership with the Ministry of Education (Ministério da Educação - MEC) and the Ministry of Science and Technology (Ministério da Ciência e Tecnologia - MCT), to support the development of family healthcare teams throughout the country. The São Paulo Telehealth Center has developed the Telehealth Lactation Support program, which provides primary healthcare professionals with information on diverse aspects of breastfeeding. This paper reports the development of the Lactation Support program and the nursing contributions. Project methodology included the formation of a multidisciplinary group of pediatricians, nurses, speech and language therapists, nutritionists, and dentists. Multimedia teaching resources were prepared for inclusion in the Cybertutor platform. Telehealth Lactation Support is an innovative and promising addition to continuing education for healthcare professionals and provides a framework for the development of other programs.

  2. A qualitative study of Telehealth patient information leaflets (TILs): are we giving patients enough information?

    PubMed

    Kayyali, Reem; Hesso, Iman; Ejiko, Evelyn; Nabhani Gebara, Shereen

    2017-05-19

    The provision of patient information leaflets regarding telehealth has been perceived by potential consumers as a strategy to promote awareness and adoption of telehealth services. However, such leaflets need to be designed carefully if adoption and awareness among potential users is to be promoted. Therefore, the aims of this study were: first, to see how telehealth was portrayed in some of the existing telehealth leaflets (THLs). Second, to explore patients' perceptions of the existing THLs and their engagement with the concept and how THLs can be optimised. A two-step approach was employed to address the aims of this study. The first phase involved the use of discourse analysis to compare 12 electronically and publically available THLs, with the existing THL guidance "Involve Yorkshire and Humber". The second phase involved conducting 14 semi-structured interviews with potential telehealth users/patients to gauge their perception and engagement with the concept, using the two leaflets that were mostly matching with the guidance used. Six interviews were audio-recorded and eight had detailed jotted notes. The interviews were transcribed and thematically analysed to identify key themes. The discourse analysis showed certain gaps and variations within the screened leaflets when addressing the following aspects: cost of the telehealth service, confidentiality, patients' choices in addition to equipment use and technical support. Analysis of the interviews revealed patients' need for having clear and sufficient information about the telehealth service within the THLs; in addition to, patients' preference for the use of simpler terminologies for telehealth description and the provision of clear simple texts with pictorial presentations. The interviews also revealed certain limitations against adoption of telehealth by the participants, such as: lack of privacy and confidentiality of information, fear of technology breakdown and equipment failure, loss of face

  3. Our experience in using telehealth for paediatric plastic surgery in Western Australia.

    PubMed

    Rimal, Debesh; Huang Fu, Ju Hui; Gillett, David

    2017-04-01

    Western Australia accounts for one-third of Australia's total land mass. Princess Margaret Hospital is the only dedicated plastic surgery tertiary referral centre providing services to over 500 000 children across the state. The aim of this study is to share our experience using telehealth for service provision and delivery of care in a geographically challenging setting. A retrospective review was conducted, and data were extracted from patients' notes. The time period was from January 2014 to 31 December 2015 and included all patients registered for plastic surgery telehealth service. There were a total of 194 rural patients (66 males and 128 females), 26 of whom were elective cases. A total of 358 telehealth follow-up consultations were conducted for the 194 patients during the study period. A total of 10 patients were managed via telehealth alone without a clinical review in Perth; 24 patients had their first clinical review in Perth and further follow-up via telehealth, and 99 patients were post-operative cases. Case load ranged from skin lacerations to complex soft tissue and bony injuries as well as elective hand and craniofacial post-operative follow-up cases. Telehealth service was utilized mainly for post-operative follow-up. It is our experience that telehealth provides access to Specialist Plastic Surgery service across the state. We utilize telehealth for a wide scope of functions. Patients in rural areas are managed in their home environments, reducing financial and psychosocial burden with the option of transfer to Princess Margaret Hospital should an intervention be required. © 2017 Royal Australasian College of Surgeons.

  4. Implementation of video telehealth to improve access to evidence-based psychotherapy for posttraumatic stress disorder.

    PubMed

    Lindsay, Jan A; Kauth, Michael R; Hudson, Sonora; Martin, Lindsey A; Ramsey, David J; Daily, Lawrence; Rader, John

    2015-06-01

    Increasing access to psychotherapy for posttraumatic stress disorder (PTSD) is a primary focus of the Department of Veterans Affairs (VA) healthcare system. Delivery of treatment via video telehealth can expand availability of treatment and be equally effective as in-person treatment. Despite VA efforts, barriers to establishing telehealth services remain, including both provider acceptance and organizational obstacles. Thus, development of specific strategies is needed to implement video telehealth services in complex healthcare systems, like the VA. This project was guided by the Promoting Action on Research Implementation in Health Services framework and used external facilitation to increase access to psychotherapy via video telehealth. The project was conducted at five VA Medical Centers and their associated community clinics across six states in the South Central United States. Over a 21-month period, 27 video telehealth clinics were established to provide greater access to evidence-based psychotherapies for PTSD. Examination of change scores showed that participating sites averaged a 3.2-fold increase in unique patients and a 6.5-fold increase in psychotherapy sessions via video telehealth for PTSD. Differences between participating and nonparticipating sites in both unique patients and encounters were significant (p=0.041 and p=0.009, respectively). Two groups emerged, separated by degree of engagement in the facilitation intervention. Facilitation was perceived as useful by providers. To our knowledge, this is the first prospective study of external facilitation as an implementation strategy for telehealth. Our findings suggest that external facilitation is an effective and acceptable strategy to support providers as they establish clinics and make complex practice changes, such as implementing video telehealth to deliver psychotherapy.

  5. Participatory design methods for the development of a clinical telehealth service for neonatal homecare

    PubMed Central

    Garne Holm, Kristina; Brødsgaard, Anne; Zachariassen, Gitte; Smith, Anthony C.; Clemensen, Jane

    2017-01-01

    Objectives: Neonatal homecare delivered during home visits by neonatal nurses is a common method for supporting families of preterm infants following discharge. Telehealth has been introduced for the provision of neonatal homecare, resulting in positive feedback from parents of preterm infants. While the benefits are beginning to be realised, widespread uptake of telehealth has been limited due to a range of logistical challenges. Understanding user requirements is important when planning and developing a clinical telehealth service. We therefore used participatory design to develop a clinical telehealth service for neonatal homecare. Methods: The study adopted a participatory design approach to engage users in the development and design of a new telehealth service. Participatory design embraces qualitative research methods. Creative and technical workshops were conducted as part of the study. Tests of the telehealth service were conducted in the neonatal unit. Participants in this study were former and current parents of preterm infants eligible for neonatal homecare, and clinical staff (medical and nursing) from the neonatal unit. Preterm infants accompanied their parents. Results: Based on the results obtained during the workshops and subsequent testing, we developed an application (app), which was integrated into the medical record at the neonatal unit. The app was used to initiate videoconferences and chat messages between the family at home and the neonatal unit, and to share information regarding infant growth and well-being. Conclusion: Results obtained from the workshops and testing demonstrated the importance of involving users when developing new telehealth applications. The workshops helped identify the challenges associated with delivery of the service, and helped instruct the design of a new telehealth service for neonatal homecare based on the needs of parents and clinical staff. PMID:28975028

  6. Telehealth exercise-based cardiac rehabilitation: a systematic review and meta-analysis.

    PubMed

    Rawstorn, Jonathan C; Gant, Nicholas; Direito, Artur; Beckmann, Christina; Maddison, Ralph

    2016-08-01

    Despite proven effectiveness, participation in traditional supervised exercise-based cardiac rehabilitation (exCR) remains low. Telehealth interventions that use information and communication technologies to enable remote exCR programme delivery can overcome common access barriers while preserving clinical supervision and individualised exercise prescription. This meta-analysis aimed to determine the benefits of telehealth exCR on exercise capacity and other modifiable cardiovascular risk factors compared with traditional exCR and usual care, among patients with coronary heart disease (CHD). CINAHL, The Cochrane Library, Embase, MEDLINE, PubMed and PsycINFO were searched from inception through 31 May 2015 for randomised controlled trials comparing telehealth exCR with centre-based exCR or usual care among patients with CHD. Outcomes included maximal aerobic exercise capacity, modifiable cardiovascular risk factors and exercise adherence. 11 trials (n=1189) met eligibility criteria and were included in the review. Physical activity level was higher following telehealth exCR than after usual care. Compared with centre-based exCR, telehealth exCR was more effective for enhancing physical activity level, exercise adherence, diastolic blood pressure and low-density lipoprotein cholesterol. Telehealth and centre-based exCR were comparably effective for improving maximal aerobic exercise capacity and other modifiable cardiovascular risk factors. Telehealth exCR appears to be at least as effective as centre-based exCR for improving modifiable cardiovascular risk factors and functional capacity, and could enhance exCR utilisation by providing additional options for patients who cannot attend centre-based exCR. Telehealth exCR must now capitalise on technological advances to provide more comprehensive, responsive and interactive interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  7. Integrating telehealth services into a remote allied health service: A pilot study.

    PubMed

    O'Hara, Rebecca; Jackson, Sarah

    2017-02-01

    The continuity of care for people with neurological conditions in a remote northwest Queensland town as services are currently only available intermittently. Mixed methods design using questionnaires and staff review of the program and processes. Intermittent community rehabilitation service for clients with neurological conditions has been offered in Mount Isa and is supported by a similar fulltime service in Townsville. Both services use a unique client-centred, student-assisted, interprofessional model of care. Understanding participant experiences by obtaining feedback from clients, students and allied health professionals (AHPs) regarding their experiences of using telehealth in this setting. Previous clients of the North West Community Rehabilitation service were offered a review assessment using telehealth by an interprofessional team. Using telehealth enabled the client, remote AHP and students in Mount Isa to be connected to expert assistance in Townsville. The findings suggest that telehealth was useful in a community rehabilitation setting to provide review services for clients. This improved continuity of care for these clients because without this telehealth assessment, the clients would have had to wait up to 12 months for the next service period in Mount Isa or travel to a major urban centre to access a similar service. Feedback from clients, students and AHPs was positive; however, some challenges were identified. Recommendations for future service delivery using telehealth are outlined in the paper. © 2015 National Rural Health Alliance Inc.

  8. Telehealth and the recruitment and retention of physicians in rural and remote regions: a Delphi study.

    PubMed

    Duplantie, Julie; Gagnon, Marie-Pierre; Fortin, Jean-Paul; Landry, Réjean

    2007-01-01

    The availability of a medical workforce is a growing concern for rural and remote communities across Canada. In the last decade, various telehealth experiences have highlighted the potential impact of this technology on professional as well as organizational practices. But could telehealth be a strategy to attract and maintain physicians in rural and remote communities? The objective of this study was to identify a reliable list of recruitment and retention factors on which telehealth could have an impact. We conducted 2 literature reviews and a Delphi study among 12 telehealth experts across Canada. The literature reviews identified 7 categories of recruitment and retention factors on which telehealth could have an impact: 1) individual, 2) familial, 3) contextual, 4) professional, 5) organizational, 6) educational, and 7) economic. Experts consulted through the Delphi study reached consensus on 31 out of 34 of the proposed statements about the impact of telehealth. This consensus can now be used as a conceptual model for further studies on the topic.

  9. A systematic review of the use of telehealth in Asian countries.

    PubMed

    Durrani, Hammad; Khoja, Shariq

    2009-01-01

    We conducted a systematic review of the literature on telehealth in Asia. The Medline database was searched, together with three specialist journals, for peer-reviewed articles published in the ten years to June 2007 which were related to any telehealth application involving one or more Asian country. Out of the 1504 abstracts retrieved, 109 articles were selected by two independent reviewers for the final review. The number of published articles on telehealth in Asia increased during the review period. The largest number of studies were conducted in Japan (37%). Most telehealth applications were based on the store-and-forward modality (43%), with 35% using videoconferencing and 15% using a hybrid approach. Most of the studies were descriptive (75%) and only eight included a control group against which telehealth was compared. The most common means of telecommunication was ISDN lines, which were employed in 32% of the studies. Some 40% of the studies mentioned improved quality of health care; about 20% mentioned improved access to health care. Although most studies mentioned cost, only 13 of them assessed resource utilization and cost. The overall findings gave a generally optimistic picture of telehealth in Asia. However, there is a lack of good quality studies.

  10. Older adults' acceptance of a community-based telehealth wellness system.

    PubMed

    Demiris, George; Thompson, Hilaire; Boquet, Jaime; Le, Thai; Chaudhuri, Shomir; Chung, Jane

    2013-01-01

    The development of ongoing assessment tools to monitor older adult health and wellness can support improved quality of life and independence. These technologies have often been employed within private residences. Our work describes a telehealth kiosk system implemented within a community setting, which reduces the costs of installing and maintaining individual systems. Though user acceptance of telehealth systems has been studied within the context of home residences, this has yet to be addressed for community-based systems. Older adults in a retirement community were recruited to use a telehealth system including assessment of vital signs and cognitive performance. With a series of focus groups (N = 12, average age 79.3 years), we examined user perceptions of the telehealth kiosk, addressing issues of usability, effectiveness and privacy. Older adults were favorable towards the collection of health monitoring information, recognizing the utility of these data sources. There were issues of usability, especially regarding ergonomics of the telehealth kiosk. We found no concerns over privacy, with some participants expressing increased preference for the social interactions afforded through the community setting. Understanding the social, technical and human factors involved with a community-based telehealth system can inform the design of cost-effective health monitoring systems.

  11. A review of the efficacy and effectiveness of using telehealth for paediatric speech and language assessment.

    PubMed

    Taylor, Olivia D; Armfield, Nigel R; Dodrill, Pamela; Smith, Anthony C

    2014-10-01

    We reviewed the literature relating to the use of telehealth for paediatric speech and language assessment. Four databases, and relevant reference lists, were searched for articles published between January 2004 and July 2014. A total of 180 articles were identified, of which only five were relevant. All studies assessed efficacy using method comparison techniques; no studies assessed effectiveness. The method comparison studies investigated the validity and/or reliability of speech and language assessment via telehealth, when compared with face-to-face assessment. Studies varied in terms of participant group, assessment tools, statistical analysis and telehealth equipment. The papers reviewed presented some evidence that telehealth can be used to make valid assessments of oromotor function, speech intelligibility and language. Articulation screening via telehealth was found to be valid, but there was conflicting evidence about full articulation assessment. Intra- and inter-rater reliability was good for all speech and language tasks, with the exception of oromotor assessment, which also had reduced reliability when assessed face-to-face. There were discrepancies between the two modalities for individual oromotor tasks, judgement of individual speech sounds, detection of pluralisation, and discriminating between similar sounding words; these have the potential to be clinically important. Evidence regarding satisfaction was extremely limited, with only one study reporting parental satisfaction, and no studies reporting child or clinician satisfaction. Although there is limited evidence to support the validity and reliability of speech and language assessment via telehealth, it is probably not yet sufficient to influence clinical practice or policy development.

  12. Older adults’ acceptance of a community-based telehealth wellness system

    PubMed Central

    Demiris, George; Thompson, Hilaire; Boquet, Jaime; Le, Thai; Chaudhuri, Shomir; Chung, Jane

    2014-01-01

    The development of ongoing assessment tools to monitor older adult health and wellness can support improved quality of life and independence. These technologies have often been employed within private residences. Our work describes a telehealth kiosk system implemented within a community setting, which reduces the costs of installing and maintaining individual systems. Though user acceptance of telehealth systems has been studied within the context of home residences, this has yet to be addressed for community-based systems. Older adults in a retirement community were recruited to use a telehealth system including assessment of vital signs and cognitive performance. With a series of focus groups (N = 12, average age 79.3 years), we examined user perceptions of the telehealth kiosk, addressing issues of usability, effectiveness and privacy. Older adults were favorable towards the collection of health monitoring information, recognizing the utility of these data sources. There were issues of usability, especially regarding ergonomics of the telehealth kiosk. We found no concerns over privacy, with some participants expressing increased preference for the social interactions afforded through the community setting. Understanding the social, technical and human factors involved with a community-based telehealth system can inform the design of cost-effective health monitoring systems. PMID:22571733

  13. Implementing telehealth to support medical practice in rural/remote regions: what are the conditions for success?

    PubMed

    Gagnon, Marie-Pierre; Duplantie, Julie; Fortin, Jean-Paul; Landry, Réjean

    2006-08-24

    Telehealth, as other information and communication technologies (ICTs) introduced to support the delivery of health care services, is considered as a means to answer many of the imperatives currently challenging health care systems. In Canada, many telehealth projects are taking place, mostly targeting rural, remote or isolated populations. So far, various telehealth applications have been implemented and have shown promising outcomes. However, telehealth utilisation remains limited in many settings, despite increased availability of technology and telecommunication infrastructure. A qualitative field study was conducted in four remote regions of Quebec (Canada) to explore perceptions of physicians and managers regarding the impact of telehealth on clinical practice and the organisation of health care services, as well as the conditions for improving telehealth implementation. A total of 54 respondents were interviewed either individually or in small groups. Content analysis of interviews was performed and identified several effects of telehealth on remote medical practice as well as key conditions to ensure the success of telehealth implementation. According to physicians and managers, telehealth benefits include better access to specialised services in remote regions, improved continuity of care, and increased availability of information. Telehealth also improves physicians' practice by facilitating continuing medical education, contacts with peers, and access to a second opinion. At the hospital and health region levels, telehealth has the potential to support the development of regional reference centres, favour retention of local expertise, and save costs. Conditions for successful implementation of telehealth networks include the participation of clinicians in decision-making, the availability of dedicated human and material resources, and a planned diffusion strategy. Interviews with physicians and managers also highlighted the importance of considering

  14. Telehealth Delivery of Mental Health Services: An Analysis of Private Insurance Claims Data in the United States.

    PubMed

    Wilson, Fernando A; Rampa, Sankeerth; Trout, Kate E; Stimpson, Jim P

    2017-09-01

    This study characterizes telehealth claims for mental health and substance abuse (MH/SA) services by using national private claims data. Telehealth-related mental health service claims were identified with private claims data from 2009 to 2013. These data-provided by the Health Care Cost Institute-included claims from Aetna, Humana, and UnitedHealth for more than 50 million individuals per year. In 2009-2013, there were 13,480 MH/SA telehealth provider claims out of 3,986,159 claims, with the majority of telehealth claims submitted by psychiatrists. For telehealth services, there was a decreasing trend for average reimbursements ($54.61 in 2009 to $43.28 in 2013). Average reimbursements for telehealth claims were half those for nontelehealth claims. Reimbursements for nine of the top 10 telehealth services were lower in 2015 dollars than for the same services provided during face-to-face treatment. Widespread adoption and use of costly telehealth technologies for mental health services may be limited by low reimbursements for telehealth services.

  15. Initial Impressions of Community-Dwelling Older Adults and Case Managers about Community-Based Telehealth Kiosks

    PubMed Central

    Courtney, Karen L.; Lingler, Jennifer H.; Mecca, Laurel Person; Garlock, Laurie A.; Schulz, Richard; Dick, Andrew W.; Olshansky, Ellen

    2010-01-01

    Community-based (multi-user) telehealth interventions may be beneficial for older adults, but there is little research regarding community-based telehealth. We used a qualitative descriptive approach to examine the acceptability and perceived value of community-based telehealth kiosks with regard to current health self-management practices of community-dwelling older adults as a first step in feasibility assessment. Participants included residents (n=6) and community agency case managers (n=3) of a HUD-subsidized senior apartment building. Both positive impressions and concerns of each group are presented. Findings helped guide the plans for future telehealth kiosk implementation and training. PMID:20509594

  16. Home-based mobile cardio-pulmonary rehabilitation consultant system.

    PubMed

    Lee, Hsu-En; Wang, Wen-Chih; Lu, Shao-Wei; Wu, Bo-Yuan; Ko, Li-Wei

    2011-01-01

    Cardiovascular diseases are the most popular cause of death in the world recently. For postoperatives, cardiac rehabilitation is still asked to maintain at home (phase II) to improve cardiac function. However, only one third of outpatients do the exercise regularly, reflecting the difficulty for home-based healthcare: lacking of monitoring and motivation. Hence, a cardio-pulmonary rehabilitation system was proposed in this research to improve rehabilitation efficiency for better prognosis. The proposed system was built on mobile phone and receiving electrocardiograph (ECG) signal from a wireless ECG holter via Bluetooth connection. Apart from heart rate (HR) monitor, an ECG derived respiration (EDR) technique is also included to provide respiration rate (RR). Both HR and RR are the most important vital signs during exercise but only used one physiological signal recorder in this system. In clinical test, there were 15 subjects affording Bruce Task (treadmill) to simulate rehabilitation procedure. Correlation between this system and commercial product (Custo-Med) was up to 98% in HR and 81% in RR. Considering the prevention of sudden heart attack, an arrhythmia detection expert system and healthcare server at the backend were also integrated to this system for comprehensive cardio-pulmonary monitoring whenever and wherever doing the exercise.

  17. Automated Clinical Assessment from Smart home-based Behavior Data

    PubMed Central

    Dawadi, Prafulla Nath; Cook, Diane Joyce; Schmitter-Edgecombe, Maureen

    2016-01-01

    Smart home technologies offer potential benefits for assisting clinicians by automating health monitoring and well-being assessment. In this paper, we examine the actual benefits of smart home-based analysis by monitoring daily behaviour in the home and predicting standard clinical assessment scores of the residents. To accomplish this goal, we propose a Clinical Assessment using Activity Behavior (CAAB) approach to model a smart home resident’s daily behavior and predict the corresponding standard clinical assessment scores. CAAB uses statistical features that describe characteristics of a resident’s daily activity performance to train machine learning algorithms that predict the clinical assessment scores. We evaluate the performance of CAAB utilizing smart home sensor data collected from 18 smart homes over two years using prediction and classification-based experiments. In the prediction-based experiments, we obtain a statistically significant correlation (r = 0.72) between CAAB-predicted and clinician-provided cognitive assessment scores and a statistically significant correlation (r = 0.45) between CAAB-predicted and clinician-provided mobility scores. Similarly, for the classification-based experiments, we find CAAB has a classification accuracy of 72% while classifying cognitive assessment scores and 76% while classifying mobility scores. These prediction and classification results suggest that it is feasible to predict standard clinical scores using smart home sensor data and learning-based data analysis. PMID:26292348

  18. Creating an integrated care model for childhood obesity: a randomized pilot study utilizing telehealth in a community primary care setting.

    PubMed

    Fleischman, A; Hourigan, S E; Lyon, H N; Landry, M G; Reynolds, J; Steltz, S K; Robinson, L; Keating, S; Feldman, H A; Antonelli, R C; Ludwig, D S; Ebbeling, C B

    2016-12-01

    In an integrated care model, involving primary care providers (PCPs) and obesity specialists, telehealth may be useful for overcoming barriers to treating childhood obesity. We conducted a pilot study comparing body mass index (BMI) changes between two arms (i) PCP in-person clinic visits plus obesity specialist tele-visits ( PCP visits + specialist tele-visits) and (ii) PCP in-person clinic visits only ( PCP visits only), with ongoing tele-consultation between PCPs and obesity specialists for both arms. Patients (N = 40, 10-17 years, BMI ≥ 95th percentile) were randomized to Group 1 or 2. Both groups had PCP visits every 3 months for 12 months. Using a cross-over protocol, Group 1 had PCP visits + specialist tele-visits during the first 6 months and PCP visits only during the second 6 months, and Group 2 followed the opposite sequence. Each of 12 tele-visits was conducted by a dietitian or psychologist with a patient and parent. Retention rates were 90% at 6 months and 80% at 12 months. BMI (z-score) decreased more for Group 1 (started with PCP visits + specialist tele-visits) vs. Group 2 (started with PCP visits only) at 3 months (-0.11 vs. -0.05, P = 0.049) following frequent tele-visits. At 6 months (primary outcome), BMI was lower than baseline within Group 1 (-0.11, P = 0.0006) but not Group 2 (-0.06, P = 0.08); however, decrease in BMI at 6 months did not differ between groups. After crossover, BMI remained lower than baseline for Group 1 and dropped below baseline for Group 2. An integrated care model utilizing telehealth holds promise for treating children with obesity. © 2016 World Obesity Federation.

  19. Employees’ views on home-based, after-hours telephone triage by Dutch GP cooperatives

    PubMed Central

    2013-01-01

    Background Dutch out-of-hours (OOH) centers find it difficult to attract sufficient triage staff. They regard home-based triage as an option that might attract employees. Specially trained nurses are supposed to conduct triage by telephone from home for after-hours medical care. The central aim of this research is to investigate the views of employees of OOH centers in The Netherlands on home-based telephone triage in after-hours care. Methods The study is a Q methodology study. Triage nurses, general practitioners (GPs) and managers of OOH centers ranked 36 opinion statements on home-based triage. We interviewed 10 participants to help develop and validate the statements for the Q sort, and 77 participants did the Q sort. Results We identified four views on home-based telephone triage. Two generally favor home-based triage, one highlights some concerns and conditions, and one opposes it out of concern for quality. The four views perceive different sources of credibility for nurse triagists working from home. Conclusion Home-based telephone triage is a controversial issue among triage nurses, GPs and managers of OOH centers. By identifying consensus and dissension among GPs, triagists, managers and regulators, this study generates four perspectives on home-based triage. In addition, it reveals the conditions considered important for home-based triage. PMID:24188407

  20. Latino Parent Home-Based Practices that Bolster Student Academic Persistence

    ERIC Educational Resources Information Center

    Mena, Jasmine A.

    2011-01-01

    Home-based parental involvement practices (i.e., educational encouragement, monitoring, and support) and their impact on students' academic persistence were investigated with a sample of 137, ninth-grade Latino students in a northeast high school. Structural Equation Modeling results indicate that the relationship between home-based parental…

  1. Entrepreneurial Checklist Tool for Beginning Farm and Home-Based Businesses

    ERIC Educational Resources Information Center

    Rafie, A. R.; Nartea, Theresa

    2012-01-01

    Extension educators entertain frequent questions on beginning a farm or starting a home-based business. Retired, unemployed, and displaced workers consider starting a small farm or home-based business. Determining educational needs or individual business aptitude is time consuming. Lengthy and comprehensive skill-based checklists exist for…

  2. Family Members Providing Home-Based Palliative Care to Older Adults: The Enactment of Multiple Roles

    ERIC Educational Resources Information Center

    Clemmer, Sarah J.; Ward-Griffin, Catherine; Forbes, Dorothy

    2008-01-01

    Canadians are experiencing increased life expectancy and chronic illness requiring end-of-life care. There is limited research on the multiple roles for family members providing home-based palliative care. Based on a larger ethnographic study of client-family-provider relationships in home-based palliative care, this qualitative secondary analysis…

  3. Latino Parent Home-Based Practices that Bolster Student Academic Persistence

    ERIC Educational Resources Information Center

    Mena, Jasmine A.

