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Sample records for protocol home-based telehealth

  1. 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.

  2. Home-Based Telehealth Hospitalization for Exacerbation of Chronic Obstructive Pulmonary Disease: Findings from “The Virtual Hospital” Trial

    PubMed Central

    Laursen, Lars C.; Rydahl-Hansen, Susan; Østergaard, Birte; Gerds, Thomas Alexander; Emme, Christina; Schou, Lone; Phanareth, Klaus

    2015-01-01

    Abstract Background: Telehealth interventions for patients with chronic obstructive pulmonary disease (COPD) have focused primarily on stable outpatients. Telehealth designed to handle the acute exacerbation that normally requires hospitalization could also be of interest. The aim of this study was to compare the effect of home-based telehealth hospitalization with conventional hospitalization for exacerbation in severe COPD. Materials and Methods: A two-center, noninferiority, randomized, controlled effectiveness trial was conducted between June 2010 and December 2011. Patients with severe COPD admitted because of exacerbation were randomized 1:1 either to home-based telehealth hospitalization or to continue standard treatment and care at the hospital. The primary outcome was treatment failure defined as re-admission due to exacerbation in COPD within 30 days after initial discharge. The noninferiority margin was set at 20% of the control group's risk of re-admission. Secondary outcomes were mortality, need for manual or mechanical ventilation or noninvasive ventilation, length of hospitalization, physiological parameters, health-related quality of life, user satisfaction, healthcare costs, and adverse events. Results: In total, 57 patients were randomized: 29 participants in the telehealth group and 28 participants in the control group. Testing the incidence of re-admission within 30 days after discharge could not confirm noninferiority (lower 95% confidence limit [CL], −24.8%; p=0.35). Results were also nonsignificant at 90 days (lower 95% CL, −16.2%; p=0.33) and 180 days (lower 95% CL, −16.6%; p =0.33) after discharge. Superiority testing on secondary outcomes showed nonsignificant differences between groups. Healthcare costs have not yet been evaluated. Conclusions: Whether home-based telehealth hospitalization is noninferior to conventional hospitalization requires further investigation. The results indicate that a subgroup of patients with severe COPD

  3. Patient Compliance in Home-Based Self-Care Telehealth Projects.

    PubMed

    Maeder, Anthony; Poultney, Nathan; Morgan, Gary; Lippiatt, Robert

    2015-12-01

    This paper presents the findings of a literature review on patient compliance in home-based self-care telehealth monitoring situations, intended to establish a knowledge base for this aspect which is often neglected alongside more conventional clinical, economic and service evaluations. A systematic search strategy led to 72 peer-reviewed published scientific papers being selected as most relevant to the topic, 58 of which appeared in the last 10 years. Patient conditions in which most evidence for compliance was found were blood pressure, heart failure and stroke, diabetes, asthma, chronic obstructive pulmonary disease and other respiratory diseases. In general, good compliance at the start of a study was found to drop off over time, most rapidly in the period immediately after the start. Success factors identified in the study included the extent of patient health education, telehealth system implementation style, user training and competence in system usage, active human support from the healthcare provider and maintaining strong participant motivation. PMID:26556057

  4. Multi-site videoconferencing for home-based education of older people with chronic conditions: the Telehealth Literacy Project.

    PubMed

    Banbury, Annie; Parkinson, Lynne; Nancarrow, Susan; Dart, Jared; Gray, Len; Buckley, Jennene

    2014-10-01

    We examined the acceptability of multi-site videoconferencing as a method of providing group education to older people in their homes. There were 9 groups comprising 52 participants (mean age 73 years) with an average of four chronic conditions. Tablet computers or PCs were installed in participant's homes and connected to the Internet by the National Broadband Network (high-speed broad band network) or by the 4G wireless network. A health literacy and self-management programme was delivered by videoconference for 5 weeks. Participants were able to view and interact with all group members and the facilitator on their devices. During the study, 44 group videoconferences were conducted. Evaluation included 16 semi-structured interviews, 3 focus groups and a journal detailing project implementation. The participants reported enjoying home-based group education by videoconference and found the technology easy to use. Using home-based groups via videoconference was acceptable for providing group education, and considered particularly valuable for people living alone and/or with limited mobility. Audio difficulties were the most commonly reported problem. Participants connected with 4G experienced more problems (audio and visual) than participants on the National Broadband Network and those living in multi-dwelling residences reported more problems than those living in single-dwelling residences. Older people with little computer experience can be supported to use telehealth equipment. Telehealth has the potential to improve access to education about chronic disease self-management.

  5. Telehealth

    MedlinePlus

    Telehealth; Telemedicine; Mobile health (mHealth); Remote patient monitoring; E-health ... hard time getting to appointments You get regular monitoring of health problems without having to go in as often ...

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

    PubMed

    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

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

    PubMed

    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.

  9. Attitudes towards acceptance of an innovative home-based and remote sensing rehabilitation protocol among cardiovascular patients in Shantou, China

    PubMed Central

    Fang, Jia-Ying; Li, Ji-Lin; Li, Zhong-Han; Xu, Duan-Min; Chen, Chang; Xie, Bin; Chen, Helen; Au, William W

    2016-01-01

    Background Cardiac rehabilitation (CR) protocols have diversified to include home-based cardiac tele-rehabilitation (HBCTR) as an alternative to hospital-based or center-based CR. To adopt the use of home-based cardiac tele-rehabilitation, it is necessary to assess cardiac patients' attitudes towards acceptance of such e-health technology, especially in China where knowledge of such technology is deficient. Methods Interviews were conducted in the First Affiliated Hospital of Shantou University Medical College, Shantou, China. After percutaneous coronary interventional (PCI) surgery, patients completed the survey. Results Among the 150 patients, only 13% had ever heard of HBCTR. After an introduction of our HBCTR program, 60% of patients were willing to participate in the program. From our multivariate analysis of questionnaire data, age (OR: 0.92, 95% CI: 0.86–0.98; P = 0.007), average family monthly income (OR: 0.13, 95% CI: 0.05–0.34; P < 0.001), education level (OR: 0.24, 95% CI: 0.10–0.59; P = 0.002) and physical exercise time (OR: 0.19, 95% CI: 0.06–0.56; P = 0.003) were independent predictors for acceptance of HBCTR. From the reasons for participation, patients selected: enhanced safety and independence (28.3%), ability to self-monitor physical conditions daily (25.4%), and having automatic and emergency alert (23.1%). Reasons for refusal were: too cumbersome operation (34.3%) and unnecessary protocol (19.4%). Conclusions Most patients lacked knowledge about HBCTR but volunteered to participate after they have learned about the program. Several personal and life-style factors influenced their acceptance of the program. These indicate that both improvement of technology and better understanding of the program will enhance active participation. PMID:27403142

  10. 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

  11. 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.

  12. A brief retrospective review of medical records comparing outcomes for inpatients treated via telehealth versus in-person protocols: is telehealth equally effective as in-person visits for treating neutropenic fever, bacterial pneumonia, and infected bacterial wounds?

    PubMed

    Assimacopoulos, Aristides; Alam, Rabiul; Arbo, Manuel; Nazir, Jawad; Chen, Ding-Geng; Weaver, Susan; Dahler-Penticoff, Marilyn; Knobloch, Karla; DeVany, Mary; Ageton, Cheryl

    2008-10-01

    The incidence of infectious diseases in the United States has been increasing since 1980. Re-emergent conditions, multidrug-resistant bacteria, newly identified infections, and bioterrorism have prompted public health surveillance and control initiatives, including the use of telehealth technology. Infectious diseases, such as West Nile Virus, pose a particular threat to rural areas, where access to infectious disease specialists (IDS) is limited. Initial, in-patient IDS consultations are reimbursed by Centers for Medicare & Medicaid Services for in-person and for telehealth services. Follow-up consultation and subsequent care visits are reimbursed when delivered via in-person care, but not reimbursed when delivered via telehealth. The purpose of this study is to investigate the efficacy of telehealth technology (interactive videoconferencing) in providing timely, efficient, and prudent infectious disease care for rural patients. We conducted a retrospective, comparative review of medical records (n = 107) from inpatients at a metropolitan hospital (n = 59) in a rural state who received in-person IDS treatment, with records from inpatients at nonmetropolitan, rural, and frontier hospitals (n = 48) in the same state who received telehealth IDS treatment. Outcome measures, including number of days hospitalized, number of days receiving intravenous antibiotic, survival, and transfer to another hospital, were compared for three commonly occurring infectious diseases: neutropenic fever, bacterial pneumonia, or bacterial wound infection. Patients treated via telehealth had fewer days on antibiotics and fewer days hospitalized than patients treated via in-person intervention. Survival rates did not differ significantly between groups, but were lower for telehealth patients. Fewer in-person patients required transfer to hospitals offering a higher level of care. Ninety percent of telehealth patients were able to remain at their local hospital for treatment. Results were

  13. 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

  14. 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

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

    PubMed Central

    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

  16. 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

  17. Atlantic Telehealth Knowledge Exchange.

    PubMed

    Dwyer, Patricia; Hagerman, Valerie; Ingram, Chris-Anne; MacFarlane, Ron; McCourt, Sherry

    2004-01-01

    Atlantic Canada has some of the earliest, most comprehensive, well-established networks, and innovative applications for telehealth in the country. The region offers a range of models for telehealth, in terms of management structure, coordination, funding, equipment, utilization, and telehealth applications. Collectively, this diversity, experience, and wealth of knowledge can significantly contribute to the development of a knowledge base for excellence in telehealth services. There is no formal process in place for the sharing of information amongst the provinces. Information sharing primarily occurs informally through professional contacts and participation in telehealth organizations. A core group of organizations partnered to develop a process for knowledge exchange to occur. This type of collaborative approach is favored in Atlantic Canada, given the region's economy and available resources. The Atlantic Telehealth Knowledge Exchange (ATKE) project centred on the development of a collaborative structure, information sharing and dissemination, development of a knowledge repository and sustainability. The project is viewed as a first step in assisting telehealth stakeholders with sharing knowledge about telehealth in Atlantic Canada. Significant progress has been made throughout the project in increasing the profile of telehealth in Atlantic Canada. The research process has captured and synthesized baseline information on telehealth, and fostered collaboration amongst telehealth providers who might otherwise have never come together. It has also brought critical awareness to the discussion tables of governments and key committees regarding the value of telehealth in sustaining our health system, and has motivated decision makers to take action to integrate telehealth into e-health discussions.

  18. Home based exercise to improve turning and mobility performance among community dwelling older adults: protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Turning is a common activity for older people, and is one of the activities commonly associated with falls during walking. Falls that occur while walking and turning have also been associated with an increased risk of hip fracture in older people. Despite the importance of stability during turning, there has been little focus on identifying this impairment in at risk older people, or in evaluating interventions aiming to improve this outcome. This study will evaluate the effectiveness of a 16 week tailored home based exercise program in older adults aged (50 years and above) who were identified as having unsteadiness during turning. Methods/Design A single blind randomized controlled trial will be conducted, with assessors blind to group allocation. Study participants will be aged 50 years and above, living in the community and have been identified as having impaired turning ability [outside of age and gender normal limits on the Step Quick Turn (180 degree turn) task on the Neurocom® Balance Master with long plate]. After a comprehensive baseline assessment, those classified as having balance impairment while turning will be randomized to intervention or control group. The intervention group will receive a 16 week individualized balance and strength home exercise program, based on the Otago Exercise Program with additional exercises focused on improving turning ability. Intervention group will attend four visit to the assessment centre over 16 weeks period, for provision, monitoring, modification of the exercise and encourage ongoing participation. Participants in the control group will continue with their usual activities. All participants will be re-assessed on completion of the 16 week program. Primary outcome measures will be the Step Quick Turn Test and Timed-Up and Go test. Secondary outcomes will include other clinical measures of balance, psychological aspects of falls, incidence of falls and falls risk factors. Discussion Results of this study

  19. 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

  20. Telehealth Education in Nursing Curricula.

    PubMed

    Ali, Nagia S; Carlton, Kay Hodson; Ali, Omar S

    2015-01-01

    Telehealth care is a fast-growing avenue of providing health care services at a distance. A descriptive study was conducted to identify trends of telehealth education in 43 schools of nursing. Findings reflected inadequate integration of telehealth in classroom content, simulation, and clinical experiences. Interviews with 4 nursing leaders of telehealth provided some recommendations on how to integrate telehealth education in nursing curricula.

  1. 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

  2. Caring in telehealth.

    PubMed

    Varghese, Shainy B; Phillips, Carolyn A

    2009-12-01

    The overall goal of this study was to explore and describe the perceptions of advanced practice nurses (APNs) about caring while providing primary care using telehealth technology. This study used naturalistic inquiry methodology to elicit the subjective perceptions and reflections of a sample of APNs about how they convey caring in the context of telehealth. Thirteen APNs, selected by purposive and snowball sampling, participated in the study. The data for the study consisted of interviews conducted by e-mail using a semistructured interview guide. Data analysis used the constant comparison method; rigor and trustworthiness of the study procedures were established using the criteria of credibility, confirmability, dependability, and transferability. The findings of this study revealed that the APNs conveyed caring to their telehealth patients by (1) being with them, (2) personifying the images, and (3) possessing certain attributes. The major constructs that emerged from the data together formed a model of how APNs conveyed caring in telehealth. The findings provide insights and increase the understanding of how caring in telehealth was perceived by APNs. The findings of the study can make important contributions in improving our profession's preparation of future telehealth APNs. The study findings also can lend themselves to developing an instrument to measure caring in telehealth. The study findings also contribute to the nursing literature in a number of ways.

  3. Telehealth Remote Monitoring Systematic Review

    PubMed Central

    Young, Heather M.; Quinn, Charlene C.

    2014-01-01

    The aim was to summarize research on telehealth remote patient monitoring interventions that incorporate key elements of structured self-monitoring of blood glucose (SMBG) identified as essential for improving A1C. A systematic review was conducted using the Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and OVID Medline databases with search terms “Telemedicine” AND “Monitoring, Physiologic” AND “Diabetes Mellitus, Type 2.” Study selection criteria included original randomized clinical trials evaluating the impact of telehealth remote patient monitoring on A1C among adults with type 2 diabetes and incorporated 1 or more essential elements of SMBG identified by the International Diabetes Federation (patient education, provider education, structured SMBG profile, SMBG goals, feedback, data used to modify treatment, interactive communication or shared decision making). Fifteen studies were included, with interventions ranging from 3 to 12 months (mean 8 months) with sample sizes from 30 to 1665. Key SMBG elements were grouped into 3 categories: education, SMBG protocols, and feedback. Research incorporating 5 of the 7 elements consistently achieved significant A1C improvements between study groups. Interventions using more SMBG elements are associated with an improvement in A1C. Studies with the largest A1C decrease incorporated 6 of the 7 elements and computer decision support. Two studies with 5 of the 7 elements and active medication management achieved significant A1C decreases. Telehealth remote patient monitoring interventions in type 2 diabetes have not included all structured monitoring elements recommended by the IDF. Incorporating more elements of structured SMBG is associated with improved A1C. PMID:24876591

  4. 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

  5. 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.

  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. PMID:21893945

  7. 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

  8. 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

  9. 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

  10. Telehealth brings benefits.

    PubMed

    2016-08-01

    A telehealth clinical lead writing in Primary Health Care says that for the NHS to thrive, front line staff and patients must be empowered. New ways of working are needed and the use of technology should be maximised. Telehealth allows nurses to work more efficiently, communicate better with patients and families, and improve health outcomes cost-effectively. The author encourages frontline nurses to implement changes in the work place and suggests NHS Change Day in October as a starting point. The article also notes the importance of social media in opening up opportunities to connect with other nurses. PMID:27484572

  11. 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. PMID:27553999

  12. Maternity telehealth: ringing the changes.

    PubMed

    Finlay, Dorothy; Brown, Sheona

    2013-12-01

    This article describes NHS Scotland's Maternity telehealth options project and the implementation of the recommendations made. This 17-month project resulted in the development of national documentation for recording telehealth calls; the development of a self-directed eLearning tool on maternity telehealth call structure which was made available to all health boards in Scotland; a comprehensive programme of training on telehealth for student midwives; a programme of 'Train-the-trainer' events for qualified midwives to enable the cascade of learning throughout the service. The project also involved collaboration with Health Scotland, signposting for women to contact the appropriate caregiver at the appropriate time. PMID:24386706

  13. Nurses: extending care through telehealth.

    PubMed

    Allen, Maryah; Aylott, Mya; Loyola, Margarita; Moric, Mika; Saffarek, Lisa

    2015-01-01

    Nurses have an immense impact on the growth and scope of Telehealth as they embrace diverse roles. TeleNursing introduces transformational change which positively impacts both clients and providers, increasing access to care and reducing the time and costs associated with traveling for health care. Integration of clinical support and remote diagnostic tools inspire new uses of Telehealth, thus enabling care previously only possible in person to be delivered virtually. Nurses currently leverage Telehealth to deliver care and education, monitor clients remotely and support medical consultations. Over 90% of Island Health nurses surveyed recommend Telehealth as a care modality to clients and 100% support Telehealth as a means to increase care to vulnerable communities. Programs wish to increase uptake of TeleNursing but face numerous challenges regarding funding, resourcing, scheduling and geographical ownership. TeleNursing goes beyond clinical support and has the potential to exponentially expand Telehealth services, normalizing Telehealth as a care modality. Nurses look to Telehealth to improve their ability to partner with clients over distance, providing surgical care, maternal/pediatric care and group education. PMID:25676943

  14. Task–Technology Fit of Video Telehealth for Nurses in an Outpatient Clinic Setting

    PubMed Central

    Finkelstein, Stanley M.

    2014-01-01

    Abstract Background: Incorporating telehealth into outpatient care delivery supports management of consumer health between clinic visits. Task–technology fit is a framework for understanding how technology helps and/or hinders a person during work processes. Evaluating the task–technology fit of video telehealth for personnel working in a pediatric outpatient clinic and providing care between clinic visits ensures the information provided matches the information needed to support work processes. Materials and Methods: The workflow of advanced practice registered nurse (APRN) care coordination provided via telephone and video telehealth was described and measured using a mixed-methods workflow analysis protocol that incorporated cognitive ethnography and time–motion study. Qualitative and quantitative results were merged and analyzed within the task–technology fit framework to determine the workflow fit of video telehealth for APRN care coordination. Results: Incorporating video telehealth into APRN care coordination workflow provided visual information unavailable during telephone interactions. Despite additional tasks and interactions needed to obtain the visual information, APRN workflow efficiency, as measured by time, was not significantly changed. Analyzed within the task–technology fit framework, the increased visual information afforded by video telehealth supported the assessment and diagnostic information needs of the APRN. Conclusions: Telehealth must provide the right information to the right clinician at the right time. Evaluating task–technology fit using a mixed-methods protocol ensured rigorous analysis of fit within work processes and identified workflows that benefit most from the technology. PMID:24841219

  15. 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

  16. 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. PMID:27563386

  17. 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

  18. Practical aspects of telehealth: financial considerations.

    PubMed

    Loh, P K; Sabesan, S; Allen, D; Caldwell, P; Mozer, R; Komesaroff, P A; Talman, P; Williams, M; Shaheen, N; Grabinski, O; Withnall, D

    2013-07-01

    The second in a series of articles about the practical aspects of telehealth, this paper includes information and a case history on the cost-benefits for patients and practitioners using telehealth. The case history demonstrates that telehealth can save travel time for patients, carers and specialists, and can reduce out-of-pocket expenses. The practical aspects of telehealth article series considers the contextual, clinical, technical and ethical components of online video consultations.

  19. Economic assessment of home-based COPD management programs.

    PubMed

    Liu, Sheena Xin; Lee, Michael C; Atakhorrami, Maryam; Tatousek, Jan; McCormack, Meredith; Yung, Rex; Hart, Nicholas; White, David P

    2013-12-01

    Home-based exacerbation management programs have been proposed as an approach to reducing the clinical and financial burden of COPD. We demonstrate a framework to evaluate such programs in order to guide program design and performance decisions towards optimizing cost and clinical outcomes. This study models the impact of hypothetical exacerbation management programs through probabilistic Markov simulations. Patients were stratified by risk using exacerbation rates from the ECLIPSE study and expert opinion. Three scenarios were modeled, using base, worst and best case parameters to suggest potential telehealth program performance. In these scenarios, acute exacerbations could be detected early, with sensitivity and specificity ranging from 60-90%. Detected acute exacerbations could be diverted to either a sub-acute pathway (12.5-50% probability), thus entirely avoiding hospitalization, or a lower cost pathway through length-of-stay reduction (14-28% reduction). For a cohort of patients without prior hospitalization, the base case telehealth scenario results in a cumulative per-patient lifetime savings of $2.9 K over ≈ 12 years. For a higher risk cohort of patients with a prior admission and 1 to 2 acute exacerbations per year, a cumulative $16K per patient was saved during the remaining ≈ 3 life-years. Acceptable prices for home-based exacerbation detection testing were highly dependent on patient risk and scenario, but ranged from $290-$1263 per month for the highest risk groups. These results suggest the economic viability of exacerbation management programs and highlight the importance of risk stratification in such programs. The presented model can further be adapted to model specific programs as trial data becomes available. PMID:23848542

  20. Telehealth practice recommendations for diabetic retinopathy.

    PubMed

    Cavallerano, Jerry; Lawrence, Mary G; Zimmer-Galler, Ingrid; Bauman, Wendell; Bursell, Sven; Gardner, W Kelley; Horton, Mark; Hildebrand, Lloyd; Federman, Jay; Carnahan, Lisa; Kuzmak, Peter; Peters, John M; Darkins, Adam; Ahmed, Jehanara; Aiello, Lloyd M; Aiello, Lloyd P; Buck, Gary; Cheng, Ying Ling; Cunningham, Denise; Goodall, Eric; Hope, Ned; Huang, Eugene; Hubbard, Larry; Janczewski, Mark; Lewis, J W L; Matsuzaki, Hiro; McVeigh, Francis L; Motzno, Jordana; Parker-Taillon, Diane; Read, Robert; Soliz, Peter; Szirth, Bernard; Vigersky, Robert A; Ward, Thomas

    2004-01-01

    Telehealth holds the promise of increased adherence to evidenced-based medicine and improved consistency of care. Goals for an ocular telehealth program include preserving vision, reducing vision loss, and providing better access to medicine. Establishing recommendations for an ocular telehealth program may improve clinical outcomes and promote informed and reasonable patient expectations. This document addresses current diabetic retinopathy telehealth clinical and administrative issues and provides recommendations for designing and implementing a diabetic retinopathy ocular telehealth care program. The recommendations also form the basis for evaluating diabetic retinopathy telehealth techniques and technologies. Recommendations in this document are based on careful reviews of current evidence, medical literature and clinical practice. They do not, however, replace sound medical judgment or traditional clinical decision-making. "Telehealth Practice Recommendations for Diabetic Retinopathy" will be annually reviewed and updated to reflect evolving technologies and clinical guidelines. PMID:15689653

  1. Telehealth success: evaluation framework development.

    PubMed

    Hebert, M

    2001-01-01

    Implementing telehealth applications represents a substantial investment of resources, which is one reason why success is of great interest. Many research and evaluation studies have investigated measures of successful telehealth systems. However, the term "telehealth" represents a wide range of variables including clinical application, characteristics of the information being transmitted, temporal relationships of data transfer and the organizational context. These sources of variability pose many challenges for evaluation as well as for building a cumulative history of research. A conceptual framework is required that assists in categorizing results and drawing conclusions based on an accumulation of findings. One measure of "success" in health care is quality patient care and this reflects a primary reason for ICT investments. For this reason, Donabedian's work in evaluating quality provides the basis for the proposed framework. DeLone and McLean's definitions of IS success assist in conceptualizing Donabedian's structure-outcome-process variables in a telehealth context. Multiple evaluation approaches have been used to address different types of questions. Prior to the technologies being introduced to clinical care, there are usually many studies to demonstrate their effectiveness. Health Technology Assessment examines a broader context than the technology alone, including costs and comparing alternatives that would exist in the absence of telehealth. It considers performance measures; outcomes; summary measures, operational considerations, and other issues. Program Evaluation examines use of the technology to provide a service or deliver a program. Evaluation questions often address whether the program goals have been met and if it is operating as expected. Perhaps of greater concern than the evaluation approach taken is generalizability of findings. Recent studies have given inadequate attention to defining what is done (i.e. comparison of telehealth to most

  2. Telehealth application in occupational health.

    PubMed

    Morrison, Janet G

    2015-01-01

    While occupational health is a significant driver of population health, productivity, and well-being in Canadian society, most workers do not currently have adequate access to qualified occupational health services. A case study is used to demonstrate the utility of a telehealth approach to service delivery.