    2011-01-01

    Home-based parental involvement practices (i.e., educational encouragement, monitoring, and support) and their impact on students' academic persistence were investigated with a sample of 137, ninth-grade Latino students in a northeast high school. Structural Equation Modeling results indicate that the relationship between home-based parental…

  4. Entrepreneurial Checklist Tool for Beginning Farm and Home-Based Businesses

    ERIC Educational Resources Information Center

    Rafie, A. R.; Nartea, Theresa

    2012-01-01

    Extension educators entertain frequent questions on beginning a farm or starting a home-based business. Retired, unemployed, and displaced workers consider starting a small farm or home-based business. Determining educational needs or individual business aptitude is time consuming. Lengthy and comprehensive skill-based checklists exist for…

  5. A Controlled Trial of Hospital versus Home-Based Exercise in Cardiac Patients.

    ERIC Educational Resources Information Center

    Arthur, Heather M.; Smith, Kelly M.; Kodis, Jennifer; McKelvie, Robert

    2002-01-01

    Examined the effect of 6-month hospital-based exercise training versus 6-month monitored home-based training in cardiac rehabilitation patients following surgery, investigating which conferred the greatest physical, quality of life, and social support benefits. Home-based training resulted in improvements in exercise performance as great as those…

  6. A Controlled Trial of Hospital versus Home-Based Exercise in Cardiac Patients.

    ERIC Educational Resources Information Center

    Arthur, Heather M.; Smith, Kelly M.; Kodis, Jennifer; McKelvie, Robert

    2002-01-01

    Examined the effect of 6-month hospital-based exercise training versus 6-month monitored home-based training in cardiac rehabilitation patients following surgery, investigating which conferred the greatest physical, quality of life, and social support benefits. Home-based training resulted in improvements in exercise performance as great as those…

  7. Muscle strength enhancement following home-based virtual cycling training in ambulatory children with cerebral palsy.

    PubMed

    Chen, Chia-Ling; Hong, Wei-Hsien; Cheng, Hsin-Yi Kathy; Liaw, Mei-Yun; Chung, Chia-Ying; Chen, Chung-Yao

    2012-01-01

    This study is the first well-designed randomized controlled trial to assess the effects of a novel home-based virtual cycling training (hVCT) program for improving muscle strength in children with spastic cerebral palsy (CP). Twenty-eight ambulatory children with spastic CP aged 6-12 years were randomly assigned to an hVCT group (n=13) or a control group (n=15). Outcome measures, including gross motor function of the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) and muscle strength (isokinetic torque of knee extensor and flexor muscle), were administered before and immediately after the 12-week intervention. Analysis of covariance (ANCOVA) at post-treatment showed that, compared to the control group, the hVCT group had significantly higher isokinetic torque in the knee extensor and flexor muscles at 60°/s and 120°/s angular velocities (p<0.05). At post-treatment, the hVCT group also showed greater isokinetic strength improvement in the knee flexor than in the knee extensor at 60°/s (knee flexor: 41%; knee extensor: 19%) and at 120°/s (knee flexor: 36%; knee extensor: 30%). However, the BOTMP scores at post-treatment did not differ between the two groups. Although the proposed 12-week hVCT protocol does not improve gross motor function, it enhances knee muscle strength in children with CP. The protocol obtains larger gains in the knee flexor than in the knee extensor at different angular velocities. The study findings will help clinicians to provide more effective and efficient strategies for muscle strength training in children with CP. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. Is Home-Based, High-Intensity Interval Training Cycling Feasible and Safe for Patients With Knee Osteoarthritis?

    PubMed Central

    Keogh, Justin W. L.; Grigg, Josephine; Vertullo, Christopher J.

    2017-01-01

    Background: Osteoarthritis (OA) is a degenerative joint disease affecting the knee joint of many middle-aged and older adults. As OA symptoms typically involve knee pain and stiffness, individuals with knee OA are often insufficiently physically active, have low levels of physical function, and are at increased risk of other comorbidities and reduced quality of life. While moderate-intensity continuous training (MICT) cycling is often recommended, little is known about the feasibility, safety, and benefits of high-intensity interval training (HIIT) cycling for this population, even though the feasibility, safety, and benefits of HIIT have been demonstrated in other chronic disease groups. Purpose: The primary objective of this pilot study was to examine the feasibility and safety of home-based HIIT and MICT cycling in middle-aged and older adults with knee OA. A secondary objective was to gain some insight into the relative efficacy of HIIT and MICT for improving health status (pain, stiffness, and disability), muscle function, and body composition in this population. This study protocol is being published separately to allow a detailed description of the research methods, explain the rationale for choosing the methodological details, and to stimulate consideration of the best means to simulate a research protocol that is relevant to a real-life treatment environment. Study Design: Randomized pilot study protocol. Methods: This trial sought to recruit 40 middle-aged and older adults with knee OA. Participants were randomly allocated to either continuous (MICT) or HIIT home-based cycle training programs, with both programs requiring the performance of 4 cycling sessions (approximately 25 minutes per session) each week. Participants were measured at baseline and postintervention (8 weeks). Feasibility and safety were assessed by adherence rate, dropout rate, and number of adverse events. The relative efficacy of the cycling programs was investigated by 2 knee OA

  9. CE: Telehealth: a case study in disruptive innovation.

    PubMed

    Grady, Janet

    2014-04-01

    Technologic advances in health care have often outpaced our ability to integrate the technology efficiently, establish best practices for its use, and develop policies to regulate and evaluate its effectiveness. However, these may be insufficient reasons to put the brakes on innovation-particularly those "disruptive innovations" that challenge the status quo and have the potential to produce better outcomes in a number of important areas. This article discusses the concept of disruptive innovation and highlights data supporting its necessity within health care in general and nursing in particular. Focusing on telehealth as a case study in disruptive innovation, the author provides examples of its application and reviews literature that examines its effectiveness in both nursing practice and education.

  10. Lessons Learned from Mississippi's Telehealth Approach to Health Disparities.

    PubMed

    deShazo, Richard D; Parker, Sara Bolen

    2017-04-01

    Many people see telemedicine as a solution to the nation's health disparities and in Mississippi as a solution to our last place in health. More than 13 years ago, the University of Mississippi Medical Center developed a successful TelEmergency program that saved rural Critical Access Hospitals and now provides telehealth services throughout the state. This occurred without acrimony because of partnerships that the University of Mississippi Medical Center developed with telecommunications companies, state government, health professions' licensure boards, and private donors. Today, the telemedicine market is exploding across the country with the entry of for-profit corporations into the medical market. These corporations often are more inclined to work with legislators rather than physicians, and some physician groups have attempted to limit their expansion. With the future of telemedicine now determined in part by the courts, rather than the providers, new pitfalls have arisen. The Mississippi experience may be helpful in navigating this new territory.

  11. A telehealth behavioral coaching intervention for neurocognitive disorder family carers

    PubMed Central

    Gant, Judith R.

    2015-01-01

    Objectives This study examined the differential impact of two telehealth programs for women caring for an older adult with a neurocognitive disorder. Outcomes examined were depressive symptoms, upset following disruptive behaviors, anxious and angry mood states, and caregiving self‐efficacy. Methods Women cohabitating with a family member diagnosed with a neurocognitive disorder were assigned via random allocation to either of the following: (1) a 14‐week behavioral intervention using video instructional materials, workbook and telephone coaching in behavioral management, pleasant events scheduling, and relaxation or (2) a basic education guide and telephone support comparison condition. Telephone assessments were conducted by interviewers blind to treatment condition at pre‐intervention, post‐intervention, and 6 months following intervention. Results For those providing in‐home care at post‐treatment, depressive symptoms, upset following disruptive behaviors, and negative mood states were statistically lower in the behavioral coaching condition than in the basic education and support condition. Reliable change index analyses for Beck Depression Inventory II scores favored the behavioral coaching condition. Caregiving self‐efficacy scores for obtaining respite and for managing patient behavioral disturbances were significantly higher in the coaching condition. Effect sizes were moderate but not maintained at the 6‐month follow‐up. Conclusions This study provides some initial evidence for the efficacy of a telehealth behavioral coaching intervention compared with basic education and telephone support. Carers' abilities to maintain strategy use during progressive disorders such as Alzheimer's disease likely require longer intervention contact than provided in the current study. Dementia carers, including those living in rural areas, can benefit from accessible and empirically supported interventions that can be easily disseminated across distances

  12. A telehealth behavioral coaching intervention for neurocognitive disorder family carers.

    PubMed

    Steffen, Ann M; Gant, Judith R

    2016-02-01

    This study examined the differential impact of two telehealth programs for women caring for an older adult with a neurocognitive disorder. Outcomes examined were depressive symptoms, upset following disruptive behaviors, anxious and angry mood states, and caregiving self-efficacy. Women cohabitating with a family member diagnosed with a neurocognitive disorder were assigned via random allocation to either of the following: (1) a 14-week behavioral intervention using video instructional materials, workbook and telephone coaching in behavioral management, pleasant events scheduling, and relaxation or (2) a basic education guide and telephone support comparison condition. Telephone assessments were conducted by interviewers blind to treatment condition at pre-intervention, post-intervention, and 6 months following intervention. For those providing in-home care at post-treatment, depressive symptoms, upset following disruptive behaviors, and negative mood states were statistically lower in the behavioral coaching condition than in the basic education and support condition. Reliable change index analyses for Beck Depression Inventory II scores favored the behavioral coaching condition. Caregiving self-efficacy scores for obtaining respite and for managing patient behavioral disturbances were significantly higher in the coaching condition. Effect sizes were moderate but not maintained at the 6-month follow-up. This study provides some initial evidence for the efficacy of a telehealth behavioral coaching intervention compared with basic education and telephone support. Carers' abilities to maintain strategy use during progressive disorders such as Alzheimer's disease likely require longer intervention contact than provided in the current study. Dementia carers, including those living in rural areas, can benefit from accessible and empirically supported interventions that can be easily disseminated across distances at modest cost. © 2015 The Authors. International

  13. The costs and benefits of technology-enabled, home-based cardiac rehabilitation measured in a randomised controlled trial.

    PubMed

    Whittaker, Frank; Wade, Victoria

    2014-10-01

    We conducted a cost benefit analysis of a home telehealth-based cardiac rehabilitation programme compared to the standard hospital-based programme. A total of 120 participants were enrolled in a trial, with 60 randomised to the telehealth group and 60 randomised to usual care. Participants in the telehealth group received a mobile phone, Wellness Diary and a Wellness web portal, with daily text messaging. Participants in the usual care group received the standard 6-week hospital-based outpatient cardiac rehabilitation programme, including gym sessions. The cost of delivery by telehealth was slightly lower than for patients attending a rehabilitation service in person. From the provider's perspective, the telehealth intervention could be delivered for $1633 per patient, compared to $1845 for the usual care group. From the participant's perspective, patient travel costs for home rehabilitation were substantially less than for hospital attendance ($80 vs $400). Cardiac rehabilitation by telehealth offers obvious advantages and the option should be available to all patients who are eligible for cardiac rehabilitation. © The Author(s) 2014 Reprints and permissions:]br]sagepub.co.uk/journalsPermissions.nav.

  14. Home-based educational interventions for children with asthma.

    PubMed

    Welsh, Emma J; Hasan, Maryam; Li, Patricia

    2011-10-05

    of good methodological quality. They differed markedly in terms of age, severity of asthma, context and content of the educational intervention leading to substantial clinical heterogeneity. Due to this clinical heterogeneity, we did not pool results for our primary outcome, the number of patients with exacerbations requiring emergency department (ED) visit. The mean number of exacerbations requiring ED visits per person at six months was not significantly different between the home-based intervention and control groups (N = 2 studies; MD 0.04; 95% confidence interval (CI) -0.20 to 0.27). Only one trial contributed to our other primary outcome, exacerbations requiring a course of oral corticosteroids. Hospital admissions also demonstrated wide variation between trials with significant changes in some trials in both directions. Quality of life improved in both education and control groups over time.A table summarising some of the key components of the education programmes is included in the review. We found inconsistent evidence for home-based asthma educational interventions compared to standard care, education delivered outside of the home or a less intensive educational intervention delivered at home. Although education remains a key component of managing asthma in children, advocated in numerous guidelines, this review does not contribute further information on the fundamental content and optimum setting for such educational interventions.

  15. HOME-BASED BLOOD PRESSURE INTERVENTIONS FOR AFRICAN AMERICANS

    PubMed Central

    Feldman, Penny H.; McDonald, Margaret V.; Mongoven, Jennifer M.; Peng, Timothy R.; Gerber, Linda M.; Pezzin, Liliana E.

    2009-01-01

    Background Efforts to increase blood pressure (BP) control rates in African Americans, a traditionally underserved, high risk population must address both provider practice and patient adherence issues. The Home-Based BP Intervention for African Americans study is a three-arm randomized controlled trial designed to test two strategies to improve HTN management and outcomes in a decentralized service setting serving a vulnerable and complex home care population. The primary study outcomes are systolic BP, diastolic BP, and BP control; secondary outcomes are nurse adherence to HTN management recommendations, and patient adherence to medication, healthy diet and other self-management strategies. Methods and Results Nurses (N=312) in a nonprofit Medicare-certified home health agency are randomized along with their eligible hypertensive patients (N=845). The two interventions being tested are: (i) a “basic” intervention delivering key evidence-based reminders to home care nurses and patients while the patient is receiving traditional post-acute home health care; and (ii) an “augmented” intervention that includes that same as the basic intervention, plus transition to an ongoing HTN Home Support Program that extends support for 12 months. Outcomes are measured at 3 and 12 months post baseline interview. The interventions will be assessed relative to usual care and to each other. Conclusions Systems change to improve BP management and outcomes in home health will not easily occur without new intervention models and rigorous evaluation of their impact. Results from this trial will provide important information on potential strategies to improve BP control in a low income, chronically ill patient population. PMID:20031844

  16. Cost-benefit analysis of telehealth in pre-hospital care.

    PubMed

    Langabeer, James R; Champagne-Langabeer, Tiffany; Alqusairi, Diaa; Kim, Junghyun; Jackson, Adria; Persse, David; Gonzalez, Michael

    2017-09-01

    Objective There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform the current delivery model. In this study, we explore the costs and benefits of one large telehealth EMS initiative. Methods Using a case-control study design and both micro- and gross-costing data from the Houston Fire Department EMS electronic patient care record system, we conducted a cost-benefit analysis (CBA) comparing costs with potential savings associated with patients treated through a telehealth-enabled intervention. The intervention consisted of telehealth-based consultation between the 911 patient and an EMS physician, to evaluate and triage the necessity for patient transport to a hospital emergency department (ED). Patients with non-urgent, primary care-related conditions were then scheduled and transported by alternative means to an affiliated primary care clinic. We measured CBA as both total cost savings and cost per ED visit averted, in US Dollars ($USD). Results In total, 5570 patients were treated over the first full 12 months with a telehealth-enabled care model. We found a 6.7% absolute reduction in potentially medically unnecessary ED visits, and a 44-minute reduction in total ambulance back-in-service times. The average cost for a telehealth patient was $167, which was a statistically significantly $103 less than the control group ( p < .0001). The programme produced a $928,000 annual cost savings from the societal perspective, or $2468 cost savings per ED visit averted (benefit). Conclusion Patient care enabled by telehealth in a pre-hospital environment, is a more cost effective alternative compared to the traditional EMS 'treat and transport to ED' model.

  17. Are telehealth technologies for hypertension care and self-management effective or simply risky and costly?

    PubMed

    McKoy, June; Fitzner, Karen; Margetts, Miranda; Heckinger, Elizabeth; Specker, James; Roth, Laura; Izenberg, Maxwell; Siegel, Molly; McKinney, Shannon; Moss, Gail

    2015-06-01

    Hypertension is a prevalent chronic disease that requires ongoing management and self-care. The disease affects 31% of American adults and contributed to or caused the deaths of 348,000 Americans in 2008, fewer than 50% of whom effectively self-managed the disease. However, self-management is complex, with patients requiring ongoing support and easy access to care. Telehealth may help foster the knowledge and skills necessary for those with hypertension to engage in successful self-management. This paper considers the applicability, efficacy, associated risks, and cost-effectiveness of telehealth for individuals and populations with hypertension. Telehealth is a broad term, encompassing telemedicine and mobile health that is used for physician-patient interactions, diagnostics, care delivery, education, information sharing, monitoring, and reminders. Telemedicine may have considerable utility for people diagnosed with hypertension who have poor access or social barriers that constrain access, but potential risks exist. Telehealth technology is evolving rapidly, even in the absence of fully proven cost-effectiveness and efficacy. Considering the cost of inpatient and emergency department care for patients with hypertension, telehealth is a highly attractive alternative, but there are risks to consider. Incorporating telehealth, which is increasingly characterized by mobile health, can increase both the capacity of health care providers and the reach of patient support, clinical management, and self-care. Telehealth studies need improvement; long-term outcome data on cardiovascular events must be obtained, and robust risk analyses and economic studies are needed to prospectively evaluate the safety and cost savings for hypertension self-management.

  18. High patient satisfaction with telehealth in Parkinson disease: A randomized controlled study.

    PubMed

    Wilkinson, Jayne R; Spindler, Meredith; Wood, Stephanie M; Marcus, Steven C; Weintraub, Daniel; Morley, James F; Stineman, Margaret G; Duda, John E

    2016-06-01

    Parkinson disease (PD) is a complex neurodegenerative disorder that benefits from specialty care. Telehealth is an innovative resource that can enhance access to this care within a patient-centered framework. Research suggests that telehealth can lead to increased patient satisfaction, equal or better clinical outcomes, and cost savings, but these outcomes have not been well-studied in PD. We conducted a dual active-arm 12-month randomized controlled trial to assess patient satisfaction, clinical outcomes, travel burden, and health care utilization in PD using video telehealth for follow-up care with specialty providers. Telehealth visits took place either at a facility nearer to the patient (satellite clinic arm) or in the patient's home (home arm). Each control group received usual in-person care. Patient satisfaction, assessed by quantitative questionnaires, was the primary outcome. Eighty-six men were enrolled (home arm: 18 active, 18 control; satellite clinic arm: 26 active, 24 control) with a mean age of 73 years (range 42-87). There were no differences in baseline characteristics between the active group and the controls in each arm (p > 0.05). A significant difference in overall patient satisfaction was not found; however, high levels of patient satisfaction were found in all groups. Greater satisfaction for the telehealth modality was found in assessments of convenience and accessibility/distance. Clinical outcomes were similar between groups, travel burden was reduced using telehealth, and health care utilization was largely similar in both groups. As the need for PD subspecialty care increases, innovative patient-centered solutions to overcoming barriers to access, such as video telehealth, will be invaluable to patients and may provide high patient satisfaction.

  19. Home-based multidimensional survivorship programmes for breast cancer survivors.

    PubMed

    Cheng, Karis Kin Fong; Lim, Yee Ting Ethel; Koh, Zhi Min; Tam, Wilson Wai San

    2017-08-24

    The prognosis and survival rate of women with breast cancer have significantly improved worldwide. Effective home-based multidimensional programmes for breast cancer survivors have gained an ever greater emphasis in survivorship care to maximise women's quality of life for their successful transition to rehabilitation and normal life. It is important to summarise the best available evidence to evaluate the effects of home-based multidimensional survivorship programmes on quality of life in women within 10 years of the completion of surgery or adjuvant cancer therapy for breast cancer, or both. To assess the effects of home-based, multidimensional survivorship (HBMS) programmes on maintaining or improving the quality of life in breast cancer survivors. In April 2016 we searched the Cochrane Breast Cancer Specialised Register, CENTRAL, PubMed, Embase, CINAHL Plus, PsycINFO, Web of Science, and the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. We also screened reference lists of all identified studies and contacted study authors. Randomised controlled trials (RCTs) and quasi-RCTs assessing the effects of HBMS programmes in maintaining or improving quality of life in women with stages 0 to 3 breast cancer who completed primary cancer treatment (surgery or adjuvant cancer therapy, or both) up to 10 years earlier. We considered studies where the interventions included more than one of the following listed components: educational (such as information provision and self-management advice), physical (such as exercise training and resistance training) and psychological (such as counselling and cognitive therapies), to constitute a multidimensional programme. Interventions had to be allowed to be carried out at home. Two authors independently assessed eligible studies for inclusion, and performed quality assessment and extracted relevant data of the included studies. Quality of life was the primary outcome of

  20. Home-based child vaccination records--a reflection on form.

    PubMed

    Brown, David W; Gacic-Dobo, Marta; Young, Stacy L

    2014-04-01

    Home-based child vaccination records play an important role in documenting immunization services received by children. We report some of the results of a review of home-based vaccination records from 55 countries. In doing so, we categorize records into three groups (vaccination only cards, vaccination plus cards, child health books) and describe differences in characteristics related to the quality of data recorded on immunization. Moreover, we highlight areas of potential concern and areas in need of further research and investigation to improve our understanding of the home-based vaccination record form related to improved data quality from immunization service delivery.

  1. Is there a business case for telehealth in home health agencies?

    PubMed

    Rumberger, Jill Schumann; Dansky, Kathryn

    2006-04-01

    Telehealth is a tool being considered by home health agencies (HHAs) to help manage costs. Most HHAs in the United States rely on Medicare reimbursement as their primary revenue source. With the implementation of a new payment system in October 2000, HHAs went from a cost-based, fee-for-service payment to a per episode prospective payment reimbursement model. For HHAs, the revenue goal changed from maximizing the number of visits under feefor- service to maximizing the number of patients and managing the episode within the prospective payment reimbursement formula. This paper addresses whether or not there is a financial business case for telehealth in HHAs. For this research effort, building a business case involved identifying and measuring the factors that contribute to the financial effectiveness of the home health organization. Utilizing a return on investment breakeven analysis model, we investigated the financial impact of telehealth, utilizing data from 32 HHAs in the Commonwealth of Pennsylvania. The breakeven analysis demonstrated that telehealth can have a positive impact on the HHA's financial position. Results indicate that HHAs should seriously consider the use of telehealth as part of their agency's care delivery model.

  2. Direct-To-Consumer Telehealth May Increase Access To Care But Does Not Decrease Spending.

    PubMed

    Ashwood, J Scott; Mehrotra, Ateev; Cowling, David; Uscher-Pines, Lori

    2017-03-01

    The use of direct-to-consumer telehealth, in which a patient has access to a physician via telephone or videoconferencing, is growing rapidly. A key attraction of this type of telehealth for health plans and employers is the potential savings involved in replacing physician office and emergency department visits with less expensive virtual visits. However, increased convenience may tap into unmet demand for health care, and new utilization may increase overall health care spending. We used commercial claims data on over 300,000 patients from three years (2011-13) to explore patterns of utilization and spending for acute respiratory illnesses. We estimated that 12 percent of direct-to-consumer telehealth visits replaced visits to other providers, and 88 percent represented new utilization. Net annual spending on acute respiratory illness increased $45 per telehealth user. Direct-to-consumer telehealth may increase access by making care more convenient for certain patients, but it may also increase utilization and health care spending. Project HOPE—The People-to-People Health Foundation, Inc.

  3. Developing a measure of engagement with telehealth systems: The mHealth Technology Engagement Index.

    PubMed

    Dewar, Alexis R; Bull, Tyler P; Malvey, Donna M; Szalma, James L

    2017-02-01

    Introduction Telehealth systems and mobile health (mHealth) devices allow for the exchange of both physical and mental healthcare data, as well as information from a patient to a practitioner, or care recipient to caregiver; but there has been little research on why users are motivated to engage with telehealth systems. Given this, we sought to create a measure that satisfactorily assesses human motivation to use telehealth devices. Methods 532 survey responses were used in an exploratory factor analysis and confirmatory factor analysis, which tested and retested the feasibility of this new measure. Convergent and divergent validity analyses indicated that the mHealth Technology Engagement Index (mTEI) is a unique measure of motivation. Results The results indicated that autonomy, competence, relatedness, goal attainment, and goal setting underpin motivation to use telehealth systems. Discussion The mTEI shows promise in indexing human motivation to use telehealth technologies. We also discuss the importance of developing measurement tools based on theory and how practitioners can best utilize the mTEI.

  4. Web- vs. telehealth-based delivery of cognitive behavioral therapy for insomnia: a randomized controlled trial.

    PubMed

    Holmqvist, M; Vincent, N; Walsh, K

    2014-02-01

    The purpose of our study was to evaluate and compare two methods of service delivery (web-based and telehealth-based) for chronic insomnia with regard to patient preference, clinical effectiveness, and patient satisfaction. Our study was a randomized controlled trial with manualized telehealth- and web-based delivery conditions (nonblinded). The sample comprised 73 adults with chronic insomnia. Participants received web-based delivery from their homes or telehealth-based delivery from a nearby clinic. Both interventions consisted of identical psychoeducation, sleep hygiene and stimulus control instruction, sleep restriction treatment, relaxation training, cognitive therapy, mindfulness meditation, and medication-tapering assistance. Using a linear mixed model analysis, results showed that both delivery methods produced equivalent changes in insomnia severity, with large effect sizes. Attendance patterns favored telehealth, whereas homework adherence and preference data favored web-based delivery. Web- and telehealth-based delivery are both helpful in treating chronic insomnia in rural-dwelling adults. Copyright © 2013 Elsevier B.V. All rights reserved.

  5. Role of telehealth in seating clinics: a case study of learners' perspectives.

    PubMed

    Khoja, Shariq; Casebeer, Ann; Young, Sybil

    2005-01-01

    We conducted a qualitative case study of the introduction of telehealth in a seating clinic, which was an existing outreach service between two hospitals in Alberta, approximately 300 km apart. Interviews were conducted with the staff who were involved in planning and implementing the telehealth initiative. The study showed that, from the perspective of the staff (who were learners), implementation of telehealth in seating clinics differs from other less tactile telehealth applications in certain ways: (1) the importance of multidisciplinary teams in the procedures, (2) the importance of proper visualization and communication among the staff to convey the pressure changes and measurements to the technicians at the major centre to help them build or adjust the seating devices and (3) the reluctance of staff to trust others' judgements. Planning of service provision and telelearning for seating clinics requires the involvement of staff at all stages. Thus, the implementation of telehealth should be a stepwise process, allowing a highly interactive approach, without affecting the multidisciplinary nature of seating clinics.

  6. Internet-based telehealth assessment of language using the CELF-4.

    PubMed

    Waite, Monique C; Theodoros, Deborah G; Russell, Trevor G; Cahill, Louise M

    2010-10-01

    Telehealth has the potential to improve children's access to speech-language pathology services. Validation of telehealth applications, including the assessment of childhood language disorders, is necessary for telehealth to become an accepted alternative mode of service provision. The aim of this study was to validate an Internet-based telehealth system for assessing childhood language disorders. Twenty-five children ages 5 to 9 years were assessed using the core language subtests of the Clinical Evaluation of Language Fundamentals--4th Edition (CELF-4; Semel, Wiig, & Secord, 2003). Each participant was simultaneously assessed online and face-to-face (FTF). Assessments were administered by either an online or an FTF speech-language pathologist (SLP), but were simultaneously rated by both SLPs. No significant difference was found between the online and FTF total raw scores and scaled scores for each subtest. Weighted kappas revealed very good agreement on the individual items, total raw scores, scaled scores, core language score, and severity level. Intra- and interrater reliability were determined for a sample of online ratings, with intraclass correlation analysis revealing very good agreement on all measures. The results of this study support the validity and reliability of scoring the core language subtests of the CELF-4 via telehealth.

  7. Pediatric Obesity Management in Rural Clinics in California and the Role of Telehealth in Distance Education

    PubMed Central

    Shaikh, Ulfat; Nettiksimmons, Jasmine; Romano, Patrick

    2010-01-01

    Objective To determine health care provider needs related to pediatric obesity management in rural California and to explore strategies to improve care through telehealth. Methods Cross-sectional survey of health care providers who treated children and adolescents at 41 rural clinics with existing telehealth connectivity. Results Most of the 135 respondents were family physicians at designated rural health clinics serving low-income families. Respondents had practiced in rural areas for an average of 10 years. Most providers rated their self-efficacy in managing pediatric obesity as 2 or 3 on a 5-point scale. The barriers most frequently reported by health care providers were lack of local weight management programs, lack of patient motivation, and lack of family involvement in treatment. Providers reported that the resources they would find most helpful were readily accessible patient education materials, strategies to link patients with community treatment programs and training in brief, focused counseling skills. Three-quarters of providers already used telehealth for distance learning. Providers reported very high interest in participating in continuing education on pediatric obesity delivered by telehealth, specifically Internet communication with specialists, web-based education, and interactive video case-conferencing. Conclusions Rural health care providers face several barriers related to pediatric obesity management. Targeted interventions provided via telehealth to rural health care providers may enhance the care of obese children and adolescents. The results of this study provide directions and priorities for the design of appropriate interventions. PMID:21729153

  8. Pediatric obesity management in rural clinics in California and the role of telehealth in distance education.

    PubMed

    Shaikh, Ulfat; Nettiksimmons, Jasmine; Romano, Patrick

    2011-01-01

    To determine health care provider needs related to pediatric obesity management in rural California and to explore strategies to improve care through telehealth. Cross-sectional survey of health care providers who treated children and adolescents at 41 rural clinics with existing telehealth connectivity. Most of the 135 respondents were family physicians at designated rural health clinics serving low-income families. Respondents had practiced in rural areas for an average of 10 years. Most providers rated their self-efficacy in managing pediatric obesity as 2 or 3 on a 5-point scale. The barriers most frequently reported by health care providers were lack of local weight management programs, lack of patient motivation, and lack of family involvement in treatment. Providers reported that the resources they would find most helpful were readily accessible patient education materials, strategies to link patients with community treatment programs and training in brief, focused counseling skills. Three-quarters of providers already used telehealth for distance learning. Providers reported very high interest in participating in continuing education on pediatric obesity delivered by telehealth, specifically Internet communication with specialists, web-based education, and interactive video case-conferencing. Rural health care providers face several barriers related to pediatric obesity management. Targeted interventions provided via telehealth to rural health care providers may enhance the care of obese children and adolescents. The results of this study provide directions and priorities for the design of appropriate interventions. © 2010 National Rural Health Association.

  9. Clinical management of multiple sclerosis through home telehealth monitoring: results of a pilot project.

    PubMed

    Turner, Aaron P; Wallin, Mitchell T; Sloan, Alicia; Maloni, Heidi; Kane, Robert; Martz, Lore; Haselkorn, Jodie K

    2013-01-01

    This study examined the feasibility of using home telehealth monitoring to improve clinical care and promote symptom self-management among veterans with multiple sclerosis (MS). This was a longitudinal cohort study linking mailed survey data at baseline and 6-month follow-up with information from home telehealth monitors. The study was conducted in two large Department of Veterans Affairs (VA) MS clinics in Seattle, Washington, and Washington, DC, and involved 41 veterans with MS. The measures were demographic information and data from a standardized question set using a home telehealth monitor. Participants reported moderate levels of disability (median Expanded Disability Status Scale [EDSS] score, 6.5) and substantial distance from the nearest VA MS clinic (mean distance, 93.6 miles). Of the participants, 61.0% reported current use of MS disease-modifying treatments. A total of 85.4% of participants provided consistent data from home monitoring. Overall satisfaction with home telehealth monitoring was high, with 87.5% of participants rating their experience as good or better. The most frequently reported symptoms at month 1 were fatigue (95.1%), depression (78.0%), and pain (70.7%). All symptoms were reported less frequently by month 6, with the greatest reduction in depression (change of 23.2 percentage points), although these changes were not statistically significant. Home telehealth monitoring is a promising tool for the management of chronic disease, although substantial practical barriers to efficient implementation remain.

  10. Nurses’ and community support workers’ experience of telehealth: a longitudinal case study

    PubMed Central

    2014-01-01

    Background Introduction of telehealth into the healthcare setting has been recognised as a service that might be experienced as disruptive. This paper explores how this disruption is experienced. Methods In a longitudinal qualitative study, we conducted focus group discussions prior to and semi structured interviews post introduction of a telehealth service in Nottingham, U.K. with the community matrons, congestive heart failure nurses, chronic obstructive pulmonary disease nurses and community support workers that would be involved in order to elicit their preconceptions and reactions to the implementation. Results Users experienced disruption due to the implementation of telehealth as threatening. Three main factors add to the experience of threat and affect the decision to use the technology: change in clinical routines and increased workload; change in interactions with patients and fundamentals of face-to-face nursing work; and change in skills required with marginalisation of clinical expertise. Conclusion Since the introduction of telehealth can be experienced as threatening, managers and service providers should aim at minimising the disruption caused by taking the above factors on board. This can be achieved by employing simple yet effective measures such as: providing timely, appropriate and context specific training; provision of adequate technical support; and procedures that allow a balance between the use of telehealth and personal visit by nurses delivering care to their patients. PMID:24721599

  11. Telehealth, Wearable Sensors, and the Internet: Will They Improve Stroke Outcomes Through Increased Intensity of Therapy, Motivation, and Adherence to Rehabilitation Programs?

    PubMed

    Burridge, Jane H; Lee, Alan Chong W; Turk, Ruth; Stokes, Maria; Whitall, Jill; Vaidyanathan, Ravi; Clatworthy, Phil; Hughes, Ann-Marie; Meagher, Claire; Franco, Enrico; Yardley, Lucy

    2017-07-01

    Stroke, predominantly a condition of older age, is a major cause of acquired disability in the global population and puts an increasing burden on health care resources. Clear evidence for the importance of intensity of therapy in optimizing functional outcomes is found in animal models, supported by neuroimaging and behavioral research, and strengthened by recent meta-analyses from multiple clinical trials. However, providing intensive therapy using conventional treatment paradigms is expensive and sometimes not feasible because of social and environmental factors. This article addresses the need for cost-effective increased intensity of practice and suggests potential benefits of telehealth (TH) as an innovative model of care in physical therapy. We provide an overview of TH and present evidence that a web-supported program, used in conjunction with constraint-induced therapy (CIT), can increase intensity and adherence to a rehabilitation regimen. The design and feasibility testing of this web-based program, "LifeCIT," is presented. We describe how wearable sensors can monitor activity and provide feedback to patients and therapists. The methodology for the development of a wearable device with embedded inertial and mechanomyographic sensors, algorithms to classify functional movement, and a graphical user interface to present meaningful data to patients to support a home exercise program is explained. We propose that wearable sensor technologies and TH programs have the potential to provide most-effective, intensive, home-based stroke rehabilitation.

  12. The Incidence and Wage Consequences of Home-Based Work in the United States, 1980-2000

    ERIC Educational Resources Information Center

    Oettinger, Gerald S.

    2011-01-01

    This study documents the rapid growth in home-based wage and salary employment and the sharp decline in the home-based wage penalty in the United States between 1980 and 2000. These twin patterns, observed for both men and women in most occupation groups, suggest that employer costs of providing home-based work arrangements have decreased.…

  13. The Incidence and Wage Consequences of Home-Based Work in the United States, 1980-2000

    ERIC Educational Resources Information Center

    Oettinger, Gerald S.

    2011-01-01

    This study documents the rapid growth in home-based wage and salary employment and the sharp decline in the home-based wage penalty in the United States between 1980 and 2000. These twin patterns, observed for both men and women in most occupation groups, suggest that employer costs of providing home-based work arrangements have decreased.…

  14. Service and business model for technology enabled and home-based cardiac rehabilitation programs.

    PubMed

    Sarela, Antti; Whittaker, Frank; Korhonen, Ilkka

    2009-01-01

    Cardiac rehabilitation programs are comprehensive life-style programs aimed at preventing recurrence of a cardiac event. However, the current programs have globally significantly low levels of uptake. Home-based model can be a viable alternative to hospital-based programs. We developed and analysed a service and business model for home based cardiac rehabilitation based on personal mentoring using mobile phones and web services. We analysed the different organizational and economical aspects of setting up and running the home based program and propose a potential business model for a sustainable and viable service. The model can be extended to management of other chronic conditions to enable transition from hospital and care centre based treatments to sustainable home-based care.

  15. Home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized clinical trial

    PubMed Central

    Dias, Fernanda Dultra; Sampaio, Luciana Maria Malosá; da Silva, Graziela Alves; Gomes, Évelim LF Dantas; do Nascimento, Eloisa Sanches Pereira; Alves, Vera Lucia Santos; Stirbulov, Roberto; Costa, Dirceu

    2013-01-01

    Introduction Pulmonary rehabilitation (PR) is a multidisciplinary program of care for patients with chronic obstructive pulmonary disease (COPD) with the goal of improving the functional capacity and quality of life, as well as maintaining the clinical stability of COPD sufferers. However, not all patients are available for such a program despite discomfort with their condition. The aim of this study was to evaluate the effects of a home-based PR (HBPR) program on functional ability, quality of life, and respiratory muscle strength and endurance. Patients and methods Patients with COPD according to the Global Initiative of Chronic Obstructive Lung Disease were randomized (double-blind) into two groups. One group performed a protocol at home with aerobic and muscle strength exercises and was called the intervention group; the other group received only instructions to perform breathing and stretching exercises, characterizing it as the control group (CG). We assessed the following variables at baseline and 2 months: exercise tolerance (incremental shuttle walk test and upper limb test), respiratory muscle (strength and endurance test), and health-related quality of life (Airways Questionnaire 20). Results There were no significant changes after the intervention in either of the two groups in exercise tolerance and quality of life. However, the intervention group had improved respiratory endurance compared with the CG, while the CG presented a decrease in the load sustained by the respiratory muscles after the HBPR. Conclusion A program of HBPR with biweekly supervision (although not enough to provide significant improvements in physical capacity or quality of life) played an important role in maintaining the stability of the clinical features of patients with COPD; the patients had no worsening of symptoms during the intervention period according to the daily log. PMID:24235824

  16. Implementation of home-based medication order entry at a community hospital.

    PubMed

    Thorne, Alicia; Williamson, Sarah; Jellison, Tara; Jellison, Chris

    2009-11-01

    The implementation of a home-based order-entry program at a community hospital is described. Parkview Hospital is a 600-bed, community-based facility located in Fort Wayne, Indiana, that provides 24-hour pharmacy services. The main purpose for establishing a home-based order-entry program was to provide extra pharmacist coverage during the event of a spontaneous order surge in an effort to maintain excellent customer service. A virtual private network (VPN) was created to ensure the security and confidentiality of patients' health care information. The names of volunteer pharmacists who met specific criteria and who were capable of performing home-based order entry were collected. These pharmacists were trained and tested in the home-based order-entry process. When home-based order-entry is needed, the lead pharmacist contacts the pharmacists on the list by telephone. If available, the pharmacists (maximum of three) are notified to log into the Internet, access the VPN, and perform order entry with the same vigilance, confidentiality, and care as they would onsite. Home-based order entry is discontinued when off-trigger points are met. Pharmacists entering orders from home are paid by the time spent conducting order entry. Pharmacists reported that the program was easy to contact home-based order-entry volunteers, there were no problems with logging into the VPNs, and turnaround time was close to our target of 25 minutes. A community-based hospital successfully implemented a home-based medication order-entry program. The program alleviated the shortage of pharmacists during spontaneous surges of medication orders.

  17. Conducting Functional Communication Training via Telehealth to Reduce the Problem Behavior of Young Children with Autism

    PubMed Central

    Wacker, David P.; Lee, John F.; Padilla Dalmau, Yaniz C.; Kopelman, Todd G.; Lindgren, Scott D.; Kuhle, Jennifer; Pelzel, Kelly E.; Dyson, Shannon; Schieltz, Kelly M.; Waldron, Debra B.

    2012-01-01

    Functional communication training (FCT) was conducted by parents of 17 young children with autism spectrum disorders who displayed problem behavior. All procedures were conducted at regional clinics located an average of 15 miles from the families’ homes. Parents received coaching via telehealth from behavior consultants who were located an average of 222 miles from the regional clinics. Parents first conducted functional analyses with telehealth consultation (Wacker, Lee, et al., in press) and then conducted FCT that was matched to the identified function of problem behavior. Parent assistants located at the regional clinics received brief training in the procedures and supported the families during the clinic visits. FCT, conducted within a nonconcurrent multiple baseline design, reduced problem behavior by an average of 93.5%. Results suggested that FCT can be conducted by parents via telehealth when experienced applied behavior analysts provide consultation. PMID:23543855

  18. Telehealth for Expanding the Reach of Early Autism Training to Parents

    PubMed Central

    Vismara, Laurie A.; Young, Gregory S.; Rogers, Sally J.

    2012-01-01

    Although there is consensus that parents should be involved in interventions designed for young children with autism spectrum disorder (ASD), parent participation alone does not ensure consistent, generalized gains in children's development. Barriers such as costly intervention, time-intensive sessions, and family life may prevent parents from using the intervention at home. Telehealth integrates communication technologies to provide health-related services at a distance. A 12 one-hour per week parent intervention program was tested using telehealth delivery with nine families with ASD. The goal was to examine its feasibility and acceptance for promoting child learning throughout families' daily play and caretaking interactions at home. Parents became skilled at using teachable moments to promote children's spontaneous language and imitation skills and were pleased with the support and ease of telehealth learning. Preliminary results suggest the potential of technology for helping parents understand and use early intervention practices more often in their daily interactions with children. PMID:23227334

  19. The effect of telehealth systems and satisfaction with health expenditure among patients with metabolic syndrome.

    PubMed

    Uei, Shu-Lin; Tsai, Chung-Hung; Kuo, Yu-Ming

    2016-04-29

    Telehealth cost analysis has become a crucial issue for governments in recent years. In this study, we examined cases of metabolic syndrome in Hualien County, Taiwan. This research adopted the framework proposed by Marchand to establish a study process. In addition, descriptive statistics, a t test, analysis of variance, and regression analysis were employed to analyze 100 questionnaires. The results of the t$ test revealed significant differences in medical health expenditure, number of clinical visits for medical treatment, average amount of time spent commuting to clinics, amount of time spent undergoing medical treatment, and average number of people accompanying patients to medical care facilities or assisting with other tasks in the past one month, indicating that offering telehealth care services can reduce health expenditure. The statistical analysis results revealed that customer satisfaction has a positive effect on reducing health expenditure. Therefore, this study proves that telehealth care systems can effectively reduce health expenditure and directly improve customer satisfaction with medical treatment.

  20. Developing a strategy for studying critical thinking in a nurse telehealth setting: a participatory approach.

    PubMed

    Tuden, Danica; Gidora, Hanne; Quick, Peter D; Ebdon, Nikki; Glover, Karen; Harmer, Sherrill; Miller, Wendy; Taylor, Mary; Borycki, Elizabeth M

    2013-01-01

    Telehealth nursing is a specialized area of nursing practice that has grown in response to the emergence of new technologies and consumer demand for health care services in the community. HealthLinkBC Nursing Services provides symptom triage and health education to residents of British Columbia and Yukon over the phone. Unlike traditional nursing care, telenurses are limited in terms of information they receive from callers. Therefore, there is a need for critical thinking skills to be developed. The purpose of this paper is to describe a participatory approach towards identifying: (1) the factors that affect telehealth nursing practice including critical thinking, and (2) developing a research strategy aimed at identifying the ways in which critical thinking can be supported in a telehealth nursing environment. A HealthLinkBC working group has begun work in developing a definition of critical thinking specific to nursing, identifying future research opportunities and methodologies.

  1. Usability and feasibility of smartphone video capabilities for telehealth care in the U.S. military.

    PubMed

    Luxton, David D; Mishkind, Matthew C; Crumpton, Rosa M; Ayers, Todd D; Mysliwiec, Vincent

    2012-01-01

    The two-way audio/visual capabilities on the latest smartphone platforms bring new possibilities for the delivery of healthcare services to users. Because this technology is so new, the feasibility and the basic usability of the technology need to be evaluated before more research is conducted on its application in the telehealth field. The purpose of this study was to conduct preliminary usability testing of smartphone two-way video capabilities for potential telehealth use for U.S. military service members. Seven service member volunteers communicated with research staff at a large military installation via Apple's (Cupertino, CA) FaceTime® app on the iPhone® 4 smartphone platform and conducted basic usability testing of the technology. Preferences for potential use of the technology were also assessed. The results showed that the technology has both limitations as well as potential for telehealth applications that warrant additional research.

  2. The Use of Telehealth to Teach Reproductive Health to Female Rural High School Students.

    PubMed

    Yoost, Jennie Lee; Starcher, Rachael Whitley; King-Mallory, Rebecca Ann; Hussain, Nafeeza; Hensley, Christina Ann; Gress, Todd William

    2017-04-01

    To evaluate the use of telehealth to teach reproductive health to rural areas with high rates of teen pregnancy. Prospective cohort study. Two high schools in rural West Virginia. High school female students who attended telehealth sessions. Teleconferencing equipment connected rural high schools to a distal academic institution. Telehealth sessions included reproductive health and life skills topics. Demographic information, session pre- and post-tests, and 6- month assessment was obtained. Reproductive health knowledge, behavior, and self-efficacy were assessed at intervention and at 6 months, along with Likert scale evaluation of telehealth as an educational tool. Fifty-five students participated in the program with an average age of 16.14 (SD 1.24) years. Only 20% (10/50) of subjects' mothers and 12% (6/50) of subjects' fathers had achieved education beyond high school, and 20% (10/50) of subject's mothers had experienced teen pregnancies (age 18 or younger). Sexual activity was reported among 52% (26/50) of subjects, 4/50 (8%) reported desire to become pregnant within the next year, and 4/50 (8%) reported already pregnant. Thirty-seven students completed the 6-month follow-up survey. Reported condom use increased from 20% (10/50) at baseline to 40% (15/37) at 6 months (P = .04) and hormonal contraception use increased from 22% (11/50) to 38% (14/37) (P = .12). Report of human papillomavirus vaccination increased from 38% (10/26) to 70% (26/37) (P = .001) among all subjects. At 6 months, 91.8% (34/37) reported the use of telehealth was "very effective" as a means to teach the material. Telehealth is an effective tool to teach reproductive health to rural areas. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  3. Telehealth for paediatric burn patients in rural areas: a retrospective audit of activity and cost savings.

    PubMed

    McWilliams, Tania; Hendricks, Joyce; Twigg, Di; Wood, Fiona; Giles, Margaret

    2016-11-01

    Since 2005, the Western Australian paediatric burn unit has provided a state-wide clinical consultancy and support service for the assessment and management of acute and rehabilitative burn patients via its telehealth service. Since then, the use of this telehealth service has steadily increased as it has become imbedded in the model of care for paediatric burn patients. Primarily, the service involves acute and long term patient reviews conducted by the metropolitan-located burn unit in contact with health practitioners, advising patients and their families who reside outside the metropolitan area thereby avoiding unnecessary transfers and inpatient bed days. A further benefit of the paediatric burn service using telehealth is more efficient use of tertiary level burn unit beds, with only those patients meeting clinical criteria for admission being transferred. To conduct a retrospective audit of avoided transfers and bed days in 2005/06-2012/13 as a result of the use of the paediatric Burns Telehealth Service and estimate their cost savings in 2012/13. A retrospective chart audit identified activity, avoided unnecessary acute and scar review patient transfers, inpatient bed days and their associated avoided costs to the tertiary burn unit and patient travel funding. Over the period 2005/06-2012/13 the audit identified 4,905 avoided inpatient bed days, 364 avoided acute patient transfers and 1,763 avoided follow up review transfers for a total of 1,312 paediatric burn patients as a result of this telehealth service. This paper presents the derivation of these outcomes and an estimation of their cost savings in 2012/13 of AUD 1.89million. This study demonstrates avoided patient transfers, inpatient bed days and associated costs as the result of an integrated burns telehealth service. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  4. Transitioning a home telehealth project into a sustainable, large-scale service: a qualitative study.

    PubMed

    Wade, Victoria A; Taylor, Alan D; Kidd, Michael R; Carati, Colin

    2016-05-16

    This study was a component of the Flinders Telehealth in the Home project, which tested adding home telehealth to existing rehabilitation, palliative care and geriatric outreach services. Due to the known difficulty of transitioning telehealth projects services, a qualitative study was conducted to produce a preferred implementation approach for sustainable and large-scale operations, and a process model that offers practical advice for achieving this goal. Initially, semi-structured interviews were conducted with senior clinicians, health service managers and policy makers, and a thematic analysis of the interview transcripts was undertaken to identify the range of options for ongoing operations, plus the factors affecting sustainability. Subsequently, the interviewees and other decision makers attended a deliberative forum in which participants were asked to select a preferred model for future implementation. Finally, all data from the study was synthesised by the researchers to produce a process model. 19 interviews with senior clinicians, managers, and service development staff were conducted, finding strong support for home telehealth but a wide diversity of views on governance, models of clinical care, technical infrastructure operations, and data management. The deliberative forum worked through these options and recommended a collaborative consortium approach for large-scale implementation. The process model proposes that the key factor for large-scale implementation is leadership support, which is enabled by 1) showing solutions to the problems of service demand, budgetary pressure and the relationship between hospital and primary care, 2) demonstrating how home telehealth aligns with health service policies, and 3) achieving clinician acceptance through providing evidence of benefit and developing new models of clinical care. Two key actions to enable change were marketing telehealth to patients, clinicians and policy-makers, and building a community of

  5. Telehealth delivery of Rapid Syllable Transitions (ReST) treatment for childhood apraxia of speech.

    PubMed

    Thomas, Donna C; McCabe, Patricia; Ballard, Kirrie J; Lincoln, Michelle

    2016-11-01

    Rapid Syllable Transitions (ReST) treatment uses pseudo-word targets with varying lexical stress to target simultaneously articulation, prosodic accuracy and coarticulatory transitions in childhood apraxia of speech (CAS). The treatment is efficacious for the acquisition of imitated pseudo-words, and generalization of skill to untreated pseudo-words and real words. Despite the growing popularity of telehealth as a method of service delivery, there is no research into the efficacy of telehealth treatments for CAS. Telehealth service delivery is associated with compromised audio and visual signal transmission that may affect the efficacy of treatment. To conduct a phase 1 efficacy study of telehealth delivery of ReST treatment for CAS, and to discuss the efficacy with reference to face-to-face ReST treatment. Using a multiple baseline across participants design, five children aged 5-11 years with CAS received ReST treatment four times a week for 3 weeks via video conferencing with Adobe Connect. The children's ability to imitate new pseudo-words, generalize the skills to untreated pseudo-words and real word items, and maintain the skills following treatment were assessed. Both visual and statistical analyses were utilized. All five children significantly improved with their production of the imitated treated pseudo-word items and significantly generalized to similar untreated pseudo-words and real words. Additionally, two of the children showed significant generalization to imitated phrases with the treatment items. Four of the children maintained their treatment gains up to 4 months post-treatment. Telehealth delivery produced similar acquisition of pseudo-words and generalization to untreated behaviours as face-to-face delivery; however, in the 4 months following treatment, the children showed stable rather than improving speech skills. The intra- and inter-judge reliability was similar in telehealth delivery for face-to-face delivery. Caregivers and clinicians

  6. Cancer Survivors' Experience With Telehealth: A Systematic Review and Thematic Synthesis.

    PubMed

    Cox, Anna; Lucas, Grace; Marcu, Afrodita; Piano, Marianne; Grosvenor, Wendy; Mold, Freda; Maguire, Roma; Ream, Emma

    2017-01-09

    Net survival rates of cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer the care of cancer survivors-individuals living with and beyond cancer-to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and health care professionals (HCPs), is an important contributor to this evolving model of care. Telehealth interventions are "complex," and understanding patient experiences of them is important in evaluating their impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth are yet to be synthesized. To systematically identify, appraise, and synthesize qualitative research evidence on the experiences of adult cancer survivors participating in telehealth interventions, to characterize the patient experience of telehealth interventions for this group. Medline (PubMed), PsychINFO, Cumulative Index for Nursing and Allied Health Professionals (CINAHL), Embase, and Cochrane Central Register of Controlled Trials were searched on August 14, 2015, and March 8, 2016, for English-language papers published between 2006 and 2016. Inclusion criteria were as follows: adult cancer survivors aged 18 years and over, cancer diagnosis, experience of participating in a telehealth intervention (defined as remote communication or remote monitoring with an HCP delivered by telephone, Internet, or hand-held or mobile technology), and reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) checklist for qualitative research was used to assess paper quality. The results section of each included article was coded line by line, and all papers underwent inductive analysis, involving comparison, reexamination, and grouping of codes to develop descriptive themes. Analytical themes were developed

  7. Cancer Survivors’ Experience With Telehealth: A Systematic Review and Thematic Synthesis

    PubMed Central

    Lucas, Grace; Marcu, Afrodita; Piano, Marianne; Grosvenor, Wendy; Mold, Freda; Maguire, Roma; Ream, Emma

    2017-01-01

    Background Net survival rates of cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer the care of cancer survivors—individuals living with and beyond cancer—to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and health care professionals (HCPs), is an important contributor to this evolving model of care. Telehealth interventions are “complex,” and understanding patient experiences of them is important in evaluating their impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth are yet to be synthesized. Objective To systematically identify, appraise, and synthesize qualitative research evidence on the experiences of adult cancer survivors participating in telehealth interventions, to characterize the patient experience of telehealth interventions for this group. Methods Medline (PubMed), PsychINFO, Cumulative Index for Nursing and Allied Health Professionals (CINAHL), Embase, and Cochrane Central Register of Controlled Trials were searched on August 14, 2015, and March 8, 2016, for English-language papers published between 2006 and 2016. Inclusion criteria were as follows: adult cancer survivors aged 18 years and over, cancer diagnosis, experience of participating in a telehealth intervention (defined as remote communication or remote monitoring with an HCP delivered by telephone, Internet, or hand-held or mobile technology), and reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) checklist for qualitative research was used to assess paper quality. The results section of each included article was coded line by line, and all papers underwent inductive analysis, involving comparison, reexamination, and grouping of codes to develop descriptive themes

  8. The influence of a telehealth project on healthcare professional recruitment and retention in remote areas in Mali: A longitudinal study.

    PubMed

    Mbemba, Gisèle Irène Claudine; Bagayoko, Cheick Oumar; Gagnon, Marie-Pierre; Hamelin-Brabant, Louise; Simonyan, David A

    2016-01-01

    The telehealth project EQUI-ResHuS (in French, Les TIC pour un accès Équitable aux Ressources Humaines en Santé) aimed to contribute to more equitable access to care and support practice in remote regions in Mali. This study explored the evolution of perceptions concerning telehealth among healthcare professionals in the four district health centres that participated in the EQUI-ResHus project and identified variables influencing their perceptions of telehealth impact on recruitment and retention of health professionals. One year after a first survey (T1), a second data collection (T2) was carried out among healthcare professionals using a 91-item questionnaire. Questions assessing telehealth use and perceptions and perceived impact on recruitment and retention of healthcare professionals were rated on a 5-point Likert scale. A total of 10 independent variables were considered for the analyses. A Wilcoxon signed-rank test was performed to detect differences between T1 and T2, and a bivariate linear regression model for repeated measures was carried out to assess the impact of independent variables on dependent variables. There were no noticeable changes in perceptions related to telehealth influence on recruitment and retention. Only access to information and communication technology significantly differed between T1 and T2 according the Wilcoxon rank test (p = 0.001). Perceived influence of telehealth on recruitment and retention was mostly explained by attitude towards telehealth, perceived effect on recruitment and retention and barriers to recruitment and retention. Based on our results, telehealth was perceived as having a positive influence but mostly indirect influence on healthcare professional recruitment and retention. Also, there were no major changes after 1 year of telehealth use.

  9. The influence of a telehealth project on healthcare professional recruitment and retention in remote areas in Mali: A longitudinal study

    PubMed Central

    Mbemba, Gisèle Irène Claudine; Bagayoko, Cheick Oumar; Gagnon, Marie-Pierre; Hamelin-Brabant, Louise; Simonyan, David A

    2016-01-01

    Objectives: The telehealth project EQUI-ResHuS (in French, Les TIC pour un accès Équitable aux Ressources Humaines en Santé) aimed to contribute to more equitable access to care and support practice in remote regions in Mali. This study explored the evolution of perceptions concerning telehealth among healthcare professionals in the four district health centres that participated in the EQUI-ResHus project and identified variables influencing their perceptions of telehealth impact on recruitment and retention of health professionals. Methods: One year after a first survey (T1), a second data collection (T2) was carried out among healthcare professionals using a 91-item questionnaire. Questions assessing telehealth use and perceptions and perceived impact on recruitment and retention of healthcare professionals were rated on a 5-point Likert scale. A total of 10 independent variables were considered for the analyses. A Wilcoxon signed-rank test was performed to detect differences between T1 and T2, and a bivariate linear regression model for repeated measures was carried out to assess the impact of independent variables on dependent variables. Results: There were no noticeable changes in perceptions related to telehealth influence on recruitment and retention. Only access to information and communication technology significantly differed between T1 and T2 according the Wilcoxon rank test (p = 0.001). Perceived influence of telehealth on recruitment and retention was mostly explained by attitude towards telehealth, perceived effect on recruitment and retention and barriers to recruitment and retention. Conclusion: Based on our results, telehealth was perceived as having a positive influence but mostly indirect influence on healthcare professional recruitment and retention. Also, there were no major changes after 1 year of telehealth use. PMID:27231552

  10. The Use of Telehealth to Reduce Inequalities in Cardiovascular Outcomes in Australia and New Zealand: A Critical Review.