  3. Effect of telehealth on hospital utilisation and mortality in routine clinical practice: a matched control cohort study in an early adopter site

    PubMed Central

    Steventon, Adam; Ariti, Cono; Fisher, Elizabeth; Bardsley, Martin

    2016-01-01

    Objectives To assess the effects of a home-based telehealth intervention on the use of secondary healthcare and mortality. Design Observational study of a mainstream telehealth service, using person-level administrative data. Time to event analysis (Cox regression) was performed comparing telehealth patients with controls who were matched using a machine-learning algorithm. Setting A predominantly rural region of England (North Yorkshire). Participants 716 telehealth patients were recruited from community, general practice and specialist acute care, between June 2010 and March 2013. Patients had chronic obstructive pulmonary disease, congestive heart failure or diabetes, and a history of associated inpatient admission. Patients were matched 1:1 to control patients, also selected from North Yorkshire, with respect to demographics, diagnoses of health conditions, previous hospital use and predictive risk score. Interventions Telehealth involved the remote exchange of medical data between patients and healthcare professionals as part of the ongoing management of the patient's health condition. Monitoring centre staff alerted healthcare professionals if the telemonitored data exceeded preset thresholds. Control patients received usual care, without telehealth. Primary and secondary outcome measures Time to the first emergency (unplanned) hospital admission or death. Secondary metrics included time to death and time to first admission, outpatient attendance and emergency department visit. Results Matched controls and telehealth patients were similar at baseline. Following enrolment, telehealth patients were more likely than matched controls to experience emergency admission or death (adjusted HR 1.34, 95% CI 1.16 to 1.56, p<0.001). They were also more likely to have outpatient attendances (adjusted HR=1.25, 1.11 to 1.40, p<0.001), but mortality rates were similar between groups. Sensitivity analyses showed that we were unlikely to have missed reductions in the

  4. Transforming home health nursing with telehealth technology.

    PubMed

    Farrar, Francisca Cisneros

    2015-06-01

    Telehealth technology is an evidence-based delivery model tool that can be integrated into the plan of care for mental health patients. Telehealth technology empowers access to health care, can help decrease or prevent hospital readmissions, assist home health nurses provide shared decision making, and focuses on collaborative care. Telehealth and the recovery model have transformed the role of the home health nurse. Nurses need to be proactive and respond to rapidly emerging technologies that are transforming their role in home care.

  5. 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

  6. 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.

  7. 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

  8. 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.

  9. 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

  10. 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

  11. 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

  12. Efficacy of a minimal home-based psychoeducative intervention versus usual care for managing anxiety and dyspnoea in patients with severe chronic obstructive pulmonary disease: a randomised controlled trial protocol

    PubMed Central

    Bove, Dorthe Gaby; Overgaard, Dorthe; Lomborg, Kirsten; Lindhardt, Bjarne Ørskov; Midtgaard, Julie

    2015-01-01

    Introduction In its final stages, chronic obstructive pulmonary disease is a severely disabling condition that is characterised by dyspnoea, which causes substantial anxiety. Anxiety is associated with an impaired quality of life and increased hospital admissions. Untreated comorbid anxiety can have devastating consequences for both patients and their relatives. Non-pharmacological interventions, including cognitive–behavioural therapy, have been effective in managing anxiety and dyspnoea in patients with chronic obstructive pulmonary disease. However, the majority of existing interventions have tested the efficacy of relatively intensive comprehensive programmes and primarily targeted patients who have moderate pulmonary disease. We present the rationale and design for a trial that focused on addressing the challenges experienced by severe pulmonary disease populations. The trial investigates the efficacy of a minimal home-based psychoeducative intervention versus usual care for patients with severe chronic obstructive pulmonary disease. Methods and analysis The trial is a randomised controlled trial with a 4-week and 3-month follow-up. 66 patients with severe chronic obstructive pulmonary disease and associated anxiety will be randomised 1:1 to either an intervention or control group. The intervention consists of a single psychoeducative session in the patient's home in combination with a telephone booster session. The intervention is based on a manual, with a theoretical foundation in cognitive–behavioural therapy and psychoeducation. The primary outcome is patient-reported anxiety as assessed by the Hospital and Anxiety and Depression Scale (HADS). Ethics and dissemination This trial complies with the latest Declaration of Helsinki, and The Ethics Committee of the Capital Region of Denmark (number H-1-2013-092) was queried for ethical approval. Trial results will be disseminated in peer-reviewed publications and presented at scientific conferences. Trial

  13. Practical aspects of telehealth: doctor-patient relationship and communication.

    PubMed

    Sabesan, S; Allen, D; Caldwell, P; Loh, P K; Mozer, R; Komesaroff, P A; Talman, P; Williams, M; Shaheen, N; Grabinski, O

    2014-01-01

    The fourth in a series of articles about the practical aspects of telehealth, this paper provides advice and information for specialists to communicate effectively with patients during a telehealth video consultation. PMID:24450527

  14. [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.

  15. 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

  16. 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.

  17. 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

  18. 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

  19. 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

  20. 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. PMID:20155874

  1. Occupational Therapy Home Safety Intervention via Telehealth.

    PubMed

    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

  2. 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.

  3. 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

    2016-01-01

    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

  4. 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

  5. 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.

  6. Nurses Leading the Transformation of Patient Care Through Telehealth.

    PubMed

    Yesenofski, Lori; Kromer, Sharon; Hitchings, Kim

    2015-12-01

    The essential role of nurses in leading, developing, and improving Lehigh Valley Health Network (LVHN) telehealth services and programs was a key reason the organization was selected to receive the American Nurses Credentialing Center 2013 Magnet® Prize. This article describes the application of telehealth as a nurse-led technology. The innovations within LVHN telehealth services are presented as well as essential success factors of design, implementation, and evaluation. PMID:26565644

  7. 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

  8. Building a telehealth network through collaboration: the story of the nebraska statewide telehealth network.

    PubMed

    Meyers, Laura; Gibbs, Dale; Thacker, Max; Lafile, Lesley

    2012-01-01

    With the recent governmental focus on increasing broadband capabilities throughout the nation, with rapid advances in technology, and with other regulatory and reimbursement barriers falling, a great number of sites across the United States are in the process of either initiating or expanding their Telehealth capabilities. The Nebraska Statewide Telehealth Network, one of the most comprehensive networks in the nation, is no exception. Built through a collaborative effort of hospitals, health departments, the Nebraska Hospital Association, and other organizations, the Network's members include nearly every hospital and health department in the State. The Nebraska Statewide Telehealth Network has been awarded more than $1.4 million in grant funding since 2008 and, last year, provided 3633 clinical consultations to rural residents across the State.Among its many benefits, Telehealth increases access to specialty care for patients in rural areas; decreases travel time and saves money for patients and caretakers alike; provides the potential for earlier disease intervention; enhances clinical support between specialists and primary care providers; and serves as a medium for easy access to professional education, training, and collaboration. And, now, this technology is becoming increasingly mobile, allowing practitioners the opportunity to connect anywhere. In a rural state dominated by Health Care Professional Shortage Areas and Medically Underserved Areas, Telehealth has the opportunity to help patients receive care at home.

  9. Clinical telehealth across the disciplines: lessons learned.

    PubMed

    Jarvis-Selinger, Sandra; Chan, Elmira; Payne, Ryan; Plohman, Kerenza; Ho, Kendall

    2008-09-01

    Videoconferencing technologies can vastly expand the reach of healthcare practitioners by providing patients (particularly those in rural/remote areas) with unprecedented access to services. While this represents a fundamental shift in the way that healthcare professionals care for their patients, very little is known about the impact of these technologies on clinical workflow practices and interprofessional collaboration. In order to better understand this, we have conducted a focused literature review, with the aim of providing policymakers, administrators, and healthcare professionals with an evidence-based foundation for decision-making. A total of 397 articles focused on videoconferencing in clinical contexts were retrieved, with 225 used to produce this literature review. Literature in the fields of medicine (including general and family practitioners and specialists in neurology, dermatology, radiology, orthopedics, rheumatology, surgery, cardiology, pediatrics, pathology, renal care, genetics, and psychiatry), nursing (including hospital-based, community-based, nursing homes, and home-based care), pharmacy, the rehabilitation sciences (including occupational and physical therapy), social work, and speech pathology were included in the review. Full utilization of the capacity of videoconferencing tools in clinical contexts requires some basic necessary technical conditions to be in place (including basic technological infrastructure, site-to-site technological compatibility, and available technical support). The available literature also elucidates key strategies for organizational readiness and technology adoption (including the development of a change management and user training plan, understanding program cost and remuneration issues, development of organizational protocols for system use, and strategies to promote interprofessional collaboration).

  10. Ethical Considerations in Home-Based Programs.

    ERIC Educational Resources Information Center

    Levenstein, Phyllis

    This paper provides a checklist of 10 potential ethical problems associated with intervention in families through home-based programs. Problems which directly involve program participants are (1) pressure on parents to join the program, (2) violation of confidentiality, (3) intrusiveness, (4) need to respect the family's style of living, (5)…

  11. Extension and Home-Based Businesses.

    ERIC Educational Resources Information Center

    Loker, Suzanne; And Others

    1990-01-01

    Includes "Building Home Businesses in Rural Communities" (Loker et al.); "Home-Based Business...A Means to Economic Growth in Rural Areas" (Bastow-Shoop et al.); "Business Not As Usual" (Millar, Mallilo); and "Economic Options for Farm Families" (Williams). (SK)

  12. Telehealth behavioral treatment for medication nonadherence: a pilot and feasibility study

    PubMed Central

    Hommel, Kevin A.; Hente, Elizabeth; Herzer, Michele; Ingerski, Lisa M.; Denson, Lee A.

    2013-01-01

    Objective To evaluate an individually tailored multicomponent nonadherence treatment protocol using a telehealth delivery approach in adolescents with inflammatory bowel disease. Methods Nine participants, age 13.71±1.35 years, completed a brief treatment online through Skype. Medication nonadherence, severity of disease, and feasibility/acceptability data were obtained. Results Adherence increased markedly from 62% at baseline to 91% for mesalamine (δ = 0.63), but decreased slightly from 61% at baseline to 53% for 6-mercaptopurine /azathioprine. The telehealth delivery approach resulted in cost savings of $100 in mileage and 4 h of travel time/patient. Treatment session attendance was 100%, and the intervention was rated as acceptable, particularly in terms of treatment convenience. Conclusion Individually tailored treatment of nonadherence through telehealth delivery is feasible and acceptable. This treatment shows promise for clinical efficacy to improve medication adherence and reduce costs. Large-scale testing is necessary to determine the impact of this intervention on adherence and health outcomes. PMID:23325274

  13. Extent of telehealth use in rural and urban hospitals.

    PubMed

    Ward, Marcia M; Ullrich, Fred; Mueller, Keith

    2014-01-01

    Key Findings. Data from 4,727 hospitals in the 2013 HIMSS Analytics database yielded these findings: (1) Two-thirds (66.0% of rural defined as nonmetropolitan and 68.0% of urban) had no telehealth services or were only in the process of implementing a telehealth application. One-third (34.0%rural and 32.0% urban) had at least one telehealth application currently in use. (2) Among hospitals with "live and operational" telehealth services, 61.4% indicated only a single department/program with an operational telehealth service, and 38.6% indicated two or more departments/programs with operational telehealth services. Rural hospitals were significantly less likely to have multiple services (35.2%) than were urban hospitals (42.1%) (3) Hospitals that were more likely to have implemented at least one telehealth service were academic medical centers, not-for-profit institutions, hospitals belonging to integrated delivery systems, and larger institutions (in terms of FTEs but not licensed beds). Rural and urban hospitals did not differ significantly in overall telehealth implementation rates. (4) Urban and rural hospitals did differ in the department where telehealth was implemented. Urban hospitals were more likely than rural hospitals to have operational telehealth implementations in cardiology/stroke/heart attack programs (7.4% vs. 6.2%), neurology (4.4% vs. 2.1%), and obstetrics/gynecology/NICU/pediatrics (3.8% vs. 2.5%). In contrast, rural hospitals were more likely than urban hospital to have operational telehealth implementations in radiology departments (17.7% vs. 13.9%) and in emergency/trauma care (8.8% vs. 6.3%).

  14. Nursing Telehealth, Caring from a Distance.

    PubMed

    Botin, Lars; Nøhr, Christian

    2016-01-01

    Tele-technology in the health care system is prognosed to be able to produce better health, better care at lower cost (Triple aim). This paper will discuss the validity of this prognosis, which in many ways is considered as some sort of diagnosis of the conditions concerning triple aim in relation to Tele-technology. Tele-technology in the health care system covers three different types of technological settings: telecare, telehealth and telemedicine. This paper will disclose the different meanings of telecare, telehealth and telemedicine and discusses how nursing informatics can accomplish and gain from this disclosure. Theoretically and methodologically the paper is based on post-phenomenological readings and reflections, where use, practice, users, participants, values and knowledge systems are addressed on an equal level in order to understand technology and how we act appropriately through and with technology.

  15. 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

  16. 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…

  17. 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…

  18. 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. PMID:11871451

  19. 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

  20. 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

  1. 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.

  2. 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

  3. 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.

  4. An overview of the national telehealth initiative in Malaysia.

    PubMed

    Maon, Siti N; Edirippulige, Sisira

    2010-01-01

    Malaysia's national health statistics for the last half century show a remarkable improvement in the nation's health status. One important factor for this improvement is the Malaysian government's proactive intervention in the health sector. Among others, e-health has played a vital role in delivering and managing healthcare services in Malaysia. While the Government has integrated telehealth in its national digital infrastructure re-design, it has heavily invested in telehealth. The enactment of new laws to facilitate telehealth practices can also be noted as an important measure.

  5. Telehealth: a rapidly developing service delivery model for occupational therapy.

    PubMed

    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

  6. A Telehealth Case Study of Videophone Use Between Family Members

    PubMed Central

    Hensel, Brian K.; Oliver, Debra Parker; Demiris, George; Willis, Lia

    2006-01-01

    This case study extends beyond the institution-centric provider-patient dyad to examine telehealth communication between a nursing home resident and a geographically distant family member. The participants communicated regularly for three months by videophone. They found technical performance and usability acceptable and were generally satisfied with this application of telehealth technology. They assumed a strong role in self-remedying technical and usability problems they experienced. Potential implications associated with such use of telehealth technology by residence-based patients and their significant others, and the self-directedness displayed by participants in this case study, are discussed. PMID:17238567

  7. Telehealth: Applications From a Legal and Regulatory Perspective.

    PubMed

    Marcoux, Rita M; Vogenberg, F Randy

    2016-09-01

    Telehealth is becoming mainstream in the U.S., as more consumers, employers, hospital systems, and even insurers adopt the technology. The authors explore the challenges of regulation, reimbursement, and licensing as the modality evolves. PMID:27630526

  8. Telehealth: Applications From a Legal and Regulatory Perspective.

    PubMed

    Marcoux, Rita M; Vogenberg, F Randy

    2016-09-01

    Telehealth is becoming mainstream in the U.S., as more consumers, employers, hospital systems, and even insurers adopt the technology. The authors explore the challenges of regulation, reimbursement, and licensing as the modality evolves.

  9. Clinician acceptance is the key factor for sustainable telehealth services.

    PubMed

    Wade, Victoria A; Eliott, Jaklin A; Hiller, Janet E

    2014-05-01

    Telehealth, the delivery of health care services at a distance using information and communications technology, has been slow to be adopted and difficult to sustain. Researchers developing theories concerning the introduction of complex change into health care usually take a multifactorial approach; we intentionally sought a single point of intervention that would have maximum impact on implementation. We conducted a qualitative interview study of 36 Australian telehealth services, sampled for maximum variation, and used grounded theory methods to develop a model from which we chose the most important factor affecting the success of telehealth. We propose that clinician acceptance explains much of the variation in the uptake, expansion, and sustainability of Australian telehealth services, and that clinician acceptance could, in most circumstances, overcome low demand, technology problems, workforce pressure, and lack of resourcing. We conclude that our model offers practical advice to those seeking to implement change with limited resources.

  10. 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.

  11. Contributors to Frequent Telehealth Alerts Including False Alerts for Patients with Heart Failure: A Mixed Methods Exploration

    PubMed Central

    Radhakrishna, K.; Bowles, K.; Zettek-Sumner, A.

    2013-01-01

    Summary Background Telehealth data overload through high alert generation is a significant barrier to sustained adoption of telehealth for managing HF patients. Objective To explore the factors contributing to frequent telehealth alerts including false alerts for Medicare heart failure (HF) patients admitted to a home health agency. Materials and Methods A mixed methods design that combined quantitative correlation analysis of patient characteristic data with number of telehealth alerts and qualitative analysis of telehealth and visiting nurses’ notes on follow-up actions to patients’ telehealth alerts was employed. All the quantitative and qualitative data was collected through retrospective review of electronic records of the home heath agency. Results Subjects in the study had a mean age of 83 (SD = 7.6); 56% were female. Patient co-morbidities (p<0.05) of renal disorders, anxiety, and cardiac arrhythmias emerged as predictors of telehealth alerts through quantitative analysis (n = 168) using multiple regression. Inappropriate telehealth measurement technique by patients (54%) and home healthcare system inefficiencies (37%) contributed to most telehealth false alerts in the purposive qualitative sub-sample (n = 35) of patients with high telehealth alerts. Conclusion Encouraging patient engagement with the telehealth process, fostering a collaborative approach among all the clinicians involved with the telehealth intervention, tailoring telehealth alert thresholds to patient characteristics along with establishing patient-centered telehealth outcome goals may allow meaningful generation of telehealth alerts. Reducing avoidable telehealth alerts could vastly improve the efficiency and sustainability of telehealth programs for HF management. PMID:24454576

  12. Home-based system for stroke rehabilitation.

    PubMed

    Durfee, William; Deng, Huiqiong; Nuckley, David; Rheude, Brandon; Severson, Amy; Skluzacek, Katie; Spindler, Kristen; Davey, Cynthia; Carey, James

    2011-01-01

    A system was developed for home-based stroke motor rehabilitation of the ankle. A study was conducted to test the hypothesis that moving while concentrating will lead to greater recovery than movement alone. Sixteen post-stroke subjects participated, one half in a tracking training group and the other have in a move group. The tracking training group tracked a target waveform by moving their ankle to control the tracking cursor while the move group moved their ankle approximately the same amount but without target following. Over four weeks subjects completed 3600 trials. The results showed that the Tracking group had more improvement in ankle dorsiflexion compared to the Move group. The remaining assessment criteria showed no significant differences between the groups. PMID:22254683

  13. 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

  14. The evaluation of diabetic patients' use of a telehealth program.

    PubMed

    Lee, Ting-Ting; Huang, Tzu-Yi; Chang, Chi-Ping; Lin, Kuan-Chia; Tu, Hsiu-Mei; Fan, Ching-Jih; Mills, Mary Etta

    2014-12-01

    Diabetes is a metabolic disorder that, if not treated promptly and appropriately, can cause complex health complications and mortality. Care models that apply technology, such as telehealth, may be useful in working with diabetes patients. The development and application of wireless communication telehealth have significantly affected healthcare in recent years. Thus, the purpose of this study was to evaluate diabetic patients' use of a telehealth program by using questionnaire survey and laboratory data results. A quantitative study, 1-group pretest-posttest design, was conducted. This study recruited 20 diabetic patients who received telehealth service to measure their glucose, heart rate, and blood pressure, with data uploaded back to the hospital daily. A questionnaire survey was conducted in May 2012 and between August and January 2013 with 20 participants. The test values (blood pressure, heart rate, and blood glucose) of subjects were obtained from the hospital telecare platform and the outpatient monthly reporting system. Study findings showed an overall satisfaction rating of 91% by telehealth participants. Nonparametric statistical analysis demonstrated a significant difference (P < .01) in participants' glycosylated hemoglobin and resultant effective control. These findings indicated that participants accepted this care model, and telehealth could improve participants' glucose control.

  15. 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.

  16. An economic evaluation of a telehealth network in British Columbia.

    PubMed

    Schaafsma, Joseph; Pantazi, Stefan V; Moehr, Jochen R; Anglin, Christine R; Grimm, Nicole A

    2007-01-01

    We carried out an economic evaluation of the northernmost five sites of the British Columbia telehealth network. The videoconferencing network links health-care facilities in 12 communities with Vancouver, for clinical consultations, administrative meetings and educational sessions. The economic evaluation was based on the netcost criterion (i.e. cost of telehealth minus travel costs avoided). Cost and utilization data were obtained from client interviews and log data compiled between September 2001 and January 2003. The results showed that the subnetwork of five sites was not only cost reducing, but also cost-effective. Travel costs for administrative meetings were reduced by $724,457/annum and were greater than the annual fixed and variable costs of all the telehealth sessions ($553,740). A sensitivity analysis was conducted on six parameters: amortization period, opportunity cost of capital, operating cost of a telehealth session (by type of session), number of telehealth sessions, travel time and the opportunity cost of travel time. The study suggests that the cost-effectiveness of telehealth to remote areas will increase over time as the cost of equipment continues to fall, as network connections become cheaper and as utilization rates rise. PMID:17697513

  17. The value of an evaluation framework for telehealth initiatives.

    PubMed

    Scott, R E; Coates, K; McCarthy, G F

    1999-01-01

    Healthcare managers and policy makers will, in the immediate and near future, make major decisions about the allocation of scarce healthcare resources for telehealth 'solutions'. In our haste to capitalize on what technology can do we may be obscuring discussion and research about what technology should do. For example, currently much attention is being paid to standardization for technological aspects of telehealth. In contrast few efforts have been made to seek standardization in regards to a broad evaluation framework for telehealth. A body of opinion believes that missing in our rush into the on-line world is a systematic approach to research into the human, social, cultural, economic, and political factors associated with healthcare. As a result we lack the tools and experience necessary to assess the true value and implications of telehealth 'solutions'. Developing general guidelines for an evaluation framework, from needs assessment through integrated research to post-study assessment, would greatly enhance the quality of decision making by healthcare managers and policy makers. We propose a model--the Telehealth Integrated Research Model (TIRM)--as the first step in encouraging discussion and development of an internationally accepted standardized telehealth evaluation framework.

  18. 75 FR 15496 - Agency Information Collection (Care Coordination Home Telehealth (CCHT)) Activity Under OMB Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-29

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Agency Information Collection (Care Coordination Home Telehealth (CCHT)) Activity Under OMB Review...).'' SUPPLEMENTARY INFORMATION: Title: Care Coordination Home Telehealth (CCHT) Patient Satisfaction Survey, VA...

  19. 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...

  20. 75 FR 2595 - Proposed Information Collection (Care Coordination Home Telehealth (CCHT) Activity: Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-15

    ... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF VETERANS AFFAIRS Proposed Information Collection (Care Coordination Home Telehealth (CCHT) Activity: Comment... use of other forms of information technology. Title: Care Coordination Home Telehealth (CCHT)...

  1. 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…

  2. 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. PMID:15747978

  3. 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.

  4. 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.

  5. Integrating telehealth into Aboriginal healthcare: the Canadian experience.

    PubMed

    Muttitt, Sarah; Vigneault, Robert; Loewen, Liz

    2004-12-01

    Telehealth, the use of information communication technologies to deliver health care over distance, has been identified as a key mechanism for improving access to health services internationally. Canada is well suited to realize the benefits of telehealth particularly for individuals in remote, rural and isolated locations, many of whom are of Aboriginal descent. The health status of Canada's Aboriginal population is generally lower than that of the non-Aboriginal population emphasizing the need for new health care solutions. The challenges associated with implementing telehealth are not unique to Aboriginal settings but, in many instances, are more pronounced as a result of cultural, political and jurisdictional issues. These challenges are not insurmountable however, and there have been a number of successes in Canada to serve as a blueprint for a national strategy for sustainable Aboriginal telehealth. This review will highlight challenges and successes related to telehealth implementation in Canadian Aboriginal communities including: geography, technical infrastructure, human resources, cross-jurisdictional services, and community readiness. The need for champions within government, community and health care settings and the use of a needs-driven and integrated approach to implementation are highlighted. Several Canadian examples are provided including lessons learned within the MBTelehealth Network.

  6. Clinical Management of Multiple Sclerosis Through Home Telehealth Monitoring

    PubMed Central

    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. PMID:24453757

  7. 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.

  8. 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. PMID:23061644

  9. The Promise of Direct-to-Consumer Telehealth for Disaster Response and Recovery.

    PubMed

    Uscher-Pines, Lori; Fischer, Shira; Chari, Ramya

    2016-08-01

    Telehealth has great promise to improve and even revolutionize emergency response and recovery. Yet telehealth in general, and direct-to-consumer (DTC) telehealth in particular, are underutilized in disasters. Direct-to-consumer telehealth services allow patients to request virtual visits with health care providers, in real-time, via phone or video conferencing (online video or mobile phone applications). Although DTC services for routine primary care are growing rapidly, there is no published literature on the potential application of DTC telehealth to disaster response and recovery because these services are so new. This report presents several potential uses of DTC telehealth across multiple disaster phases (acute response, subacute response, and recovery) while noting the logistical, legal, and policy challenges that must be addressed to allow for expanded use. Uscher-Pines L , Fischer S , Chari R . The promise of direct-to-consumer telehealth for disaster response and recovery. Prehosp Disaster Med. 2016;31(4):454-456.

  10. Experience and hopes for telehealth in Tokelau.

    PubMed

    Adam, P

    2000-09-01

    The two key factors affecting healthcare in Tokelau are its small population and its great isolation. Both of these make telehealth a critical issue for the development of health services and it is hard to see how the services can develop to a modern standard without a larger component of telemedicine. The Tokelau islands consist of three roughly equal atolls usually served by 1-2 doctors who deal with all aspects of medical care. There is a small hospital on each atoll and each is staffed by a Nurse manager, two staff nurses and some nurse aides. There is a need for a communication facility for the nurse on the atoll(s) without a doctor to consult with a doctor about medical cases; doctors to consult each other; and for doctors to consult outside specialists about the management of cases. Distance education for health care staff is another perceived need. The current communications systems are still basic and although there is a PeaceSat terminal on each atoll it has largely failed to provide the above communication needs and most is still done by the costly telephone system. Recently ITC has been made a priority for the health department. PMID:11588926

  11. Alabama: A Successful Home-Based Business Model.

    ERIC Educational Resources Information Center

    Centrallo, Carol B.

    1999-01-01

    The Alabama Cooperative Extension Service transformed a traditional textile/clothing program into a home-based business program. It was delivered by multiple methods including meetings, printed materials, audiovisual resources, and, in the second phase, videoconferencing. (SK)

  12. Telehealth among US hospitals: several factors, including state reimbursement and licensure policies, influence adoption.

    PubMed

    Adler-Milstein, Julia; Kvedar, Joseph; Bates, David W

    2014-02-01

    Telehealth is widely believed to hold great potential to improve access to, and increase the value of, health care. Gaining a better understanding of why some hospitals adopt telehealth technologies while others do not is critically important. We examined factors associated with telehealth adoption among US hospitals. Data from the Information Technology Supplement to the American Hospital Association's 2012 annual survey of acute care hospitals show that 42 percent of US hospitals have telehealth capabilities. Hospitals more likely to have telehealth capabilities are teaching hospitals, those equipped with additional advanced medical technology, those that are members of a larger system, and those that are nonprofit institutions. Rates of hospital telehealth adoption by state vary substantially and are associated with differences in state policy. Policies that promote private payer reimbursement for telehealth are associated with greater likelihood of telehealth adoption, while policies that require out-of-state providers to have a special license to provide telehealth services reduce the likelihood of adoption. Our findings suggest steps that policy makers can take to achieve greater adoption of telehealth by hospitals.

  13. Telehealth as gatekeeper: policy implications for geography and scope of services.

    PubMed

    Kraetschmer, Nancy M; Deber, Raisa B; Dick, Paul; Jennett, Penny

    2009-09-01

    Why, despite enthusiasm, is telehealth still a relatively minor part of healthcare delivery in many health systems? We examined two less-considered policy issues: (1) the scope of services being offered by telehealth and how this matches existing arrangements for insured services; and (2) how the ability of telehealth services to minimize barriers associated with geography is dealt with in a system organized and financed on geographical boundaries. Fifty-three semistructured interviews with key stakeholders involved in the management of 43 Canadian telehealth programs were conducted. In addition, quantitative activity data were analyzed from 33 telehealth programs. Two telehealth approaches emerged: telephone-based (N = 3), and video-conferencing-based (N = 40). Most programs reflected, rather than superceded, existing geographical boundaries; with the technology being used, the videoconferencing models imposed significant barriers to unfettered access by outlying communities because they required sites to acquire expensive technology, be affiliated with an existing telehealth network, and schedule visits in advance. In consequence, much activity was administrative and educational, rather than clinical, and often extended beyond the set of mandatory insured services. Despite high hopes that telehealth would improve access to care for rural/remote areas, gatekeeping inherent in certain telehealth systems imposes barriers to unfettered use by rural/remote areas, although it does facilitate other valued activities. Policy approaches are needed to promote a closer match between the expectations for telehealth and the realities reflected by many existing models.

  14. Home-based Senior Fitness Test measurement system using collaborative inertial and depth sensors.

    PubMed

    Chen Chen; Kui Liu; Jafari, Roozbeh; Kehtarnavaz, Nasser

    2014-01-01

    This paper presents a home-based Senior Fitness Test (SFT) measurement system by using an inertial sensor and a depth camera in a collaborative way. The depth camera is used to monitor the correct pose of a subject for a fitness test and any deviation from the correct pose while the inertial sensor is used to measure the number of a fitness test action performed by the subject within the time duration specified by the fitness protocol. The results indicate that this collaborative approach leads to high success rates in providing the SFT measurements under realistic conditions.

  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. World Federation of occupational therapists' position statement on telehealth.

    PubMed

    2014-01-01

    The purpose of this document is to state the World Federation of Occupational Therapists' (WFOT) position on the use of telehealth for the delivery of occupational therapy services. Telehealth is the use of information and communication technologies (ICT) to deliver health-related services when the provider and client are in different physical locations. Additional terms used to describe this service delivery model include: tele-occupational therapy, telerehabilitation, teletherapy, telecare, telemedicine, and telepractice, among other terms. Telehealth may be used by occupational therapy practitioners for evaluation, intervention, monitoring, supervision, and consultation (between remote therapist, client, and/or local health-care provider) as permitted by jurisdictional, institutional, and professional regulations and policies governing the practice of occupational therapy. Occupational therapy services via telehealth should be appropriate to the individuals, groups and cultures served, and contextualized to the occupations and interests of clients. Important considerations related to licensure/registration, collaboration with local occupational therapists, client selection, consent to treat, professional liability insurance, confidentiality, personal and cultural attributes, provider competence/standards of care, reimbursement/payer guidelines, and authentic occupational therapy practice are discussed. PMID:25945221

  17. 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…

  18. 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.

  19. 42 CFR 414.65 - Payment for telehealth services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Payment for telehealth services. 414.65 Section 414.65 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...), individual and group medical nutrition therapy services, individual and group kidney disease...

  20. 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... access site), individual medical nutrition therapy, and individual health and behavior assessment...

  1. 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…

  2. Telehealth on heart failure: results of the Recap project.

    PubMed

    Varon, Carolina; Alao, Morenikeji; Minter, Jan; Stapleton, Michelle; Thomson, Stuart; Jaecques, Siegfried; Rocca, Hans-Peter Bl; Huffel, Sabine V

    2015-09-01

    Telehealth has become a very important tool that allows the monitoring of heart failure patients in a home environment. However, little is known about the effect that such monitoring systems have on patients' compliance, evolution and self-care behaviour. In particular, the effect that the selected user interface has on these factors is unknown. This study aims to investigate this, and to determine some practicalities that must be considered when designing and implementing a telehealth programme for heart failure. To achieve this, daily measurements of blood pressure, pulse, SpO2 and weight were collected from 534 patients suffering from heart failure. In addition, they were asked to fill in the European heart failure self-care behaviour scale questionnaire and the EQ-5D quality of life questionnaire, before and after the monitoring period. Two telehealth systems were used, the Motiva platform provided by Philips and the standalone unit provided by Docobo, the Doc@Home system. Significant differences were found between both systems concerning the compliance and adherence of patients. Moreover, a general, positive effect of telehealth was identified due to the fact that patients showed an increased self-awareness when managing their condition. These findings are supported by behavioural changes and a better understanding of heart failure from the patients' perspective.

  3. 42 CFR 414.65 - Payment for telehealth services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...), individual and group health and behavior assessment and intervention, smoking cessation services, alcohol and... 42 Public Health 3 2014-10-01 2014-10-01 false Payment for telehealth services. 414.65 Section 414.65 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  4. 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…

  5. 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

  6. The decreasing cost of telemedicine and telehealth.

    PubMed

    Doolittle, Gary C; Spaulding, Ashley O'Neal; Williams, Arthur R

    2011-11-01

    The teleoncology practice based at the University of Kansas Medical Center (KUMC) in Kansas City, Kansas, is one of the longest running practices of its kind worldwide. The practice began in 1995 and connected an oncologist at KUMC with a rural medical center in Hays, Kansas. Fifteen years later, the practice continues to thrive at Hays Medical Center and has also expanded to include two additional sites within the state-the Northeast Kansas Center for Health and Wellness in Horton and Goodland Regional Medical Center in Goodland-that offer regularly scheduled teleoncology clinics. While the KUMC practice has witnessed an expansion in service sites throughout its history, the practice has seen a significant decrease in the costs associated with providing such services since its inception. The cost decrease can, in part, be attributed to an increase in the number of teleoncology visits conducted through the practice since it began. In Fiscal Year 1995 (FY 1995), 103 teleoncology visits resulted in a cost per visit of $812. Five years later, the FY 2000 $410 per visit cost for 121 visits was almost half the cost identified in the initial cost analysis. The FY 2003 cost per visit for 219 visits saw another decrease to $401, and the most recent FY 2005 cost analysis yielded another decrease to $251 per visit for 235 visits. The data reported below are likely to be the best now available to track time trends in the cost of providing telemedicine or telehealth consultations. The Conclusion and Policy Recommendations at the end of this article will focus on both the cost-time profile and some other challenges and lessons learned. PMID:22035320

  7. 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

  8. 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.

  9. 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…

  10. 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... treatment plans by regularly following up with physicians and medical professionals, taking medication...

  11. 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

  12. 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

  13. Telehealth opportunities in regional Queensland: a scoping study.

    PubMed

    Croll, Jasmine; Norton, Chrissie J; Gray, Leonard C; Bryett, Andrew; Smith, Anthony C

    2012-12-01

    We carried out a six month scoping study to ascertain current health service needs in the Queensland towns of Dalby, Chinchilla and Miles. The towns have a high proportion of their populations in the dependent age groups of over 65 years of age and less than 14 years of age. This implies a need for ready access to paediatric and geriatric specialist services. The hospitals in the three towns provided a range of health services, but patients still had to be referred to Toowoomba and Brisbane for specialist consultations. All three hospitals had videoconference facilities, but videoconferencing was mainly used for education, administration and training. General practitioners in the three towns did not use telehealth in their practice. The study reinforced the potential for telehealth services in three key domains: regional hospitals, residential aged-care facilities and general practice. PMID:23209272

  14. 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

  15. Health care on demand: four telehealth priorities for 2016.

    PubMed

    Grube, Mark E; Kaufman, Kenneth; Clarin, Dan; O'Riordan, Jason

    2016-01-01

    Consumers who are accustomed to on-demand, virtual services are looking for more convenient ways to access health care. Giving patients the opportunity to connect with physicians remotely can promote higher patient satisfaction and engagement. Telehealth options may have a high start-up cost, but that cost is likely well-justified by the potential to enhance quality, outcomes, and customer attraction and satisfaction/retention over the long-term.

  16. Health care on demand: four telehealth priorities for 2016.

    PubMed

    Grube, Mark E; Kaufman, Kenneth; Clarin, Dan; O'Riordan, Jason

    2016-01-01

    Consumers who are accustomed to on-demand, virtual services are looking for more convenient ways to access health care. Giving patients the opportunity to connect with physicians remotely can promote higher patient satisfaction and engagement. Telehealth options may have a high start-up cost, but that cost is likely well-justified by the potential to enhance quality, outcomes, and customer attraction and satisfaction/retention over the long-term. PMID:26863834

  17. Enhancing efficiency and quality of ambulatory care through telehealth technology.

    PubMed

    Prince, Thomas R; Croghan, John E; Sheridan, Phillip H; Weatherly, Jonathan D

    2005-01-01

    Technology has made great strides in healthcare, but has been slow in reaching a Senior's home or residence. At 35 million and growing, the Senior population is making it known that home is where they want to stay. Technology advancements in devices, communications, and wireless capability are now making possible the delivery of customized telehealth solutions to provide Seniors with "enabled independence," allowing them to confidently "age in place" at home or residence for much longer, with improved health outcomes and quality of life. Combined with traditional ambulatory care services, integrating telehealth technology services now allows delivery of "virtual assisted living" services at home that can more efficiently meet Senior health requirements, and can simplify other aspects of a Senior's life that can play a role in extending time at home. To be successful, an integrated service must be able to usefully address a range of activities of daily living-instrumental activities of daily living, and enhanced activities of daily living-requirements. Already proven in other areas such as radiology, intensive care units, prisons, and rural communities, companies are working to develop practical telehealth service offerings designed for the home or residence. These services must be (a) packaged to meet individual Senior needs and (b) reviewed and revised regularly to match changes in Senior requirements over time. A core element of this service is the use of regular "virtual visits" between healthcare professionals and a Senior at home or residence, which have been shown to both increase efficiency and Senior health outcomes. Another important element is centralizing key data from the telehealth technology into a single database to improve information delivered to a Senior's doctor, family, and other ambulatory care providers. North Shore eCare and other companies are conducting extensive market tests and pilot efforts to make sure service offerings meet Senior

  18. 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

  19. Home-Based Programs: Nightmare or Dream of the Future.

    ERIC Educational Resources Information Center

    Levenstein, Phyllis

    This essay discusses methodological and ethical problems in the implementation and evaluation of home-based intervention programs for young children and their families. Part I notes the difficulties in (1) selecting an appropriate research design to evaluate a program (e.g., preventing sample bias), (2) specifying precisely the intervention method…

  20. 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.…

  1. Predictors of Home Based Long-Term Care Services.

    ERIC Educational Resources Information Center

    Luppens, Jean; And Others

    An attempt was made to determine predictors of service need, use, and outcome among chronically impaired adults and aged who were living in the community and using the home-based, long term care services of the Chronic Illness Center (CIC) of the Cuyahoga County Hospitals (Ohio). Randomly selected consumer service records (N=200) were coded for…

  2. 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…

  3. Extension and Home-Based Business: A Collaborative Approach.

    ERIC Educational Resources Information Center

    Burns, Marilyn; Biers, Karen

    1991-01-01

    The Center for Home-Based Entrepreneurship at Oklahoma State University developed from collaborative efforts of extension, government agencies, business associations, and the vo-tech system. It provides education, directories, information services, and other assistance to people interested in establishing businesses in their homes. (SK)

  4. Home-Based Educational Curricula for Mothers and Infants.

    ERIC Educational Resources Information Center

    Apfel, Nancy; Brion, LaRue

    This package contains five home-based intervention curricula for families with children between 12 and 30 months of age. Three independent curricula (each emphasizing children's language, play or social development) enlist the mother's aid as observer, teacher and researcher, and promote a three-way interaction among mother, child, and…

  5. 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. PMID:18729757

  6. Refocussing our attention on 'need' in the application of telehealth.

    PubMed

    Scott, Richard E; Affleck-Hall, Louise C; Mars, Maurice

    2014-01-01

    Given that e-health (including telehealth) is an opportunity cost (i.e., redirecting already scarce healthcare resources away from more traditional healthcare delivery needs), performing needs assessment ensures that investment of resources in e-health is appropriate. Yet the current literature shows research is on clever, narrow, or 'one disease' telehealth applications (e.g., telediabetes; telesurgery), or creation of electronic records (e.g., EHR's; EMRs; HIS's) and accumulation of 'big data' (e.g. biosurveillance). Given the reality of comorbidity, the complexity of telesurgery, and the lack of successful country-wide EHR implementations, are we using our investments in e-health wisely? The requirement for needs assessment to guide selection and implementation of evidence-based and needs-based e-health solutions is seldom adhered to. We must refocus our efforts on more pragmatic needs. Where might insight to evidence-based health needs come from? Using South Africa as an example, this paper highlights several readily available resources, and how they may guide future telehealth implementations in South Africa and elsewhere.

  7. 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.

  8. 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

  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. 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.

  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. 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 Program…

  13. 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.

  14. Interpersonal Communication in Behavioral Telehealth: What Can We Learn from Other Fields?

    ERIC Educational Resources Information Center

    Collie, Katharine R.

    In this paper, research about mediated communication is used to shed light on questions that have arisen in relation to behavioral telehealth about the relative merits of different modes of distance communication for the transaction of behavioral telehealth services. The paper is in two parts. The first part contains a presentation of questions…

  15. 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

  16. An Analysis Of State Telehealth Laws And Regulations For Occupational Therapy And Physical Therapy

    PubMed Central

    Calouro, Christine; Kwong, Mei Wa; Gutierrez, Mario

    2014-01-01

    This study conducted a scan of telehealth occupational therapy and physical therapy state laws and regulations. The laws and regulations were analyzed to determine the potential effect they could have on occupational therapists’ and physical therapists’ utilization of telehealth. The results indicate that the majority of occupational therapy and physical therapy boards are silent on telehealth. A handful of physical therapy laws and regulations address “consultation by means of telecommunication,” but do not provide any guidance for practitioners seeking to provide direct telehealth-delivered services to patients. Of the few states that do provide guidance, policy had the potential to provide clarity or inhibit adoption. The findings suggest that as state boards consider crafting telehealth regulations, they should do so in a manner that facilitates, rather than hampers adoption, while upholding their providers to a high standard of care. PMID:25945218

  17. 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.

  18. 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.

  19. Data review of an ongoing telehealth programme in a tertiary paediatric hospital.

    PubMed

    Jury, Susan C; Kornberg, Andrew J

    2014-10-01

    The Royal Children's Hospital (RCH) in Melbourne has been providing teleconsultations since 2011 using web-based videoconferencing. We reviewed telehealth activity over the first 30 months of the programme. The average consultation rate was 14 per month in 2012, 39 in 2013 and 49 per month in the first half of 2014. One-third of all activity (265 out of 852 consultations) was provided by only two departments: neurology and respiratory medicine. By June 2014, 92% of departments (n = 34) had provided one or more video-consultations. Most telehealth activity was provided by just a few clinicians. A review of actual and billed activity between July 2013 and April 2014 showed that 36% of booked telehealth appointments (n = 144 of 395) were not billed to Medicare; financial and other processes have since been streamlined. A snapshot of telehealth activity over a two-month period was used to estimate the revenue from telehealth. Approximately 65 billed telehealth appointments per month would be required to fund a 0.6 FTE coordinator's post. Overall, the findings have been valuable in planning the future expansion of telehealth at the RCH. PMID:25399999

  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. “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

  3. Merging home and health via contemporary care delivery: program management insights on a home telehealth project.

    PubMed

    Abraham, Chon; Rosenthal, David A

    2008-01-01

    This article discusses a home telehealth program that uses innovative informatics and telemedicine technologies to meet the needs of a Veterans Affairs Medical Center. We provide background information for the program inclusive of descriptions for the decision support system, patient selection process, and selected home telehealth technologies. Lessons learned based on interview data collected from the project team highlight issues regarding implementation and management of the program. Our goal is to provide useful information to other healthcare systems considering home telehealth as a contemporary option for care delivery. PMID:18769182

  4. 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…

  5. 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

  6. Hospital at home: home-based end of life care

    PubMed Central

    Shepperd, Sasha; Wee, Bee; Straus, Sharon E

    2014-01-01

    Background The policy in a number of countries is to provide people with a terminal illness the choice of dying at home. This policy is supported by surveys indicating that the general public and patients with a terminal illness would prefer to receive end of life care at home. Objectives To determine if providing home-based end of life care reduces the likelihood of dying in hospital and what effect this has on patients’ symptoms, quality of life, health service costs and care givers compared with inpatient hospital or hospice care. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library) to October 2009, Ovid MED-LINE(R) 1950 to March 2011, EMBASE 1980 to October 2009, CINAHL 1982 to October 2009 and EconLit to October 2009. We checked the reference lists of articles identified for potentially relevant articles. Selection criteria Randomised controlled trials, interrupted time series or controlled before and after studies evaluating the effectiveness of home-based end of life care with inpatient hospital or hospice care for people aged 18 years and older. Data collection and analysis Two authors independently extracted data and assessed study quality. We combined the published data for dichotomous outcomes using fixed-effect Mantel-Haenszel meta-analysis. When combining outcome data was not possible we presented the data in narrative summary tables. Main results We included four trials in this review. Those receiving home-based end of life care were statistically significantly more likely to die at home compared with those receiving usual care (RR 1.33, 95% CI 1.14 to 1.55, P = 0.0002; Chi 2 = 1.72, df = 2, P = 0.42, I2 = 0% (three trials; N=652)). We detected no statistically significant differences for functional status (measured by the Barthel Index), psychological well-being or cognitive status, between patients receiving home-based end of life care compared with those receiving standard care (which

  7. 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

  8. 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

  9. Telehealth etiquette in home healthcare: the key to a successful visit.

    PubMed

    Haney, Tina; Kott, Karen; Fowler, Christianne

    2015-05-01

    The use of telehealth by home healthcare agencies is growing. It has been shown to reduce rehospitalizations by up to 62%, reduce costs, and increase efficiency. Due to the use of telehealth technology, new and unique rules of etiquette must be followed to make both the patient and clinician comfortable and satisfied with the process. Little literature exists regarding telehealth etiquette. This article explores the techniques and methods that home care clinicians should utilize to assure that the telehealth experience is positive and effective. After providing a less successful scenario, steps for success are outlined and a suggested successful conclusion is provided for the scenario. Home care agencies will benefit greatly from expanding their ability to visit patients in different ways. Simple steps need to be taken to assure successful visits that follow the rules for assuring patient comfort, autonomy, and protection. PMID:25943217

  10. 78 FR 76193 - Agency Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-16

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Agency Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction... Retaining Nurses at State Homes).'' SUPPLEMENTARY INFORMATION: Title: Care Coordination Home...

  11. [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.

  12. Implementation of Video Telehealth to Improve Access to Evidence-Based Psychotherapy for Posttraumatic Stress Disorder

    PubMed Central

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

    2015-01-01

    Abstract Background: 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. Materials and Methods: 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. Results: 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. Conclusions: 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. PMID:25714664

  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. 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. PMID:25787720

  15. Delivery of family therapy in the treatment of anorexia nervosa using telehealth.

    PubMed

    Goldfield, Gary S; Boachie, Ahmed

    2003-01-01

    Family therapy plays an important role in the comprehensive treatment of adolescents with anorexia nervosa (AN). However, most comprehensive hospital-based treatment facilities for eating disorders are situated in large urban centers, thus not accessible to individuals living in underserviced rural communities. Telehealth is now being used to provide psychiatric services to individuals who do not have access to urban-based treatment centers. We report the therapeutic outcome and patient satisfaction of using telehealth to provide family therapy as an adjunctive treatment for AN to an adolescent female admitted to a large urban-based hospital treatment program. Family therapy was delivered via telehealth in a therapeutic environment within a hospital setting, and was received in a telehealth facility in the rural community. Family therapy was effectively delivered and contributed to patient recovery, as measured by objective criteria (weight gain, improved medical condition) and subjective clinical observations. In addition, all family members reported high satisfaction with telehealth without any concern regarding confidentiality. The advantages of telehealth are discussed in the context of legal and ethical issues relating to the use of this technology to deliver psychiatric care.