    PubMed

    Wade, Victoria; Stocks, Nigel

    2017-04-01

    Telehealth, the delivery of health care services at a distance using information and communications technology, is one means of redressing inequalities in cardiovascular outcomes for disadvantaged groups in Australia. This critical review argues that there is sufficient evidence to move to larger-scale implementation of telehealth for acute cardiac, acute stroke, and cardiac rehabilitation services. For cardiovascular chronic disease and risk factor management, telehealth-based services can deliver value but the evidence is less compelling, as the outcomes of these programs are variable and depend upon the context of their implementation.

  11. Care Coordination/Home Telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions.

    PubMed

    Darkins, Adam; Ryan, Patricia; Kobb, Rita; Foster, Linda; Edmonson, Ellen; Wakefield, Bonnie; Lancaster, Anne E

    2008-12-01

    Between July 2003 and December 2007, the Veterans Health Administration (VHA) introduced a national home telehealth program, Care Coordination/Home Telehealth (CCHT). Its purpose was to coordinate the care of veteran patients with chronic conditions and avoid their unnecessary admission to long-term institutional care. Demographic changes in the veteran population necessitate VHA increase its noninstitutional care (NIC) services 100% above its 2007 level to provide care for 110,000 NIC patients by 2011. By 2011, CCHT will meet 50% of VHA's anticipated NIC provision. CCHT involves the systematic implementation of health informatics, home telehealth, and disease management technologies. It helps patients live independently at home. Between 2003 and 2007, the census figure (point prevalence) for VHA CCHT patients increased from 2,000 to 31,570 (1,500% growth). CCHT is now a routine NIC service provided by VHA to support veteran patients with chronic conditions as they age. CCHT patients are predominantly male (95%) and aged 65 years or older. Strict criteria determine patient eligibility for enrollment into the program and VHA internally assesses how well its CCHT programs meet standardized clinical, technology, and managerial requirements. VHA has trained 5,000 staff to provide CCHT. Routine analysis of data obtained for quality and performance purposes from a cohort of 17,025 CCHT patients shows the benefits of a 25% reduction in numbers of bed days of care, 19% reduction in numbers of hospital admissions, and mean satisfaction score rating of 86% after enrolment into the program. The cost of CCHT is $1,600 per patient per annum, substantially less than other NIC programs and nursing home care. VHA's experience is that an enterprise-wide home telehealth implementation is an appropriate and cost-effective way of managing chronic care patients in both urban and rural settings.

  12. Home-based exercise may not decrease the insulin resistance in individuals with metabolic syndrome.

    PubMed

    Chen, Chiao-Nan; Chuang, Lee-Ming; Korivi, Mallikarjuna; Wu, Ying-Tai

    2015-01-01

    This study investigated the differences in exercise self-efficacy, compliance, and effectiveness of home-based exercise in individuals with and without metabolic syndrome (MetS). One hundred and ten individuals at risk for diabetes participated in this study. Subjects were categorized into individuals with MetS and individuals without MetS. Metabolic risk factors and exercise self-efficacy were evaluated for all subjects before and after 3 months of home-based exercise. Univariate analysis of variance was used to compare the effectiveness of a home-based exercise program between individuals with and without MetS. The home-based exercise program improved body mass index and lipid profile in individuals at risk for diabetes, regardless of MetS status at baseline. Individuals without MetS had higher exercise self-efficacy at baseline and performed greater exercise volume compared with individuals with MetS during the intervention. The increased exercise volume in individuals without MetS may contribute to their better control of insulin resistance than individuals with MetS. Furthermore, baseline exercise self-efficacy was correlated with exercise volume executed by subjects at home. We conclude that home-based exercise programs are beneficial for individuals at risk for diabetes. However, more intensive and/or supervised exercise intervention may be needed for those with MetS.

  13. Effectiveness of a home-based exercise program on anthropometric and metabolic changes among school cooks.

    PubMed

    Mediano, Mauro Felippe Felix; de Souza, Rita Adriana Gomes; Souza, Amanda Moura; Sichieri, Rosely

    2015-12-01

    The scope of this study was to evaluate the anthropometric and metabolic changes after low intensity home-based exercise. In the school year of 2007, 95 school cooks in the city of Niteroi (State of Rio de Janeiro, Brazil) were randomly assigned to one of the following groups: home-based exercise (n = 47) or control group (n = 48). The home-based exercise program was performed three times a week, during 40 minutes at moderate intensity. Anthropometric variables were collected at the baseline and after 4 and 8 months, whereas biochemical and individual food intake were measured at the baseline and after 8 months. Energy expenditure was evaluated only at the baseline. The home-based exercise group exhibited a greater weight loss (-0.9 vs. -0.2; p = 0.05) in comparison with controls during the follow-up and the same pattern was found for BMI (-0.1 vs. +0.1; p = 0.07), although without statistical significance. Exercise showed no effects on waist circumference, lipid profile and glucose. In conclusion, greater weight loss was observed in the group that performed low intensity home-based exercise and this strategy can assist in body weight control even without alterations in terms of lipids and glucose.

  14. Economic Evidence for US Asthma Self-Management Education and Home-Based Interventions.

    PubMed

    Hsu, Joy; Wilhelm, Natalie; Lewis, Lillianne; Herman, Elizabeth

    The health and economic burden of asthma in the United States is substantial. Asthma self-management education (AS-ME) and home-based interventions for asthma can improve asthma control and prevent asthma exacerbations, and interest in health care-public health collaboration regarding asthma is increasing. However, outpatient AS-ME and home-based asthma intervention programs are not widely available; economic sustainability is a common concern. Thus, we conducted a narrative review of existing literature regarding economic outcomes of outpatient AS-ME and home-based intervention programs for asthma in the United States. We identified 9 outpatient AS-ME programs and 17 home-based intervention programs with return on investment (ROI) data. Most programs were associated with a positive ROI; a few programs observed positive ROIs only among selected populations (eg, higher health care utilization). Interpretation of existing data is limited by heterogeneous ROI calculations. Nevertheless, the literature suggests promise for sustainable opportunities to expand access to outpatient AS-ME and home-based asthma intervention programs in the United States. More definitive knowledge about how to maximize program benefit and sustainability could be gained through more controlled studies of specific populations and increased uniformity in economic assessments. Published by Elsevier Inc.

  15. Evaluation of a Telehealth Training Package to Remotely Train Staff to Conduct a Preference Assessment

    ERIC Educational Resources Information Center

    Higgins, William J.; Luczynski, Kevin C.; Carroll, Regina A.; Fisher, Wayne W.; Mudford, Oliver C.

    2017-01-01

    Recent advancements in telecommunication technologies make it possible to conduct a variety of healthcare services remotely (e.g., behavioral-analytic intervention services), thereby bridging the gap between qualified providers and consumers in isolated locations. In this study, web-based telehealth technologies were used to remotely train…

  16. Pediatric Tele-Health Consultation to Rural Schools and Clinics in the Pacific Northwest

    ERIC Educational Resources Information Center

    Sulzbacher, Stephen; Mas, Jennifer; Larson, Eric H.; Shurtleff, David B.

    2004-01-01

    The primary telehealth technology described in these articles is interactive video teleconferencing (IVTC), which allows parties at both ends of the communication to see and hear each other. The author have used this application during the past decade for consultation with rural practitioners and schools, and it has become a primary focus of our…

  17. Use of Telehealth for Research and Clinical Measures in Cochlear Implant Recipients: A Validation Study

    PubMed Central

    Hughes, Michelle L.; Goehring, Jenny L.; Baudhuin, Jacquelyn L.; Diaz, Gina R.; Sanford, Todd; Harpster, Roger; Valente, Daniel L.

    2012-01-01

    Purpose The goal of this study was to compare clinical and research-based cochlear-implant (CI) measures using telehealth versus traditional methods. Method This prospective study used an ABA design (A: laboratory, B: remote site). All measures were made twice per visit to assess within-session variability. Twenty nine adult and pediatric CI recipients participated. Measures included: electrode impedance, electrically evoked compound action potential (ECAP) thresholds, psychophysical thresholds using an adaptive procedure, map thresholds and upper comfort levels, and speech perception. Subjects completed a questionnaire at the end of the study. Results Results for all electrode-specific measures revealed no statistically significant differences between traditional and remote conditions. Speech perception was significantly poorer in the remote condition, which was likely due to the lack of a sound booth. In general, subjects indicated that they would take advantage of telehealth options at least some of the time, if it were available. Conclusions Results from this study demonstrate that telehealth is a viable option for research and clinical measures. Additional studies are needed to investigate ways to improve speech perception at remote locations that lack sound booths, and to validate the use of telehealth for pediatric services (e.g., play audiometry), sound-field threshold testing, and troubleshooting equipment. PMID:22232388

  18. 77 FR 13195 - Exempting In-Home Video Telehealth From Copayments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-06

    ...), Traumatic Brain Injury (TBI) and Multiple Sclerosis (MS). Clinical video telehealth uses real-time... wound management, psychiatric or psychotherapeutic care, exercise plans, and medication management. The.... VA will consider such comments in developing a subsequent final rule. Effect of Rulemaking Title...

  19. Telehealth tools for public health, emergency, or disaster preparedness and response: a summary report.

    PubMed

    Alverson, Dale C; Edison, Karen; Flournoy, Larry; Korte, Brenda; Magruder, Charles; Miller, Craig

    2010-01-01

    Rapid advances in telehealth development and adoption are increasing the spectrum of information and communication technologies that can be applied not only to individual patient care but more broadly to population health as well. Participants in this breakout session were asked to address, from their diverse perspectives, a series of questions relating to the current and potential uses of telehealth applications and networks for public health and emergency/disaster preparedness and response systems. Participants identified several gaps in current understanding and research emphasis. There is a clear need for more and larger outcome studies to assess the impact and cost benefit of telehealth applications in terms of improving public health at the population and community levels. In addition, more research is needed to demonstrate the ability of telehealth tools and technologies to facilitate and extend the reach of major national clinical and public health research initiatives. Perhaps most importantly, the National Institutes of Health should develop and/or strengthen strategic partnerships with other funding agencies with overlapping or complementary interests to accelerate interdisciplinary research in this rapidly evolving but relatively understudied and complex field.

  20. Current Clinical Status of Telehealth in Korea: Categories, Scientific Basis, and Obstacles

    PubMed Central

    Kim, Hun-Sung; Kim, Hyunah; Lee, Suehyun; Lee, Kye Hwa

    2015-01-01

    Objectives Through telehealth, medical services have expanded beyond spatial boundaries and are now available in living spaces outside of hospitals. It can also contribute to patient medical knowledge improvement because patients can access their hospital records and data from home. However, concepts of telehealth are rather vague in Korea. Methods We refer to several clinical reports to determine the current clinical status of and obstacles to telehealth in Korea. Results Patients' health conditions are now reported regularly to doctors remotely, and patients can receive varied assistance. Self-improvement based on minute details that are beyond medical staff's reach is another possible benefit that may be realized with the help of a variety of medical equipment (sensors). The feasibility, clinical effect, and cost-benefit of telehealth have been verified by scientific evidence. Conclusions Patients will be able to improve their treatment adherence by receiving help from various professionals, such as doctors, nurses, nutritionists, and sports therapists. This means that the actual treatment time per patient will increase as well. Ultimately, this will increase the quality of patients' self-administration of care to impede disease progression and prevent complications. PMID:26618030

  1. Utilization of Telehealth Technology to Develop and Implement a Comprehensive Management Initiative for Chronic Diseases

    DTIC Science & Technology

    2012-10-01

    alone or in various combinations . The program indicates which dose or doses of medications should be increased or decreased, when there has been... combined best educational practices with telehealth technology offered a promising solution to this problem. Thus, the CMICD evaluated the... combination of poor access to and compliance with periodic eye examinations that target early detection of sight- threatening eye disease. Even in

  2. Telehealth: New Directions and Technology for Health Care Delivery in the Schools.

    ERIC Educational Resources Information Center

    Miller, Thomas W.

    Advances in technology and health care delivery have included the use of telemedicine and telepsychology for crisis intervention, assessment, treatment, and education of patients. The use of telemedicine and telepsychology is examined for a variety of health care services to rural America. Telehealth has been considered a partial solution to the…

  3. Steps to Offering Low Vision Rehabilitation Services through Clinical Video Telehealth

    ERIC Educational Resources Information Center

    Ihirig, Carolyn

    2016-01-01

    Telehealth clinical applications, which allow medical professionals to use telecommunications technologies to provide services to individuals remotely, continue to expand in areas such as low vision rehabilitation, where evaluations are provided to patients who live in rural areas. As with face-to-face low vision rehabilitation, the goal of…

  4. Telehealth interventions to reduce management complications in type 1 diabetes: A review.

    PubMed

    Balkhi, Amanda M; Reid, Adam M; Westen, Sarah C; Olsen, Brian; Janicke, David M; Geffken, Gary R

    2015-04-15

    Type 1 diabetes is a chronic illness with a high burden of care. While effective interventions and recommendations for diabetes care exist, the intensive nature of diabetes management makes compliance difficult. This is especially true in children and adolescents as they have unique psychosocial and diabetes needs. Despite the development of effective in-person interventions targeting improving self-management and ameliorating psychosocial difficulties there are still a number of barriers to implementing these interventions, namely time, cost, and access. Telehealth interventions allow for the dissemination of these interventions to a broader audience. Self-management and psychosocial telehealth interventions are reviewed with a special emphasis on mobile phone and internet based technology use. While efficacy has been demonstrated in a number of telehealth interventions with improved cost effectiveness over in-person interventions, many challenges remain including high participant attrition and difficulties with receiving reimbursement for services rendered. These and other challenges are discussed with recommendations for researchers and telehealth providers provided.

  5. Pediatric Tele-Health Consultation to Rural Schools and Clinics in the Pacific Northwest

    ERIC Educational Resources Information Center

    Sulzbacher, Stephen; Mas, Jennifer; Larson, Eric H.; Shurtleff, David B.

    2004-01-01

    The primary telehealth technology described in these articles is interactive video teleconferencing (IVTC), which allows parties at both ends of the communication to see and hear each other. The author have used this application during the past decade for consultation with rural practitioners and schools, and it has become a primary focus of our…

  6. Telehealth--an effective delivery method for diabetes self-management education?

    PubMed

    Fitzner, Karen; Moss, Gail

    2013-06-01

    Diabetes is a chronic disease that is often comorbid with cardiovascular disease, hypertension, kidney disease, and neuropathy. Its management is complex, requiring ongoing clinical management, lifestyle changes, and self-care. This article examines recent literature on telehealth and emerging technological tools for supporting self-management of diabetes and identifies best practices. The authors conducted a PubMed search (January 2008-2012) that was supplemented by review of meeting materials and a scan of the Internet to identify emerging technologies. Fifty-eight papers were reviewed; 12 were selected for greater analysis. This review supports earlier findings that the delivery of diabetes self-management and training (DSME/T) via telehealth is useful, appropriate, and acceptable to patients and providers. Best practices are emerging; not all technology is appropriate for all populations--interactive technology needs to be appropriate to the patient's age, abilities, and sensitivities. Telehealth is scalable and sustainable provided that it adds value, does not add to the provider's workload, and is fairly reimbursed. However, there are multiple barriers (patient, provider, health system) to remotely provided DSME/T. DSME/T delivered via telehealth offers effective, efficient, and affordable ways to reach and support underserved minorities and other people with diabetes and related comorbidities. The new generation of smartphones, apps, and other technologies increase access, and the newest interventions are designed to meet patient needs, do not increase workloads, are highly appropriate, enhance self-management, and are desired by patients.

  7. Use of Telehealth for Research and Clinical Measures in Cochlear Implant Recipients: A Validation Study

    ERIC Educational Resources Information Center

    Hughes, Michelle L.; Goehring, Jenny L.; Baudhuin, Jacquelyn L.; Diaz, Gina R.; Sanford, Todd; Harpster, Roger; Valente, Daniel L.

    2012-01-01

    Purpose: The goal of this study was to compare clinical and research-based cochlear implant (CI) measures using telehealth versus traditional methods. Method: This prospective study used an ABA design (A = laboratory, B = remote site). All measures were made twice per visit for the purpose of assessing within-session variability. Twenty-nine adult…

  8. Communication Intervention for Young Children with Severe Neurodevelopmental Disabilities via Telehealth

    ERIC Educational Resources Information Center

    Simacek, Jessica; Dimian, Adele F.; McComas, Jennifer J.

    2017-01-01

    Young children with neurodevelopmental disorders such as autism spectrum disorders (ASD) and Rett syndrome often experience severe communication impairments. This study examined the efficacy of parent-implemented communication assessment and intervention with remote coaching via telehealth on the acquisition of early communication skills of three…

  9. Development of Standardized Clinical Training Cases for Diagnosis of Sexual Abuse using a Secure Telehealth Application

    ERIC Educational Resources Information Center

    Frasier, Lori D.; Thraen, Ioana; Kaplan, Rich; Goede, Patricia

    2012-01-01

    Objectives: The training of physicians, nurse examiners, social workers and other health professional on the evidentiary findings of sexual abuse in children is challenging. Our objective was to develop peer reviewed training cases for medical examiners of child sexual abuse, using a secure web based telehealth application (TeleCAM). Methods:…

  10. The Nature and Requirements of Work in University-Based Telehealth Units: A Qualitative Study

    ERIC Educational Resources Information Center

    Seale, Deborah E.

    2013-01-01

    Telehealth units are one of many university administrative units created to foster innovation in universities over the last 40 years. Despite the proliferation of such units, few organizational studies have examined the work undertaken inside of these units. This qualitative study used a sequential two-part research design to understand the…

  11. Telehealth: New Directions and Technology for Health Care Delivery in the Schools.

    ERIC Educational Resources Information Center

    Miller, Thomas W.

    Advances in technology and health care delivery have included the use of telemedicine and telepsychology for crisis intervention, assessment, treatment, and education of patients. The use of telemedicine and telepsychology is examined for a variety of health care services to rural America. Telehealth has been considered a partial solution to the…

  12. Preliminary Findings of a Telehealth Approach to Parent Training in Autism

    ERIC Educational Resources Information Center

    Vismara, Laurie A.; McCormick, Carolyn; Young, Gregory S.; Nadhan, Anna; Monlux, Katerina

    2013-01-01

    Telehealth or online communication technologies may lessen the gap between intervention requirements for children with autism spectrum disorders (ASDs) and the available resources to provide these services. This study used a video conferencing and self-guided website to provide parent training in the homes of children with ASD. The first eight…

  13. Use of Telehealth for Research and Clinical Measures in Cochlear Implant Recipients: A Validation Study

    ERIC Educational Resources Information Center

    Hughes, Michelle L.; Goehring, Jenny L.; Baudhuin, Jacquelyn L.; Diaz, Gina R.; Sanford, Todd; Harpster, Roger; Valente, Daniel L.

    2012-01-01

    Purpose: The goal of this study was to compare clinical and research-based cochlear implant (CI) measures using telehealth versus traditional methods. Method: This prospective study used an ABA design (A = laboratory, B = remote site). All measures were made twice per visit for the purpose of assessing within-session variability. Twenty-nine adult…

  14. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments.

    PubMed

    Langabeer, James R; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

    2016-11-01

    Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system's capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P<.001). EMS productivity (median time from EMS notification to unit back in service) was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median). There were no statistically significant differences in mortality or patient satisfaction. We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.

  15. The Effect of Technology and Testing Environment on Speech Perception Using Telehealth with Cochlear Implant Recipients

    ERIC Educational Resources Information Center

    Goehring, Jenny L.; Hughes, Michelle L.; Baudhuin, Jacquelyn L.; Valente, Daniel L.; McCreery, Ryan W.; Diaz, Gina R.; Sanford, Todd; Harpster, Roger

    2012-01-01

    Purpose: In this study, the authors evaluated the effect of remote system and acoustic environment on speech perception via telehealth with cochlear implant recipients. Method: Speech perception was measured in quiet and in noise. Systems evaluated were Polycom visual concert (PVC) and a hybrid presentation system (HPS). Each system was evaluated…

  16. A systematic review of telehealth tools and interventions to support family caregivers

    PubMed Central

    Chi, Nai-Ching; Demiris, George

    2015-01-01

    Summary We conducted a systematic review of studies employing telehealth interventions which focused on family caregivers’ outcomes. The Embase, CINHAL, Cochrane and PubMed databases were searched using combinations of keywords including “telehealth,” “telemedicine,” “telecare,” “telemonitoring,” “caregiver” and “family.” The initial search produced 4205 articles, of which 65 articles met the inclusion criteria. The articles included 52 experimental studies, 11 evaluation studies, one case study and one secondary analysis. Thirty-three articles focused on family caregivers of adult and older patients, while 32 articles focused on parental caregivers of paediatric patients. The technologies included video, web-based, telephone-based and telemetry/remote monitoring. Six main categories of interventions were delivered via technology: education, consultation (including decision support), psychosocial/cognitive behavioural therapy (including problem solving training), social support, data collection and monitoring, and clinical care delivery. More than 95% of the studies reported significant improvements in the caregivers’ outcomes and that caregivers were satisfied and comfortable with telehealth. The review showed that telehealth can positively affect chronic disease care, home and hospice care. PMID:25475220

  17. The Effect of Technology and Testing Environment on Speech Perception Using Telehealth with Cochlear Implant Recipients

    ERIC Educational Resources Information Center

    Goehring, Jenny L.; Hughes, Michelle L.; Baudhuin, Jacquelyn L.; Valente, Daniel L.; McCreery, Ryan W.; Diaz, Gina R.; Sanford, Todd; Harpster, Roger

    2012-01-01

    Purpose: In this study, the authors evaluated the effect of remote system and acoustic environment on speech perception via telehealth with cochlear implant recipients. Method: Speech perception was measured in quiet and in noise. Systems evaluated were Polycom visual concert (PVC) and a hybrid presentation system (HPS). Each system was evaluated…

  18. Maugeri Centre for Telehealth and Telecare: A real-life integrated experience in chronic patients.

    PubMed

    Scalvini, Simonetta; Bernocchi, Palmira; Zanelli, Emanuela; Comini, Laura; Vitacca, Michele

    2017-01-01

    Management of chronic diseases in a progressively aging population is a major issue in western industrialized countries and telehealth is one way to ensure the continuity of care in chronic illness. We describe here our personal experience in a telehealth and telecare centre in Italy. Between January 2000 and December 2015, 1635 elderly patients (71% male) with one or more comorbidities have undergone a telehealth program tailored to their specific disease: chronic obstructive pulmonary disease (COPD)/chronic respiratory insufficiency; amyotrophic lateral sclerosis/neuromuscular diseases; chronic heart failure (CHF); post-stroke; and post-cardiac surgery patients discharged from hospital after an acute event. COPD and CHF represent the majority of patients treated (accounting for 80%). Interventions performed by the nurse tutor account for 39-82% of all activities in the five different programs. Specialist second opinion represents 12-27% of the health staff activities. Previously reported results show a reduction of the re-hospitalization rate and costs, and increase in quality of life and patient satisfaction with the service. A multidisciplinary telehealth and telecare integrated approach can provide efficient management for the growing number of complex patients.

  19. The Nature and Requirements of Work in University-Based Telehealth Units: A Qualitative Study

    ERIC Educational Resources Information Center

    Seale, Deborah E.

    2013-01-01

    Telehealth units are one of many university administrative units created to foster innovation in universities over the last 40 years. Despite the proliferation of such units, few organizational studies have examined the work undertaken inside of these units. This qualitative study used a sequential two-part research design to understand the…

  20. Utilization of Telehealth Technology to Develop and Implement a Comprehensive Management Initiative for Chronic Diseases

    DTIC Science & Technology

    2009-10-21

    age adults, yet it is largely preventable with timely diagnosis and treatment ( Diabetic Retinopathy Study Research Group, 1981; Early Treatment ...macular edema, the telehealth eye care assessments agree substantially with mydriatic seven-standard field Early Treatment Diabetic Retinopathy...with Early Treatment Diabetic Retinopathy Study seven standard field 35-mm stereo color photos for determining level of diabetic retinopathy

  1. 77 FR 50549 - Agency Information Collection: Emergency Submission for OMB Review (Telehealth in the Parkinson's...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-21

    ... Disease Research, Education and Clinical Center (PADRECC): The Key to the Patient-Centered Medical Home... ``Telehealth in the Parkinson's Disease Research, Education and Clinical Center (PADRECC): The Key to the Patient-Centered Medical Home?'', VA Form 10-0533. b. Geriatric Depression Scale (GDS) Short Form, VA...

  2. Controversy clarified: an updated review of clinical psychology and tele-health.

    PubMed

    Perle, Jonathan G; Langsam, Leah C; Nierenberg, Barry

    2011-12-01

    One of the most controversial topics in the field of clinical psychology, online tele-health, or the integration of computers and the internet with therapeutic techniques, remains at the forefront of many debates. Despite potential interest, there are numerous factors that a psychologist must consider before integrating an online tele-health intervention into their own practice. This article outlines literature pertinent to the debate. The article begins with a brief history of the use of non-face-to-face interventions as well as the earliest recorded use of "tele-health" before discussing the modern benefits and risks associated with usage. Considerations for the psychologist as well as the client are detailed; incorporating ethical implications. The authors conclude that the utilization of tele-health interventions is an exponentially expanding field that should continue to be explored. Despite many well-conceived studies, a psychologist should educate themselves in all aspects of the new modes of intervention (e.g., ethical, legal, evidence-based treatments) before attempting to implement them into everyday practice. The article ends with a discussion on the acceptance among psychologists, as well as the outlook for the future. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. 78 FR 76193 - Agency Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-16

    ... AFFAIRS Agency Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction... (CCHT) Patient Satisfaction Survey, VA Form 10-0481. Type of Review: Extension of a currently approved..., (Regulation on Reduction of Nursing Shortages in State Homes; Application for Assistance for Hiring and...

  4. Telehealth interventions to reduce management complications in type 1 diabetes: A review

    PubMed Central

    Balkhi, Amanda M; Reid, Adam M; Westen, Sarah C; Olsen, Brian; Janicke, David M; Geffken, Gary R

    2015-01-01

    Type 1 diabetes is a chronic illness with a high burden of care. While effective interventions and recommendations for diabetes care exist, the intensive nature of diabetes management makes compliance difficult. This is especially true in children and adolescents as they have unique psychosocial and diabetes needs. Despite the development of effective in-person interventions targeting improving self-management and ameliorating psychosocial difficulties there are still a number of barriers to implementing these interventions, namely time, cost, and access. Telehealth interventions allow for the dissemination of these interventions to a broader audience. Self-management and psychosocial telehealth interventions are reviewed with a special emphasis on mobile phone and internet based technology use. While efficacy has been demonstrated in a number of telehealth interventions with improved cost effectiveness over in-person interventions, many challenges remain including high participant attrition and difficulties with receiving reimbursement for services rendered. These and other challenges are discussed with recommendations for researchers and telehealth providers provided. PMID:25897348

  5. Home Telehealth for Patients With Chronic Obstructive Pulmonary Disease (COPD)

    PubMed Central

    Franek, J

    2012-01-01

    Executive Summary In July 2010, the Medical Advisory Secretariat (MAS) began work on a Chronic Obstructive Pulmonary Disease (COPD) evidentiary framework, an evidence-based review of the literature surrounding treatment strategies for patients with COPD. This project emerged from a request by the Health System Strategy Division of the Ministry of Health and Long-Term Care that MAS provide them with an evidentiary platform on the effectiveness and cost-effectiveness of COPD interventions. After an initial review of health technology assessments and systematic reviews of COPD literature, and consultation with experts, MAS identified the following topics for analysis: vaccinations (influenza and pneumococcal), smoking cessation, multidisciplinary care, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation for acute and chronic respiratory failure, hospital-at-home for acute exacerbations of COPD, and telehealth (including telemonitoring and telephone support). Evidence-based analyses were prepared for each of these topics. For each technology, an economic analysis was also completed where appropriate. In addition, a review of the qualitative literature on patient, caregiver, and provider perspectives on living and dying with COPD was conducted, as were reviews of the qualitative literature on each of the technologies included in these analyses. The Chronic Obstructive Pulmonary Disease Mega-Analysis series is made up of the following reports, which can be publicly accessed at the MAS website at: http://www.hqontario.ca/en/mas/mas_ohtas_mn.html. Chronic Obstructive Pulmonary Disease (COPD) Evidentiary Framework Influenza and Pneumococcal Vaccinations for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Smoking Cessation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Community-Based Multidisciplinary Care for Patients With Stable Chronic Obstructive

  6. Risk management and clinical governance for complex home-based health care.

    PubMed

    Lewis, Mary; Noyes, Jane

    2007-07-01

    Healthcare professionals have an obligation to enable children with complex needs to lead 'ordinary lives' at home but the views of professionals and family members often diverge in relation to the management of risks. Nurses are increasingly taking on the clinical responsibility for children with complex needs within a multidisciplinary, multi-agency team, yet have little training or experience in adapting risk management and clinical governance frameworks to home-based settings. Risk management frameworks for home-based care for children with complex health and social care needs are introduced in this article. Best practice guidance and resources for adapting risk management frameworks are presented to meet this identified gap in knowledge and experience. Children, young people and their parents have increasing expectations relating to the type and quality of home-based support they receive. Developing and applying clinical governance and risk management frameworks are part of improving outcomes for children with complex needs and their families.