  16. Conceptualizing Telehealth in Nursing Practice: Advancing a Conceptual Model to Fill a Virtual Gap.

    PubMed

    Nagel, Daniel A; Penner, Jamie L

    2016-03-01

    Increasingly nurses use various telehealth technologies to deliver health care services; however, there has been a lag in research and generation of empirical knowledge to support nursing practice in this expanding field. One challenge to generating knowledge is a gap in development of a comprehensive conceptual model or theoretical framework to illustrate relationships of concepts and phenomena inherent to adoption of a broad range of telehealth technologies to holistic nursing practice. A review of the literature revealed eight published conceptual models, theoretical frameworks, or similar entities applicable to nursing practice. Many of these models focus exclusively on use of telephones and four were generated from qualitative studies, but none comprehensively reflect complexities of bridging nursing process and elements of nursing practice into use of telehealth. The purpose of this article is to present a review of existing conceptual models and frameworks, discuss predominant themes and features of these models, and present a comprehensive conceptual model for telehealth nursing practice synthesized from this literature for consideration and further development. This conceptual model illustrates characteristics of, and relationships between, dimensions of telehealth practice to guide research and knowledge development in provision of holistic person-centered care delivery to individuals by nurses through telehealth technologies. PMID:25858897

  17. Designing Clinically Valuable Telehealth Resources: Processes to Develop a Community-Based Palliative Care Prototype

    PubMed Central

    Morgan, Deidre Diane; Swetenham, Kate; To, Timothy Hong Man; Currow, David Christopher

    2014-01-01

    Background Changing population demography and patterns of disease are increasing demands on the health system. Telehealth is seen as providing a mechanism to support community-based care, thus reducing pressure on hospital services and supporting consumer preferences for care in the home. Objective This study examined the processes involved in developing a prototype telehealth intervention to support palliative care patients involved with a palliative care service living in the community. Methods The challenges and considerations in developing the palliative care telehealth prototype were reviewed against the Center for eHealth Research (CeHRes) framework, a telehealth development model. The project activities to develop the prototype were specifically mapped against the model’s first four phases: multidisciplinary project management, contextual inquiry, value specification, and design. This project has been developed as part of the Telehealth in the Home: Aged and Palliative Care in South Australia initiative. Results Significant issues were identified and subsequently addressed during concept and prototype development. The CeHRes approach highlighted the implicit diversity in views and opinions among participants and stakeholders and enabled issues to be considered, resolved, and incorporated during design through continuous engagement. Conclusions The CeHRes model provided a mechanism that facilitated “better” solutions in the development of the palliative care prototype by addressing the inherent but potentially unrecognized differences in values and beliefs of participants. This collaboration enabled greater interaction and exchange among participants resulting in a more useful and clinically valuable telehealth prototype. PMID:25189279

  18. At the crossroads: NRTRC white paper examines trends driving the convergence of telehealth, EHRs and HIE.

    PubMed

    Thielst, Christina Beach

    2010-01-01

    From the American Recovery and Reinvestment Act (ARRA) and the newly passed healthcare reform legislation to emerging reimbursement models and shifting consumer health trends, a confluence of events are driving radical change in the nation's healthcare system and bringing about the convergence of telehealth, electronic health records (EHRs) and health information exchange (HIE). That is the focus of "The Crossroads of Telehealth, Electronic Health Records & Health Information Exchange: Planning for Rural Communities," a new white paper from the Northwest Regional Telehealth Resource Center (NRTRC). "Accelerating adoption and utilization of telehealth technologies, telemedicine in particular, will be critical to a successful stakeholder response to the disruptive changes that are underway in healthcare," said NRTRC Executive Director Christina B. Thielst, FACHE. "By leveraging telehealth networks and their existing infrastructures, Regional Extension Centers, HIEs and other data-sharing initiatives will be better-positioned to fulfill their commitments to the healthcare delivery system of the future--a system in which even the most rural and remote populations have timely access to care and their health records." The white paper explores emerging trends and recent disruptors impacting the healthcare delivery system and examines the opportunities they present for the advancement of telecommunications-based health solutions and the broadband infrastructure available through telehealth networks. It also takes an in-depth look at the various uses of telehealth and the most common delivery models of telemedicine, as well as the role of the telehealth network and Telehealth Resource Centers (TRCs) in expanding the reach of these vital initiatives. Finally, the white paper highlights the evolution of the REACH Montana Telehealth Network from facilitating teleradiology at three remote sites into a consortium of healthcare providers at 18 sites linked by high

  19. Patient and professional user experiences of simple telehealth for hypertension, medication reminders and smoking cessation: a service evaluation

    PubMed Central

    Cottrell, Elizabeth; Cox, Tracey; O'Connell, Phil; Chambers, Ruth

    2015-01-01

    Objectives To establish patient and professional user satisfaction with the Advice & Interactive Messaging (AIM) for Health programme delivered using a mobile phone-based, simple telehealth intervention, ‘Florence’. Design A service evaluation using data extracted from Florence and from a professional user electronic survey. Setting 425 primary care practices across 31 Clinical Commissioning Groups in England. Participants 3381 patients registered on 1 of 10 AIM protocols between March 2013 and January 2014 and 77 professional users. Intervention The AIM programme offered 10 clinical protocols, in three broad groups: (1) hypertension diagnosis/monitoring, (2) medication reminders and (3) smoking cessation. Florence sent patients prompts to submit clinical information, educational messages and user satisfaction questions. Patient responses were reviewed by their primary healthcare providers. Primary outcome measures Patients and professional user experiences of using AIM, and within this, Florence. Results Patient activity using Florence was generally good at month 1 for the hypertension protocols (71–80%), but reduced over 2–3 months (31–60%). For the other protocols, patient activity was 0–39% at 3 months. Minimum target days of texting were met for half the hypertension protocols. 1707/2304 (74%) patients sent evaluative texts responded at least once. Among responders, agreement with the adapted friends and family statement generally exceeded preproject aspirations. Professional responders were generally positive or equivocal about the programme. Conclusions Satisfaction with AIM appeared optimal when patients were carefully selected for the protocol; professional users were familiar with the system, the programme addressed a problem with the previous service delivery that was identified by users and users took an active approach to achieve clinical goals. However, there was a significant decrease in patients’ use of Florence over time. Future

  20. 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

  1. TIDE: an intelligent home-based healthcare information & diagnostic environment.

    PubMed

    Abidi, S S

    1999-01-01

    The 21st century promises to usher in an era of Internet based healthcare services--Tele-Healthcare. Such services augur well with the on-going paradigm shift in healthcare delivery patterns, i.e. patient centred services as opposed to provider centred services and wellness maintenance as opposed to illness management. This paper presents a Tele-Healthcare info-structure TIDE--an 'intelligent' wellness-oriented healthcare delivery environment. TIDE incorporates two WWW-based healthcare systems: (1) AIMS (Automated Health Monitoring System) for wellness maintenance and (2) IDEAS (Illness Diagnostic & Advisory System) for illness management. Our proposal comes from an attempt to rethink the sources of possible leverage in improving healthcare; vis-à-vis the provision of a continuum of personalised home-based healthcare services that emphasise the role of the individual in self health maintenance.

  2. 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.

  3. 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.

  4. Biofeedback via telehealth: a new frontier for applied psychophysiology.

    PubMed

    Folen, R A; James, L C; Earles, J E; Andrasik, F

    2001-09-01

    Psychophysiological diagnostic and therapeutic methods, to include biofeedback, have been found to be empirically effective in the treatment of a variety of physical disorders. In many areas of the country, however, certified biofeedback practitioners are not well distributed, limiting patient access to this treatment modality. Psychologists at Tripler Army Medical Center have pioneered efforts to develop and provide these needed services via a telehealth venue. Such capability significantly improves access to care, particularly for patient's located at considerable distance from the provider. As the telecommunications infrastructure in rural and remote areas is often quite basic, such a system must be capable of operating within these limited parameters. The system developed by the authors provides real-time video and audio interactivity and allows the therapist to monitor and control biofeedback equipment located at the remote site. The authors discuss the clinical applications, the technology, and relevant practical and ethical issues. PMID:11680283

  5. 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

  6. 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

  7. 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.

  8. Knowing, caring, and telehealth technology: "going the distance" in nursing practice.

    PubMed

    Nagel, Daniel A; Pomerleau, Sophie G; Penner, Jamie L

    2013-06-01

    The use of technology in delivery of health care services is rapidly increasing, and more nurses are using telehealth to provide care by distance to persons with complex health challenges. The rapid uptake of telehealth modalities and dynamic evolution of technologies has outpaced the generation of empirical knowledge to support nursing practice in this emerging field, specifically in relation to how nurses come to know the person and engage in holistic care in a virtual environment. Knowing the person and nursing care have historically been associated with physical presence and close proximity in the nurse-client relationship, and the use of telehealth can limit the ways in which a nurse can observe the person, potentiate perceptions of distance, and lead to a reductionist perspective in care. The purpose of this article is to illuminate the dynamic and evolving nature of nursing practice in relation to the use of telehealth and to highlight gaps in nursing knowledge specific to knowing the person in a virtual environment. Such an understanding is necessary to inform future research and generate empirical evidence to support nurses in providing ethical, safe, effective, and holistic care by distance to persons through telehealth technology. PMID:23175170

  9. Crossing the Chasm: From Adoption to Diffusion of a Telehealth Innovation

    NASA Astrophysics Data System (ADS)

    Cho, Sunyoung; Mathiassen, Lars; Gallivan, Michael

    Telehealth innovations promise to provide extensive medical benefits by increasing access to healthcare services and lowering costs at the same time. However, many telehealth initiatives fail to go beyond the status of prototype applications despite being considered technically viable and medically relevant. Based on a longitudinal investigation of a successful telehealth program, we identify a chasm between the initial adoption mode of the innovation as a prototype within a network of hospitals and the subsequent diffusion mode of the innovation as a commercialized product. Subsequently, we analyze how key actors negotiated the chasm to successfully diffuse the innovation beyond the initial hospital setting. In terms of research, the paper presents a longitudinal, empirical investigation of a successful telehealth innovation. Drawing on the metaphor of "crossing the chasm," we explain why many telehealth initiatives fail to go beyond prototype application status. In terms of practice, the paper provides lessons on how key actors can negotiate the chasm to transition from adoption mode to diffusion mode.

  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. Mortality Benefit of a Fourth-Generation Synchronous Telehealth Program for the Management of Chronic Cardiovascular Disease: A Longitudinal Study

    PubMed Central

    Hung, Chi-Sheng; Yu, Jiun-Yu; Lin, Yen-Hung; Chen, Ying-Hsien; Huang, Ching-Chang; Lee, Jen-Kuang; Chuang, Pao-Yu; Chen, Ming-Fong

    2016-01-01

    Background We have shown that a fourth-generation telehealth program that analyzes and responds synchronously to data transferred from patients is associated with fewer hospitalizations and lower medical costs. Whether a fourth-generation telehealth program can reduce all-cause mortality has not yet been reported for patients with chronic cardiovascular disease. Objective We conducted a clinical epidemiology study retrospectively to determine whether a fourth-generation telehealth program can reduce all-cause mortality for patients with chronic cardiovascular disease. Methods We enrolled 576 patients who had joined a telehealth program and compared them with 1178 control patients. A Cox proportional hazards model was fitted to analyze the impact of risk predictors on all-cause mortality. The model adjusted for age, sex, and chronic comorbidities. Results There were 53 (9.3%) deaths in the telehealth group and 136 (11.54%) deaths in the control group. We found that the telehealth program violated the proportional hazards assumption by the Schoenfeld residual test. Thus, we fitted a Cox regression model with time-varying covariates. The results showed an estimated hazard ratio (HR) of 0.866 (95% CI 0.837-0.896, P<.001; number needed to treat at 1 year=55.6, 95% CI 43.2-75.7 based on HR of telehealth program) for the telehealth program on all-cause mortality after adjusting for age, sex, and comorbidities. The time-varying interaction term in this analysis showed that the beneficial effect of telehealth would increase over time. Conclusions The results suggest that our fourth-generation telehealth program is associated with less all-cause mortality compared with usual care after adjusting for chronic comorbidities. PMID:27177497

  12. 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. PMID:25400004

  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.

  14. 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…

  15. 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…

  16. Values Held by Office-Based and Home-Based Therapists in Northern New England.

    ERIC Educational Resources Information Center

    Day, H. D.; McCain, Victoria M.

    1999-01-01

    In first study of values of rural mental-health professionals, the Survey of Personal Values and Survey of Interpersonal Values were completed by 51 office-based psychotherapists and 87 home-based therapists from rural areas in three northern New England states. That home-based therapists would more highly value independence and goal orientation…

  17. 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…

  18. 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…

  19. Diabetes Telehealth and Computerized Decision Support Systems: A Sound System with a Human Touch Is Needed

    PubMed Central

    Holmström, Inger

    2010-01-01

    Telehealth holds the promise of improved consistency and fast and equal access to care, and will have great impact on future care. To enhance its quality and safety, computerized decision support systems (CDSS) have been launched. This commentary focuses specifically on the impact of telehealth and CDSS on diabetes patient management. Ideally, clinical information should be linked to evidence based recommendations and guidelines in the CDSS to provide tailored recommendations at the moment of care. However, technical support such as CDSS is not enough. The human touch is essential. A named healthcare provider with access to telehealth and CDSS seems to promise a way of providing both patient-centered and evidence-based care. PMID:20663469

  20. 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. PMID:27163314

  1. A Pilot Exploration of Speech Sound Disorder Intervention Delivered by Telehealth to School–Age Children

    PubMed Central

    Grogan-Johnson, Susan; Gabel, Rodney M.; Taylor, Jacquelyn; Rowan, Lynne E.; Alvares, Robin; Schenker, Jason

    2011-01-01

    This article describes a school-based telehealth service delivery model and reports outcomes made by school-age students with speech sound disorders in a rural Ohio school district. Speech therapy using computer-based speech sound intervention materials was provided either by live interactive videoconferencing (telehealth), or conventional side-by-side intervention. Progress was measured using pre- and post-intervention scores on the Goldman Fristoe Test of Articulation-2 (Goldman & Fristoe, 2002). Students in both service delivery models made significant improvements in speech sound production, with students in the telehealth condition demonstrating greater mastery of their Individual Education Plan (IEP) goals. Live interactive videoconferencing thus appears to be a viable method for delivering intervention for speech sound disorders to children in a rural, public school setting. PMID:25945180

  2. 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

  3. The potential for telehealth technologies to facilitate charity care. Creating virtual dental homes.

    PubMed

    Glassman, Paul; Harrington, Maureen; Namakian, Maysa; Harrison-Noonan, Jesse

    2014-01-01

    The dramatic increase in broadband connectivity is opening up the possibility for using telehealth-connected teams in an improved system for charity care. The Virtual Dental Home demonstration taking place in California provides a model for the development and deployment of such teams. Teams using telehealth connections to provide oral health care can transform episodic or one-time visits into an ongoing system of care with a much greater emphasis on prevention and early intervention techniques and a greater likelihood of improved oral health for the population.

  4. The telehealth divide: disparities in searching public health information online.

    PubMed

    Schmeida, Mary; McNeal, Ramona S

    2007-08-01

    This article explores e government inequalities to searching Medicare and Medicaid information online. Telehealth, a branch of e government, can bring public health service and insurance information to the citizen. The Centers for Medicare and Medicaid Services website, among others, has critical information for potential beneficiaries and recipients of services. Using Pew survey data and multivariate regression analysis we find people in most need of Medicare and Medicaid information online (the elderly and poor) are accessing it, and people with years of online experience are strong proponents of online searches. Despite being less likely to have broadband services, individuals in rural areas were not found to be less likely to search for information online. In conclusion, some disparities are narrowing as the elderly and poor in need of access to public health insurance are searching for it online. However, people without Internet access and experience (perhaps the oldest and poorest) remain disadvantaged with respect to accessing critical information that can link them to needed health care services.

  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. 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.

  7. 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…

  8. 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

  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 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.

  12. 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

  13. A modeled analysis of telehealth methods for treating pressure ulcers after spinal cord injury.

    PubMed

    Smith, Mark W; Hill, Michelle L; Hopkins, Karen L; Kiratli, B Jenny; Cronkite, Ruth C

    2012-01-01

    Home telehealth can improve clinical outcomes for conditions that are common among patients with spinal cord injury (SCI). However, little is known about the costs and potential savings associated with its use. We developed clinical scenarios that describe common situations in treatment or prevention of pressure ulcers. We calculated the cost implications of using telehealth for each scenario and under a range of reasonable assumptions. Data were gathered primarily from US Department of Veterans Affairs (VA) administrative records. For each scenario and treatment method, we multiplied probabilities, frequencies, and costs to determine the expected cost over the entire treatment period. We generated low-, medium-, and high-cost estimates based on reasonable ranges of costs and probabilities. Telehealth care was less expensive than standard care when low-cost technology was used but often more expensive when high-cost, interactive devices were installed in the patient's home. Increased utilization of telehealth technology (particularly among rural veterans with SCI) could reduce the incidence of stage III and stage IV ulcers, thereby improving veterans' health and quality of care without increasing costs. Future prospective studies of our present scenarios using patients with various healthcare challenges are recommended.

  14. 77 FR 58952 - Exempting In-Home Video Telehealth From Copayments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-25

    ... Federal Register on March 6, 2012, 77 FR 13195, VA amended 38 CFR 17.108 to eliminate copayments for in-home video telehealth. VA published a companion substantially identical proposed rule at 77 FR 13236 on... described in 77 FR 13195 and 77 FR 13236, the direct final rule became effective on May 7, 2012, because...

  15. 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…

  16. 2,000,000 Electrocardiograms by Distance: An Outstanding Achievement for Telehealth in Brazil.

    PubMed

    Marcolino, Milena Soriano; Alkmim, Maria Beatriz Moreira; Bonisson, Leonardo; Minelli Figueira, Renato; Ribeiro, Antonio Luiz

    2015-01-01

    Our aim is to describe the evolution of the telediagnostic service of the Telehealth Network of Minas Gerais (TNMG), a public telehealth service in Brazil. It started in 2006 with 82 cities, restricted to electrocardiography analysis. Currently it extends to 772 cities--performing also Holter, ambulatory blood pressure monitoring and retinography analysis--and 48 ambulances in the north of the state, as part of a myocardial infarction system of care. Using low-cost equipment and simple technology, TNMG has employed various strategies to increase telehealth use. The number of ECGs performed by TNMG has progressively increased. It was expected to achieve 2 million in February 2015. The utilization rates were around 90%. It proved to be economically sound, promoting savings of 45M USD for an investment of 10.2M USD. It is currently a regular health service in the state, integrated into the healthcare system. In conclusion, the telehealth model developed in Minas Gerais produced good clinical and economical results.

  17. 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.

  18. The Adaptive Aerosol Delivery System in a Telehealth Setting: Patient Acceptance, Performance and Feasibility

    PubMed Central

    Denyer, John; Dodd, Mary; Dyche, Tony; Webb, Kevin; Weller, Peter; Stableforth, David

    2010-01-01

    Abstract Background The telehealth service is one of the fastest growing healthcare segments. It is increasingly utilizing computer technology and telecommunication equipment to either provide continuous vital sign monitoring or facilitate patient care at home, rather than relying solely on in-person care. Methods We conducted a 6-week open study in nineteen patients with cystic fibrosis enrolled from three centers, to investigate patient perception of a telehealth enabled nebulizer system (Prodose Adaptive Aerosol Delivery [AAD] System), which enabled the doorstep delivery of repeat medication. Results The results showed that patient confidence in the device and perception of ease of use was high with no significant change between the start and end of the trial. Views on the home delivery of medication were split between ‘great’ and ‘inconvenient.’ However, if the delivery system had been more flexible and delivered all the patients' drugs, the majority of patients would have had their medication delivered in this way. Conclusions The trial showed that it was possible to build telehealth technology into an advanced nebulizer system, and that patient acceptance of the technology was unlikely to be a barrier to the adoption of such a telehealth system. PMID:20373906

  19. 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.…

  20. 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

  1. 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

  2. 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.

  3. HOME-BASED THERAPY FOR OEDEMATOUS MALNUTRITION WITH READY-TO-USE THERAPEUTIC FOOD

    Technology Transfer Automated Retrieval System (TEKTRAN)

    BACKGROUND: Standard recommendations are that children with oedematous malnutrition receive inpatient therapy with a graduated feeding regimen. Aim: To investigate exclusive home-based therapy for children with oedematous malnutrition. METHODS: Children with oedematous malnutrition, good appetite, a...

  4. 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

  5. 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? PMID:20043711

  6. 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

  7. 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.

  8. 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

  9. Understanding exercise behaviour during home-based cardiac rehabilitation: a theory of planned behaviour perspective.

    PubMed

    Blanchard, Christopher

    2008-01-01

    Although home-based cardiac rehabilitation (CR) programs have been shown to produce significant increases in exercise capacity, obtaining patient adherence to these programs has been challenging. It is therefore critical to identify key theoretical determinants of exercise during home-based CR in order to inform the development of behavioural interventions that improve adherence. The present study examined the utility of the theory of planned behaviour (TPB) in explaining exercise behaviour during home-based CR. Seventy-six patients who were receiving 6 months of home-based CR completed a TPB questionnaire at the beginning and mid-point of the program and a physical activity scale at the mid-point and end of the program. Path analyses showed that attitude and perceived behavioural control significantly predicted intention for both time intervals (baseline to 3 months, and 3 months to 6 months), whereas subjective norm only predicted intention within the 1st 3 months. Intention significantly predicted implementation intention, which, in turn, significantly predicted exercise for both time intervals. Finally, several underlying accessible beliefs were significantly related to exercise for both time intervals. Therefore, results suggest that the TPB is a potentially useful framework for understanding exercise behaviour during home-based CR.

  10. Telehealth for "the digital illiterate"--elderly heart failure patients experiences.

    PubMed

    Lind, Leili; Karlsson, Daniel

    2014-01-01

    Telehealth solutions should be available also for elderly patients with no interest in using, or capacity to use, computers and smartphones. Fourteen elderly, severely ill heart failure patients in home care participated in a telehealth study and used digital pens for daily reporting of their health state--a technology never used before by this patient group. After the study seven patients and two spouses were interviewed face-to-face. A qualitative content analysis of the interview material was performed. The informants had no experience of computers or the Internet and no interest in learning. Still, patients found the digital pen and the health diary form easy to use, thus effortlessly adopting to changes in care provision. They experienced an improved contact with the caregivers and had a sense of increased security despite a multimorbid state. Our study shows that, given that technologies are tailored to specific patient groups, even "the digital illiterate" may use the Internet. PMID:25160205

  11. 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

  12. 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

  13. 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. PMID:26186425

  14. 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.

  15. 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. PMID:18534949

  16. Sustained Effects of a Nurse Coaching Intervention via Telehealth to Improve Health Behavior Change in Diabetes

    PubMed Central

    Young, Heather; Ward, Deborah; Dharmar, Madan; Tang-Feldman, Yajarayma; Berglund, Lars

    2014-01-01

    Abstract Background: 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. Materials and Methods: 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. Results: 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). Conclusions: 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. PMID:25061688

  17. 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

  18. Environmental aspects of health care in the Grampian NHS region and the place of telehealth.

    PubMed

    Wootton, Richard; Tait, Alex; Croft, Amanda

    2010-01-01

    Detailed information about the composition of the carbon footprint of the NHS in the Grampian health region, and in Scotland generally, is not available at present. Based on the limited information available, our best guess is that travel emissions in Grampian are substantial, perhaps 49,000 tonnes CO(2) per year. This is equivalent to 233 million km of car travel per year. A well-established telemedicine network in the Grampian region, which saves over 2000 patient journeys a year from community hospitals, avoids about 260,000 km travel per year, or about 59 tonnes CO(2) per year. Therefore using telehealth as it has been used historically (primarily to facilitate hospital-to-hospital interactions) seems unlikely to have a major environmental impact--although of course there may be other good reasons for persevering with conventional telehealth. On the other hand, telehealth might be useful in reducing staff travel and to a lesser extent, visitor travel. It looks particularly promising for reducing outpatient travel, where substantial carbon savings might be made by reconfiguring the way that certain services are provided.

  19. Virtual worlds and avatars as the new frontier of telehealth care.

    PubMed

    Morie, J; Haynes, E; Chance, E; Purohit, D

    2012-01-01

    We are entering a new age where people routinely visit, inhabit, play in and learn within virtual worlds (VWs). One in eight people worldwide are VW participants, according to the latest 2011 figures from KZERO [1]. VWs are also emerging as a new and advanced form of telehealth care delivery. In addition to existing telehealth care advantages; VWs feature three powerful affordances that can benefit a wide range of physical and psychological issues. First, the highly social nature of VWs encourages social networking and the formation of essential support groups. Secondly, the type of spaces that have been proven in the physical world to promote psychological health and well-being can be virtually recreated. Finally, research suggests that embodied avatar representation within VWs can affect users psychologically and physically. These three aspects of VWs can be leveraged for enhanced patient-client interactions, spaces that promote healing and positive responses, and avatar activities that transfer real benefits from the virtual to the physical world. This paper explains the mounting evidence behind these claims and provides examples of VWs as an innovative and compelling form of telehealth care destined to become commonplace in the future. PMID:22954822

  20. Environmental aspects of health care in the Grampian NHS region and the place of telehealth

    PubMed Central

    Wootton, Richard; Tait, Alex; Croft, Amanda

    2010-01-01

    Detailed information about the composition of the carbon footprint of the NHS in the Grampian health region, and in Scotland generally, is not available at present. Based on the limited information available, our best guess is that travel emissions in Grampian are substantial, perhaps 49,000 tonnes CO2 per year. This is equivalent to 233 million km of car travel per year. A well-established telemedicine network in the Grampian region, which saves over 2000 patient journeys a year from community hospitals, avoids about 260,000 km travel per year, or about 59 tonnes CO2 per year. Therefore using telehealth as it has been used historically (primarily to facilitate hospital-to-hospital interactions) seems unlikely to have a major environmental impact – although of course there may be other good reasons for persevering with conventional telehealth. On the other hand, telehealth might be useful in reducing staff travel and to a lesser extent, visitor travel. It looks particularly promising for reducing outpatient travel, where substantial carbon savings might be made by reconfiguring the way that certain services are provided. PMID:20511579

  1. A review of paediatric telehealth for pre- and post-operative surgical patients.

    PubMed

    Smith, Anthony C; Garner, Lisa; Caffery, Liam J; McBride, Craig A

    2014-10-01

    The Queensland Telepaediatric Service (QTS) was established in the year 2000 to deliver a broad range of paediatric specialist health services from the Royal Children's Hospital (RCH) in Brisbane, mainly via videoconference. During a 13-year study period, the QTS facilitated 18,949 video consultations, comprising Mental Health (42%), Medicine (30%), Surgery (21%) and Other (8%). We reviewed the surgical services provided through the QTS. There were 3880 video consultations with a paediatric surgeon. Most of these (91%) used fixed videoconferencing units, 8% were delivered via mobile units (robots) and 1% were delivered using Skype. Surgical consultations were provided by telehealth to 106 sites: 89% in Queensland and the rest to other states. The main surgical specialties were burns (50%), ear, nose and throat (19%), general surgery (21%), orthopaedics (9%) and vascular anomalies (2%). During a 12-month audit period, there were 224 teleconsultations in general surgery; the most common reason for referral was for undescended testes (17%). During the study period there was a significant growth in all surgical telehealth activity: linear regression showed an annual increase of 17 cases per year (P < 0.02). In the last four years of the study, there was a substantial growth in the general surgical component, although there was also a reduction in the burns component. Telehealth has potential for other specialist consultations which require periodic assessment and review. PMID:25400001

  2. 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

  3. The Telehealth Enhancement of Adherence to Medication in Pediatric IBD (TEAM) Trial: Design and Methodology

    PubMed Central

    Hommel, Kevin A.; Gray, Wendy N.; Hente, Elizabeth; Loreaux, Katherine; Ittenbach, Richard F.; Maddux, Michele; Baldassano, Robert; Sylvester, Francisco; Crandall, Wallace; Doarn, Charles; Heyman, Melvin B.; Keljo, David; Denson, Lee A.

    2015-01-01

    Medication nonadherence is a significant health care issue requiring regular behavioral treatment. Lack of sufficient health care resources and patient/family time commitment for weekly treatment are primary barriers to receiving appropriate self-management support. We describe the methodology of the Telehealth Enhancement of Adherence to Medication (TEAM) trial for medication nonadherence in pediatric inflammatory bowel disease (IBD). For this trial, participants 11–18 years of age will be recruited from seven pediatric hospitals and will complete an initial 4-week run in to assess adherence to a daily medication. Those who take less than 90% of their prescribed medication will be randomized. A total of 194 patients with IBD will be randomized to either a telehealth behavioral treatment (TBT) arm or education only (EO) arm. All treatment will be delivered via telehealth video conferencing. Patients will be assessed at baseline, post-treatment, 3-, 6-, and 12-months. We anticipate that participants in the TBT arm will demonstrate a statistically significant improvement at post-treatment and 3-, 6-, and 12-month follow-up compared to participants in the EO arm for both medication adherence and secondary outcomes (i.e., disease severity, patient quality of life, and health care utilization). If efficacious, the TEAM intervention could be disseminated broadly and reduce health care access barriers so that patients could receive much needed self-management intervention. PMID:26003436

  4. Home-based caregivers in Africa: alliance building, advocacy and policy environments.

    PubMed

    Ransom, Pamela E; Asaki, Becca

    2014-01-01

    Home-based caregiving in Africa was examined in the context of the work of the Home-Based Care Alliance, first launched in 2005 to provide support and advocacy for approximately 30,000 caregivers. A review of ten countries in Africa shows that caregivers were either not included, or only selectively included in government programs. With respect to caregiver advocacy, additional resources, recognition and increased involvement in decision-making were the primary identified concerns. Increased health systems capacity for AIDS management, new regulation, innovative collaborations, decentralization, task-shifting, and caregiver burnout are among the trends identified in the broader policy environment impacting caregivers.

  5. Predictors and processes associated with home-based family therapists' professional quality of life.

    PubMed

    Macchi, C R; Johnson, Matthew D; Durtschi, Jared A

    2014-07-01

    This study examined whether home-based family therapists' (HBFT) workload and clinical experience were associated with therapists' professional quality of life directly and indirectly through self-care activities and frequency of clinical supervision. Hypotheses were tested using structural equation modeling with a sample of 225 home-based therapists. Results suggested that therapists' workload and HBFT experience significantly predicted therapists' professional quality of life. These associations between therapists' workload and HBFT experience were partially mediated through participation in self-care and frequency of clinical supervision. Implications for improving therapists' quality of life are discussed as a function of therapists' workload, clinical experience, self-care, and supervision.

  6. Teledermatology protocol for screening of Skin Cancer*

    PubMed Central

    Piccoli, Maria Fernanda; Amorim, Bruna Dücker Bastos; Wagner, Harley Miguel; Nunes, Daniel Holthausen

    2015-01-01

    BACKGROUND Telemedicine refers to the use of technology as improvement of healthcare delivery to places where distance becomes an obstacle. Its use represents a great potential for dermatology, a specialty whose visual analysis phase is essential in diagnosis. OBJECTIVES To analyze the compatibility index of skin cancer diagnoses between primary care and teledermatology, and to validate a protocol for standardization of digital imaging to obtain the reports in teledermatology. METHODS An observational cross-sectional study developed through the census of 333 examination requests, received between January/2012 and July/2012, in the Center for Telemedicine and Telehealth of SES-SC. We used a protocol for photographic lesion standardization, consisting of three steps (panoramic photo, close-up with ruler and dermoscopy). After collection, the data were sent to a virtual site on the Internet, and recorded with the use of an electronic health record containing the images, the skin phototype and demographic characteristics. RESULTS The level of compatibility between the diagnosis of skin cancer in Santa Catarina's primary care and the diagnosis proposed by teledermatology was 19.02%. Proportionally, it was 21.21% for BCC, 44.44% for SCC and 6.98% for MM. The protocol was statistically significant (p <0.05), with an OR of 38.77. CONCLUSION The rate of diagnostic compatibility of skin cancer was low and the use of the protocol optimized the chance of validating requests for examination. PMID:25830990

  7. Using telehealth to augment an intensive case monitoring program in veterans with schizophrenia and suicidal ideation: A pilot trial

    PubMed Central

    Kasckow, John; Zickmund, Susan; Gurklis, John; Luther, James; Fox, Lauren; Taylor, Melissa; Richmond, Ira; Haas, Gretchen L

    2016-01-01

    Veterans with schizophrenia admitted for suicidal ideation were recruited into a post-discharge program consisting of Intensive Case Monitoring (ICM) with daily monitoring with the Health Buddy (HB; experimental group) or ICM alone (control group). This study tested the feasibility of the telehealth monitoring intervention in this population. Secondly, we determined whether augmentation of ICM with our intervention for 3 months would result in a reduction in suicidal ideation. Twenty of 25 telehealth participants could set up the device. Monthly adherence for telehealth participants was > 80%. A qualitative analysis of endpoint surveys revealed that the majority of participants had positive responses. In both groups, there were improvements in Beck Scale for Suicidal Ideation (BSS) scores at endpoint relative to baseline. No group differences were present with survival analysis when using remission (i.e., BSS score = 0) as the outcome; however, in a subgroup with a history of suicide attempt, there was a trend (p = .093) for a higher rate of remission for those in the HB condition. In conclusion, telehealth monitoring for this population appears to be feasible for those who are able to start using the system. The pilot data obtained should help investigators design better telehealth interventions for this population. PMID:27137970

  8. 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…

  9. 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…

  10. 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…

  11. 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…

  12. 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…

  13. Home-based therapy for severe acute malnutrition with ready-to-use food

    Technology Transfer Automated Retrieval System (TEKTRAN)

    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...

  14. Practice Related Home-Based Family Centered Services Course for Master of Social Work Curricula.

    ERIC Educational Resources Information Center

    Virginia Commonwealth Univ., Richmond. Region III Child Welfare Training Center.

    This course outline provides a framework for incorporating material about home-based family centered services (HBFCS) in existing masters-level family/child welfare curricula. The placement of the course in the curriculum is discussed, with suggestions for appropriate background knowledge/course work. Seven major topics are outlined: (1)…

  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. A Message from Home: A Home-Based Intervention Method for Low-Income Preschoolers.

    ERIC Educational Resources Information Center

    Levenstein, Phyllis

    Described in this report is a home-based, cognitive-affective intervention program involving 93 mothers and their children. This demonstration program sought to show that the principal cognitive element missing from the experience of low-income children in preparation for schooling is a sufficient amount of concept-building verbal interaction in…

  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. 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…

  19. 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…

  20. 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…

  1. 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…

  2. VA and HRS Local Coordination of Florida's Home-Based Services to the Elderly.

    ERIC Educational Resources Information Center

    Bradham, Douglas D.; Chico, Innette Mary

    Florida's District 12 Veterans Administration (VA) wanted to deliver medical case-management services to veterans not receiving home-based services due to the geographic restrictions of the VA's Hospital-Based Home Care Program. The Florida Department of Health and Rehabilitative Services (HRS) desired to demonstrate the effectiveness of nurse…

  3. Rural Alberta Home-Based Businesses: A Profile of Workshop Participants.

    ERIC Educational Resources Information Center

    Capjack, M. Linda; Fetterman, Nelma I.

    1992-01-01

    Of 252 rural Alberta attendees of home-based business workshops, 60 were in business. Of these, 65 percent produced sewing, textile, or food-related products; 73 percent contributed less than 5 percent of family income; 72 percent worked at home because a hobby became profitable; and the majority were married women over 40. (SK)

  4. Home-Based School Teachers in Afghanistan: Teaching for Tarbia and Student Well-Being

    ERIC Educational Resources Information Center

    Kirk, Jackie; Winthrop, Rebecca

    2008-01-01

    Teachers in community-based or home-based schools in Afghanistan play a critical role in extending access to education to children who are unable to access the government schools, especially girls. These teachers--men and women--are nominated by the community to teach, without necessarily having teaching experience or even completing their own…

  5. 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...

  6. 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…

  7. 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…

  8. 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.

  9. 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

  10. Internet-based telehealth system for the treatment of agoraphobia.

    PubMed

    Alcañiz, Mariano; Botella, Cristina; Baños, Rosa; Perpiñá, Concepción; Rey, Beatriz; Lozano, José Antonio; Guillén, Verónica; Barrera, Francisco; Gil, José Antonio

    2003-08-01

    In this work that is being validated within the VEPSY project, we present a system that allows the patient to continue a psychological virtual reality treatment from his or her home PC as complementary therapy. In the consulting room, we have been using virtual therapy for panic disorder and agoraphobia treatment to expose the patient to several situations. For the complementary therapy, a structured treatment via the Internet has been prepared, which consists of several parts: an assessment protocol; a structured treatment protocol organized in several blocks (such as psychoeducation and exposure); and an outcome protocol. The same situations as in the consulting room have been selected for the exposure, but each of them has been divided into several virtual environments with specific characteristics that limit its difficulty level. The stimuli that are used at each level are controlled automatically by the system. The information of the patient is stored in a database, which is placed in a remote server using XML format and used to control which stages of the treatment he or she can access. The psychologist can limit the evolution of the patient. The virtual environments are installed in the patient's PC, and they are implemented with a mechanism that ensures that they can only be run when the patient connects to the web. The user should not have any special virtual reality hardware at home, so head rotations have been simulated with the navigation system.

  11. 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…

  12. 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…

  13. 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

  14. Telehealth and Telenursing Perception and Knowledge Among University Students of Nursing in Poland

    PubMed Central

    Pawłowska, Katarzyna; Kozłowska, Lena

    2013-01-01

    Abstract Objective: Telehealth and telenursing are becoming the new reality in studying nursing. Little is known whether undergraduate nursing students receive adequate education on telenursing for patient care. The aim for this study was to evaluate the knowledge and attitude of nursing students toward telenursing. Subjects and Methods: Students of nursing faculties from medical universities in Poland were invited to complete a survey about telehealth and telenursing. The survey was conducted utilizing a Web-based surveying platform (www.mini-ankiety.pl). Results: We surveyed 308 undergraduate students of nursing faculty—291 females (94%) and 17 males (6%)—from medical universities in Poland. There were 116 students in their first year (course) (38%) and 96 students each in the second and third years (31%). Most of the students (220 [71%]) in the study group were in the age range from 20 to 23 years. The accurate definition of telemedicine was identified by 251 (82%) respondents. The definition of telenursing was recognized properly by 230 (75%) respondents. Of the students, 207 (67%) would anticipate telenursing service implementation into the national healthcare system, and 214 (69.49%) would appreciate the addition of telenursing classes to the curriculum. Students from a few universities showed significantly higher willingness to introduce telenursing classes into nursing curriculum and the intention to use telenursing services in their future nursing practice. The difference among universities could be influenced by regional e-health initiatives. This study has shown the rise of trust in technology along with the increase in the year of nursing study. Conclusions: The current generation of university students of nursing seems to be well educated in medical informatics and technology use. They are better prepared for and open to information society membership, including the practice of telehealth. The advancement in university education has an influence on

  15. Evaluating the benefits of home-based management of atrial fibrillation: current perspectives

    PubMed Central

    Sheikh, Azfar B; Felzer, Jamie R; Munir, Abdullah Bin; Morin, Daniel P; Lavie, Carl J

    2016-01-01

    Atrial fibrillation (AF) is the most common arrhythmia worldwide, leading to an extensive public health and economic burden. The increasing incidence and prevalence of AF is due to the advancing age of the population, structural heart disease, hypertension, diabetes, and thyroid disease. The majority of costs associated with AF have been attributed to the cost of hospitalization. In order to minimize costs and decrease hospitalizations, counseling on modifiable risk factors contributing to AF has been strongly emphasized. With the release of novel oral anticoagulants bypassing the need for anticoagulant bridging or laboratory monitoring, post-discharge nurse-led home intervention, and novel methods of heart rate monitoring, home-based AF management has reached a new level of ease and sophistication. In this review, we aimed to review modifiable risk factors for AF and various methods of home-based management of AF, along with their benefits. PMID:27799843

  16. Integration of telehealth and telecare: the implementation model for chronic disease management in the veneto region.

    PubMed

    Mancin, Silvia; Centis, Giorgia

    2014-01-01

    The integration of health and social care is the latest dogma for improving the quality of care for chronic and frail patients. In the Veneto Region, a unique platform has been developed for the provision of both telecare and telehealth to chronic patients that are equipped at home with a personal health system for real time detection of emergencies situations and to measure their clinical parameters according to a plan scheduled by their clinician. The integrated service is centrally managed by a regional eHealth center that represents the point of intermediation between the patient and the health and social care professionals.

  17. Telehealth and Occupational Therapy: Integral to the Triple Aim of Health Care Reform.

    PubMed

    Cason, Jana

    2015-01-01

    Programs and concepts included in the Patient Protection and Affordable Care Act of 2010 are expected to transform health care in the United States from a volume-based health system to a value-based health system with increased emphasis on prevention and health promotion. The Triple Aim, a framework set forth by the Institute for Healthcare Improvement, focuses on improving the health care experience, the health of populations, and the affordability of care. This article describes telehealth as an integral component in achieving the Triple Aim of health care and discusses implications for occupational therapy practitioners. PMID:26122676

  18. Telehealth nurse practitioner student clinical experiences: an essential educational component for today's health care setting.

    PubMed

    Hawkins, Shelley Yerger

    2012-11-01

    In order to meet the continuous changes and innovations within the health care system, nurse practitioner faculty must look to the future and prepare nurse practitioner graduates who deliver safe, quality patient care addressing the realities of a global society with a fast-paced expansion of technologies. Preparing nurse practitioner students for practice must include more than information technology knowledge in graduate nursing programs. Formal clinical experiences using various telehealth applications must be integrated into nurse practitioner training. Innovative strategies must be explored by nurse practitioner faculty to assure that graduates can meet the demanding technological demands of our current health care society.

  19. Connected health: a review of technologies and strategies to improve patient care with telemedicine and telehealth.

    PubMed

    Kvedar, Joseph; Coye, Molly Joel; Everett, Wendy

    2014-02-01

    With the advent of national health reform, millions more Americans are gaining access to a health care system that is struggling to provide high-quality care at reduced costs. The increasing adoption of electronic technologies is widely recognized as a key strategy for making health care more cost-effective. This article examines the concept of connected health as an overarching structure for telemedicine and telehealth, and it provides examples of its value to professionals as well as patients. Policy makers, academe, patient advocacy groups, and private-sector organizations need to create partnerships to rapidly test, evaluate, deploy, and pay for new care models that use telemedicine.

  20. Clinics and home-based care organisations: an interface between theformal and informal health sectors.

    PubMed

    Boros, Adam Kenneth

    2010-12-01

    The article outlines the findings of a study designed to explore the working relationship between home-based caregivers and clinic nurses at locations in two informal settlements in Johannesburg, South Africa. By considering the views and experiences of both sponsored and unsponsored caregivers, the research focused on how degrees of informality affect this relationship. The nurse/caregiver relationship represents a primary interface between the formal and informal health sectors and is an important part of the country's primary healthcare system. Despite the attention given to linking home-based care (HBC) with the formal health system, very little research has examined the functionality of this link at the ground level. Through a number of qualitative, semi-structured interviews with nurses, home-based caregivers, and staff from the Department of Health, information was collected to better understand what systems are in place to facilitate the relationship between clinics and HBC organisations, and whether these systems are helping to create the desired results. Do the formal and informal health sectors complement and strengthen or do they distract and damage each other? By examining the influence of degrees of informality, the research also lends insight into how this distinction plays a role in healthcare provision. For instance, how does state support impact the link between the formal and informal health sectors and the ultimate quality of care? And what steps can be taken to improve the health system in this regard, as a whole? The findings point to a number of problems and challenges with integrating HBC into the formal health sector. Degrees of informality are found to have a profound impact on the work of home-based caregivers in some respects, but a surprising lack of impact in others. These issues need to be confronted in order to improve the existing system and, ultimately, health outcomes in South Africa. PMID:25875880

  1. Muscle Strength Enhancement Following Home-Based Virtual Cycling Training in Ambulatory Children with Cerebral Palsy

    ERIC Educational Resources Information Center

    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…

  2. Effect of home based HIV counselling and testing intervention in rural South Africa: cluster randomised trial

    PubMed Central

    Tabana, Hanani; Jackson, Debra; Naik, Reshma; Zembe, Wanga; Lombard, Carl; Swanevelder, Sonja; Fox, Matthew P; Thorson, Anna; Ekström, Anna Mia; Chopra, Mickey

    2013-01-01

    Objective To assess the effect of home based HIV counselling and testing on the prevalence of HIV testing and reported behavioural changes in a rural subdistrict of South Africa. Design Cluster randomised controlled trial. Setting 16 communities (clusters) in uMzimkhulu subdistrict, KwaZulu-Natal province, South Africa. Participants 4154 people aged 14 years or more who participated in a community survey. Intervention Lay counsellors conducted door to door outreach and offered home based HIV counselling and testing to all consenting adults and adolescents aged 14-17 years with guardian consent. Control clusters received standard care, which consisted of HIV counselling and testing services at local clinics. Main outcome measures Primary outcome measure was prevalence of testing for HIV. Other outcomes were HIV awareness, stigma, sexual behaviour, vulnerability to violence, and access to care. Results Overall, 69% of participants in the home based HIV counselling and testing arm versus 47% in the control arm were tested for HIV during the study period (prevalence ratio 1.54, 95% confidence interval 1.32 to 1.81). More couples in the intervention arm had counselling and testing together than in the control arm (2.24, 1.49 to 3.03). The intervention had broader effects beyond HIV testing, with a 55% reduction in multiple partners (0.45, 0.33 to 0.62) and a stronger effect among those who had an HIV test (0.37, 0.24 to 0.58) and a 45% reduction in casual sexual partners (0.55, 0.42 to 0.73). Conclusions Home based HIV counselling and testing increased the prevalence of HIV testing in a rural setting with high levels of stigma. Benefits also included higher uptake of couple counselling and testing and reduced sexual risk behaviour. Trial registration Current Controlled Trials ISRCTN31271935. PMID:23766483

  3. Home-Based Treadmill Training to Improve Gait Performance in Persons With a Chronic Transfemoral Amputation

    PubMed Central

    Darter, Benjamin J.; Nielsen, David H.; Yack, H. John; Janz, Kathleen F.

    2014-01-01

    Objective To investigate the effectiveness of a home-based multiple-speed treadmill training program to improve gait performance in persons with a transfemoral amputation (TFA). Design Repeated measures. Setting Research laboratory. Participants Individuals with a TFA (N=8) who had undergone a unilateral amputation at least 3 years prior as a result of limb trauma or cancer. Intervention Home-based treadmill walking for a total of 30 minutes a day, 3 days per week for 8 weeks. Each 30-minute training session involved 5 cycles of walking for 2 minutes at 3 speeds. Main Outcome Measures Participants were tested pretraining and after 4 and 8 weeks of training. The primary measures were temporal-spatial gait performance (symmetry ratios for stance phase duration and step length), physiological gait performance (energy expenditure and energy cost), and functional gait performance (self-selected walking speed [SSWS], maximum walking speed [MWS], and 2-minute walk test [2MWT]). Results Eight weeks of home-based training improved temporal-spatial gait symmetry at SSWS but not at MWS. A relative interlimb increase in stance duration for the prosthetic limb and proportionally greater increases in step length for the limb taking shorter steps produced the improved symmetry. The training effect was significant for the step length symmetry ratio within the first 4 weeks of the program. Energy expenditure decreased progressively during the training with nearly 10% improvement observed across the range of walking speeds. SSWS, MWS, and 2MWT all increased by 16% to 20%. Conclusions Home-based treadmill walking is an effective method to improve gait performance in persons with TFA. The results support the application of training interventions beyond the initial rehabilitation phase, even in individuals considered highly functional. PMID:23954560

  4. Clinical waste management in the context of the Kanye community home-based care programme, Botswana.

    PubMed

    Kang'ethe, Simon M

    2008-07-01

    This study examines clinical waste disposal and handling in the context of a community home-based care (CHBC) programme in Kanye, southern Botswana. This qualitative study involved 10 focus group discussions with a total of 82 HIV/AIDS primary caregivers in Kanye, one-to-one interviews with the five nurses supervising the programme, and participant observation. Numerous aspects of clinical or healthcare waste management were found to be hazardous and challenging to the home-based caregivers in the Kanye CHBC programme, namely: lack of any clear policies for clinical waste management; unhygienic waste handling and disposal by home-based caregivers, including burning and burying the healthcare wastes, and the absence of pre-treatment methods; inadequate transportation facilities to ferry the waste to clinics and then to appropriate disposal sites; stigma and discrimination associated with the physical removal of clinical waste from homes or clinics; poor storage of the healthcare waste at clinics; lack of incinerators for burning clinical waste; and a high risk of contagion to individuals and the environment at all stages of managing the clinical waste.