  7. House Calls: The Impact of Home-Based Care for Older Adults With Alzheimer's and Dementia.

    PubMed

    Wilson, Kasey; Bachman, Sara S

    2015-01-01

    Older adults with Alzheimer's/dementia have high health care costs; they may benefit from home-based care, but few have home visits. This article describes a home-based care program for frail elders, including those with Alzheimer's/dementia. Descriptive statistics are provided for Medicare-enrolled program participants and matched controls with Alzheimer's/dementia on expenditures along six services: skilled nursing facility, inpatient acute, physician, home health, hospice, and social services. Cases with dementia were significantly more likely to have home health and hospice expenditures than controls, suggesting potential for the program to improve end-of-life care. Very few cases or controls had any social service expenditures. Social workers should advocate for the expanded role of home-based care for older adults with dementia and for increased Medicare reimbursement of social work services.

  8. Exercise therapy for claudication: Should home-based exercise therapy be prescribed in clinical practice?

    PubMed

    Lindo, Fae A

    2015-12-01

    Peripheral artery disease is a cause of morbidity and mortality in the United States. The literature suggests evidence that an exercise program can be beneficial in the treatment of patients with claudication. Supervised exercise therapy is well documented in the literature, and national guidelines recommend it as an initial conservative management. When a supervised exercise program is unavailable or not covered by insurance, an alternative to supervised exercise is vital. The purpose of this review is to examine the evidence regarding the efficacy of a home-based exercise program. Four studies were included in this review, and although the evidence supporting a home-based exercise program is limited in the literature, the findings indicate that a home-based exercise program increases claudication onset time, resulting in greater mobility and improvement in the patient's quality of life.

  9. Improving patient access to specialized health care: the Telehealth Network of Minas Gerais, Brazil

    PubMed Central

    Alkmim, Maria Beatriz; Figueira, Renato Minelli; Marcolino, Milena Soriano; Cardoso, Clareci Silva; Pena de Abreu, Monica; Cunha, Lemuel Rodrigues; da Cunha, Daniel Ferreira; Antunes, Andre Pires; de A Resende, Adélson Geraldo; Resende, Elmiro Santos

    2012-01-01

    Abstract Problem The Brazilian population lacks equitable access to specialized health care and diagnostic tests, especially in remote municipalities, where health professionals often feel isolated and staff turnover is high. Telehealth has the potential to improve patients’ access to specialized health care, but little is known about it in terms of cost-effectiveness, access to services or user satisfaction. Approach In 2005, the State Government of Minas Gerais, Brazil, funded the establishment of the Telehealth Network, intended to connect university hospitals with the state’s remote municipal health departments; support professionals in providing tele-assistance; and perform tele-electrocardiography and teleconsultations. The network uses low-cost equipment and has employed various strategies to overcome the barriers to telehealth use. Local setting The Telehealth Network connects specialists in state university hospitals with primary health-care professionals in 608 municipalities of the large state of Minas Gerais, many of them in remote areas. Relevant changes From June 2006 to October 2011, 782 773 electrocardiograms and 30 883 teleconsultations were performed through the network, and 6000 health professionals were trained in its use. Most of these professionals (97%) were satisfied with the system, which was cost-effective, economically viable and averted 81% of potential case referrals to distant centres. Lessons learnt To succeed, a telehealth service must be part of a collaborative network, meet the real needs of local health professionals, use simple technology and have at least some face-to-face components. If applied to health problems for which care is in high demand, this type of service can be economically viable and can help to improve patient access to specialized health care. PMID:22589571

  10. Telehealth to Expand Community Health Nurse Education in Rural Guatemala: A Pilot Feasibility and Acceptability Evaluation

    PubMed Central

    McConnell, Kelly A.; Krisher, Lyndsay K.; Lenssen, Maureen; Bunik, Maya; Bunge Montes, Saskia; Domek, Gretchen J.

    2017-01-01

    Telehealth education has the potential to serve as an important, low-cost method of expanding healthcare worker education and support, especially in rural settings of low- and middle-income countries. We describe an innovative educational strategy to strengthen a long-term health professional capacity building partnership between Guatemalan and US-based partners. In this pilot evaluation, community health nurses in rural Guatemala received customized, interactive education via telehealth from faculty at the supporting US-based institution. Program evaluation of this 10 lecture series demonstrated high levels of satisfaction among learners and instructors as well as knowledge gain by learners. An average of 5.5 learners and 2 instructors attended the 10 lectures and completed surveys using a Likert scale to rate statements regarding lecture content, technology, and personal connection. Positive statements about lecture content and the applicability to daily work had 98% or greater agreement as did statements regarding ease of technology and convenience. The learners agreed with feeling connected to the instructors 100% of the time, while instructors had 86.4% agreement with connection related statements. Instructors, joining at their respective work locations, rated convenience statements at 100% agreement. This evaluation also demonstrated effectiveness with an average 10.7% increase in pre- to posttest knowledge scores by learners. As the global health community considers efficiency in time, money, and our environment, telehealth education is a critical method to consider and develop for health worker education. Our pilot program evaluation shows that telehealth may be an effective method of delivering education to frontline health workers in rural Guatemala. While larger studies are needed to quantify the duration and benefits of specific knowledge gains and to perform a cost-effectiveness analysis of the program, our initial pilot results are encouraging and

  11. Implementation of telehealth support for patients with type 2 diabetes using insulin treatment: an exploratory study.

    PubMed

    Turner, Jane; Larsen, Mark; Tarassenko, Lionel; Neil, Andrew; Farmer, Andrew

    2009-01-01

    Initiating and adjusting insulin treatment for people with type 2 diabetes (T2D) requires frequent clinician contacts both face-to-face and by telephone. We explored the use of a telehealth system to offer additional support to these patients. Twenty-three patients with uncontrolled T2D were recruited from nine general practices to assess the feasibility and acceptability of telehealth monitoring and support for insulin initiation and adjustment. The intervention included a standard algorithm for self-titration of insulin dose, a Bluetooth enabled glucose meter linked to a mobile phone, an integrated diary to record insulin dose, feedback of charted blood glucose data and telehealth nurse review with telephone follow-up. Additional contact with patients was initiated when no readings were transmitted for >3 days or when persistent hyper- or hypoglycaemia was identified. Reponses of patients and clinicians to the system were assessed informally. The mean (SD) patient age was 58 years (12) with 78% male. The mean (SD) diabetes duration was 6.4 years (4.5), HbA1c at baseline was 9.5% (2.2), and the decrease in HbA1c at three months was 0.52% (0.91) with an insulin dose increase of 9 units (26). A mean (SD) of 160 (93) blood glucose readings was transmitted per patient in these three months. Practice nurses and general practitioners (GPs) viewed the technology as having the potential to improve patient care. Most patients were able to use the equipment with training and welcomed review of their blood glucose readings by a telehealth nurse. Although the concept of telehealth monitoring is unfamiliar to most patients and practice nurses, the technology improved the support available for T2D patients commencing insulin treatment.

  12. Developing Next-Generation Telehealth Tools and Technologies: Patients, Systems, and Data Perspectives

    PubMed Central

    Filart, Rosemarie; Burgess, Lawrence P.; Lee, Insup; Poropatich, Ronald K.

    2010-01-01

    Abstract The major goals of telemedicine today are to develop next-generation telehealth tools and technologies to enhance healthcare delivery to medically underserved populations using telecommunication technology, to increase access to medical specialty services while decreasing healthcare costs, and to provide training of healthcare providers, clinical trainees, and students in health-related fields. Key drivers for these tools and technologies are the need and interest to collaborate among telehealth stakeholders, including patients, patient communities, research funders, researchers, healthcare services providers, professional societies, industry, healthcare management/economists, and healthcare policy makers. In the development, marketing, adoption, and implementation of these tools and technologies, communication, training, cultural sensitivity, and end-user customization are critical pieces to the process. Next-generation tools and technologies are vehicles toward personalized medicine, extending the telemedicine model to include cell phones and Internet-based telecommunications tools for remote and home health management with video assessment, remote bedside monitoring, and patient-specific care tools with event logs, patient electronic profile, and physician note-writing capability. Telehealth is ultimately a system of systems in scale and complexity. To cover the full spectrum of dynamic and evolving needs of end-users, we must appreciate system complexity as telehealth moves toward increasing functionality, integration, interoperability, outreach, and quality of service. Toward that end, our group addressed three overarching questions: (1) What are the high-impact topics? (2) What are the barriers to progress? and (3) What roles can the National Institutes of Health and its various institutes and centers play in fostering the future development of telehealth? PMID:20043711

  13. Accuracy of Telehealth-Administered Measures to Screen Language in Spanish-Speaking Preschoolers

    PubMed Central

    Rodríguez, Barbara L.; Zajacova, Anna

    2015-01-01

    Abstract Introduction: There is a critical need for telehealth language screening measures for use with Spanish-speaking children because of the shortage of bilingual providers and the current lack of psychometrically sound measures that can be administered via telehealth. The purpose of the current study was to describe the classification accuracy of individual telehealth language screening measures as well as the accuracy of combinations of measures used with Spanish-speaking preschoolers from rural and underserved areas of the country. Materials and Methods: This study applied a hybrid telehealth approach that implemented synchronous videoconferencing, videocasting, and traditional pen and paper measures. Screening measures included a processing efficiency measure (Spanish nonword repetition [NWR]), language sampling, and a developmental language questionnaire. Eighty-two mostly Spanish-speaking preschool-age children and their parents participated. Thirty-four children had language impairment (LI), and 48 had typical language development. Results: Although many of the individual measures were significantly associated with standardized language scores (r=0.27–0.55), not one of the measures had classification values of 0.8 or higher, which is recommended when screening for LI. However, when NWR scores were combined with language sample or parent survey measures, promising classification accuracy values that approached or were higher than 0.8 were obtained. Conclusions: This research provides preliminary evidence showing the effectiveness of a hybrid telehealth model in screening the language development of Spanish-speaking children. A processing efficiency measure, NWR, combined with a parent survey or language sample measure can provide informative and accurate diagnostic information when screening Spanish-speaking preschool-age children for LI. PMID:25942401

  14. Accuracy of Telehealth-Administered Measures to Screen Language in Spanish-Speaking Preschoolers.

    PubMed

    Guiberson, Mark; Rodríguez, Barbara L; Zajacova, Anna

    2015-09-01

    There is a critical need for telehealth language screening measures for use with Spanish-speaking children because of the shortage of bilingual providers and the current lack of psychometrically sound measures that can be administered via telehealth. The purpose of the current study was to describe the classification accuracy of individual telehealth language screening measures as well as the accuracy of combinations of measures used with Spanish-speaking preschoolers from rural and underserved areas of the country. This study applied a hybrid telehealth approach that implemented synchronous videoconferencing, videocasting, and traditional pen and paper measures. Screening measures included a processing efficiency measure (Spanish nonword repetition [NWR]), language sampling, and a developmental language questionnaire. Eighty-two mostly Spanish-speaking preschool-age children and their parents participated. Thirty-four children had language impairment (LI), and 48 had typical language development. Although many of the individual measures were significantly associated with standardized language scores (r=0.27-0.55), not one of the measures had classification values of 0.8 or higher, which is recommended when screening for LI. However, when NWR scores were combined with language sample or parent survey measures, promising classification accuracy values that approached or were higher than 0.8 were obtained. This research provides preliminary evidence showing the effectiveness of a hybrid telehealth model in screening the language development of Spanish-speaking children. A processing efficiency measure, NWR, combined with a parent survey or language sample measure can provide informative and accurate diagnostic information when screening Spanish-speaking preschool-age children for LI.

  15. Telehealth Measures Screening for Developmental Language Disorders in Spanish-Speaking Toddlers.

    PubMed

    Guiberson, Mark

    2016-09-01

    This is the second of two studies that described the use of telehealth language screening measures for use with young Spanish-speaking children. The purpose of this study was to describe the classification accuracy of individual telehealth language screening measures as well as the accuracy of combinations of measures used with Spanish-speaking toddler-age children from rural and underserved areas of the country. This study applied an asynchronous hybrid telehealth approach that implemented parent-structured play activities with a standard set of stimuli, and interaction with a My First Words e-book. These interactions were recorded with a mini camcorder. In addition, a traditional pen and paper parent questionnaire measure was collected. Sixty-two mostly Spanish-speaking preschool-age children and their parents participated. Twenty-two children had developmental language disorders (DLDs) and 40 had typical language development. Although several of the individual measures were significantly and strongly associated with standardized language scores, only reported vocabulary had classification accuracy values that were desirable for screening for DLDs. An improvement was observed when reported vocabulary was combined with a number of different words children produced during interactions with parents. This research provides additional evidence showing the effectiveness of a hybrid telehealth model in screening the language development of Spanish-speaking children. More specifically, reported vocabulary combined with number of different words produced by a child can provide informative and accurate diagnostic information when screening Spanish-speaking toddler-age children for DLDs. These findings replicate the first study in showing that hybrid telehealth approaches that combine the use of video technology and traditional pen and paper surveys yield strong results, and may be a viable screening alternative when face-to-face access to a bilingual provider is not

  16. Telehealth distance education course in Latin America: analysis of an experience involving 15 countries.

    PubMed

    dos Santos, Alaneir de Fátima; Alves, Humberto José; Nogueira, Janaina Teixeira; Torres, Rosoália Mpraes; Melo, Maria do Carmo Barros

    2014-08-01

    Telehealth activities are already going on in many Latin American countries. This article aims to present and evaluate a distance learning telehealth training course in the region. This was a cross-sectional descriptive study. A coordinating committee was formed, composed of medical school faculty from 15 countries, which defined the course's syllabus, teaching model, and mentoring structure. A questionnaire was prepared, using a Likert scale, in order to verify if the parameters of gender, age, professional category, postgraduate degree, and experience in distance education indicated any difference in relation to the course evaluation. The responses were analyzed by chi-squared test, considering as significant a value of p<0.05. Of the 353 enrolled participants, 251 (71.10%) did the basic modules, and 96 (43.91%) completed the full training. In relation to the overall course assessment, it was considered excellent or good by 80.92% of participants, the mentors received positive evaluations by 72.83% of students, the course content was evaluated as excellent or good by 87.4% of students, and 94.40% of participants would recommend it. As for the parameters assessed, only experience in distance education was statistically significant for the evaluation of the tutors. The results presented indicate an important concern on the part of the Latin American countries participating on the course in relation to telehealth training activities. Regarding course assessment, high approval rates in relation to tutoring, educational model, course content, and goals were noted, corroborating literature data. The experience of conducting a Latin American shared telehealth training course was indeed positive, contributing to the development of telehealth actions.

  17. Telehealth to Expand Community Health Nurse Education in Rural Guatemala: A Pilot Feasibility and Acceptability Evaluation.

    PubMed

    McConnell, Kelly A; Krisher, Lyndsay K; Lenssen, Maureen; Bunik, Maya; Bunge Montes, Saskia; Domek, Gretchen J

    2017-01-01

    Telehealth education has the potential to serve as an important, low-cost method of expanding healthcare worker education and support, especially in rural settings of low- and middle-income countries. We describe an innovative educational strategy to strengthen a long-term health professional capacity building partnership between Guatemalan and US-based partners. In this pilot evaluation, community health nurses in rural Guatemala received customized, interactive education via telehealth from faculty at the supporting US-based institution. Program evaluation of this 10 lecture series demonstrated high levels of satisfaction among learners and instructors as well as knowledge gain by learners. An average of 5.5 learners and 2 instructors attended the 10 lectures and completed surveys using a Likert scale to rate statements regarding lecture content, technology, and personal connection. Positive statements about lecture content and the applicability to daily work had 98% or greater agreement as did statements regarding ease of technology and convenience. The learners agreed with feeling connected to the instructors 100% of the time, while instructors had 86.4% agreement with connection related statements. Instructors, joining at their respective work locations, rated convenience statements at 100% agreement. This evaluation also demonstrated effectiveness with an average 10.7% increase in pre- to posttest knowledge scores by learners. As the global health community considers efficiency in time, money, and our environment, telehealth education is a critical method to consider and develop for health worker education. Our pilot program evaluation shows that telehealth may be an effective method of delivering education to frontline health workers in rural Guatemala. While larger studies are needed to quantify the duration and benefits of specific knowledge gains and to perform a cost-effectiveness analysis of the program, our initial pilot results are encouraging and

  18. Developing next-generation telehealth tools and technologies: patients, systems, and data perspectives.

    PubMed

    Ackerman, Michael J; Filart, Rosemarie; Burgess, Lawrence P; Lee, Insup; Poropatich, Ronald K

    2010-01-01

    The major goals of telemedicine today are to develop next-generation telehealth tools and technologies to enhance healthcare delivery to medically underserved populations using telecommunication technology, to increase access to medical specialty services while decreasing healthcare costs, and to provide training of healthcare providers, clinical trainees, and students in health-related fields. Key drivers for these tools and technologies are the need and interest to collaborate among telehealth stakeholders, including patients, patient communities, research funders, researchers, healthcare services providers, professional societies, industry, healthcare management/economists, and healthcare policy makers. In the development, marketing, adoption, and implementation of these tools and technologies, communication, training, cultural sensitivity, and end-user customization are critical pieces to the process. Next-generation tools and technologies are vehicles toward personalized medicine, extending the telemedicine model to include cell phones and Internet-based telecommunications tools for remote and home health management with video assessment, remote bedside monitoring, and patient-specific care tools with event logs, patient electronic profile, and physician note-writing capability. Telehealth is ultimately a system of systems in scale and complexity. To cover the full spectrum of dynamic and evolving needs of end-users, we must appreciate system complexity as telehealth moves toward increasing functionality, integration, interoperability, outreach, and quality of service. Toward that end, our group addressed three overarching questions: (1) What are the high-impact topics? (2) What are the barriers to progress? and (3) What roles can the National Institutes of Health and its various institutes and centers play in fostering the future development of telehealth?

  19. Telehealth to improve asthma control in pregnancy: A randomized controlled trial.

    PubMed

    Zairina, Elida; Abramson, Michael J; McDonald, Christine F; Li, Jonathan; Dharmasiri, Thanuja; Stewart, Kay; Walker, Susan P; Paul, Eldho; George, Johnson

    2016-07-01

    Poorly controlled asthma during pregnancy is hazardous for both mother and foetus. Better asthma control may be achieved if patients are involved in regular self-monitoring of symptoms and self-management according to a written asthma action plan. Telehealth applications to optimize asthma management and outcomes in pregnant women have not yet been evaluated. This study evaluated the efficacy of a telehealth programme supported by a handheld respiratory device in improving asthma control during pregnancy. Pregnant women with asthma (n = 72) from two antenatal clinics in Melbourne, Australia, were randomized to one of two groups: (i) intervention-involving a telehealth programme (management of asthma with supportive telehealth of respiratory function in pregnancy (MASTERY(©) )) supported by a handheld respiratory device and an Android smart phone application (Breathe-easy(©) ) and written asthma action plan or (ii) control-usual care. The primary outcome was change in asthma control at 3 and 6 months (prenatal). Secondary outcomes included changes in quality of life and lung function, and perinatal/neonatal outcomes. At baseline, participants' mean (± standard deviation) age was 31.4 ± 4.5 years and gestational age 16.7 ± 3.1 weeks. At 6 months, the MASTERY group had better asthma control (P = 0.02) and asthma-related quality of life (P = 0.002) compared with usual care. There were no significant differences between groups in lung function, unscheduled health-care visits, days off work/study, oral corticosteroid use, or perinatal outcomes. Differences between groups were not significant at 3 months. Telehealth interventions supporting self-management are feasible and could potentially improve asthma control and asthma-related quality of life during pregnancy. © 2016 Asian Pacific Society of Respirology.

  20. Meta-analysis and meta-regression of telehealth programmes for patients with chronic heart failure.

    PubMed

    Xiang, Rui; Li, Lin; Liu, Sheena Xin

    2013-07-01

    To assess the effectiveness of telehealth used for chronic heart failure (CHF) patients, we searched for peer-reviewed, randomized controlled trials published between 2001 and 2012. A total of 33 studies met the inclusion criteria. There were 26 studies (79%) which concerned tele-monitoring and 7 (21%) which concerned case management or nurse administered telephone-based management. There were 7530 patients in all, with an average age of 69 years. A meta-analysis showed that telehealth programmes had significant overall effectiveness in reducing all-cause mortality (Fixed effect model risk ratio 0.76, 95% CI 0.66 to 0.88), CHF-related hospitalization (Random effect model risk ratio 0.72, 95% CI 0.61 to 0.85) and CHF-related length of stay (Random effect model mean difference -1.41 days, 95% CI -2.43 to -0.39). In addition, telehealth programmes showed significantly greater effectiveness in reducing mortality and hospitalizations among patients with higher New York Heart Association (NYHA) categories. With age and NYHA held constant, recording questionnaire (symptoms) data could reduce the mortality risk by 34% and the risk of CHF-related hospitalization by 15%; adding a pulse (heart rate) detector could reduce the mortality risk by 40% and the risk of CHF-related hospitalization by 43%. Finally, telehealth programmes showed a tapering effect on mortality reduction: the longer the follow-up period, the less effective they were on decreasing mortality. In conclusion, telehealth programmes demonstrated clinical effectiveness in patients with CHF compared with usual care.

  1. Hype, harmony and human factors: applying user-centered design to achieve sustainable telehealth program adoption and growth.

    PubMed

    Rossos, P G; St-Cyr, O; Purdy, B; Toenjes, C; Masino, C; Chmelnitsky, D

    2015-01-01

    Despite decades of international experience with the use of information and communication technologies in healthcare delivery, widespread telehealth adoption remains limited and progress slow. Escalating health system challenges related to access, cost and quality currently coincide with rapid advancement of affordable and reliable internet based communication technologies creating unprecedented opportunities and incentives for telehealth. In this paper, we will describe how Human Factors Engineering (HFE) and user-centric elements have been incorporated into the establishment of telehealth within a large academic medical center to increase acceptance and sustainability. Through examples and lessons learned we wish to increase awareness of HFE and its importance in the successful implementation, innovation and growth of telehealth programs.

  2. Infectious Diseases Society of America Position Statement on Telehealth and Telemedicine as Applied to the Practice of Infectious Diseases.

    PubMed

    Siddiqui, Javeed; Herchline, Thomas; Kahlon, Summerpal; Moyer, Kay J; Scott, John D; Wood, Brian R; Young, Jeremy

    2017-02-01

    The use of telehealth and telemedicine offers powerful tools for delivering clinical care, conducting medical research, and enhancing access to infectious diseases physicians. The Infectious Diseases Society of America (IDSA) has prepared a position statement to educate members on the use of telehealth and telemedicine technologies. The development of telehealth and telemedicine programs requires the consideration of several issues such as HIPAA, state and local licensure requirements, credentialing and privileging, scope of care, quality, and responsibility and liability. IDSA supports appropriate use of telehealth and telemedicine to provide timely, cost-effective specialty care to resource-limited populations. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  3. Balance training in individuals with Parkinson's disease: Therapist-supervised vs. home-based exercise programme.

    PubMed

    Atterbury, Elizabeth Maria; Welman, Karen Estelle

    2017-06-01

    Poor locomotion and balance in Parkinson's disease (PD) often diminishes independence. Accordingly, gait is considered one of the most relevant rehabilitation outcomes, and home-based balance exercises might be a viable mode of exercise delivery for individuals with PD. However, research on PD interventions rarely indicate best practices to deliver exercises. Therefore, this study endeavoured to compare the efficacy of a home-based and therapist-supervised balance programme on gait parameters, dynamic balance, balance confidence and motivation in individuals diagnosed with PD. An experimental study design, including a cluster randomized convenience sample, of 40 participants with idiopathic PD (Hoehn and Yahr stage I-III; age: 65.0±7.7years). Participants were divided into a therapist-supervised (n=24) and home-based group (n=16). Groups received either eight weeks of balance training with an exercise therapist or a DVD. Outcome measures include the instrumented Timed-Up-and-Go, Functional Gait Analysis (FGA), Activity-specific Balance confidence (ABC) scale and Intrinsic Motivation Inventory (IMI). Both groups improved in stride length (p<0.05). Similar FGA improved by 9% and 16% in the therapist-supervised and home-based group, respectively (p<0.01). Only the therapist-supervised group showed improvements in ABC (p=0.051), stride velocity (p=0.0006) and cadence (p=0.046) over the intervention; the latter two were also better compared to home-based (p<0.05). Furthermore the therapist-supervised group were more motivated (p=002). The home-based balance programme was effective in improving some aspects of gait, albeit the programme supervised by an exercise therapist included somewhat more benefits after the intervention i.e. stride velocity and cadence in individuals with mild to moderate PD. Copyright © 2017. Published by Elsevier B.V.

  4. Bauru School of Dentistry Tele-Health League: an educational strategy applied to research, teaching and extension among applications in tele-health

    PubMed Central

    da SILVA, Andressa Sharllene Carneiro; RIZZANTE, Fabio Antonio Piola; PICOLINI, Mirela Machado; de CAMPOS, Karis; CORRÊA, Camila de Castro; FRANCO, Elen Caroline; PARDO-FANTON, Cássia de Souza; BLASCA, Wanderléia Quinhoneiro; BERRETIN-FELIX, Giédre

    2011-01-01

    Tele-health is more than an innovative alternative; it is an excellent tool that enables access to health and education in health, making it possible to minimize distances, optimize time and reduce costs. Based on these advantages, some Brazilian Universities have used these actions in strategies of education, research and extension, aiming at the application of Tele-health in Brazil. In that way, the Bauru School of Dentistry - University of São Paulo (FOB-USP) has applied the use of information and communication technologies in health by means of a "Tele-Health League" (TL), in order to diagnose, prevent and treat diseases, in addition to educate the population and health services. Objective The present study aims to introduce the characteristics of the Tele-Health League of FOB-USP, as well as the development of its projects. Material and Methods The Tele-Health League consisted as a Diffusion Course approved by the Provost of Culture and Academic Extension of the University of São Paulo. It is composed as a large group enclosing professoriate coordinator, academician principal, contributing professors and league members, those, diversified between undergraduates students, graduated, health employees, technology and information areas. The participant members are evaluated by the presence frequency (minimum of 85%), and by the performance of tests and paperwork about the theoretical content provided. Results In four years of activities, the TLFOB-USP obtained a high satisfaction index (90%), an increased number of vacancies due to the interest to become a member, more commitment of the professors of the University and the accomplishment of association with other Brazilian leagues. It is emphasized that the approval percentage of the course results in approval from approximately half of its members. Also, it is important to identify and repair the causes related to the quitting of some members. Conclusions The results showed that the TLFOB-USP members, adjoining

  5. Bauru School of Dentistry Tele-Health League: an educational strategy applied to research, teaching and extension among applications in tele-health.