  5. Home-based asthma self-management education for inner city children.

    PubMed

    Butz, Arlene M; Syron, Laura; Johnson, Betty; Spaulding, Joanne; Walker, Melissa; Bollinger, Mary Elizabeth

    2005-01-01

    Optimal home self-management in young children with asthma includes accurate symptom identification followed by timely and appropriate treatment. The objective of this study was to evaluate a home-based asthma educational intervention targeting symptom identification for parents of children with asthma. Two hundred twenty-one children with asthma were enrolled into an ongoing home-based clinical trial and randomized into either a standard asthma education (SAE) or a symptom/nebulizer education intervention (SNEI). Data included home visit records and parent's self-report on questionnaires. Symptom identification and self-management skills significantly improved from preintervention to postintervention for parents in both groups with the exception of checking medications for expiration dates and the frequency of cleaning nebulizer device and equipment. However, significantly more parents of children in the SNEI group reported treating cough symptoms as compared with the SAE group (p = 0.05). Of concern is that only 38% of all parents reported having an asthma action plan in the home. A targeted home-based asthma education intervention can be effective for improving symptom identification and appropriate use of medications in children with asthma. Home asthma educational programs should address accurate symptom identification and a demonstration of asthma medication delivery devices. PMID:15982192

  6. Peer tutoring with or without home-based reinforcement, for reading remediation.

    PubMed Central

    Trovato, J; Bucher, B

    1980-01-01

    An operant-based corrective reading program was established to study effectiveness of peer tutoring in the school, for reading deficient children. Sixty-nine second to fourth grade students were matched on measures of initial reading ability and level of reading retardation, and randomly assigned to three groups: Peer Tutoring Only, Peer Tutoring with Home Based Reinforcement, and Control. SRA materials were used in training for the experimental groups, supplemented with additional reading materials. The program continued for 15 weeks, in seven public schools. Changes in oral reading accuracy and comprehansion were assessed. Both reading and comprehension were significantly increased by peer tutoring, relative to the control group. The addition of home-based reinforcement doubled this increase. The measured gain in oral reading, based upon standardized testing, was 0.19 years for the controls and 1.27 years for peer tutoring with home-based reinforcement. Internal measures of gain showed similar results, and comprehension gains were also comparable. A high rate of compliance with the tutoring program was maintained by the tutors. High ratings of satisfaction were obtained for the program, from all groups of participants. The feasibility of the program for application in the school system is discussed. PMID:7364691

  7. Self-reported impact of caregiving on voluntary home-based caregivers in Mutale Municipality, South Africa

    PubMed Central

    Netshandama, Vhonani O.; Mudau, Makondelela J.

    2016-01-01

    Background The establishment of home-based care (HBC) programmes in developing countries has resulted in a shift of burden from hospitals to communities where palliative care is provided by voluntary home-based caregivers. Aim The study investigated the impact of caregiving on voluntary home-based caregivers. Setting The study was conducted at HBC organisations located in Mutale Municipality of Limpopo Province, South Africa. Methods A quantitative cross-sectional descriptive survey design was applied to investigate the impact of caregiving on voluntary home-based caregivers. The sample was comprised of (N = 190) home-based caregivers. Home-based caregivers provide care to people in need of care in their homes, such as orphans, the elderly and those suffering from chronic illnesses such as tuberculosis, HIV and/or AIDS, cancer and stroke. Self-administered questionnaires were used to collect data which were analysed descriptively using the Statistical Package for the Social Sciences software, Version 20. Results The results showed that 101 (53.2%) participants were worried about their financial security because they were not registered as workers, whilst 74 (39.0%) participants were always worried about getting infection from their clients because they often do not have protective equipment. Conclusion Voluntary home-based caregivers have an important role in the provision of palliative care to people in their own homes, and therefore, the negative caregiving impact on the lives of caregivers may compromise the provision of quality palliative care. PMID:27380854

  8. Outcomes of a Telehealth Intervention for Homebound Older Adults with Heart or Chronic Respiratory Failure: A Randomized Controlled Trial

    ERIC Educational Resources Information Center

    Gellis, Zvi D.; Kenaley, Bonnie; McGinty, Jean; Bardelli, Ellen; Davitt, Joan; Ten Have, Thomas

    2012-01-01

    Purpose: Telehealth care is emerging as a viable intervention model to treat complex chronic conditions, such as heart failure (HF) and chronic obstructive pulmonary disease (COPD), and to engage older adults in self-care disease management. Design and Methods: We report on a randomized controlled trial examining the impact of a multifaceted…

  9. Telehealth: Telecommunications Technology in Health Care and Health Education in Canada. New Technologies in Canadian Education Series. Paper 15.

    ERIC Educational Resources Information Center

    Cervinskas, Jenny

    This examination of the use of telecommunications systems in the health care field in Canada notes that the use of such systems to assist in the delivery of health care at a distance is critical to the remote and isolated regions of the country. The report begins by reviewing the development of 'telemedicine' or 'telehealth' systems using various…

  10. Implementation of health information technology in Veterans Health Administration to support transformational change: telehealth and personal health records.

    PubMed

    Chumbler, Neale R; Haggstrom, David; Saleem, Jason J

    2011-12-01

    The Institute of Medicine report, Crossing the Quality Chasm, called for significant improvements in 6 elements of healthcare performance: safety, effectiveness, patient centeredness, timeliness, efficiency, and equity. To meet the changing care needs of older veterans, many of whom are trying to manage the complexities of their chronic diseases in their own homes, the Veterans Health Administration (VHA) has promoted many of the Institute of Medicine elements by implementing health information technology (health IT), such as telehealth and a personal health record (PHR). To that end, approximately 5 years ago, VHA created the Office of Care Coordination and in particular a patient-centered Care Coordination/Home Telehealth (CCHT) program, which uses telehealth technologies (eg, messaging devices) to coordinate care directly from a patient's home to help self-manage their chronic diseases. VHA has also developed a PHR, My HealtheVet, which is a secure web-based portal that provides veterans the capability to access and manage health information. This article discusses the mechanisms by which these forms of health IT have been implemented to improve access to care and improve health. For telehealth, we present the outcomes from some of the published literature. For PHRs, we outline what is known to date and future research directions. The article also examines some structural, policy-related, and organizational barriers to health IT implementation and offers suggestions for future research.

  11. Telehealth Delivery of Cognitive-Behavioral Intervention to Youth with Autism Spectrum Disorder and Anxiety: A Pilot Study

    ERIC Educational Resources Information Center

    Hepburn, Susan L.; Blakeley-Smith, Audrey; Wolff, Brian; Reaven, Judy A.

    2016-01-01

    Youth with autism spectrum disorders frequently experience significant symptoms of anxiety. Empirically supported psychosocial interventions exist, yet access is limited, especially for families in rural areas. Telehealth (i.e. videoconferencing) has potential to reduce barriers to access to care; however, little is known about the feasibility or…

  12. A qualitative case study of telehealth for in-home monitoring to support the management of type 2 diabetes.

    PubMed

    Carlisle, Karen; Warren, Robin

    2013-10-01

    The present study formed part of a randomised controlled trial of telehealth for in-home monitoring to support people with poorly controlled type 2 diabetes. We explored the experiences of patients and healthcare practitioners, and their perceptions of the telehealth model of care used in the trial. In addition to their usual diabetes care, participants receive diabetes care from a diabetes educator nurse via an in-home broadband communication device. On average, each patient participated in 14 videoconferences with a diabetes care coordinator during the 12-month trial period. Qualitative data was collected from two general practices and included semi-structured interviews and document review of patient clinical notes. A total of 12 people were interviewed: 8 health practitioners and 4 patients. Patients and health practitioners expressed a high level of satisfaction with the model of care provided. Patients also reported positive health and social outcomes as a result of being involved in the trial and indicated that in the main they had achieved their goals and were happy with their progress over the 12-month period. Analysis of interviews revealed three broad elements associated with the implementation of telehealth: interpersonal factors, operational problems and the wider health system context within which the general practices and trial team were operating. The findings suggest that adopting telehealth in the management of type 2 diabetes can lead to improved diabetes control, but more support is required to ensure sustainability and widespread implementation.

  13. The use of deployable telehealth centers by military beneficiaries to access behavioral healthcare: an exploratory evaluation in American Samoa.

    PubMed

    Mishkind, Matthew C; Martin, Suzanne; Husky, George; Miyahira, Sarah D; Gahm, Gregory A

    2012-12-01

    Some U.S. Military Health System (MHS) beneficiaries face unique challenges accessing available behavioral healthcare because of the nature of their occupations, deployments to and permanent duty stations in isolated geographies, and discontinuity of services. The use of deployable telehealth centers such as modified shipping containers offers promise as an innovative solution to increase access to behavioral healthcare in remote and otherwise austere environments. The first telehealth modified 20-foot shipping container, known as a relocatable telehealth center (RTeC), was deployed to increase access to care for MHS beneficiaries on American Samoa. The goal of this study was to conduct an exploratory evaluation of patient satisfaction with and usability perceptions of this solution as a place to receive behavioral healthcare services. Twenty-eight beneficiaries participated in this evaluation. Results suggest that the RTeC is safe and private and ultimately an appropriate telebehavioral-originating site. These data provide insight into usability considerations and inform future research and deployable telehealth center development. Additionally, a brief discussion about potential cost offset is provided as cost efficiencies impact RTeC viability. PMID:23078182

  14. Evaluating the Treatment Fidelity of Parents Who Conduct In-Home Functional Communication Training with Coaching via Telehealth

    ERIC Educational Resources Information Center

    Suess, Alyssa N.; Romani, Patrick W.; Wacker, David P.; Dyson, Shannon M.; Kuhle, Jennifer L.; Lee, John F.; Lindgren, Scott D.; Kopelman, Todd G.; Pelzel, Kelly E.; Waldron, Debra B.

    2014-01-01

    We conducted a retrospective, descriptive evaluation of the fidelity with which parents of three children with autism spectrum disorders conducted functional communication training (FCT) in their homes. All training was provided to the parents via telehealth by a behavior consultant in a tertiary-level hospital setting. FCT trials coached by the…

  15. The use of deployable telehealth centers by military beneficiaries to access behavioral healthcare: an exploratory evaluation in American Samoa.

    PubMed

    Mishkind, Matthew C; Martin, Suzanne; Husky, George; Miyahira, Sarah D; Gahm, Gregory A

    2012-12-01

    Some U.S. Military Health System (MHS) beneficiaries face unique challenges accessing available behavioral healthcare because of the nature of their occupations, deployments to and permanent duty stations in isolated geographies, and discontinuity of services. The use of deployable telehealth centers such as modified shipping containers offers promise as an innovative solution to increase access to behavioral healthcare in remote and otherwise austere environments. The first telehealth modified 20-foot shipping container, known as a relocatable telehealth center (RTeC), was deployed to increase access to care for MHS beneficiaries on American Samoa. The goal of this study was to conduct an exploratory evaluation of patient satisfaction with and usability perceptions of this solution as a place to receive behavioral healthcare services. Twenty-eight beneficiaries participated in this evaluation. Results suggest that the RTeC is safe and private and ultimately an appropriate telebehavioral-originating site. These data provide insight into usability considerations and inform future research and deployable telehealth center development. Additionally, a brief discussion about potential cost offset is provided as cost efficiencies impact RTeC viability.

  16. Communications protocol

    NASA Technical Reports Server (NTRS)

    Zhou, Xiaoming (Inventor); Baras, John S. (Inventor)

    2010-01-01

    The present invention relates to an improved communications protocol which increases the efficiency of transmission in return channels on a multi-channel slotted Alohas system by incorporating advanced error correction algorithms, selective retransmission protocols and the use of reserved channels to satisfy the retransmission requests.

  17. Embedded DSP-based telehealth radar system for remote in-door fall detection.

    PubMed

    Garripoli, Carmine; Mercuri, Marco; Karsmakers, Peter; Jack Soh, Ping; Crupi, Giovanni; Vandenbosch, Guy A E; Pace, Calogero; Leroux, Paul; Schreurs, Dominique

    2015-01-01

    Telehealth systems and applications are extensively investigated nowadays to enhance the quality-of-care and, in particular, to detect emergency situations and to monitor the well-being of elderly people, allowing them to stay at home independently as long as possible. In this paper, an embedded telehealth system for continuous, automatic, and remote monitoring of real-time fall emergencies is presented and discussed. The system, consisting of a radar sensor and base station, represents a cost-effective and efficient healthcare solution. The implementation of the fall detection data processing technique, based on the least-square support vector machines, through a digital signal processor and the management of the communication between radar sensor and base station are detailed. Experimental tests, for a total of 65 mimicked fall incidents, recorded with 16 human subjects (14 men and two women) that have been monitored for 320 min, have been used to validate the proposed system under real circumstances. The subjects' weight is between 55 and 90 kg with heights between 1.65 and 1.82 m, while their age is between 25 and 39 years. The experimental results have shown a sensitivity to detect the fall events in real time of 100% without reporting false positives. The tests have been performed in an area where the radar's operation was not limited by practical situations, namely, signal power, coverage of the antennas, and presence of obstacles between the subject and the antennas.

  18. Embedded DSP-based telehealth radar system for remote in-door fall detection.

    PubMed

    Garripoli, Carmine; Mercuri, Marco; Karsmakers, Peter; Jack Soh, Ping; Crupi, Giovanni; Vandenbosch, Guy A E; Pace, Calogero; Leroux, Paul; Schreurs, Dominique

    2015-01-01

    Telehealth systems and applications are extensively investigated nowadays to enhance the quality-of-care and, in particular, to detect emergency situations and to monitor the well-being of elderly people, allowing them to stay at home independently as long as possible. In this paper, an embedded telehealth system for continuous, automatic, and remote monitoring of real-time fall emergencies is presented and discussed. The system, consisting of a radar sensor and base station, represents a cost-effective and efficient healthcare solution. The implementation of the fall detection data processing technique, based on the least-square support vector machines, through a digital signal processor and the management of the communication between radar sensor and base station are detailed. Experimental tests, for a total of 65 mimicked fall incidents, recorded with 16 human subjects (14 men and two women) that have been monitored for 320 min, have been used to validate the proposed system under real circumstances. The subjects' weight is between 55 and 90 kg with heights between 1.65 and 1.82 m, while their age is between 25 and 39 years. The experimental results have shown a sensitivity to detect the fall events in real time of 100% without reporting false positives. The tests have been performed in an area where the radar's operation was not limited by practical situations, namely, signal power, coverage of the antennas, and presence of obstacles between the subject and the antennas. PMID:25291803

  19. Exploring User Experience of a Telehealth System for the Danish TeleCare North Trial.

    PubMed

    Lilholt, Pernille Heyckendorff; Hæsum, Lisa Korsbakke Emtekær; Hejlesen, Ole Kristian

    2015-01-01

    The aim was to explore user experiences of using a telehealth system (Telekit) designed for the Danish TeleCare North trial. Telekit is designed for patients diagnosed with chronic obstructive pulmonary disease (COPD) in order to manage the disease and support patient empowerment. This article sums up COPD-participants' user experiences in terms of increased sense of freedom, of security, of control, and greater awareness of COPD symptoms. A consecutive sample of sixty participants (27 women, 33 men) were recruited from the TeleCare North trial. At home the participants completed a non-standardised questionnaire while a researcher was present. The questionnaire identified their health status, their use of specific technologies, and their user experiences with the telehealth system. Results from the questionnaire indicate that the majority of participants (88%) considered the Telekit system as easy to use. 43 (72%) participants felt increased sense of security, and 37 (62%) participants felt increased sense of control by using the system. 30 (50%) participants felt greater awareness of their COPD symptoms, but only 16 (27%) participants felt increased freedom. The study has provided a general picture of COPD participants' user experiences which is important to emphasise as it has a bearing on whether a given implementation will be successful or not.

  20. Helmsley trust support for telehealth improves access to care in rural and frontier areas.

    PubMed

    Stingley, Shelley; Schultz, Heidi

    2014-02-01

    Rural residents in need of health care face many challenges. In 2009 the Leona M. and Harry B. Helmsley Charitable Trust created the Rural Healthcare Program to improve access to and quality of care in areas of the upper Midwest challenged by health care workforce shortages and low population density. The program has focused its efforts on telehealth in seven upper Midwestern states. Since 2009 the Rural Healthcare Program has approved $22 million in grants to eighty-five rural hospitals to implement eEmergency services. The service's videoconferencing technology connects rural emergency department staff with emergency physicians and nurses located at the service's "hub." Initial analyses indicate that eEmergency has helped participating rural hospitals increase patients' access to specialists, increase the use of evidence-based treatment, decrease time to transfer a patient to a facility able to provide a higher level of care, and reduce unnecessary patient transfers. This article describes the health care challenges rural communities face and the telehealth projects supported by the Helmsley Trust's Rural Healthcare Program. PMID:24493777

  1. Helmsley trust support for telehealth improves access to care in rural and frontier areas.

    PubMed

    Stingley, Shelley; Schultz, Heidi

    2014-02-01

    Rural residents in need of health care face many challenges. In 2009 the Leona M. and Harry B. Helmsley Charitable Trust created the Rural Healthcare Program to improve access to and quality of care in areas of the upper Midwest challenged by health care workforce shortages and low population density. The program has focused its efforts on telehealth in seven upper Midwestern states. Since 2009 the Rural Healthcare Program has approved $22 million in grants to eighty-five rural hospitals to implement eEmergency services. The service's videoconferencing technology connects rural emergency department staff with emergency physicians and nurses located at the service's "hub." Initial analyses indicate that eEmergency has helped participating rural hospitals increase patients' access to specialists, increase the use of evidence-based treatment, decrease time to transfer a patient to a facility able to provide a higher level of care, and reduce unnecessary patient transfers. This article describes the health care challenges rural communities face and the telehealth projects supported by the Helmsley Trust's Rural Healthcare Program.

  2. Ethical considerations regarding the use of technology for older adults. The case of telehealth.

    PubMed

    Demiris, George; Doorenbos, Ardith Z; Towle, Cara

    2009-04-01

    Life expectancy increases and ongoing growth of the population older than 65 have led to new models of aging research aimed at promoting independence and empowerment of older adults. Advances in information technology have introduced numerous ways to enhance or expand health care and support service research and development. The purpose of this article is to discuss ethical considerations associated with the use of technology with older adults in research and practice and to present a framework for such ethical parameters. Specifically, we focus on the case of telehealth and discuss examples from the Native People for Cancer Control Telehealth Network to exemplify the framework. The proposed framework includes the concepts of privacy, informed consent, equity of access, patient-provider communication, and usability. These issues constitute a roadmap for researchers, practitioners, system designers, policy makers, and administrators who aim to conduct ethical research that results in improved care and support services to older adults and increase health care access for rural and underserved populations.

  3. Using an established telehealth model to train urban primary care providers on hypertension management.

    PubMed

    Masi, Christopher; Hamlish, Tamara; Davis, Andrew; Bordenave, Kristine; Brown, Stephen; Perea, Brenda; Aduana, Glen; Wolfe, Marcus; Bakris, George; Johnson, Daniel

    2012-01-01

    The objective of this study was to determine whether a videoconference-based telehealth network can increase hypertension management knowledge and self-assessed competency among primary care providers (PCPs) working in urban Federally Qualified Health Centers (FQHCs). We created a telehealth network among 6 urban FQHCs and our institution to support a 12-session educational program designed to teach state-of-the-art hypertension management. Each 1-hour session included a brief lecture by a university-based hypertension specialist, case presentations by PCPs, and interactive discussions among the specialist and PCPs. Twelve PCPs (9 intervention and 3 controls) were surveyed at baseline and immediately following the curriculum. The mean number of correct answers on the 26-item hypertension knowledge questionnaire increased in the intervention group (13.11 [standard deviation (SD)]=3.06) to 17.44 [SD=1.59], P<.01) but not among controls (14.33 [SD=3.21] to 13.00 [SD=3.46], P=.06). Similarly, the mean score on a 7-item hypertension management self-assessed competency scale increased in the intervention group (4.68 [SD=0.94] to 5.41 [SD=0.89], P<.01) but not among controls (5.28 [SD=0.43] to 5.62 [SD=0.67], P=.64). This model holds promise for enhancing hypertension care provided by urban FQHC providers.

  4. Validation of Minimum Data of Archetyped Telehealth Clinical Report for Monitoring Prenatal Care.

    PubMed

    Santos Alves, Danielle; Times, Valéria Cesário; de Araújo Novaes, Magdala

    2015-01-01

    Studies on the validation of minimum data sets from international information standards have drawn the attention of the academic community to the identification of necessary requirements for the development of Electronic Health Records (EHRs). The primary motivation of such studies is the development of systems using archetypes. The aim of this study was to validate the minimum data set that should be used when constructing an archetyped EHR for prenatal care applications in telehealth. In order to achieve this, a data validation tool was built and used by nine expert obstetricians. The statistical analysis employed was the percentage of agreement and the content validity index. The study was conducted in three steps: 1) Literature review, 2)Instrument development, and 3) Validation of the minimum data set. Of the 179 evaluated pieces of data, 157 of them were validated to be included in the archetyped record of the first prenatal consultation, while 56 of them were allocated for the subsequent consultation record. The benefit of this research is the standardization (data validation for an archetyped system) of prenatal care, with the perspective of employing, both nationally and internationally, an archtyped telehealth system. PMID:26262011

  5. A Proposed Information Architecture for Telehealth System Interoperability

    SciTech Connect

    Craft, R.L.; Funkhouser, D.R.; Gallagher, L.K.; Garica, R.J.; Parks, R.C.; Warren, S.

    1999-04-20

    We propose an object-oriented information architecture for telemedicine systems that promotes secure `plug-and-play' interaction between system components through standardized interfaces, communication protocols, messaging formats, and data definitions. In this architecture, each component functions as a black box, and components plug together in a ''lego-like'' fashion to achieve the desired device or system functionality. Introduction Telemedicine systems today rely increasingly on distributed, collaborative information technology during the care delivery process. While these leading-edge systems are bellwethers for highly advanced telemedicine, most are custom-designed and do not interoperate with other commercial offerings. Users are limited to a set of functionality that a single vendor provides and must often pay high prices to obtain this functionality, since vendors in this marketplace must deliver en- tire systems in order to compete. Besides increasing corporate research and development costs, this inhibits the ability of the user to make intelligent purchasing decisions regarding best-of-breed technologies. This paper proposes a reference architecture for plug-and-play telemedicine systems that addresses these issues.

  6. A Proposed Information Architecture for Telehealth System Interoperability

    SciTech Connect

    Warren, S.; Craft, R.L.; Parks, R.C.; Gallagher, L.K.; Garcia, R.J.; Funkhouser, D.R.

    1999-04-07

    Telemedicine technology is rapidly evolving. Whereas early telemedicine consultations relied primarily on video conferencing, consultations today may utilize video conferencing, medical peripherals, store-and-forward capabilities, electronic patient record management software, and/or a host of other emerging technologies. These remote care systems rely increasingly on distributed, collaborative information technology during the care delivery process, in its many forms. While these leading-edge systems are bellwethers for highly advanced telemedicine, the remote care market today is still immature. Most telemedicine systems are custom-designed and do not interoperate with other commercial offerings. Users are limited to a set of functionality that a single vendor provides and must often pay high prices to obtain this functionality, since vendors in this marketplace must deliver entire systems in order to compete. Besides increasing corporate research and development costs, this inhibits the ability of the user to make intelligent purchasing decisions regarding best-of-breed technologies. We propose a secure, object-oriented information architecture for telemedicine systems that promotes plug-and-play interaction between system components through standardized interfaces, communication protocols, messaging formats, and data definitions. In this architecture, each component functions as a black box, and components plug together in a lego-like fashion to achieve the desired device or system functionality. The architecture will support various ongoing standards work in the medical device arena.