    PubMed

    Silva, Andressa Sharllene Carneiro da; Rizzante, Fabio Antonio Piola; Picolini, Mirela Machado; Campos, Karis de; Corrêa, Camila de Castro; Franco, Elen Caroline; Pardo-Fanton, Cássia de Souza; Blasca, Wanderléia Quinhoneiro; Berretin-Felix, Giédre

    2011-01-01

    Tele-health is more than an innovative alternative; it is an excellent tool that enables access to health and education in health, making it possible to minimize distances, optimize time and reduce costs. Based on these advantages, some Brazilian Universities have used these actions in strategies of education, research and extension, aiming at the application of Tele-health in Brazil. In that way, the Bauru School of Dentistry - University of São Paulo (FOB-USP) has applied the use of information and communication technologies in health by means of a "Tele-Health League" (TL), in order to diagnose, prevent and treat diseases, in addition to educate the population and health services. The present study aims to introduce the characteristics of the Tele-Health League of FOB-USP, as well as the development of its projects. The Tele-Health League consisted as a Diffusion Course approved by the Provost of Culture and Academic Extension of the University of São Paulo. It is composed as a large group enclosing professoriate coordinator, academician principal, contributing professors and league members, those, diversified between undergraduates students, graduated, health employees, technology and information areas. The participant members are evaluated by the presence frequency (minimum of 85%), and by the performance of tests and paperwork about the theoretical content provided. In four years of activities, the TLFOB-USP obtained a high satisfaction index (90%), an increased number of vacancies due to the interest to become a member, more commitment of the professors of the University and the accomplishment of association with other Brazilian leagues. It is emphasized that the approval percentage of the course results in approval from approximately half of its members. Also, it is important to identify and repair the causes related to the quitting of some members. The results showed that the TLFOB-USP members, adjoining to the professor's participants, develop projects

  6. Telehealth language assessments using consumer grade equipment in rural and urban settings: Feasible, reliable and well tolerated.

    PubMed

    Sutherland, Rebecca; Trembath, David; Hodge, Antoinette; Drevensek, Suzi; Lee, Sabrena; Silove, Natalie; Roberts, Jacqueline

    2017-01-01

    Introduction Telehealth can be an effective way to provide speech pathology intervention to children with speech and language impairments. However, the provision of reliable and feasible standardised language assessments via telehealth to establish children's needs for intervention and to monitor progress has not yet been well established. Further, there is limited information about children's reactions to telehealth. This study aimed to examine the reliability and feasibility of conducting standardised language assessment with school-aged children with known or suspected language impairment via a telehealth application using consumer grade computer equipment within a public school setting. Method Twenty-three children (aged 8-12 years) participated. Each child was assessed using a standardised language assessment comprising six subtests. Two subtests were administered by a speech pathologist face-to-face (local clinician) and four subtests were administered via telehealth. All subtests were completed within a single visit to the clinic service, with a break between the face to face and telehealth sessions. The face-to-face clinician completed behaviour observation checklists in the telehealth and face to face conditions and provided feedback on the audio and video quality of the application from the child's point of view. Parent feedback about their child's experience was elicited via survey. Results There was strong inter-rater reliability in the telehealth and face-to-face conditions (correlation coefficients ranged from r = 0.96-1.0 across the subtests) and good agreement on all measures. Similar levels of attention, distractibility and anxiety were observed in the two conditions. Clinicians rated only one session of 23 as having poor audio quality and no sessions were rated as having poor visual quality. Parent and child reactions to the use of telehealth were largely positive and supportive of using telehealth to assess rural children. Discussion The

  7. Home-based therapy for severe acute malnutrition with ready-to-use food.

    PubMed

    Murray, Ellen; Manary, Mark

    2014-11-01

    Severe acute malnutrition is a devastating condition afflicting under-5 children in many developing countries, but concentrated in sub-Saharan Africa. This paper examines the development of home-based lipid-nutrient therapeutic foods for the treatment of acute malnutrition in sub-Saharan Africa and the adoption of these therapies as a standard of care for non-complicated cases of acute malnutrition. Several of the early key clinical and operational effectiveness trials are discussed as well as the adoption of home-based treatment as a standard operating procedure in regions where malnutrition is present.

  8. TElehealth in CHronic disease: mixed-methods study to develop the TECH conceptual model for intervention design and evaluation

    PubMed Central

    Thomas, Clare; O'Cathain, Alicia; Rogers, Anne; Pope, Catherine; Yardley, Lucy; Fahey, Tom; Lewis, Glyn; Large, Shirley; Edwards, Louisa; Rowsell, Alison; Segar, Julia; Brownsell, Simon; Montgomery, Alan A

    2015-01-01

    Objective To develop a conceptual model for effective use of telehealth in the management of chronic health conditions, and to use this to develop and evaluate an intervention for people with two exemplar conditions: raised cardiovascular disease risk and depression. Design The model was based on several strands of evidence: a metareview and realist synthesis of quantitative and qualitative evidence on telehealth for chronic conditions; a qualitative study of patients’ and health professionals’ experience of telehealth; a quantitative survey of patients’ interest in using telehealth; and review of existing models of chronic condition management and evidence-based treatment guidelines. Based on these evidence strands, a model was developed and then refined at a stakeholder workshop. Then a telehealth intervention (‘Healthlines’) was designed by incorporating strategies to address each of the model components. The model also provided a framework for evaluation of this intervention within parallel randomised controlled trials in the two exemplar conditions, and the accompanying process evaluations and economic evaluations. Setting Primary care. Results The TElehealth in CHronic Disease (TECH) model proposes that attention to four components will offer interventions the best chance of success: (1) engagement of patients and health professionals, (2) effective chronic disease management (including subcomponents of self-management, optimisation of treatment, care coordination), (3) partnership between providers and (4) patient, social and health system context. Key intended outcomes are improved health, access to care, patient experience and cost-effective care. Conclusions A conceptual model has been developed based on multiple sources of evidence which articulates how telehealth may best provide benefits for patients with chronic health conditions. It can be used to structure the design and evaluation of telehealth programmes which aim to be acceptable to

  9. Can Telehealth Ontario respiratory call volume be used as a proxy for emergency department respiratory visit surveillance by public health?

    PubMed

    van Dijk, Adam; McGuinness, Don; Rolland, Elizabeth; Moore, Kieran M

    2008-01-01

    There is a paucity of information regarding the usefulness of non-traditional data streams for real-time syndromic surveillance systems. The objective of this paper is to examine the temporal relation between Ontario's emergency department (ED) visits and telephone health line (Telehealth) call volume for respiratory illnesses to test the feasibility of using Ontario's Telehealth system for real-time surveillance. Retrospective time-series data from the National Ambulatory Care Reporting System (NACRS) and the Telehealth Ontario program from June 1, 2004, to March 31, 2006, were analyzed. The added value of Telehealth Ontario data was determined by comparing it temporally with NACRS data, which uses the International Classification of Diseases (ICD) 10-Canadian Enhancement coding system for discharge diagnoses. Telehealth Ontario had 216,105 calls for respiratory complaints, while 819,832 ICD-coded complaints from NACRS were identified with a comparable diagnosis of respiratory illness. Telehealth Ontario call volume was heavily weighted for the 0-4 years age group (49%), while the NACRS visits were mainly from those 18-64 years old (44%). The Spearman rank correlation coefficient was calculated to be 0.97, with the time-series analysis also resulting in significant correlations at lags (semi-monthly) 0 and 1, indicating that increases in Telehealth Ontario call volume correlate with increases in NACRS discharge diagnosis data for respiratory illnesses. Telehealth Ontario call volume fluctuation reflects directly on ED respiratory visit data on a provincial basis. These call complaints are a timely, useful and representative data stream that shows promise for integration into a real-time syndromic surveillance system.

  10. Overcoming the tyranny of distance: An audit of process and outcomes from a pilot telehealth spinal assessment clinic.

    PubMed

    Beard, Matthew; Orlando, Joseph F; Kumar, Saravana

    2017-09-01

    Introduction There is consistent evidence to indicate people living in rural and remote regions have limited access to healthcare and poorer health outcomes. One way to address this inequity is through innovative models of care such as telehealth. The aim of this pilot trial was to determine the feasibility, appropriateness and access to a telehealth clinic. In this pilot trial, the telehealth clinic outcomes are compared with the outreach clinic. Both models of care are commonly utilised means of providing healthcare to meet the needs of people living in rural and remote regions. Methods A prospective audit was conducted on a Spinal Assessment Clinic Telehealth pilot trial for patients with spinal disorders requiring non-urgent surgical consultation. Data were recorded from all consultations managed using videoconferencing technology between the Royal Adelaide Hospital and Port Augusta Community Health Service, South Australia between September 2013 and January 2014. Outcomes included analysis of process, service activity, clinical actions, safety and costs. Data were compared to a previous spinal assessment outreach clinic in the same area between August and December 2012. Results There were 25 consultations with 22 patients over the five-month telehealth pilot trial. Spinal disorders were predominantly of the lumbar region (88%); the majority of initial consultations (64%) were discharged to the general practitioner. There were three requests for further imaging, five for minor interventions and three for other specialist/surgical consultation. Patient follow-up post telehealth pilot trial revealed no adverse outcomes. The total cost of AUD$11,187 demonstrated a 23% reduction in favour of the spinal assessment telehealth pilot trial, with the greatest savings in travel costs. Discussion The telehealth model of care demonstrated the efficient management of patients with spinal disorders in rural regions requiring non-urgent surgical consultation at low costs with

  11. Investigating the preferences of older people for telehealth as a new model of health care service delivery: A discrete choice experiment.

    PubMed

    Kaambwa, Billingsley; Ratcliffe, Julie; Shulver, Wendy; Killington, Maggie; Taylor, Alan; Crotty, Maria; Carati, Colin; Tieman, Jennifer; Wade, Victoria; Kidd, Michael R

    2017-02-01

    Introduction Telehealth approaches to health care delivery can potentially improve quality of care and clinical outcomes, reduce mortality and hospital utilisation, and complement conventional treatments. However, substantial research into the potential for integrating telehealth within health care in Australia, particularly in the provision of services relevant to older people, including palliative care, aged care and rehabilitation, is lacking. Furthermore, to date, no discrete choice experiment (DCE) studies internationally have sought the views and preferences of older people about the basic features that should make up a telehealth approach to these services. Methods Using a DCE, we investigated the relative importance of six salient features of telehealth (what aspects of care are to be pursued during telehealth sessions, distance to the nearest hospital or clinic, clinicians' attitude to telehealth, patients' experience of using technology, what types of assessments should be conducted face-to-face versus via telehealth sessions and the costs associated with receiving telehealth). Data were obtained from an online panel of older people aged 65 years and above, drawn from the Australian general population. Results The mean age for 330 study participants was 69 years. In general, individuals expressed strong preferences for telehealth services that offered all aspects of care, were relatively inexpensive and targeted specifically at individuals living in remote regions without easy access to a hospital or clinic. Participants also preferred telehealth services to be offered to individuals with some prior experience of using technology, provided by clinicians who were positive about telehealth but wanted all or some pre-telehealth health assessments to take place in a hospital or clinic. Preferences only differed by gender. Additionally, respondents did not feel that telehealth led to loss of privacy and confidentiality. Discussion Our findings indicate a

  12. A Home-Based Ecobehavioral Parent-Training and Generalization Package with a Neglectful Mother.

    ERIC Educational Resources Information Center

    Dachman, Ronald S.; And Others

    1984-01-01

    A home-based ecobehavioral parent-training package with a low-income single-parent referred for child neglect, and her seven-year-old son was effective in increasing the mother's frequency of descriptive praise and in producing demonstrable changes in the untreated corollary behaviors. Maintenance probes conducted two and six months following the…

  13. Latino Parents Utilizing Home-Based Activities to Support Algebra-Readiness Skills

    ERIC Educational Resources Information Center

    Molinar, Soledad Marie

    2010-01-01

    This dissertation involved a series of training sessions where parents from a Title I middle school participated in the learning and practice of Algebra Readiness skills. The project was based on a series of six weekly trainings for parents to learn home-based activities to increase their child's Algebra Readiness. I administered an initial…

  14. Caring relationships in home-based nursing care - registered nurses' experiences.

    PubMed

    Wälivaara, Britt-Marie; Sävenstedt, Stefan; Axelsson, Karin

    2013-01-01

    The caring relationship between the nurse and the person in need of nursing care has been described as a key concept in nursing and could facilitate health and healing by involving the person's genuine needs. The aim of this study was to explore registered nurses' experiences of their relationships with persons in need of home-based nursing care. Individual interviews with nurses (n=13 registered nurses and 11 district nurses) working in home-based nursing care were performed. A thematic content analysis was used to analyze the transcribed interviews and resulted in the main theme Good nursing care is built on trusting relationship and five sub-themes, Establishing the relationship in home-based nursing care, Conscious efforts maintains the relationship, Reciprocity is a requirement in the relationship, Working in different levels of relationships and Limitations and boundaries in the relationship. A trusting relationship between the nurse and the person in need of healthcare is a prerequisite for good home-based nursing care whether it is based on face-to-face encounters or remote encounters through distance-spanning technology. A trusting relationship could reduce the asymmetry of the caring relationship which could strengthen the person's position. The relationship requires conscious efforts from the nurse and a choice of level of the relationship. The trusting relationship was reciprocal and meant that the nurse had to communicate something about themself as the person needs to know who is entering the home and who is communicating through distance-spanning technology.

  15. Recurrent Vascular Headache: Home-Based Behavioral Treatment versus Abortive Pharmacological Treatment.

    ERIC Educational Resources Information Center

    Holroyd, Kenneth A.; And Others

    1988-01-01

    Compared the effectiveness of a home-based behavioral intervention (relaxation and thermal biofeedback training) with an abortive pharmacological intervention (with compliance training) for treating recurrent migraine and migraine/tension headaches. Both interventions yielded reductions in headache activity, psychosomatic symptoms, and daily life…

  16. THE VALUE OF HOME-BASED COLLECTION OF BIOSPECIMENS IN REPRODUCTIVE EPIDEMIOLOGY

    EPA Science Inventory

    The Value of Home-Based Collection of Biospecimens in Reproductive Epidemiology
    John C. Rockett1, Germaine M. Buck2, Courtney D. Johnson2 and Sally D. Perreault1
    1Reproductive Toxicology Division, National Health and Environmental Effects Research Laboratory, Office of Rese...

  17. Home-based therapy for severe acute malnutrition with ready-to-use food

    USDA-ARS?s Scientific Manuscript database

    Severe acute malnutrition is a devastating condition afflicting children under 5 years in many developing countries, but concentrated in sub-Saharan Africa. This paper examines the development of home-based lipid-nutrient therapeutic foods for the treatment of acute malnutrition in sub-Saharan Afric...

  18. THE VALUE OF HOME-BASED COLLECTION OF BIOSPECIMENS IN REPRODUCTIVE EPIDEMIOLOGY

    EPA Science Inventory

    The Value of Home-Based Collection of Biospecimens in Reproductive Epidemiology
    John C. Rockett1, Germaine M. Buck2, Courtney D. Johnson2 and Sally D. Perreault1
    1Reproductive Toxicology Division, National Health and Environmental Effects Research Laboratory, Office of Rese...

  19. Small and Home-Based Businesses: Measures of Success and the Contribution of Local Development Services

    ERIC Educational Resources Information Center

    Brooks, Lara; Whitacre, Brian; Shideler, Dave; Muske, Glenn; Woods, Mike

    2012-01-01

    Small and home-based businesses have long been identified by Extension educators as an important component of economic development, particularly in rural areas. The services available to these businesses can take many forms, including management training, accessibility of local funding, providing incubation facilities, or setting up mentoring…

  20. Home-Based Comprehensive Assessment of Rural Elderly Persons: The CARE Project

    ERIC Educational Resources Information Center

    Cravens, David D.; Mehr, David R.; Campbell, James D.; Armer, Jane; Kruse, Robin L.; Rubenstein, Laurence Z.

    2005-01-01

    Context: Home-based comprehensive geriatric assessment (CGA) has been effective in urban areas but has had little study in rural areas. CGA involves medical history taking, a physical exam, and evaluation of functional status, mental status, cognitive status, gait and balance, medications, vision, extent of social supports, and home safety. We…

  1. Brief Report: Relative Effectiveness of Different Home-Based Behavioral Approaches to Early Teaching Intervention

    ERIC Educational Resources Information Center

    Reed, Phil; Osborne, Lisa A.; Corness, Mark

    2007-01-01

    The effectiveness of home-based early behavioral interventions for children (2:6-4:0 years old) with autistic spectrum disorders was studied over 9-10 months. Measures of autistic severity, intellectual, educational, and adaptive behavioral functioning were taken. There was no evidence of recovery from autism. High-intensity behavioral approaches…

  2. A Review of the Research on Childminding: Understanding Children's Experiences in Home-Based Childcare Settings

    ERIC Educational Resources Information Center

    Ang, Lynn; Brooker, Elizabeth; Stephen, Christine

    2017-01-01

    This paper offers a discussion of the literature of an under-developed area of early years research--the exploration of childminding or home-based childcare and the contribution which this form of provision makes for children and families. Despite growing interest in childminding at the policy level and some international research on understanding…

  3. An Overview of Home-Based Primary Care: Learning from the Field.

    PubMed

    Klein, Sarah; Hostetter, Martha; McCarthy, Douglas

    2017-06-01

    ISSUE: Homebound and functionally limited individuals are often unable to access office-based primary care, leading to unmet needs and increased health care spending. GOAL: Show how home-based primary care affects outcomes and costs for Medicare and Medicaid beneficiaries with complex care needs. METHODS: Qualitative synthesis of expert perspectives and the experiences of six case-study sites. FINDINGS AND CONCLUSIONS: Successful home-based primary care practices optimize care by: fielding interdisciplinary teams, incorporating behavioral care and social supports into primary care, responding rapidly to urgent and acute care needs, offering palliative care, and supporting family members and caregivers. Practices participating in Medicare's Independence at Home Demonstration saved $3,070 per beneficiary on average in the first year, primarily by reducing hospital use under this shared-savings program. The experience of a risk-based medical group that contracts with health plans and health systems to provide home-based care suggests similar potential to reduce health care spending under capitated or value-based payment arrangements. Making effective home-based primary care more widely available would require a better-prepared workforce, appropriate financial incentives to encourage more clinicians to provide house calls to their home-limited patients, and relevant quality measures to ensure that value-based payment is calibrated to meet the needs of patients and their families.

  4. School- And Home-Based Drug Prevention: Environmental, Parent, and Child Risk Reduction

    ERIC Educational Resources Information Center

    Hahn, Ellen J.; Hall, Lynne A.; Rayens, Mary Kay; Myers, April V.; Bonnel, Galadriel

    2007-01-01

    The study purpose was to test the effect of a school- and home-based alcohol, tobacco, and other drug (ATOD) prevention program on reducing environmental, parent, and child risk factors for ATOD use. The design was a three-group pretest-posttest with interviews at baseline and 1 and 6 months post-intervention. The sample was 126 parents and their…

  5. Perceptions of Personal Well-Being among Youth Accessing Residential or Intensive Home-Based Treatment

    ERIC Educational Resources Information Center

    Preyde, Michele; Watkins, Hanna; Ashbourne, Graham; Lazure, Kelly; Carter, Jeff; Penney, Randy; White, Sara; Frensch, Karen; Cameron, Gary

    2013-01-01

    The outcomes of youth accessing residential treatment or intensive home-based treatment are varied. Understanding youth's perceptions of their well-being may inform service. The purpose of this report was to explore perceptions of youth's mental health, life satisfaction, and outlook for the future. Youth reported ongoing struggles with mental…

  6. Home-Based Comprehensive Assessment of Rural Elderly Persons: The CARE Project

    ERIC Educational Resources Information Center

    Cravens, David D.; Mehr, David R.; Campbell, James D.; Armer, Jane; Kruse, Robin L.; Rubenstein, Laurence Z.

    2005-01-01

    Context: Home-based comprehensive geriatric assessment (CGA) has been effective in urban areas but has had little study in rural areas. CGA involves medical history taking, a physical exam, and evaluation of functional status, mental status, cognitive status, gait and balance, medications, vision, extent of social supports, and home safety. We…

  7. A Pilot Study on the Impact of a Home-Based Parenting Intervention: Parents Plus

    ERIC Educational Resources Information Center

    Byrne, Ellie; Holland, Sally; Jerzembek, Gabi

    2010-01-01

    This article reports on a pilot study undertaken in order to explore the impact of a home-based parenting intervention (Parents Plus), on parents and families. Parents Plus is part of a Welsh Early Years strategy called Flying Start and aims to promote positive parent-child interactions. This article explores the medium-term to long-term impact of…

  8. A Pilot Study on the Impact of a Home-Based Parenting Intervention: Parents Plus

    ERIC Educational Resources Information Center

    Byrne, Ellie; Holland, Sally; Jerzembek, Gabi

    2010-01-01

    This article reports on a pilot study undertaken in order to explore the impact of a home-based parenting intervention (Parents Plus), on parents and families. Parents Plus is part of a Welsh Early Years strategy called Flying Start and aims to promote positive parent-child interactions. This article explores the medium-term to long-term impact of…

  9. Quality Improvement in Home-Based Child Care Settings: Research Resources to Inform Policy

    ERIC Educational Resources Information Center

    Lawrence, Sharmila; Stephens, Samuel A.

    2016-01-01

    This "Topic of Interest" provides a comprehensive list of research in the Research Connections collection that was published in 2005 or later addressing issues related to quality improvement specifically in home-based child care. The resources are grouped under the following headings: Overviews, Summaries, and Reviews of Quality…

  10. An Evaluation of Migrant Head Start Programs. Appendices. Preliminary Report on Home Base Findings.

    ERIC Educational Resources Information Center

    Reyes (J.A.) Associates, Inc., Washington, DC.

    Utilizing specially designed interview schedules to evaluate the kinds of services children and families receive from various Migrant Head Start programs throughout the country, this preliminary report on home base findings consists of questions asked of the staff at every Migrant Head Start site across the country and questions asked of parents…

  11. Home-based detoxification for neonatal abstinence syndrome reduces length of hospital admission without prolonging treatment.

    PubMed

    Smirk, Cameron L; Bowman, Ellen; Doyle, Lex W; Kamlin, Omar

    2014-06-01

    Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome, secondary to in utero chemical exposure and characterised by tremor, irritability and feed intolerance. It often requires prolonged hospital treatment and separation of families. Outpatient therapy may reduce this burden, but current literature is sparse. This review aimed to evaluate the safety and efficacy of our home-based detoxification programme and compare it with standard inpatient care. Infants requiring treatment for NAS between January 2004 and December 2010 were reviewed. Data on demographics, drug exposure, length of stay and type of therapy were compared between infants selected for home-based therapy and those treated conventionally. Of the 118 infants who were admitted for treatment of NAS, 38 (32%) were managed at home. Infants receiving home-based detoxification had shorter hospital stays (mean 19 days vs. 39 days), with no increase in total duration of treatment (mean 36 days vs. 41 days), and were more likely to be breastfeeding on discharge from hospital care (45% vs. 22%). In selected infants, home-based detoxification is associated with reduced hospital stays and increased rates of breastfeeding, without prolonging therapy. Safety of the infants remains paramount, which precludes many from entering such a programme. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  12. Overview of nine computerized, home-based auditory-training programs for adult cochlear implant recipients.

    PubMed

    Zhang, Ming; Miller, Aimee; Campbell, Melanie McNutt

    2014-04-01

    Computerized, home-based auditory-training programs could be attractive to cochlear implant (CI) recipients who cannot obtain direct intensive training services and also to busy clinicians who would like to enable CI recipients to benefit from these programs. However, it is difficult for either group to know which of the many programs available might best suit individual needs. Selecting a computerized home-based program can be challenging because each offers different features. This article provides an overview of currently available programs to help clinicians and recipients choose one that is most suitable. A narrative literature review and an advanced Google search of Web sites linked to auditory-training programs were conducted. This overview builds on and updates information from previous literature. Nine computerized, home-based auditory-training programs were identified for overview. Twenty-nine information items and features for each of the nine programs are presented, categorized by general product and purchase information, design features of the training paradigm, and auditory and communication targets. This article provides a descriptive overview of computerized, home-based auditory-training programs for the use of clinicians, CI recipients, researchers, and hearing aid users. American Academy of Audiology.

  13. Developing Student Knowledge and Skills for Home-Based Social Work Practice

    ERIC Educational Resources Information Center

    Allen, Susan F.; Tracy, Elizabeth M.

    2008-01-01

    Providing social work services for clients in their homes is often a distinguishing feature of social work practice. The home environment affects the intervention process at each stage of contact with a family. Home-based practice requires specific skills to deal with clients' presenting concerns as well as safety, boundary, confidentiality, and…

  14. Recurrent Vascular Headache: Home-Based Behavioral Treatment versus Abortive Pharmacological Treatment.

    ERIC Educational Resources Information Center

    Holroyd, Kenneth A.; And Others

    1988-01-01

    Compared the effectiveness of a home-based behavioral intervention (relaxation and thermal biofeedback training) with an abortive pharmacological intervention (with compliance training) for treating recurrent migraine and migraine/tension headaches. Both interventions yielded reductions in headache activity, psychosomatic symptoms, and daily life…

  15. Predictors of Home-Based Child Care Providers' Participation in Professional Development Workshops and Coaching

    ERIC Educational Resources Information Center

    Rusby, Julie C.; Jones, Laura B.; Crowley, Ryann; Smolkowski, Keith; Arthun, Chris

    2013-01-01

    Background: Little is known about factors that influence home-based child care providers' participation in professional development. Factors that predict participation in activities that are designed to promote the utilization and maintenance of skills taught are of particular interest. Objective: Our aim was to examine factors in the home-based…

  16. Parent Perspective on the Home-Based Interim Alternative Educational Setting: A Phenomenological Study

    ERIC Educational Resources Information Center

    Jones, Gregory L.

    2011-01-01

    The purpose of this study was to explore and describe the perspectives of parents of expelled disabled students placed in home-based interim alternative educational settings (IAES). The study consisted of three parent participants whose disabled children, by virtue of their violations of the school district's discipline policy, were…

  17. An Evaluation of Migrant Head Start Programs. Preliminary Report on Home Base Findings.

    ERIC Educational Resources Information Center

    Reyes (J.A.) Associates, Inc., Washington, DC.

    The report provides Indian and Migrant Program Division managers and specialists in each of the 5 Head Start component areas with a comprehensive picture of the 43 home base learning centers operating between October 1978 and May 1979, with a total enrollment of 3,108 migrant children. Using data collected from the Head Start and center directors,…

  18. School- And Home-Based Drug Prevention: Environmental, Parent, and Child Risk Reduction

    ERIC Educational Resources Information Center

    Hahn, Ellen J.; Hall, Lynne A.; Rayens, Mary Kay; Myers, April V.; Bonnel, Galadriel

    2007-01-01

    The study purpose was to test the effect of a school- and home-based alcohol, tobacco, and other drug (ATOD) prevention program on reducing environmental, parent, and child risk factors for ATOD use. The design was a three-group pretest-posttest with interviews at baseline and 1 and 6 months post-intervention. The sample was 126 parents and their…

  19. Dutch Home-Based Pre-Reading Intervention with Children at Familial Risk of Dyslexia

    ERIC Educational Resources Information Center

    van Otterloo, Sandra G.; van der Leij, Aryan

    2009-01-01

    Children (5 and 6 years old, n = 30) at familial risk of dyslexia received a home-based intervention that focused on phoneme awareness and letter knowledge in the year prior to formal reading instruction. The children were compared to a no-training at-risk control group (n = 27), which was selected a year earlier. After training, we found a small…

  20. Lessons Learned from Home Visiting with Home-Based Child Care Providers

    ERIC Educational Resources Information Center

    McCabe, Lisa A.; Peterson, Shira M.; Baker, Amy C.; Dumka, Marsha; Brach, Mary Jo; Webb, Diana

    2011-01-01

    Caring for Quality and Partners in Family Child Care are home visiting programs designed to improve the quality of home-based child care. This article describes the experiences of two different home visitors to demonstrate how programs such as these can help providers improve the overall quality of care, increase children's development, and lead…

  1. Parent Perspective on the Home-Based Interim Alternative Educational Setting: A Phenomenological Study

    ERIC Educational Resources Information Center

    Jones, Gregory L.