  7. A Retrospective Study on Patient Characteristics and Telehealth Alerts Indicative of Key Medical Events for Heart Failure Patients at a Home Health Agency

    PubMed Central

    Bowles, Kathryn; Hanlon, Alexandra; Topaz, Maxim; Chittams, Jesse

    2013-01-01

    Abstract Objective: To explore association of patient characteristics and telehealth alert data with all-cause key medical events (KMEs) of emergency department (ED) visits and hospitalizations as well as cardiac-related KMEs of ED visits, hospitalizations, and medication changes. Materials and Methods: A 6-month retrospective study was conducted of electronic patient records of heart failure (HF) patients using telehealth services at a Massachusetts home health agency. Data collected included patient demographic, psychosocial, disease severity factors and telehealth vital signs alerts. Association between patient characteristics and KMEs was analyzed by Generalized Estimating Equations. Results: The sample comprised 168 patients with a mean age of 83 years, 56% females, and 96% white. Ninety-nine cardiac-related KMEs and 87 all-cause KMEs were recorded for the subjects. Odds of a cardiac-related KME increased by 161% with the presence of valvular co-morbidity (p=0.001) and 106% with increased number of telehealth alerts (adjusted p<0.0001). Odds of an all-cause KME increased by 124% (p=0.02), 127% (p=0.01), and 70% (adjusted p<0.0001) with the presence of cancer co-morbidity, anxiety, and increased number of telehealth alerts, respectively. Overall, only 3% of all telehealth alerts were associated with KMEs. Conclusions: The very low proportion of telehealth vital sign alerts associated with KMEs indicates that telehealth alerts alone cannot inform the need for intervention within the larger context of HF care delivery in the homecare setting. Patient-relevant data such as psychosocial and symptom status, involvement with HF self-management, and presence of co-morbidities could further inform the need for interventions for HF patients in the homecare setting. PMID:23808888

  8. Effects of home-based respiratory muscle training in children and adolescents with chronic lung disease* **

    PubMed Central

    Rodríguez, Iván; Zenteno, Daniel; Manterola, Carlos

    2014-01-01

    OBJECTIVE: Respiratory muscle weakness is a functional repercussion of chronic lung disease (CLD). The objective of this study was to assess the effects of home-based respiratory muscle training (RMT) in children and adolescents with CLD or neuromuscular disease (NMD). METHODS: This was a quasi-experimental study involving children and adolescents with CLD or NMD. Before and after 6 months of home-based RMT, we measured respiratory muscle strength (MIP and MEP), PEF, and peak cough flow (PCF). We made statistical comparisons between the pre-RMT and post-RMT values, as well as evaluating the correlation between the duration and effect of RMT. RESULTS: The study included 29 patients, with a mean age of 12 years (range, 5-17 years), of whom 18 (62.1%) were male. The CLD group comprised 11 patients (37.9%), and the NMD group comprised 18 (62.1%). The mean duration of the RMT was 60 weeks (range, 46-90 weeks) in the CLD group and 39 weeks (range, 24-89 weeks) in the NMD group. In comparison with the pre-RMT values, the post-RMT values for MIP and MEP were significantly higher in both groups, whereas those for PEF and PCF were significantly higher only in the NMD group. We found no correlation between the duration and the effect of RMT. CONCLUSIONS: Home-based RMT appears to be an effective strategy for increasing respiratory muscle strength in children and adolescents with CLD or NMD, although it increased the ability to cough effectively only in those with NMD. PMID:25610503

  9. A Hybrid Process Fidelity Assessment in a Home-based Randomized Clinical Trial

    PubMed Central

    WILDE, MARY H.; LIEBEL, DIANNE; FAIRBANKS, EILEEN; WILSON, PAULA; LASH, MARGARET; SHAH, SHIVANI; McDONALD, MARGARET V.; BRASCH, JUDITH; ZHANG, FENG; SCHEID, EILEEN; McMAHON, JAMES M.

    2016-01-01

    A process fidelity assessment was conducted as a nested study within a home-based randomized clinical trial teaching self-management to 101 long-term indwelling urinary catheter users in the treatment group. Our hybrid model combined external assessments (outside observations and tape recordings) with internal evaluation methods (through study nurse forms and notes) for a comprehensive process fidelity assessment. Barriers, patient-related issues, and nurse perspectives were identified demonstrating the complexity in home care intervention research. The complementary and synergistic approaches provided in depth information about the context of the delivery and the impact of the intervention on study outcomes. PMID:25894688

  10. Space medicine innovation and telehealth concept implementation for medical care during exploration-class missions

    NASA Astrophysics Data System (ADS)

    Martin, Annie; Sullivan, Patrick; Beaudry, Catherine; Kuyumjian, Raffi; Comtois, Jean-Marc

    2012-12-01

    Medical care on the International Space Station (ISS) is provided using real-time communication with limited medical data transmission. In the occurrence of an off-nominal medical event, the medical care paradigm employed is 'stabilization and transportation', involving real-time management from ground and immediate return to Earth in the event that the medical contingency could not be resolved in due time in space. In preparation for future missions beyond Low-Earth orbit (LEO), medical concepts of operations are being developed to ensure adequate support for the new mission profiles: increased distance, duration and communication delays, as well as impossibility of emergency returns and limitations in terms of medical equipment availability. The current ISS paradigm of medical care would no longer be adequate due to these new constraints. The Operational Space Medicine group at the Canadian Space Agency (CSA) is looking towards synergies between terrestrial and space medicine concepts for the delivery of medical care to deal with the new challenges of human space exploration as well as to provide benefits to the Canadian population. Remote and rural communities on Earth are, in fact, facing similar problems such as isolation, remoteness to tertiary care centers, resource scarcity, difficult (and expensive) emergency transfers, limited access to physicians and specialists and limited training of medical and nursing staff. There are a number of researchers and organizations, outside the space communities, working in the area of telehealth. They are designing and implementing terrestrial telehealth programs using real-time and store-and-forward techniques to provide isolated populations access to medical care. The cross-fertilization of space-Earth research could provide support for increased spin-off and spin-in effects and stimulate telehealth and space medicine innovations to engage in the new era of human space exploration. This paper will discuss the benefits

  11. Predictors of client engagement and attrition in home-based child maltreatment prevention services.

    PubMed

    Damashek, Amy; Doughty, Debby; Ware, Lisa; Silovsky, Jane

    2011-02-01

    High rates of program attrition in home-based family support and child maltreatment prevention services are common. Researchexamining factors related to family engagement (i.e., enrollment and completion rates) may help program developers increase theimpact of child abuse prevention services by reducing attrition. The present study examined the relative influence of provider,program, and individual factors from the Integrated Theory of Parent Involvement (ITPI) as well as maternal and family demo-graphic and risk variables in predicting service enrollment and completion in a home-based child maltreatment prevention service(SafeCareþ) and a standard community care program (Services as Usual [SAU]). Participants were 398 female caregivers ofchildren ages 5 and below. Support was found for the primary role of program and provider factors in client enrollment andcompletion of services. Specifically, participants in SafeCareþ were 4 times more likely to enroll in services and 8.5 times morelikely to complete services than those in SAU. Family risk variables including intimate partner psychological aggression, substanceabuse, and depression were also significant predictors. Recommended next steps include integration of risk-related factors in theITPI framework and disentangling specific provider and program factors related to service engagement.

  12. Mobile Phone Based System Opportunities to Home-based Managing of Chemotherapy Side Effects

    PubMed Central

    Davoodi, Somayeh; Mohammadzadeh, Zeinab; Safdari, Reza

    2016-01-01

    Objective: Applying mobile base systems in cancer care especially in chemotherapy management have remarkable growing in recent decades. Because chemotherapy side effects have significant influences on patient’s lives, therefore it is necessary to take ways to control them. This research has studied some experiences of using mobile phone based systems to home-based monitor of chemotherapy side effects in cancer. Methods: In this literature review study, search was conducted with keywords like cancer, chemotherapy, mobile phone, information technology, side effects and self managing, in Science Direct, Google Scholar and Pub Med databases since 2005. Results: Today, because of the growing trend of the cancer, we need methods and innovations such as information technology to manage and control it. Mobile phone based systems are the solutions that help to provide quick access to monitor chemotherapy side effects for cancer patients at home. Investigated studies demonstrate that using of mobile phones in chemotherapy management have positive results and led to patients and clinicians satisfactions. Conclusion: This study shows that the mobile phone system for home-based monitoring chemotherapy side effects works well. In result, knowledge of cancer self-management and the rate of patient’s effective participation in care process improved. PMID:27482134

  13. HOME-BASED SELF-DELIVERED MIRROR THERAPY FOR PHANTOM PAIN: A PILOT STUDY*

    PubMed Central

    Darnall, Beth D.; Li, Hong

    2014-01-01

    Objective To test the feasibility and preliminary efficacy of self-delivered home-based mirror therapy for phantom pain. Design Uncontrolled prospective treatment outcome pilot study. Participants Forty community-dwelling adults with unilateral amputation and phantom pain >3 on a 0–10 numeric rating scale enrolled either during a one-time study visit (n = 30) or remotely (n = 10). Methods Participants received an explanation of mirror therapy and were asked to self-treat for 25 min daily. Participants completed and posted back sets of outcomes questionnaires at months 1 and 2 post-treatment. Main outcome was mean phantom pain intensity at post-treatment. Results A significant reduction in mean phantom pain intensity was found at month 1 (n = 31, p = 0.0002) and at month 2 (n = 26, p = 0.002). The overall median percentage reduction at month 2 was 15.4%. Subjects with high education (>16 years) compared with low education (<16 years) (37.5% vs 4.1%) had greater reduction in pain intensity (p = 0.01). Conclusion These findings support the feasibility and efficacy of home-based self-delivered mirror therapy; this low-cost treatment may defray medical costs, therapy visits, and the patient travel burden for people with motivation and a high level of education. More research is needed to determine methods of cost-effective support for people with lower levels of education. PMID:22378591

  14. Lessons learned from the usability assessment of home-based telemedicine systems.

    PubMed

    Agnisarman, Sruthy Orozhiyathumana; Chalil Madathil, Kapil; Smith, Kevin; Ashok, Aparna; Welch, Brandon; McElligott, James T

    2017-01-01

    At-home telemedicine visits are quickly becoming an acceptable alternative for in-person patient visits. However, little work has been done to understand the usability of these home-based telemedicine solutions. It is critical for user acceptance and real-world applicability to evaluate available telemedicine solutions within the context-specific needs of the users of this technology. To address this need, this study evaluated the usability of four home-based telemedicine software platforms: Doxy.me, Vidyo, VSee, and Polycom. Using a within-subjects experimental design, twenty participants were asked to complete a telemedicine session involving several tasks using the four platforms. Upon completion of these tasks for each platform, participants completed the IBM computer system usability questionnaire (CSUQ) and the NASA Task Load Index test. Upon completing the tasks on all four platforms, the participants completed a final post-test subjective questionnaire ranking the platforms based on their preference. Of the twenty participants, 19 completed the study. Statistically significant differences among the telemedicine software platforms were found for task completion time, total workload, mental demand, effort, frustration, preference ranking and computer system usability scores. Usability problems with installation and account creation led to high mental demand and task completion time, suggesting the participants preferred a system without such requirements. Majority of the usability issues were identified at the telemedicine initiation phase. The findings from this study can be used by software developers to develop user-friendly telemedicine systems. PMID:27633239

  15. Outcomes of a home-based pulmonary maintenance program for individuals with COPD: a pilot study.

    PubMed

    Cooke, Marie; Moyle, Wendy; Griffiths, Susan; Shields, Louise

    This preliminary pilot study explores sustained benefits of pulmonary rehabilitation (PR) in people with chronic obstructive pulmonary disease (COPD) attending a 12-month home-based pulmonary maintenance program. The incidence of COPD is high and ageing populations will see this continue and possibly increase. PR programs are effective, however, benefits may dissipate if the program is not continued. The maintenance program involved: strength retraining exercises; collaborative goal setting; regular telephone calls; and home visits. Around half of the 29 participants remained in contact with the program for 12 months and 21 completed final or 6-month assessment. Most participants maintained: respiratory functioning; quality of life; and self-efficacy, with some showing improvements. Outcomes provide knowledge for improving patient care through a home-based strategy to maintain benefits of PR programs. Results suggest that in light of likely decline in benefits 6-12 months after PR, the maintenance program contributed to sustained benefits for COPD individuals and also provide information to aid investigators planning the design of similar larger research with this population. PMID:20230175

  16. Home-Based versus Hospital-Based Rehabilitation Program after Total Knee Replacement

    PubMed Central

    López-Liria, Remedios; Padilla-Góngora, David; Catalan-Matamoros, Daniel; Rocamora-Pérez, Patricia; Pérez-de la Cruz, Sagrario; Fernández-Sánchez, Manuel

    2015-01-01

    Objectives. To compare home-based rehabilitation with the standard hospital rehabilitation in terms of improving knee joint mobility and recovery of muscle strength and function in patients after a total knee replacement. Materials and Methods. A non-randomised controlled trial was conducted. Seventy-eight patients with a prosthetic knee were included in the study and allocated to either a home-based or hospital-based rehabilitation programme. Treatment included various exercises to restore strength and joint mobility and to improve patients' functional capacity. The primary outcome of the trial was the treatment effectiveness measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results. The groups did not significantly differ in the leg side (right/left) or clinical characteristics (P > 0.05). After the intervention, both groups showed significant improvements (P < 0.001) from the baseline values in the level of pain (visual analogue scale), the range of flexion-extension motion and muscle strength, disability (Barthel and WOMAC indices), balance, and walking. Conclusions. This study reveals that the rehabilitation treatments offered either at home or in hospital settings are equally effective. PMID:25961017

  17. Daily home-based spirometry during withdrawal of inhaled corticosteroid in severe to very severe chronic obstructive pulmonary disease.

    PubMed

    Rodriguez-Roisin, Roberto; Tetzlaff, Kay; Watz, Henrik; Wouters, Emiel Fm; Disse, Bernd; Finnigan, Helen; Magnussen, Helgo; Calverley, Peter Ma

    2016-01-01

    The WISDOM study (NCT00975195) reported a change in lung function following withdrawal of fluticasone propionate in patients with severe to very severe COPD treated with tiotropium and salmeterol. However, little is known about the validity of home-based spirometry measurements of lung function in COPD. Therefore, as part of this study, following suitable training, patients recorded daily home-based spirometry measurements in addition to undergoing periodic in-clinic spirometric testing throughout the study duration. We subsequently determined the validity of home-based spirometry for detecting changes in lung function by comparing in-clinic and home-based forced expiratory volume in 1 second in patients who underwent stepwise fluticasone propionate withdrawal over 12 weeks versus patients remaining on fluticasone propionate for 52 weeks. Bland-Altman analysis of these data confirmed good agreement between in-clinic and home-based measurements, both across all visits and at the individual visits at study weeks 6, 12, 18, and 52. There was a measurable difference between the forced expiratory volume in 1 second values recorded at home and in the clinic (mean difference of -0.05 L), which may be due to suboptimal patient effort in performing unsupervised recordings. However, this difference remained consistent over time. Overall, these data demonstrate that home-based and in-clinic spirometric measurements were equally valid and reliable for assessing lung function in patients with COPD, and suggest that home-based spirometry may be a useful tool to facilitate analysis of changes in lung function on a day-to-day basis. PMID:27578972

  18. Daily home-based spirometry during withdrawal of inhaled corticosteroid in severe to very severe chronic obstructive pulmonary disease

    PubMed Central

    Rodriguez-Roisin, Roberto; Tetzlaff, Kay; Watz, Henrik; Wouters, Emiel FM; Disse, Bernd; Finnigan, Helen; Magnussen, Helgo; Calverley, Peter MA

    2016-01-01

    The WISDOM study (NCT00975195) reported a change in lung function following withdrawal of fluticasone propionate in patients with severe to very severe COPD treated with tiotropium and salmeterol. However, little is known about the validity of home-based spirometry measurements of lung function in COPD. Therefore, as part of this study, following suitable training, patients recorded daily home-based spirometry measurements in addition to undergoing periodic in-clinic spirometric testing throughout the study duration. We subsequently determined the validity of home-based spirometry for detecting changes in lung function by comparing in-clinic and home-based forced expiratory volume in 1 second in patients who underwent stepwise fluticasone propionate withdrawal over 12 weeks versus patients remaining on fluticasone propionate for 52 weeks. Bland–Altman analysis of these data confirmed good agreement between in-clinic and home-based measurements, both across all visits and at the individual visits at study weeks 6, 12, 18, and 52. There was a measurable difference between the forced expiratory volume in 1 second values recorded at home and in the clinic (mean difference of −0.05 L), which may be due to suboptimal patient effort in performing unsupervised recordings. However, this difference remained consistent over time. Overall, these data demonstrate that home-based and in-clinic spirometric measurements were equally valid and reliable for assessing lung function in patients with COPD, and suggest that home-based spirometry may be a useful tool to facilitate analysis of changes in lung function on a day-to-day basis. PMID:27578972

  19. Emotional Disclosure Through Journal Writing: Telehealth Intervention for Maternal Stress and Mother-Child Relationships.

    PubMed

    Whitney, Rondalyn V; Smith, Gigi

    2015-11-01

    This study examines emotional disclosure through the activity of journaling as a means of coping with maternal stress associated with parenting a child with disruptive behaviors. Through a randomized control and pre-test post-test study design of an online journal writing intervention, change to maternal stress and quality of mother-child relationship for children with ASD, ADHD and SPD was addressed. Behavioral symptoms were found to be the primary source of parenting stress for mothers and a significant relationship between child characteristics and maternal stress was identified. Emotional disclosure through the online journal writing program (especially in the presence of high disclosure of negative emotions) was shown to reduce maternal stress and improve the quality of mother-child relationship. These findings suggest cost-effective telehealth interventions may support maternal health. Important clinical implications are discussed.

  20. Successes and challenges in a field-based, multi-method study of home telehealth.

    PubMed

    Hebert, M A; Jansen, J J; Brant, R; Hailey, D; van der Pol, M

    2004-01-01

    We are conducting a three-year study of telehealth in 11 home care offices that serve rural clients in Alberta. Three hundred and twenty palliative home care clients are being recruited to participate in a randomized controlled trial (RCT) to answer three questions about the use of video-phones and their effect on symptom management, quality of life and cost, as well as readiness to use the technology. Both successes and challenges have been identified in three main areas: technology, people/organizational issues and study design. Maintaining study integrity has been the key factor in decision making, as adjustments from the original proposal are made. It is already clear that field-based RCTs are feasible, but require commitment and flexibility on the part of researchers and community partners to work through the study implementation.

  1. A security framework for nationwide health information exchange based on telehealth strategy.

    PubMed

    Zaidan, B B; Haiqi, Ahmed; Zaidan, A A; Abdulnabi, Mohamed; Kiah, M L Mat; Muzamel, Hussaen

    2015-05-01

    This study focuses on the situation of health information exchange (HIE) in the context of a nationwide network. It aims to create a security framework that can be implemented to ensure the safe transmission of health information across the boundaries of care providers in Malaysia and other countries. First, a critique of the major elements of nationwide health information networks is presented from the perspective of security, along with such topics as the importance of HIE, issues, and main approaches. Second, a systematic evaluation is conducted on the security solutions that can be utilized in the proposed nationwide network. Finally, a secure framework for health information transmission is proposed within a central cloud-based model, which is compatible with the Malaysian telehealth strategy. The outcome of this analysis indicates that a complete security framework for a global structure of HIE is yet to be defined and implemented. Our proposed framework represents such an endeavor and suggests specific techniques to achieve this goal.

  2. Identifying Early Dehydration Risk With Home-Based Sensors During Radiation Treatment: A Feasibility Study on Patients With Head and Neck Cancer

    PubMed Central

    2013-01-01

    Background Systems that enable remote monitoring of patients’ symptoms and other health-related outcomes may optimize cancer care outside of the clinic setting. CYCORE (CYberinfrastructure for COmparative effectiveness REsearch) is a software-based prototype for a user-friendly cyberinfrastructure supporting the comprehensive collection and analyses of data from multiple domains using a suite of home-based and mobile sensors. This study evaluated the feasibility of using CYCORE to address early at-home identification of dehydration risk in head and neck cancer patients undergoing radiation therapy. Methods Head and neck cancer patients used home-based sensors to capture weight, blood pressure, pulse, and patient-reported outcomes for two 5-day periods during radiation therapy. Data were sent to the radiation oncologist of each head and neck cancer patient, who viewed them online via a Web-based interface. Feasibility outcomes included study completion rate, acceptability and perceived usefulness of the intervention, and adherence to the monitoring protocol. We also evaluated whether sensor data could identify dehydration-related events. Results Fifty patients consented to participate, and 48 (96%) completed the study. More than 90% of patients rated their ease, self-efficacy, and satisfaction regarding use of the sensor suite as extremely favorable, with minimal concerns expressed regarding data privacy issues. Patients highly valued the ability to have immediate access to objective, self-monitoring data related to personal risk for dehydration. Clinician assessments indicated a high degree of satisfaction with the ease of using the CYCORE system and the resulting ability to monitor their patients remotely. Conclusion Implementing CYCORE in a clinical oncology care setting is feasible and highly acceptable to both patients and providers. PMID:24395986

  3. Effects of Home-Based Interval Walking Training on Thigh Muscle Strength and Aerobic Capacity in Female Total Hip Arthroplasty Patients: A Randomized, Controlled Pilot Study

    PubMed Central

    Morishima, Yutaka; Mizushima, Takashi; Yamauchi, Katsuya; Morikawa, Mayuko; Masuki, Shizue; Nose, Hiroshi

    2014-01-01

    Due to the reduced physical activity of patients who have undergone total hip arthroplasty (THA), there are no home-based exercise training regimens for preventing muscle atrophy and aerobic capacity impairment in these patients. We examined whether interval walking training (IWT) could prevented these issues. Twenty-eight female patients (∼60 years of age) who had undergone THA more than 2 months prior were randomly divided into IWT (n = 14) and control (CNT, n = 14) groups. The IWT subjects trained at a target of 60 min of fast walking at >70% peak aerobic capacity for walking (O2peak) per wk for 12 wk, while those in the CNT maintained their previous sedentary life during the same period. We measured the energy expenditure of the daily physical activity, except during sleeping and bathing, every minute and every day during the intervention. We also measured the isometric knee extension (FEXT) and flexion (FFLX) forces, O2peak, and anaerobic threshold during the graded cycling exercise (O2AT) before and after the intervention. All subjects, except for one in IWT, completed the protocol. FFLX increased by 23% on the operated side (P = 0.003) and 14% on the non-operated side of IWT (P = 0.006), while it only increased on the operated side of CNT (P = 0.03). The O2peak and O2AT in IWT increased by 8% (P = 0.08) and 13% (P = 0.002), respectively, and these changes were significantly higher in the IWT than in CNT group (both, P<0.05). In conclusion, IWT might be an effective home-based training regimen for preventing the muscle atrophy from reduced daily physical activity in THA patients. Trial Registration UMIN-CTR UMIN000013172 PMID:25268505

  4. Telehealth: Acceptability, clinical interventions and quality of life in peritoneal dialysis

    PubMed Central

    Dey, Vishal; Jones, Audrey; Spalding, Elaine M

    2016-01-01

    Introduction: Telehealth technologies are being widely adopted across the globe for management of long-term conditions. There are limited data on its use, effectiveness and patient experience in end-stage renal disease. The aim of this pilot project was to explore patient acceptability of technology and evaluate its effect on clinical interventions and quality of life in patients undergoing peritoneal dialysis. Methods: Peritoneal dialysis patients were provided with computer tablets (PODs). PODs contained a knowledge database with treatment- and symptom-based questionnaires that generated alerts for the clinical team. Alerts were reviewed daily and followed up by a telephone call or clinic visit. Interventions were at the discretion of clinicians. Data were recorded prospectively and quality of life and Quebec User Evaluation of Satisfaction with assistive Technology questionnaires evaluated at the start and end of the programme. Results: In all, 22 patients have participated over 15 months. The mean age was 61.6 years and PODs were utilised for an average of 341.9 days with 59.1% choosing to continue beyond the study period. We received a total of 1195 alerts with an average of 2.6 alerts per day. A total of 36 admissions were avoided and patients supported to self-manage on 154 occasions. Quebec User Evaluation of Satisfaction with assistive Technology scores remained high throughout the programme although no improvement in quality of life was seen. Discussion: Telehealth is useful to monitor patients with renal failure on peritoneal dialysis. It is acceptable across age groups and provides an additional resource for patients to self-manage. Satisfaction scores and retention rates suggest a high level of acceptability. PMID:27757228