    2011-01-01

    The purpose of this study was to explore and describe the perspectives of parents of expelled disabled students placed in home-based interim alternative educational settings (IAES). The study consisted of three parent participants whose disabled children, by virtue of their violations of the school district's discipline policy, were…

  2. Predictors of Home-Based Child Care Providers' Participation in Professional Development Workshops and Coaching

    ERIC Educational Resources Information Center

    Rusby, Julie C.; Jones, Laura B.; Crowley, Ryann; Smolkowski, Keith; Arthun, Chris

    2013-01-01

    Background: Little is known about factors that influence home-based child care providers' participation in professional development. Factors that predict participation in activities that are designed to promote the utilization and maintenance of skills taught are of particular interest. Objective: Our aim was to examine factors in the home-based…

  3. Quality Improvement in Home-Based Child Care Settings: Research Resources to Inform Policy

    ERIC Educational Resources Information Center

    Lawrence, Sharmila; Stephens, Samuel A.

    2016-01-01

    This "Topic of Interest" provides a comprehensive list of research in the Research Connections collection that was published in 2005 or later addressing issues related to quality improvement specifically in home-based child care. The resources are grouped under the following headings: Overviews, Summaries, and Reviews of Quality…

  4. Home-based exercise program in TSP/HAM individuals: a feasibility and effectiveness study.

    PubMed

    Facchinetti, Lívia D; Araújo, Abelardo Q; Silva, Marcus Tt; Leite, Ana Claudia C; Azevedo, Mariana F; Chequer, Gisele L; Oliveira, Raquel Vc; Ferreira, Arthur S; Lima, Marco Antonio

    2017-04-01

    To investigate the feasibility and effectiveness of a home-based exercise program in TSP/HAM individuals. Twenty-three TSP/HAM individuals divided in two groups according to Timed Up and Go (TUG) score (<20s vs ≥20s) performed a 20-week home-based exercise program. The primary outcomes were exercise adherence, maximum voluntary isometric contraction of lower limbs (MVIC), Barthel Index and SF-36. Secondary outcomes were adverse effects and barriers to exercise practice. MVIC and the social functioning domain in SF-36 improved significantly in TUG <20s group. The individuals in the TUG ≥20s group improved significantly their physical functioning domain in SF-36. The total adherence to the 20-week home-based exercise program was 90%. There were mild to moderate adverse events related to exercise program. There were no adverse events related to MVIC test. The home-based exercise program was feasible and effective in improving disability and quality of life in individuals with TSP/HAM.

  5. Developing a Home-Based Early Intervention Personnel Training Program in Southeast China

    ERIC Educational Resources Information Center

    Xie, Huichao; Chen, Ching-I; Chen, Chieh-Yu; Squires, Jane; Li, Wenge; Liu, Tian

    2017-01-01

    China is expected to have a rapid growth in specialized early intervention (EI) services for young children ages birth to 6 and their families. A major barrier in the provision of EI services in China is the shortage of well-trained EI personnel. In 2013, a Home-Based Early Intervention Program (HBEIP) was started at South China Normal University…

  6. Impact of Home-Based Family Therapy on Maternal and Child Outcomes in Disadvantaged Adolescent Mothers.

    ERIC Educational Resources Information Center

    Cherniss, Cary; Herzog, Elaine

    1996-01-01

    Evaluates the effects of home-based family therapy on 116 high- risk teenage mothers and their children. Subjects received case management, supportive counseling and some received family therapy. Twelve-month follow-up indicated family therapy subjects improved parenting and became less welfare dependent. No significant difference was found at 24…

  7. Perceptions of Personal Well-Being among Youth Accessing Residential or Intensive Home-Based Treatment

    ERIC Educational Resources Information Center

    Preyde, Michele; Watkins, Hanna; Ashbourne, Graham; Lazure, Kelly; Carter, Jeff; Penney, Randy; White, Sara; Frensch, Karen; Cameron, Gary

    2013-01-01

    The outcomes of youth accessing residential treatment or intensive home-based treatment are varied. Understanding youth's perceptions of their well-being may inform service. The purpose of this report was to explore perceptions of youth's mental health, life satisfaction, and outlook for the future. Youth reported ongoing struggles with mental…

  8. Suggested Structure for Meetings of Home-Based ESL Classes for Native Speakers of Spanish.

    ERIC Educational Resources Information Center

    Spener, David

    This guide for volunteer teachers of English as a Second Language to Spanish speakers in a home-based program outlines a suggested format for class time and activities. The guide describes how teachers can organize their class periods to promote learner-centeredness and participation in the English learning process. The structure, designed to help…

  9. Home Start: How a Home-Based Preschool Program Raised Black Achievements.

    ERIC Educational Resources Information Center

    Scott, Ralph

    This presentation discusses longitudinal results of a home-based program for low SES black and white children whose parents received weekly visits designed to chart children's individualized enrichment when they were from 2 to 5 years of age. The program drew upon school and community resource personnel when appropriate, to provide parents with…

  10. Home-based HIV voluntary counselling and testing (VCT) for improving uptake of HIV testing.

    PubMed

    Bateganya, Moses; Abdulwadud, Omar A; Kiene, Susan M

    2010-07-07

    The low uptake of HIV voluntary counselling and testing (VCT) has hindered global attempts to prevent new HIV infections and has limited scale-up of HIV care and treatment. Globally, only 10% of HIV-infected individuals are aware of their HIV status. One approach to increase uptake is home-based HIV VCT, which may be effective in increasing the number of patients on treatment and preventing new infections. To establish the effect of home-based HIV VCT on uptake of HIV testing We searched MEDLINE (February 2007), EMBASE (February 2007), CENTRAL (February 2007), AIDSearch (February 2007), LILACS, CINAHL and Sociofile. We also contacted relevant researchers. The original review search strategy was updated in 2008. Randomised controlled trials comparing home-based HIV VCT with other testing models Two review authors independently selected studies, assessed methodological quality, and extracted data. We planned to conduct statistical analysis using the Review Manager software and calculate summary statistics (relative risks (RRs) with 95% confidence intervals (CI)) for primary outcomes. Only one study from developing countries met the inclusion criteria and was included in the review. The study, a cluster randomised trial (10 clusters, n=849) compared VCT uptake between an optional location (including home-based) and a local clinic location in a population-based HIV survey. The study showed a higher uptake of VCT among participants in the optional-location group. Uptake was significantly greater in the optional-location group in those who were pre-test counselled only (RR=4.6; 95% CI 3.58 to 5.91); pretest counselled and tested (RR=4.6; 95% CI 3.51 to 5.92); and post-test counselled and received the test result (RR=4.8; 95% CI 3.62 to 6.21). This study, however, had significant methodological problems limiting further analysis and interpretation. Although home-based HIV VCT has the potential to enhance VCT uptake in developing countries, insufficient data exist to

  11. Behaviour change techniques in home-based cardiac rehabilitation: a systematic review

    PubMed Central

    Heron, Neil; Kee, Frank; Donnelly, Michael; Cardwell, Christopher; Tully, Mark A; Cupples, Margaret E

    2016-01-01

    Background Cardiac rehabilitation (CR) programmes offering secondary prevention for cardiovascular disease (CVD) advise healthy lifestyle behaviours, with the behaviour change techniques (BCTs) of goals and planning, feedback and monitoring, and social support recommended. More information is needed about BCT use in home-based CR to support these programmes in practice. Aim To identify and describe the use of BCTs in home-based CR programmes. Design and setting Randomised controlled trials of home-based CR between 2005 and 2015 were identified by searching MEDLINE®, Embase, PsycINFO, Web of Science, and Cochrane Database. Method Reviewers independently screened titles and abstracts for eligibility. Relevant data, including BCTs, were extracted from included studies. A meta-analysis studied risk factor change in home-based and comparator programmes. Results From 2448 studies identified, 11 of good methodological quality (10 on post-myocardial infarction, one on heart failure, 1907 patients) were included. These reported the use of 20 different BCTs. Social support (unspecified) was used in all studies and goal setting (behaviour) in 10. Of the 11 studies, 10 reported effectiveness in reducing CVD risk factors, but one study showed no improvement compared to usual care. This study differed from effective programmes in that it didn’t include BCTs that had instructions on how to perform the behaviour and monitoring, or a credible source. Conclusion Social support and goal setting were frequently used BCTs in home-based CR programmes, with the BCTs related to monitoring, instruction on how to perform the behaviour, and credible source being included in effective programmes. Further robust trials are needed to determine the relative value of different BCTs within CR programmes. PMID:27481858

  12. Prospective study on cost-effectiveness of home-based motor assessment in Parkinson's disease.

    PubMed

    Cubo, E; Mariscal, N; Solano, B; Becerra, V; Armesto, D; Calvo, S; Arribas, J; Seco, J; Martinez, A; Zorrilla, L; Heldman, D

    2017-02-01

    Introduction Treatment adjustments in Parkinson's disease (PD) are in part dependent on motor assessments. The aim of this study was to evaluate the cost-effectiveness of home-based motor monitoring plus standard in-office visits versus in-office visits alone in patients with advanced PD. Methods The procedures consisted of a prospective, one-year follow-up, randomized, case-control study. A total of 40 patients with advanced PD were randomized into two groups: 20 patients underwent home-based motor monitoring by using wireless motion sensor technology, while the other 20 patients had in-office visits. Motor and non-motor symptom severities, quality of life, neuropsychiatric symptoms, and comorbidities were assessed every four months. Direct costs were assessed using a standardized questionnaire. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). Results Both groups of PD patients were largely comparable in their clinical and demographic variables at baseline; however, there were more participants using levodopa-carbidopa intestinal gel in the home-based motor monitoring group. There was a trend for lower Unified Parkinson's Disease Rating Scale functional status (UPDRS II) scores in the patients monitored at home compared to the standard clinical follow-up ( p = 0.06). However, UPDRS parts I, III, IV and quality-adjusted life-years scores were similar between both groups. Home-based motor monitoring was cost-effective in terms of improvement of functional status, motor severity, and motor complications (UPDRS II, III; IV subscales), with an ICER/UPDRS ranging from €126.72 to €701.31, respectively. Discussion Home-based motor monitoring is a tool which collects cost-effective clinical information and helps augment health care for patients with advanced PD.

  13. A systematic review of home-based childhood obesity prevention studies.

    PubMed

    Showell, Nakiya N; Fawole, Oluwakemi; Segal, Jodi; Wilson, Renee F; Cheskin, Lawrence J; Bleich, Sara N; Wu, Yang; Lau, Brandyn; Wang, Youfa

    2013-07-01

    Childhood obesity is a global epidemic. Despite emerging research about the role of the family and home on obesity risk behaviors, the evidence base for the effectiveness of home-based interventions on obesity prevention remains uncertain. The objective was to systematically review the effectiveness of home-based interventions on weight, intermediate (eg, diet and physical activity [PA]), and clinical outcomes. We searched Medline, Embase, PsychInfo, CINAHL, clinicaltrials.gov, and the Cochrane Library from inception through August 11, 2012. We included experimental and natural experimental studies with ≥1-year follow-up reporting weight-related outcomes and targeting children at home. Two independent reviewers screened studies and extracted data. We graded the strength of the evidence supporting interventions targeting diet, PA, or both for obesity prevention. We identified 6 studies; 3 tested combined interventions (diet and PA), 1 used diet intervention, 1 combined intervention with primary care and consumer health informatics components, and 1 combined intervention with school and community components. Select combined interventions had beneficial effects on fruit/vegetable intake and sedentary behaviors. However, none of the 6 studies reported a significant effect on weight outcomes. Overall, the strength of evidence is low that combined home-based interventions effectively prevent obesity. The evidence is insufficient for conclusions about home-based diet interventions or interventions implemented at home in association with other settings. The strength of evidence is low to support the effectiveness of home-based child obesity prevention programs. Additional research is needed to test interventions in the home setting, particularly those incorporating parenting strategies and addressing environmental influences.

  14. A Systematic Review of Home-Based Childhood Obesity Prevention Studies

    PubMed Central

    Fawole, Oluwakemi; Segal, Jodi; Wilson, Renee F.; Cheskin, Lawrence J.; Bleich, Sara N.; Wu, Yang; Lau, Brandyn; Wang, Youfa

    2013-01-01

    BACKGROUND AND OBJECTIVES: Childhood obesity is a global epidemic. Despite emerging research about the role of the family and home on obesity risk behaviors, the evidence base for the effectiveness of home-based interventions on obesity prevention remains uncertain. The objective was to systematically review the effectiveness of home-based interventions on weight, intermediate (eg, diet and physical activity [PA]), and clinical outcomes. METHODS: We searched Medline, Embase, PsychInfo, CINAHL, clinicaltrials.gov, and the Cochrane Library from inception through August 11, 2012. We included experimental and natural experimental studies with ≥1-year follow-up reporting weight-related outcomes and targeting children at home. Two independent reviewers screened studies and extracted data. We graded the strength of the evidence supporting interventions targeting diet, PA, or both for obesity prevention. RESULTS: We identified 6 studies; 3 tested combined interventions (diet and PA), 1 used diet intervention, 1 combined intervention with primary care and consumer health informatics components, and 1 combined intervention with school and community components. Select combined interventions had beneficial effects on fruit/vegetable intake and sedentary behaviors. However, none of the 6 studies reported a significant effect on weight outcomes. Overall, the strength of evidence is low that combined home-based interventions effectively prevent obesity. The evidence is insufficient for conclusions about home-based diet interventions or interventions implemented at home in association with other settings. CONCLUSIONS: The strength of evidence is low to support the effectiveness of home-based child obesity prevention programs. Additional research is needed to test interventions in the home setting, particularly those incorporating parenting strategies and addressing environmental influences. PMID:23753095

  15. Increasing Access to Cost Effective Home-Based Rehabilitation for Rural Veteran Stroke Survivors

    PubMed Central

    Housley, SN; Garlow, AR; Ducote, K; Howard, A; Thomas, T; Wu, D; Richards, K; Butler, AJ

    2016-01-01

    Introduction An estimated 750,000 Americans experience a stroke annually. Most stroke survivors require rehabilitation. Limited access to rehabilitation facilities has a pronounced burden on functional outcomes and quality of life. Robotic devices deliver reproducible therapy without the need for real-time human oversight. This study examined the efficacy of using home-based, telerobotic-assisted devices (Hand and Foot Mentor: HM and FM) to improve functional ability and reduce depression symptoms, while improving access and cost savings associated with rehabilitation. Methods Twenty stroke survivors performed three months of home-based rehabilitation using a robotic device, while a therapist remotely monitored progress. Baseline and end of treatment function and depression symptoms were assessed. Satisfaction with the device and access to therapy were determined using qualitative surveys. Cost analysis was performed to compare home-based, robotic-assisted therapy to clinic-based physical therapy. Results Compared to baseline, significant improvement in upper extremity function (30.06%, p= 0.046), clinically significant benefits in gait speed (29.03%), moderate improvement in depressive symptoms (28.44%) and modest improvement in distance walked (30.2%) were observed. Participants indicated satisfaction with the device. Home-based robot therapy expanded access to post-stroke rehabilitation for 35% of the people no longer receiving formal services and increased daily access for the remaining 65%, with a cost savings of $2,352 (64.97%) compared to clinic-based therapy. Conclusion Stroke survivors made significant clinically meaningful improvements in the use of their impaired extremities using a robotic device in the home. Home-based, robotic therapy reduced costs, while expanding access to a rehabilitation modality for people who would not otherwise have received care. PMID:28018979

  16. [Home based and group based exercise programs in patients with ankylosing spondylitis: systematic review].

    PubMed

    Lopes, S; Costa, S; Mesquita, C; Duarte, J

    2016-01-01

    Ankylosing Spondylitis (AS) is a chronic inflammatory rheumatic disease characterized by inflammation of the joints of the spine and sacroiliac and to a lesser percentage of the peripheral joints. It is a debilitating condition which reduces quality of life in patients with AS. The practice of physical therapy is recommended as non-pharmacological treatment as well as the treatment and prevention of associated deformities. To collect and summarize the available evidence in scientific databases to realize the effectiveness of home based and group based programs in patients with AS. Systematic review, where articles for the study were collected from scientific database PubMed. We have found 65 articles with publication date between January 1, 2004 and January 31, 2014. Inclusion and exclusion criteria were established to make the selection of articles to include in the study. All investigators provided their agreement in presencial meeting for a final selection, and at a later stage, the articles were read in full by the three investigators. The present systematic review includes eight randomized controlled trials. All articles show functional benefits in patients with AS subject to exercise programs in group based and / or home based. From the eight articles, 4 addressed programs conducted in home based context and 4 addressed in group based context programs. There appears to be evidence that the programs carried out based on group are more effective than those home based conducted in patients with AS. It was concluded also be advantageous to carry out home based exercise programs than the absence of any exercise program.

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  17. Home-based resistance training for older adults: a systematic review.

    PubMed

    Thiebaud, Robert S; Funk, Merrill D; Abe, Takashi

    2014-10-01

    Home-based resistance exercise is commonly used for individuals who might not have access or the ability to use traditional resistance exercise. However, the extent to which home-based resistance exercise can improve both strength and functional ability has not been investigated in healthy older individuals using a systematic analysis. The current article systematically reviewed the effectiveness of home-based resistance exercise on strength and functional ability. Search engines included Academic Search Premier, CINAHL, PubMed, PsycINFO, MEDLINE, SPORTDiscus and Web of Science. A total of 649 articles were found using the key words "home-based" and "strength" and "older" or "elderly", with eight articles meeting the final criteria. The average age of the participants was 76 years, with the average duration of exercise training ranging from 8 weeks to 120 weeks. Of the eight studies, a significant increase in knee extension strength was found in five studies. Functional ability significantly improved in seven of the eight studies, with the average decrease in Timed Up & Go test being -0.8 ± 0.5 s. Three studies included greater amounts of supervised visits compared with the other five studies (∼51% vs ∼7%). The more supervised studies had significant increases in strength and functional ability. Overall, home-based resistance exercise can improve both strength and functional ability, but the improvements are generally small. The intensity of the exercises might not progress sufficiently enough to produce large improvements in strength as a result of less supervision or a lack of motivation to increase the intensity further.

  18. Behaviour change techniques in home-based cardiac rehabilitation: a systematic review.

    PubMed

    Heron, Neil; Kee, Frank; Donnelly, Michael; Cardwell, Christopher; Tully, Mark A; Cupples, Margaret E

    2016-10-01

    Cardiac rehabilitation (CR) programmes offering secondary prevention for cardiovascular disease (CVD) advise healthy lifestyle behaviours, with the behaviour change techniques (BCTs) of goals and planning, feedback and monitoring, and social support recommended. More information is needed about BCT use in home-based CR to support these programmes in practice. To identify and describe the use of BCTs in home-based CR programmes. Randomised controlled trials of home-based CR between 2005 and 2015 were identified by searching MEDLINE(®), Embase, PsycINFO, Web of Science, and Cochrane Database. Reviewers independently screened titles and abstracts for eligibility. Relevant data, including BCTs, were extracted from included studies. A meta-analysis studied risk factor change in home-based and comparator programmes. From 2448 studies identified, 11 of good methodological quality (10 on post-myocardial infarction, one on heart failure, 1907 patients) were included. These reported the use of 20 different BCTs. Social support (unspecified) was used in all studies and goal setting (behaviour) in 10. Of the 11 studies, 10 reported effectiveness in reducing CVD risk factors, but one study showed no improvement compared to usual care. This study differed from effective programmes in that it didn't include BCTs that had instructions on how to perform the behaviour and monitoring, or a credible source. Social support and goal setting were frequently used BCTs in home-based CR programmes, with the BCTs related to monitoring, instruction on how to perform the behaviour, and credible source being included in effective programmes. Further robust trials are needed to determine the relative value of different BCTs within CR programmes. © British Journal of General Practice 2016.

  19. Benefits of home-based rocking-chair exercise for physical performance in community-dwelling elderly women: a randomized controlled trial.

    PubMed

    Niemelä, Kristiina; Väänänen, Ilkka; Leinonen, Raija; Laukkanen, Pia

    2011-08-01

    Home-based exercise is a viable alternative for older adults with difficulties in exercise opportunities outside the home. The aim of this study was to investigate the benefits of home-based rocking-chair training, and its effects on the physical performance of elderly women. Community- dwelling women (n=51) aged 73-87 years were randomly assigned to the rocking-chair group (RCG, n=26) or control group (CG, n=25) by drawing lots. Baseline and outcome measurements were hand grip strength, maximal isometric knee extension, maximal walking speed over 10 meters, rising from a chair five times, and the Berg Balance Scale (BBS). The RCG carried out a six-week rocking-chair training program at home, involving ten sessions per week, twice a day for 15 minutes per session, and ten different movements. The CG continued their usual daily lives. After three months, the RCG responded to a mail questionnaire. After the intervention, the RCG improved and the CG declined. The data showed significant interactions of group by time in the BBS score (p=0.001), maximal knee extension strength (p=0.006) and maximal walking speed (p=0.046), which indicates that the change between groups during the follow-up period was significant. Adherence to the training protocol was high (96%). After three months, the exercise program had become a regular home exercise habit for 88.5% of the subjects. Results indicate that home-based elderly women benefit from this easily implemented rocking-chair exercise program. The subjects became motivated to participate in training and continued the exercises. This is a promising alternative exercise method for maintaining physical activity and leads to improvements in physical performance.

  20. The effects of a 'home-based' task-oriented exercise programme on motor and balance performance in children with spastic cerebral palsy and severe traumatic brain injury.

    PubMed

    Katz-Leurer, Michal; Rotem, Hemda; Keren, Ofer; Meyer, Shirley

    2009-08-01

    To evaluate the feasibility and the ability to recruit and retain children with severe traumatic brain injury or cerebral palsy, and their families, to a simple home-based exercise programme and to assess the immediate and short-term effects of such intervention on reducing impairment and improving function. Randomized clinical trial. Twenty children aged 7-13 years, with traumatic brain injury (N = 10) or cerebral palsy (N = 10) who were independent ambulators. Five children from each group were randomly assigned to a control group - regular daily activities, or to an experimental group - regular daily activities plus a home-based task-oriented exercise programme of sit-to-stand and step-up exercise, for six weeks. Feasibility: The number of participants who completed the programme protocol. Timed Up and Go Test and Functional Reach Test were used as functional balance tests. Maximal isometric strength was assessed by using a hand-held dynamometer; walking performance was assessed by the 10 m walk test, 2-minute walk test and Energy Expenditure Index. Nine children completed all parts of the training programme. At the end of the intervention period an increase of 3-4 cm in the mean Functional Reach Test and a reduction of 1.6 +/- 2.1 seconds in the Timed Up and Go Test were noted (P<0.01) in the experimental group while no changes were noted in the control group. In all other outcomes assessed no significant differences were noted between groups. The positive change in balance performance in the experimental group was maintained during a six-week follow-up period. A home-based task-oriented exercise programme can improve balance performance in children with spastic cerebral palsy or severe traumatic brain injury.

  1. Child Temperament and Home-Based Parent Involvement at Kindergarten Entry: Evidence from a Low-Income, Urban Sample

    ERIC Educational Resources Information Center

    Han, Jinjoo; O'Connor, Erin E.; McCormick, Meghan P.; McClowry, Sandee G.

    2017-01-01

    Research Findings: Home-based involvement--defined as the actions parents take to promote children's learning outside of school--is often the most efficient way for low-income parents to be involved with their children's education. However, there is limited research examining the factors predicting home-based involvement at kindergarten entry for…

  2. Parental Perceptions of Child Care Quality in Centre-Based and Home-Based Settings: Associations with External Quality Ratings

    ERIC Educational Resources Information Center

    Lehrer, Joanne S.; Lemay, Lise; Bigras, Nathalie

    2015-01-01

    The current study examined how parental perceptions of child care quality were related to external quality ratings and considered how parental perceptions of quality varied according to child care context (home-based or centre-based settings). Parents of 179 4-year-old children who attended child care centres (n = 141) and home-based settings…

  3. Associations of Caregiver Stress with Working Conditions, Caregiving Practices, and Child Behaviour in Home-Based Child Care

    ERIC Educational Resources Information Center

    Rusby, Julie C.; Jones, Laura Backen; Crowley, Ryann; Smolkowski, Keith

    2013-01-01

    Home-based child caregivers face unique stressors related to the nature of their work. One hundred and fifty-five home-based child care providers in Oregon, USA, participated in this cross-sectional correlational study. We investigated associations between indicators of caregiver stress and child care working conditions, the quality of caregiver…

  4. The Role of Clinical and Geographic Factors in the Use of Hospital versus Home-Based Cardiac Rehabilitation

    ERIC Educational Resources Information Center

    Brual, Janette; Gravely, Shannon; Suskin, Neville; Stewart, Donna E.; Grace, Sherry L.

    2012-01-01

    Cardiac rehabilitation (CR) is most often provided in a hospital setting. Home-based models of care have been developed to overcome geographic, among other, barriers in patients at a lower risk. This study assessed whether clinical and geographic factors were related to the use of either a hospital-based or a home-based program. Secondary analysis…

  5. Associations of Caregiver Stress with Working Conditions, Caregiving Practices, and Child Behaviour in Home-Based Child Care

    ERIC Educational Resources Information Center

    Rusby, Julie C.; Jones, Laura Backen; Crowley, Ryann; Smolkowski, Keith

    2013-01-01

    Home-based child caregivers face unique stressors related to the nature of their work. One hundred and fifty-five home-based child care providers in Oregon, USA, participated in this cross-sectional correlational study. We investigated associations between indicators of caregiver stress and child care working conditions, the quality of caregiver…

  6. Parental Perceptions of Child Care Quality in Centre-Based and Home-Based Settings: Associations with External Quality Ratings

    ERIC Educational Resources Information Center

    Lehrer, Joanne S.; Lemay, Lise; Bigras, Nathalie

    2015-01-01

    The current study examined how parental perceptions of child care quality were related to external quality ratings and considered how parental perceptions of quality varied according to child care context (home-based or centre-based settings). Parents of 179 4-year-old children who attended child care centres (n = 141) and home-based settings…

  7. Home telehealth for children with special health-care needs.

    PubMed

    Cady, Rhonda; Kelly, Anne; Finkelstein, Stanley

    2008-01-01

    The U Special Kids (USK) programme at the University of Minnesota provides intensive care coordination and case management services to children with complex special health-care needs. We conducted a one-year pilot study to evaluate the feasibility of videoconferencing between the USK office and family homes. To ensure easy installation, families were provided with prepackaged equipment and software. However, the families had different Internet providers, different modems and/or routers and different firewall software, which required case-by-case resolution during home visits by the project coordinator. Five families participated in 3-5 videoconferencing sessions with a USK nurse. All connections with urban families had clear audio and video, whereas connections with rural families had clear audio, but unclear video. All of the scheduled virtual visits were rated by nurses as providing information that was similar to a telephone call. However, the unscheduled virtual visits were rated by the nurses as providing more information than a telephone call, suggesting that home-based videoconferencing may be useful in the management of children with complex special health-care needs.

  8. Communication Intervention for Young Children with Severe Neurodevelopmental Disabilities Via Telehealth.

    PubMed

    Simacek, Jessica; Dimian, Adele F; McComas, Jennifer J

    2017-03-01

    Young children with neurodevelopmental disorders such as autism spectrum disorders (ASD) and Rett syndrome often experience severe communication impairments. This study examined the efficacy of parent-implemented communication assessment and intervention with remote coaching via telehealth on the acquisition of early communication skills of three young children with ASD (2) and Rett syndrome (1). Efficacy of the intervention was evaluated using single-case experimental designs. First, functional assessment was used to identify idiosyncratic/potentially communicative responses and contexts for each child. Next, parents implemented functional communication training (FCT). All of the children acquired the targeted communication responses. The findings support the efficacy of telehealth as a service delivery model to coach parents on intervention strategies for their children's early communication skills.

  9. Telehealth: a perspective approach for visceral leishmaniasis (kala-azar) control in India.

    PubMed

    Bhunia, Gouri Sankar; Kesari, Shreekant; Chatterjee, Nandini; Kumar, Vijay; Das, Pradeep

    2012-07-01

    Visceral leishmaniasis, also known as kala-azar, is a vector borne disease caused by the protozoan parasite, L. donovani. Poor and neglected populations in Indian sub-continent are particularly affected by this disease. Due to the diversity of epidemiological situations, no single diagnosis, treatment, or control will be suitable for all. Control measures through case findings, treatment, and vector control are seldom used, even where they could be useful. Modern tools like telehealth, using space technology, have now come in handy to address issues of disease surveillance, control checking, and evaluation. The present study focuses on telehealth as a current vector control strategy, perspectives on diagnosis, treatment, and control of visceral leishmaniasis as these deserve more attention and research.

  10. Telehealth: a perspective approach for visceral leishmaniasis (kala-azar) control in India

    PubMed Central

    Bhunia, Gouri Sankar; Kesari, Shreekant; Chatterjee, Nandini; Kumar, Vijay; Das, Pradeep

    2012-01-01

    Visceral leishmaniasis, also known as kala-azar, is a vector borne disease caused by the protozoan parasite, L. donovani. Poor and neglected populations in Indian sub-continent are particularly affected by this disease. Due to the diversity of epidemiological situations, no single diagnosis, treatment, or control will be suitable for all. Control measures through case findings, treatment, and vector control are seldom used, even where they could be useful. Modern tools like telehealth, using space technology, have now come in handy to address issues of disease surveillance, control checking, and evaluation. The present study focuses on telehealth as a current vector control strategy, perspectives on diagnosis, treatment, and control of visceral leishmaniasis as these deserve more attention and research. PMID:23265372

  11. Preliminary findings of a telehealth approach to parent training in autism.

    PubMed

    Vismara, Laurie A; McCormick, Carolyn; Young, Gregory S; Nadhan, Anna; Monlux, Katerina

    2013-12-01

    Telehealth or online communication technologies may lessen the gap between intervention requirements for children with autism spectrum disorders (ASDs) and the available resources to provide these services. This study used a video conferencing and self-guided website to provide parent training in the homes of children with ASD. The first eight families to complete the 12-week online intervention and three-month follow up period served as pilot data. Parents' intervention skills and engagement with the website, as well as children's verbal language and joint attention skills were assessed. Preliminary research suggests telehealth may support parental learning and improve child behaviors for some families. This initial assessment of new technologies for making parent training resources available to families with ASD merits further, in-depth study.

  12. Speech-language pathology telehealth in rural and remote schools: the experience of school executive and therapy assistants.

    PubMed

    Fairweather, Glenn C; Lincoln, Michelle A; Ramsden, Robyn

    2017-01-01

    Difficulties in accessing allied health services, especially in rural and remote areas, appear to be driving the use of telehealth services to children in schools. The objectives of this study were to investigate the experiences and views of school executive staff and therapy assistants regarding the feasibility and acceptability of a speech-language pathology telehealth program for children attending schools in rural and remote New South Wales, Australia. The program, called Come N See, provided therapy interventions remotely via low-bandwidth videoconferencing, with email follow-up. Over a 12-week period, children were offered therapy blocks of six fortnightly sessions, each lasting a maximum of 30 minutes. School executives (n=5) and therapy assistants (n=6) described factors that promoted or threatened the program's feasibility and acceptability, during semistructured interviews. Thematic content analysis with constant comparison was applied to the transcribed interviews to identify relationships in the data. Emergent themes related to (a) unmet speech pathology needs, (b) building relationships, (c) telehealth's advantages, (d) telehealth's disadvantages, (e) anxiety replaced by joy and confidence in growing skills, and (f) supports. School executive staff and therapy assistants verified that the delivery of the school-based telehealth service was feasible and acceptable. However, the participants saw significant opportunities to enhance this acceptability through building into the program stronger working relationships and supports for stakeholders. These findings are important for the future development of allied health telehealth programs that are sustainable as well as effective and fit the needs of all crucial stakeholders. The results have significant implications for speech pathology clinical practice relating to technology, program planning and teamwork within telehealth programs.

  13. Using Telehealth to Reduce All-Cause 30-Day Hospital Readmissions among Heart Failure Patients Receiving Skilled Home Health Services

    PubMed Central

    O’Connor, Melissa; Dempsey, Mary Louise; Huffenberger, Ann; Jost, Sandra; Flynn, Danielle; Norris, Anne

    2016-01-01

    Summary Background The reduction of all-cause hospital readmission among heart failure (HF) patients is a national priority. Telehealth is one strategy employed to impact this sought-after patient outcome. Prior research indicates varied results on all-cause hospital readmission highlighting the need to understand telehealth processes and optimal strategies in improving patient outcomes. Objectives The purpose of this paper is to describe how one Medicare-certified home health agency launched and maintains a telehealth program intended to reduce all-cause 30-day hospital readmissions among HF patients receiving skilled home health and report its impact on patient outcomes. Methods Using the Transitional Care Model as a guide, the telehealth program employs a 4G wireless tablet-based system that collects patient vital signs (weight, heart rate, blood pressure and blood oxygenation) via wireless peripherals, and is preloaded with subjective questions related to HF and symptoms and instructional videos. Results Year one all-cause 30-day readmission rate was 19.3%. Fiscal year 2015 ended with an all-cause 30-day readmission rate of 5.2%, a reduction by 14 percentage points (a 73% relative reduction) in three years. Telehealth is now an integral part of the University of Pennsylvania Health System’s readmission reduction program. Conclusions Telehealth was associated with a reduction in all-cause 30-day readmission for one mid-sized Medicare-certified home health agency. A description of the program is presented as well as lessons learned that have significantly contributed to this program’s success. Future expansion of the program is planned. Telehealth is a promising approach to caring for a chronically ill population while improving a patient’s ability for self-care. PMID:27437037

  14. The Contradictions of Telehealth User Experience in Chronic Obstructive Pulmonary Disease (COPD): A Qualitative Meta-Synthesis

    PubMed Central

    Brunton, Lisa; Bower, Peter; Sanders, Caroline

    2015-01-01

    Objective As the global burden of chronic disease rises, policy makers are showing a strong interest in adopting telehealth technologies for use in long term condition management, including COPD. However, there remain barriers to its implementation and sustained use. To date, there has been limited qualitative investigation into how users (both patients/carers and staff) perceive and experience the technology. We aimed to systematically review and synthesise the findings from qualitative studies that investigated user perspectives and experiences of telehealth in COPD management, in order to identify factors which may impact on uptake. Method Systematic review and meta-synthesis of published qualitative studies of user (patients, their carers and clinicians) experience of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease. ASSIA, CINAHL, Embase, Medline, PsychInfo and Web of Knowledge databases were searched up to October 2014. Reference lists of included studies and reference lists of key papers were also searched. Quality appraisal was guided by an adapted version of the CASP qualitative appraisal tool. Findings 705 references (after duplicates removed) were identified and 10 papers, relating to 7 studies were included in the review. Most authors of included studies had identified both positive and negative experiences of telehealth use in the management of COPD. Through a line of argument synthesis we were able to derive new insights from the data to identify three overarching themes that have the ability to either impede or promote positive user experience of telehealth in COPD: the influence on moral dilemmas of help seeking—(enables dependency or self-care); transforming interactions (increases risk or reassurance) and reconfiguration of ‘work’ practices (causes burden or empowerment). Conclusion Findings from this meta-synthesis have implications for the future design and implementation of telehealth services. Future

  15. The Contradictions of Telehealth User Experience in Chronic Obstructive Pulmonary Disease (COPD): A Qualitative Meta-Synthesis.

    PubMed

    Brunton, Lisa; Bower, Peter; Sanders, Caroline

    2015-01-01

    As the global burden of chronic disease rises, policy makers are showing a strong interest in adopting telehealth technologies for use in long term condition management, including COPD. However, there remain barriers to its implementation and sustained use. To date, there has been limited qualitative investigation into how users (both patients/carers and staff) perceive and experience the technology. We aimed to systematically review and synthesise the findings from qualitative studies that investigated user perspectives and experiences of telehealth in COPD management, in order to identify factors which may impact on uptake. Systematic review and meta-synthesis of published qualitative studies of user (patients, their carers and clinicians) experience of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease. ASSIA, CINAHL, Embase, Medline, PsychInfo and Web of Knowledge databases were searched up to October 2014. Reference lists of included studies and reference lists of key papers were also searched. Quality appraisal was guided by an adapted version of the CASP qualitative appraisal tool. 705 references (after duplicates removed) were identified and 10 papers, relating to 7 studies were included in the review. Most authors of included studies had identified both positive and negative experiences of telehealth use in the management of COPD. Through a line of argument synthesis we were able to derive new insights from the data to identify three overarching themes that have the ability to either impede or promote positive user experience of telehealth in COPD: the influence on moral dilemmas of help seeking-(enables dependency or self-care); transforming interactions (increases risk or reassurance) and reconfiguration of 'work' practices (causes burden or empowerment). Findings from this meta-synthesis have implications for the future design and implementation of telehealth services. Future research needs to include potential users at

  16. Special populations: telehealth advance practice nursing: the lived experiences of individuals with acute infections transitioning in the home.

    PubMed

    Marineau, Michelle L

    2007-01-01

    This paper aims to describe the "lived experience" of individuals with acute infections transitioning in the home with support by an advance practice nurse using telehealth. The use of telehealth in individuals' homes in the United States is increasing in an effort to cut cost by limiting admissions to hospitals and/or reducing length of stay. This increase has not been driven by conclusive research findings in support of this technology; furthermore, the majority of research conducted has been in the area of chronic disease management. A qualitative approach was used to describe the essential structure of the lived experience as told during taped interviews by individuals who had been enrolled in a pilot quantitative telehealth study over the past 2 years. Major findings consisted of three theme categories: Initial response, Engaging in care, and Experiencing the downside. The transition that occurred when an individual with an acute infection was discharged from the hospital to the home supported by telehealth technology revealed an overall positive experience from the 10 participants. There was one negative experience in a participant who had two separate telehealth enrollments. The findings add valuable insight for advanced practice nurses into the experience of participants with acute illness who are receiving telehealth as they transition from hospital care to home care. The findings highlighted the importance of the participants having a sense of control when recovering from their illness, which could be achieved at home with a family member acting as a substitute nurse. The participants shared that the hospital environment may not be optimal for recovering from an illness. This provides the advanced practice nurse with information on risk and benefits of telehealth from the individuals' perspective.

  17. Heuristic evaluation of a telehealth system from the Danish TeleCare North Trial.

    PubMed

    Lilholt, Pernille Heyckendorff; Jensen, Morten Hasselstrøm; Hejlesen, Ole K

    2015-05-01

    The aim was to evaluate the usability of the design of the telehealth system, named Telekit, developed for the Danish TeleCare North Trial, early into the design process in order to assess potential problems and limitations which could hinder its successful implementation. Five experts, including one who pilot-tested the Telekit system, individually evaluated its usability and its compliance with Jakob Nielsen's ten usability heuristics for interaction design. Usability problems were categorised according to Rolf Molich's severity classification. The five experts identified a total of 152 problems in the Telekit system, each identifying 22-40 problems. 86 (57%) out of the 152 problems were identified only once. All heuristics were used, but the three most frequently used were: "Match between system and the real world" (32%), "Consistency and standards" (13%) and "Aesthetic and minimalist design" (13%). The most widely used classifications were: "Improvement" (40%) and "Minor problem" (43%). Heuristic evaluation was an effective method for uncovering and identifying problems with the system. The consistent finding of particular usability problems confirms that the development of a telehealth system should pay particular attention to user aspects. The most serious problem was the inability of the system to inform users of how to perform measurements correctly and to "speak the users' language". The problems found in the heuristic evaluation have led to several significant changes in the telehealth system. We suggest that heuristic evaluation always be followed by user tests to evaluate the design of telehealth systems. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. A computational infrastructure for evaluating Care-Coordination and Telehealth services in Europe.

    PubMed

    Natsiavas, Pantelis; Filos, Dimitiris; Maramis, Christos; Chouvarda, Ioanna; Schonenberg, Helen; Pauws, Steffen; Bescos, Cristina; Westerteicher, Christoph; Maglaveras, Nicos

    2014-01-01

    This paper presents the computational framework that is employed for the analysis of health related key drivers and indicators within ACT, a project aiming to improve the deployment of Care Coordination and Telehealth services/programmes across Europe, through an iterative evidence collection-evaluation-refinement process. An open-source solution is proposed, combining a series of established software technologies. The paper focuses on technical aspects of the framework and presents a worked example of a usage scenario.

  19. Making a case for telehealth: measuring the carbon cost of health-related travel.

    PubMed

    Ellis, Isabelle; Cheek, Colleen; Jaffray, Linda; Skinner, Timothy

    2013-01-01

    Telehealth services are promoted to reduce the cost of travel for people living in rural areas. The previous Australian Government, through the national Digital Economy Strategy, invested heavily in telehealth service development, at the same time introducing a carbon pricing mechanism. In planning a range of new telehealth services to a rural community the authors sought to quantify the travel conducted by people from one rural area in Australia to access health care, and to calculate the associated carbon emissions. A population survey was conducted over a 1-week period of health-related travel events for the year 1 July 2011 to 30 June 2012 of all households on King Island, a community situated between the Australian mainland state of Victoria and the state of Tasmania. Validated emissions calculators were sourced from the Carbon Neutral website, including the vehicle and fuel use calculator and air travel carbon calculator, to calculate the total emissions associated with the fuel burned in tonnes of carbon dioxide equivalent (tCO2e). Thirty nine percent of the population (625 participants) reported a total of 511 healthcare-related travel events. Participants travelled a total of 346 573 km and generated 0.22 tCO2e per capita. Participants paid the cost of their own travel more than 70% of the time. Dependence on fossil fuels for transport in a carbon economy has a significant impact on total healthcare carbon emissions. Alternative models of care, such as telehealth, need be developed for an environmentally sustainable healthcare system for rural and remote areas.

  20. Federal efforts to define and advance telehealth--a work in progress.

    PubMed

    Doarn, Charles R; Pruitt, Sherilyn; Jacobs, Jessica; Harris, Yael; Bott, David M; Riley, William; Lamer, Christopher; Oliver, Anthony L

    2014-05-01

    The integration of telecommunications and information systems in healthcare is not new or novel; indeed, it is the current practice of medicine and has been an integral part of medicine in remote locations for several decades. The U.S. Government has made a significant investment, measured in hundreds of millions of dollars, and therefore has a strong presence in the integration of telehealth/telemedicine in healthcare. However, the terminologies and definitions in the lexicon vary across agencies and departments of the U.S. Government. The objective of our survey was to identify and evaluate the definitions of telehealth/telemedicine across the U.S. Government to provide a better understanding of what each agency or department means when it uses these terms. The U.S. Government, under the leadership of the Health Resources and Services Administration in the U.S. Department of Health and Human Services, established the Federal Telemedicine (FedTel) Working Group, through which all members responded to a survey on each agency or department's definition and use of terms associated with telehealth. Twenty-six agencies represented by more than 100 individuals participating in the FedTel Working Group identified seven unique definitions of telehealth in current use across the U.S. Government. Although many definitions are similar, there are nuanced differences that reflect each organization's legislative intent and the population they serve. These definitions affect how telemedicine has been or is being applied across the healthcare landscape, reflecting the U.S. Government's widespread and influential role in healthcare access and service delivery. The evidence base suggests that a common nomenclature for defining telemedicine may benefit efforts to advance the use of this technology to address the changing nature of healthcare and new demands for services expected as a result of health reform.

  1. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

    PubMed Central

    Langabeer, James R.; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

    2016-01-01

    Introduction Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. Methods The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. Results During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P<.001). EMS productivity (median time from EMS notification to unit back in service) was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median). There were no statistically significant differences in mortality or patient satisfaction. Conclusion We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions. PMID:27833678

  2. Using QALYs in telehealth evaluations: a systematic review of methodology and transparency

    PubMed Central

    2014-01-01

    Background The quality-adjusted life-year (QALY) is a recognised outcome measure in health economic evaluations. QALY incorporates individual preferences and identifies health gains by combining mortality and morbidity into one single index number. A literature review was conducted to examine and discuss the use of QALYs to measure outcomes in telehealth evaluations. Methods Evaluations were identified via a literature search in all relevant databases. Only economic evaluations measuring both costs and QALYs using primary patient level data of two or more alternatives were included. Results A total of 17 economic evaluations estimating QALYs were identified. All evaluations used validated generic health related-quality of life (HRQoL) instruments to describe health states. They used accepted methods for transforming the quality scores into utility values. The methodology used varied between the evaluations. The evaluations used four different preference measures (EQ-5D, SF-6D, QWB and HUI3), and utility scores were elicited from the general population. Most studies reported the methodology used in calculating QALYs. The evaluations were less transparent in reporting utility weights at different time points and variability around utilities and QALYs. Few made adjustments for differences in baseline utilities. The QALYs gained in the reviewed evaluations varied from 0.001 to 0.118 in implying a small but positive effect of telehealth intervention on patient’s health. The evaluations reported mixed cost-effectiveness results. Conclusion The use of QALYs in telehealth evaluations has increased over the last few years. Different methodologies and utility measures have been used to calculate QALYs. A more harmonised methodology and utility measure is needed to ensure comparability across telehealth evaluations. PMID:25086443

  3. Sustained effects of a nurse coaching intervention via telehealth to improve health behavior change in diabetes.

    PubMed

    Young, Heather; Miyamoto, Sheridan; Ward, Deborah; Dharmar, Madan; Tang-Feldman, Yajarayma; Berglund, Lars

    2014-09-01

    Diabetes educators and self-management programs are scarce in rural communities, where diabetes is the third highest-ranking health concern. The goal of this study was to evaluate the benefits of nurse telehealth coaching for persons with diabetes living in rural communities through a person-centered approach using motivational interviewing (MI) techniques. A randomized experimental study design was used to assign participants to receive either nurse telehealth coaching for five sessions (intervention group) or usual care (control group). Outcomes were measured in both groups using the Diabetes Empowerment Scale (DES), SF-12, and satisfaction surveys. Mean scores for each outcome were compared at baseline and at the 9-month follow-up for both groups using a Student's t test. We also evaluated the change from baseline by estimating the difference in differences (pre- and postintervention) using regression methods. Among the 101 participants included in the analysis, 51 received nurse telehealth coaching, and 50 received usual care. We found significantly higher self-efficacy scores in the intervention group compared with the control group based on the DES at 9 months (4.03 versus 3.64, respectively; p<0.05) and the difference in difference estimation (0.42; p<0.05). The nurse MI/telehealth coaching model used in this study shows promise as an effective intervention for diabetes self-management in rural communities. The sustained effect on outcomes observed in the intervention group suggests that this model could be a feasible intervention for long-term behavioral change among persons living with chronic disease in rural communities.

  4. Utilization of Telehealth Technology to Develop and Implement a Comprehensive Management Initiative for Chronic Diseases

    DTIC Science & Technology

    2010-10-21

    blindness among working-age adults, yet it is largely preventable with timely diagnosis and treatment ( Diabetic Retinopathy Study Research Group, 1981...Early Treatment Diabetic Retinopathy Research Group, 1991). Diabetes -related vision loss is often caused by a combination of poor access to and...retinopathy and diabetic macular edema, the telehealth eye care assessments agree substantially with mydriatic seven-standard field Early Treatment

  5. Long-term evaluation of home-based pulmonary rehabilitation in patients with COPD

    PubMed Central

    Grosbois, Jean Marie; Gicquello, Alice; Langlois, Carole; Le Rouzic, Olivier; Bart, Frédéric; Wallaert, Benoit; Chenivesse, Cécile

    2015-01-01

    Introduction Personalized, global pulmonary rehabilitation (PR) management of patients with COPD is effective, regardless of the place in which this rehabilitation is provided. The objective of this retrospective observational study was to study the long-term outcome of exercise capacity and quality of life during management of patients with COPD treated by home-based PR. Methods Home-based PR was administered to 211 patients with COPD (mean age, 62.3±11.1 years; mean forced expiratory volume in 1 second, 41.5%±17.7%). Home-based PR was chosen because of the distance of the patient’s home from the PR center and the patient’s preference. Each patient was individually managed by a team member once a week for 8 weeks with unsupervised continuation of physical exercises on the other days of the week according to an individual action plan. Exercise conditioning, therapeutic patient education, and self-management were included in the PR program. The home assessment comprised evaluation of the patient’s exercise capacity by a 6-minute stepper test, Timed Up and Go test, ten times sit-to-stand test, Hospital Anxiety and Depression score, and quality of life (Visual Simplified Respiratory Questionnaire, VQ11, Maugeri Respiratory Failure 28). Results No incidents or accidents were observed during the course of home-based PR. The 6-minute stepper test was significantly improved after completion of the program, at 6 months and 12 months, whereas the Timed Up and Go and ten times sit-to-stand test were improved after PR and at 6 months but not at 12 months. Hospital Anxiety and Depression and quality of life scores improved after PR, and this improvement persisted at 6 months and 12 months. Conclusion Home-based PR for unselected patients with COPD is effective in the short term, and this effectiveness is maintained in the medium term (6 months) and long term (12 months). Home-based PR is an alternative to outpatient management provided all activities, such as exercise

  6. Trajectories of health-related quality of life among family caregivers of individuals with dementia: A home-based caregiver-training program matters.

    PubMed

    Kuo, Li-Min; Huang, Huei-Ling; Liang, Jersey; Kwok, Yam-Ting; Hsu, Wen-Chuin; Liu, Chin-Yi; Shyu, Yea-Ing L

    To determine distinct courses of change in health-related quality of life (HRQoL) among family caregivers of individuals with dementia and how participating in a home-based caregiver-training program affects the probability of belonging to each course. Sixty three caregivers were in the intervention group, and 66 caregivers were in the control group of a single-blinded randomized clinical trial. Two distinct trajectories of HRQoL were identified: a well-functioning trajectory and a poor-functioning trajectory. Caregivers who received the training program were more likely than those who did not have a well-functioning trajectory of HRQoL over 18 months. This trajectory included bodily pain (b = 1.02, odds ratio [OR] = 2.76), general health perception (b = 1.28, OR = 3.60), social functioning (b = 1.12, OR = 3.05), vitality (b = 1.51, OR = 4.49), general mental health (b = 1.08, OR = 2.94), and mental component summary (b = 1.27, OR = 3.55). Home-based caregiver training can be considered as part of the protocol for managing patients with dementia and their caregivers. NCT02667951. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Video-based telehealth in Australian primary health care: current use and future potential.

    PubMed

    Raven, Melissa; Butler, Caryn; Bywood, Petra

    2013-01-01

    Many Australians have limited access to health-care services due to a range of barriers, including geographic distance and restricted mobility, which telehealth can potentially address. This paper reviews the current and potential use of video consultation in primary health care in Australia, drawing on international literature. There is substantial evidence of high patient satisfaction, but many studies have methodological limitations. Overall, evidence of effectiveness and cost-effectiveness is weak. There is reasonable evidence for diagnosis, home care and specialist consultations by GPs with patients present. Two telehealth initiatives using video consultation are briefly presented. Both provide evidence that video consultation has a valuable role to play, but does not obviate the need for face-to-face consultations. Video consultation challenges traditional professional roles, particularly those of nurses, and can improve health workers' skills and job satisfaction. More fundamentally, telehealth challenges the traditional distinction between primary and secondary care. This can be a source of resistance but may ultimately be one of its strengths. Appropriately targeted video consultation has much potential to improve the delivery of primary health care in Australia, particularly in rural and remote regions.

  8. Development of a Telehealth Intervention for Head and Neck Cancer Patients

    PubMed Central

    Studts, Jamie L.; Bumpous, Jeffrey M.; Gregg, Jennifer L.; Wilson, Liz; Keeney, Cynthia; Scharfenberger, Jennifer A.; Pfeifer, Mark P.

    2009-01-01

    Abstract Treatment for head and neck cancer precipitates a myriad of distressing symptoms. Patients may be isolated both physically and socially and may lack the self-efficacy to report problems and participate as partners in their care. The goal of this project was to design a telehealth intervention to address such isolation, develop patient self-efficacy, and improve symptom management during the treatment experience. Participatory action research and a review of the literature were used to develop electronically administered symptom management algorithms addressing all major symptoms experienced by patients undergoing treatment for head and neck cancers. Daily questions and related messages were then programmed into an easy-to-use telehealth messaging device, the Health Buddy®. Clinician and patient acceptance, feasibility, and technology issues were measured. Using participatory action research is an effective means for developing electronic algorithms acceptable to both clinicians and patients. The use of a simple tele-messaging device as an adjunct to symptom management is feasible, affordable, and acceptable to patients. This telehealth intervention provides support and education to patients undergoing treatment for head and neck cancers. PMID:19199847

  9. Intercontinental telehealth coaching of therapists to improve verbalizations by children with autism.

    PubMed

    Barkaia, Ana; Stokes, Trevor F; Mikiashvili, Tamar

    2017-07-01

    This study examined the effects of intercontinental telehealth coaching on the mastery of therapists' skills and improvements in verbalizations by children with autism, testing whether telehealth can be a solution for underserved communities in developing countries such as Georgia-Sakartvelo in Eastern Europe. Three therapists delivering and three children with autism receiving early-intervention services from the nongovernmental organization Children of Georgia in Tbilisi participated. Experimenters provided coaching from Virginia, USA to therapists in Georgia-Sakartvelo. Observers in Georgia-Sakartvelo and in Virginia conducted the behavioral observations. We used inexpensive communications technology to provide the coaching and a multiple-baseline design across participants to evaluate the effects of the intervention. Therapists demonstrated improvements in two classes of behaviors: correct command sequences and positive consequences. The children demonstrated improvements with echoics and mands. The study demonstrated that telehealth can be a good model for delivering early-intervention services to children with autism in underserved and distant regions of the world. © 2017 Society for the Experimental Analysis of Behavior.

  10. Automated telehealth for managing psychiatric instability in people with serious mental illness.

    PubMed

    Pratt, Sarah I; Naslund, John A; Wolfe, Rosemarie S; Santos, Meghan; Bartels, Stephen J

    2015-01-01

    Serious mental illness (SMI) with psychiatric instability accounts for disproportionately high use of emergency room visits and hospitalizations. To evaluate the effectiveness of an automated telehealth intervention supported by nurse health care management for improving psychiatric illness management and reducing acute service use among individuals with SMI and psychiatric instability. Thirty-eight individuals with SMI received the automated telehealth intervention for 6 months. Psychiatric symptoms, illness self-management, and self-reported service use (emergency room visits and hospital admissions) were collected at baseline, 3- and 6-months. Measures of quality of life, health indicators, and subjective health status were also collected. Participants demonstrated improvements in self-reported psychiatric symptoms and illness self-management skills, an 82% decrease in hospital admissions (from 76 to 14 hospitalizations, p < 0.001) and a 75% decrease in emergency room visits (from 63 to 16 visits, p < 0.001). Improvements were also observed in quality of life, severity of depressive symptoms, and mental health status. These highly promising findings support the use of an automated telehealth device monitored by a nurse care manager for people with SMI, and highlight the potential for cost savings through reductions in acute health care utilization.

  11. Integrated telehealth and care management program for Medicare beneficiaries with chronic disease linked to savings.

    PubMed

    Baker, Laurence C; Johnson, Scott J; Macaulay, Dendy; Birnbaum, Howard

    2011-09-01

    Treatment of chronically ill people constitutes nearly four-fifths of US health care spending, but it is hampered by a fragmented delivery system and discontinuities of care. We examined the impact of a care coordination approach called the Health Buddy Program, which integrates a telehealth tool with care management for chronically ill Medicare beneficiaries. We evaluated the program's impact on spending for patients of two clinics in the US Northwest who were exposed to the intervention, and we compared their experience with that of matched controls. We found significant savings among patients who used the Health Buddy telehealth program, which was associated with spending reductions of approximately 7.7-13.3 percent ($312-$542) per person per quarter. These results suggest that carefully designed and implemented care management and telehealth programs can help reduce health care spending and that such programs merit continued attention by Medicare. Meanwhile, mortality differences in the treatment and control groups suggest that the intervention may have produced noticeable changes in health outcomes, but we leave it to future research to explore these effects fully.

  12. A review of paediatric telehealth for pre- and post-operative surgical patients.