  5. Distance therapy to improve symptoms and quality of life: complementing office-based care with telehealth.

    PubMed

    Kroenke, Kurt

    2014-10-01

    Two randomized trials exemplify strategies for administering behavioral interventions through distance therapy-the use of telemedicine or e-health approaches to treating patients outside the conventional in-person office-based visit. In the first trial, telephone-based coping skills training for patients with chronic obstructive pulmonary disease was not more effective than an education control in reducing mortality or rehospitalization. However, it was superior in improving psychological and somatic quality of life. In the second trial, a web-based distress management program was not more effective than usual care in postoperative psychological outcomes in patients receiving an implantable cardioverter defibrillator. However, both of these trials raise important methodological issues in designing and interpreting trials testing telehealth delivery of behavioral interventions. Key issues include: 1) selection of the appropriate control group (e.g., when may a usual care or active comparator be preferable to an attention control?); 2) choice of the appropriate outcome (i.e., one most likely to respond to the specific intervention); 3) enrolling only patients who have at least some threshold level of the symptom or risk level for the outcome being targeted by the intervention; 4) focusing on patients likely to participate in telehealth or other distance-administered treatment programs; and 5) optimal timing for the delivery of behavioral interventions that may occur around the time of major events such as hospitalization or procedures. A policy implication is that once distance therapy interventions are proven effective, reimbursement changes will be necessary to enhance the likelihood of uptake by providers and health care systems. PMID:25304115

  6. Telehealth Technologies and Applications for Terrorism Response: A Report of the 2002 Coastal North Carolina Domestic Preparedness Training Exercise

    PubMed Central

    Simmons, Scott C.; Murphy, Timothy A.; Blanarovich, Adrian; Workman, Florence T.; Rosenthal, David A.; Carbone, Matthew

    2003-01-01

    Effective response to natural or man-made disasters (i.e., terrorism) is predicated on the ability to communicate among the many organizations involved. Disaster response exercises enable disaster planners and responders to test procedures and technologies and incorporate the lessons learned from past disasters or exercises. On May 31 and June 1, 2002, one such exercise event took place at the Camp Lejeune Marine Corps Base in Jacksonville, North Carolina. During the exercise, East Carolina University tested: (1) in-place Telehealth networks and (2) rapidly deployable communications, networking, and data collection technologies such as satellite communications, local wireless networking, on-scene video, and clinical and environmental data acquisition and telemetry. Exercise participants included local, county, state, and military emergency medical services (EMS), emergency management, specialized response units, and local fire and police units. The technologies and operations concepts tested at the exercise and recommendations for using telehealth to improve disaster response are described. PMID:12595406

  7. Medical and economic benefits of telehealth in low- and middle-income countries: results of a study in four district hospitals in Mali

    PubMed Central

    2014-01-01

    Background The aim of this study was to evaluate the impact of telehealth on 1) the diagnosis, and management in obstetrics and cardiology, 2) health care costs from patients’ perspectives, 3) attendance at health centres located in remote areas of Mali. Methods The impact of telehealth on health care utilization, quality, and costs was assessed using a five-point Likert-scale based questionnaire consisting of three dimensions. It was completed by health care professionals in four district hospitals. The role of telehealth on attendance at health centres was also assessed based on data collected from the consultations logs before and during the project, between project sites and control sites. Referrals specific to the activities of the research study were also evaluated using a questionnaire to measure the real share of telehealth tools in increasing attendance at project sites. Finally, the cost savings achieved was estimated using the transport and lodging costs incurred if patients were to travel to the capital city for the same tests or care. Results The telehealth activities contributed to improving medical diagnoses in cardiology and obstetrics (92.6%) and the patients’ management system on site (96.2%). The attendance records at health centres increased from 8 to 35% at all project sites during the study period. Patients from project sites saved an average of 12380 XOF (CFA Francs) or 25 USD (American dollar) and a maximum of 35000 XOF or 70 USD compared to patients from neighbouring sites, who must go to the capital city to receive the same care. Conclusion We conclude that in Mali, enhanced training in ultrasound / electrocardiography and the introduction of telehealth have improved the health system in remote areas and resulted in high levels of appropriate diagnosis and patient management in the areas of obstetrics and cardiology. Telehealth can also significantly reduce the cost to the patient. PMID:25080312

  8. Telehealth delivery of cognitive-behavioral intervention to youth with autism spectrum disorder and anxiety: A pilot study

    PubMed Central

    Hepburn, Susan L; Blakeley-Smith, Audrey; Wolff, Brian; Reaven, Judy A

    2015-01-01

    Youth with autism spectrum disorders frequently experience significant symptoms of anxiety. Empirically supported psychosocial interventions exist, yet access is limited, especially for families in rural areas. Telehealth (i.e. videoconferencing) has potential to reduce barriers to access to care; however, little is known about the feasibility or efficacy of directly intervening with youth with autism spectrum disorders through this modality. This study details the pilot testing of a telehealth version of an empirically supported intervention targeting anxiety in youth with autism spectrum disorders. The primary focus of this study is on feasibility, with evaluation of outcomes as a starting point for future randomized trials. In all, 33 families of youth with autism spectrum disorders and significant anxiety symptoms participated in this study (Telehealth Facing Your Fears (FYF) Intervention: n = 17; Wait-list control: n = 16). Youth of all functioning levels were included. Acceptability was strong; however, the usability of the technology was problematic for some families and impeded some sessions significantly. Fidelity of the telehealth version to the critical elements of the original, in vivo version was excellent. More work is needed to improve delivery of exposure practices and parent coaching. Preliminary efficacy analyses are promising, with improvements observed in youth anxiety over time (relative to a comparison group waiting for live intervention) and parent sense of competence (within group). Clearly, stronger designs are necessary to evaluate efficacy sufficiently; however, this study does provide support for further investigation of clinic-to-home videoconferencing as a direct intervention tool for youth with autism spectrum disorders and their parents. PMID:25896267

  9. Telehealth delivery of cognitive-behavioral intervention to youth with autism spectrum disorder and anxiety: A pilot study.

    PubMed

    Hepburn, Susan L; Blakeley-Smith, Audrey; Wolff, Brian; Reaven, Judy A

    2016-02-01

    Youth with autism spectrum disorders frequently experience significant symptoms of anxiety. Empirically supported psychosocial interventions exist, yet access is limited, especially for families in rural areas. Telehealth (i.e. videoconferencing) has potential to reduce barriers to access to care; however, little is known about the feasibility or efficacy of directly intervening with youth with autism spectrum disorders through this modality. This study details the pilot testing of a telehealth version of an empirically supported intervention targeting anxiety in youth with autism spectrum disorders. The primary focus of this study is on feasibility, with evaluation of outcomes as a starting point for future randomized trials. In all, 33 families of youth with autism spectrum disorders and significant anxiety symptoms participated in this study (Telehealth Facing Your Fears (FYF) Intervention: n = 17; Wait-list control: n = 16). Youth of all functioning levels were included. Acceptability was strong; however, the usability of the technology was problematic for some families and impeded some sessions significantly. Fidelity of the telehealth version to the critical elements of the original, in vivo version was excellent. More work is needed to improve delivery of exposure practices and parent coaching. Preliminary efficacy analyses are promising, with improvements observed in youth anxiety over time (relative to a comparison group waiting for live intervention) and parent sense of competence (within group). Clearly, stronger designs are necessary to evaluate efficacy sufficiently; however, this study does provide support for further investigation of clinic-to-home videoconferencing as a direct intervention tool for youth with autism spectrum disorders and their parents.

  10. Integrating social capital theory, social cognitive theory, and the technology acceptance model to explore a behavioral model of telehealth systems.

    PubMed

    Tsai, Chung-Hung

    2014-05-01

    Telehealth has become an increasingly applied solution to delivering health care to rural and underserved areas by remote health care professionals. This study integrated social capital theory, social cognitive theory, and the technology acceptance model (TAM) to develop a comprehensive behavioral model for analyzing the relationships among social capital factors (social capital theory), technological factors (TAM), and system self-efficacy (social cognitive theory) in telehealth. The proposed framework was validated with 365 respondents from Nantou County, located in Central Taiwan. Structural equation modeling (SEM) was used to assess the causal relationships that were hypothesized in the proposed model. The finding indicates that elderly residents generally reported positive perceptions toward the telehealth system. Generally, the findings show that social capital factors (social trust, institutional trust, and social participation) significantly positively affect the technological factors (perceived ease of use and perceived usefulness respectively), which influenced usage intention. This study also confirmed that system self-efficacy was the salient antecedent of perceived ease of use. In addition, regarding the samples, the proposed model fitted considerably well. The proposed integrative psychosocial-technological model may serve as a theoretical basis for future research and can also offer empirical foresight to practitioners and researchers in the health departments of governments, hospitals, and rural communities. PMID:24810577

  11. Integrating Social Capital Theory, Social Cognitive Theory, and the Technology Acceptance Model to Explore a Behavioral Model of Telehealth Systems

    PubMed Central

    Tsai, Chung-Hung

    2014-01-01

    Telehealth has become an increasingly applied solution to delivering health care to rural and underserved areas by remote health care professionals. This study integrated social capital theory, social cognitive theory, and the technology acceptance model (TAM) to develop a comprehensive behavioral model for analyzing the relationships among social capital factors (social capital theory), technological factors (TAM), and system self-efficacy (social cognitive theory) in telehealth. The proposed framework was validated with 365 respondents from Nantou County, located in Central Taiwan. Structural equation modeling (SEM) was used to assess the causal relationships that were hypothesized in the proposed model. The finding indicates that elderly residents generally reported positive perceptions toward the telehealth system. Generally, the findings show that social capital factors (social trust, institutional trust, and social participation) significantly positively affect the technological factors (perceived ease of use and perceived usefulness respectively), which influenced usage intention. This study also confirmed that system self-efficacy was the salient antecedent of perceived ease of use. In addition, regarding the samples, the proposed model fitted considerably well. The proposed integrative psychosocial-technological model may serve as a theoretical basis for future research and can also offer empirical foresight to practitioners and researchers in the health departments of governments, hospitals, and rural communities. PMID:24810577

  12. Caveat emptor: the need for evidence, regulation, and certification of home telehealth systems for the management of chronic conditions.

    PubMed

    Farberow, Bonne; Hatton, Valerie; Leenknecht, Cindy; Goldberg, Lee R; Hornung, Carlton A; Reyes, Bernardo

    2008-01-01

    The home telehealth market is rapidly expanding. The technology and capabilities currently available have the potential to significantly affect the clinical management of an aging population, particularly, the large number with multiple coexisting disease processes. Potential benefits of home-monitoring systems for patients with heart failure range from decreased rates of mortality and improved quality of life to providing third party payers, including the federal government (ie, Centers for Medicare and Medicaid Services), with significant long-term cost savings. The current regulatory process does not provide adequate oversight and standards for these systems that transmit and process data (telehealth systems) critical for patient management. Home telehealth vendors must address the possibility that increased utilization increases their risk of liability due to patient safety issues. In all, 5 major areas need to be addressed to maximize the benefits and safety of this technology: effectiveness of patient management; evidence-based outcomes; regulation; cost, including cost effectiveness and reimbursement; and certification to ensure reliability.

  13. Integrating social capital theory, social cognitive theory, and the technology acceptance model to explore a behavioral model of telehealth systems.

    PubMed

    Tsai, Chung-Hung

    2014-05-07

    Telehealth has become an increasingly applied solution to delivering health care to rural and underserved areas by remote health care professionals. This study integrated social capital theory, social cognitive theory, and the technology acceptance model (TAM) to develop a comprehensive behavioral model for analyzing the relationships among social capital factors (social capital theory), technological factors (TAM), and system self-efficacy (social cognitive theory) in telehealth. The proposed framework was validated with 365 respondents from Nantou County, located in Central Taiwan. Structural equation modeling (SEM) was used to assess the causal relationships that were hypothesized in the proposed model. The finding indicates that elderly residents generally reported positive perceptions toward the telehealth system. Generally, the findings show that social capital factors (social trust, institutional trust, and social participation) significantly positively affect the technological factors (perceived ease of use and perceived usefulness respectively), which influenced usage intention. This study also confirmed that system self-efficacy was the salient antecedent of perceived ease of use. In addition, regarding the samples, the proposed model fitted considerably well. The proposed integrative psychosocial-technological model may serve as a theoretical basis for future research and can also offer empirical foresight to practitioners and researchers in the health departments of governments, hospitals, and rural communities.

  14. Addressing the burden of heart failure in Australia: the scope for home-based interventions.

    PubMed

    Davidson, P; Stewart, S; Elliott, D; Daly, J; Sindone, A; Cockburn, J

    2001-10-01

    The growing burden of heart failure (HF) challenges health practitioners to implement and evaluate models of care to facilitate optimal health related outcomes. Australia supports a publicly funded universal health insurance system with a strong emphasis on primary care provided by general practitioners. The burden of chronic HF, and a social and political framework favoring community-based, noninstitutionalized care, represents an ideal environment in which home-based HF programs can be implemented successfully. Cardiovascular nurses are well positioned to champion and mentor implementation of evidence-based, patient-centered programs in Australian communities. This paper describes the facilitators and barriers to implementation of best practice models in the Australian context. These include the challenge of providing care in a diverse, multicultural society and the need for clinical governance structures to ensure equal access to the most effective models of care. PMID:11587241

  15. Analyzing the Interprofessional Working of a Home-Based Primary Care Team.

    PubMed

    Smith-Carrier, Tracy; Neysmith, Sheila

    2014-09-01

    Increasingly, interprofessional teams are responsible for providing integrated health care services. Effective teams, however, are not the result of chance but require careful planning and ongoing attention to team processes. Based on a case study involving interviews, participant observation, and a survey, we identified key attributes for effective interprofessional working (IPW) within a home-based primary care (HBPC) setting. Recognizing the importance of a theoretical model that reflects the multidimensional nature of team effectiveness research, we employed the integrated team effectiveness model to analyze our findings. The results indicated that a shared vision, common goals, respect, and trust among team members – as well as processes for ongoing communication, effective leadership, and mechanisms for conflict resolution – are vital in the development of a high-functioning IPW team. The ambiguity and uncertainty surrounding the context of service provision (clients' homes), as well the negotiation of external relationships in the HBPC field, require further investigation.

  16. An Efficacy Trial of Carescapes: Home-Based Child-Care Practices and Children's Social Outcomes.

    PubMed

    Rusby, Julie C; Jones, Laura B; Crowley, Ryann; Smolkowski, Keith

    2016-07-01

    This study reported findings from a longitudinal randomized controlled trial of Carescapes, a professional development program for home-based child-care providers in promoting children's social competence. Participants included 134 child-care providers and 310 children, ages 3-5 years, in Oregon. The Carescapes intervention group made significant improvements in observed caregiver responsiveness and monitoring, and showed decreased caregiver-reported child problem behavior and improved parent-reported peer relationships compared to the control group. Increased caregiver-reported cooperation skills were found for the intervention group at follow-up. No differences in condition were found for kindergarten teacher-reported social-behavioral, classroom, and academic skills. Moderation effects on children's behavior and peer relations were found for child age and exposure to the intervention child care. PMID:27174665

  17. Indian experience of home based mothers card: ICMR task force study.

    PubMed

    Abraham, S; Joshi, S; Kumar, V; Patwary, A; Pratinidhi, A; Saxena, V B; Maitra, K; Singh, K K; Saxena, N C; Saxena, B N

    1991-01-01

    To improve the quality of MCH services, a Home Based Mothers Card (HBMC) prepared and recommended by World Health Organization was adapted to Indian situation, and introduced in 1.5 lakh population of rural area covered by 6 participating centres under the aegis of Indian Council of Medical Research. Two thousand four hundred and forty six mothers were given this card and were followed up for a period of 2 years. Only 89.2 percent retrieval of the cards was possible after a period of 18 months. Screening of the population for "at risk" women monitoring and referral could be undertaken with the help of this card. Improved antenatal, and referral services were observed during the study period. The card (HBMC) was acceptable to the mothers as well as to the health workers, as a tool for improving the quality and coverage of MCH services being rendered at the Primary Health Centre. PMID:1818874

  18. The use of computer vision techniques to augment home based sensorised environments.

    PubMed

    Uhríková, Zdenka; Nugent, Chris D; Hlavác, Václav

    2008-01-01

    Technology within the home environment is becoming widely accepted as a means to facilitate independent living. Nevertheless, practical issues of detecting different tasks between multiple persons within the same environment along with managing instances of uncertainty associated with recorded sensor data are two key challenges yet to be fully solved. This work presents details of how computer vision techniques can be used as both alternative and complementary means in the assessment of behaviour in home based sensorised environments. Within our work we assessed the ability of vision processing techniques in conjunction with sensor based data to deal with instances of multiple occupancy. Our Results indicate that the inclusion of the video data improved the overall process of task identification by detecting and recognizing multiple people in the environment using color based tracking algorithm.

  19. Early home-based intervention in the Netherlands for children at familial risk of dyslexia.

    PubMed

    van Otterloo, Sandra G; van der Leij, Aryan; Henrichs, Lotte F

    2009-08-01

    Dutch children at higher familial risk of reading disability received a home-based intervention programme before formal reading instruction started to investigate whether this would reduce the risk of dyslexia. The experimental group (n=23) received a specific training in phoneme awareness and letter knowledge. A control group (n=25) received a non-specific training in morphology, syntax, and vocabulary. Both interventions were designed to take 10 min a day, 5 days a week for 10 weeks. Most parents were sufficiently able to work with the programme properly. At post-test the experimental group had gained more on phoneme awareness than the control group. The control group gained more on one of the morphology measures. On average, these specific training results did not lead to significant group differences in first-grade reading and spelling measures. However, fewer experimental children scored below 10th percentile on word recognition. PMID:18819166

  20. Evaluation of A Novel Information-Sharing Instrument for Home-Based Palliative Care

    PubMed Central

    Sawada, Koichiro; Shimada, Masanari; Kadoya, Shinichi; Endo, Naoki; Ishiguro, Kaname; Takashima, Rumi; Amemiya, Yoko; Fujikawa, Yasunaga; Ikezaki, Tomoaki; Takeuchi, Miyako; Kitazawa, Hidenori; Iida, Hiroyuki; Koseki, Shiro; Morita, Tatsuya; Sasaki, Koji; Kashii, Tatsuhiko; Murakami, Nozomu

    2015-01-01

    Aim: To examine the feasibility and usefulness of a novel region-based pathway: the Regional Referral Clinical Pathway for Home-Based Palliative Care. Method: This was a feasibility study to evaluate the frequency of variances and the perceived usefulness of pathway using in-depth interviews. All patients with cancer referred to the palliative care team between 2011 and 2013 and received home care services were enrolled. Result: A total of 44 patients were analyzed, and pathway was completed in all the patients. The target outcome was achieved in 61.4% while some variances occurred in 54.5%. Nine categories were identified as the usefulness of the pathway, such as reviewing and sharing information and promoting communication, education, motivation, and relationships. Conclusion: This novel pathway is feasible and seems to be useful. PMID:24814723

  1. Predictors of caregiver burden across the home-based palliative care trajectory in Ontario, Canada.

    PubMed

    Guerriere, Denise; Husain, Amna; Zagorski, Brandon; Marshall, Denise; Seow, Hsien; Brazil, Kevin; Kennedy, Julia; Burns, Sheri; Brooks, Heather; Coyte, Peter C

    2016-07-01

    Family caregivers of patients enrolled in home-based palliative care programmes provide unpaid care and assistance with daily activities to terminally ill family members. Caregivers often experience caregiver burden, which is an important predictor of anxiety and depression that can extend into bereavement. We conducted a longitudinal, prospective cohort study to comprehensively assess modifiable and non-modifiable patient and caregiver factors that account for caregiver burden over the palliative care trajectory. Caregivers (n = 327) of patients with malignant neoplasm were recruited from two dedicated home-based palliative care programmes in Southern Ontario, Canada from 1 July 2010 to 31 August 2012. Data were obtained from bi-weekly telephone interviews with caregivers from study admission until death, and from palliative care programme and home-care agency databases. Information collected comprised patient and caregiver demographics, utilisation of privately and publicly financed resources, patient clinical status and caregiver burden. The average age of the caregivers was 59.0 years (SD: 13.2), and almost 70% were female. Caregiver burden increased over time in a non-linear fashion from study admission to patient death. Increased monthly unpaid care-giving time costs, monthly public personal support worker costs, emergency department visits and low patient functional status were associated with higher caregiver burden. Greater use of hospice care was associated with lower burden. Female caregivers tended to report more burden compared to men as death approached, and burden was higher when patients were male. Low patient functional status was the strongest predictor of burden. Understanding the influence of modifiable and non-modifiable factors on the experience of burden over the palliative trajectory is essential for the development and targeting of programmes and policies to support family caregivers and reduce burden. Supporting caregivers can have

  2. Perceived acceptability of home-based couples voluntary HIV counseling and testing in Northern Tanzania.

    PubMed

    Njau, B; Watt, M H; Ostermann, J; Manongi, R; Sikkema, K J

    2012-01-01

    It is estimated that 5.6% of the Tanzanian population ages 15-49 are infected with HIV, but only 30% of adults have ever had an HIV test. Couples' testing has proven to increase testing coverage and introduce HIV prevention, but barriers include access to testing services and unequal gender dynamics in relationships. Innovative approaches are needed to address barriers to couple's testing and increase uptake of HIV testing. Using qualitative data collection methods, a formative study was conducted to assess the acceptability of a home-based couples counseling and testing (HBCCT) approach. Eligible study participants included married men and women, HIV-infected individuals, health care and home-based care providers, voluntary counseling and testing counselors, and community leaders. A total of 91 individuals participated in focus group discussions (FGDs) and in-depth interviews conducted between September 2009 and January 2010 in rural settings in Northern Tanzania. An HBCCT intervention appears to be broadly acceptable among participants. Benefits of HBCCT were identified in terms of access, confidentiality, and strengthening the relationship. Fears of negative consequences from knowing one's HIV status, including stigma, blame, physical abuse, or divorce, remain a concern and a potential barrier to the successful provision of the intervention. Lessons for implementation highlighted the importance of appointments for home visits, building relationships of confidence and trust between counselors and clients, and assessing and responding to a couple's readiness to undergo HIV testing. HBCCT should addresses HIV stigma, emphasize confidentiality, and improve communication skills for disclosure and decision-making among couples.

  3. Home based therapy for severe malnutrition with ready-to-use food

    PubMed Central

    Manary, M; Ndkeha, M; Ashorn, P; Maleta, K; Briend, A

    2004-01-01

    Background: The standard treatment of severe malnutrition in Malawi often utilises prolonged inpatient care, and after discharge results in high rates of relapse. Aims: To test the hypothesis that the recovery rate, defined as catch-up growth such that weight-for-height z score >0 (WHZ, based on initial height) for ready-to-use food (RTUF) is greater than two other home based dietary regimens in the treatment of malnutrition. Methods: HIV negative children >1 year old discharged from the nutrition unit in Blantyre, Malawi were systematically allocated to one of three dietary regimens: RTUF, RTUF supplement, or blended maize/soy flour. RTUF and maize/soy flour provided 730 kJ/kg/day, while the RTUF supplement provided a fixed amount of energy, 2100 kJ/day. Children were followed fortnightly. Children completed the study when they reached WHZ >0, relapsed, or died. Outcomes were compared using a time-event model. Results: A total of 282 children were enrolled. Children receiving RTUF were more likely to reach WHZ >0 than those receiving RTUF supplement or maize/soy flour (95% v 78%, RR 1.2, 95% CI 1.1 to 1.3). The average weight gain was 5.2 g/kg/day in the RTUF group compared to 3.1 g/kg/day for the maize/soy and RTUF supplement groups. Six months later, 96% of all children that reached WHZ >0 were not wasted. Conclusions: Home based therapy of malnutrition with RTUF was successful; further operational work is needed to implement this promising therapy. PMID:15155403

  4. Home-based rehabilitation interventions for adults living with HIV: a scoping review.

    PubMed

    Cobbing, Saul; Hanass-Hancock, Jill; Myezwa, Hellen

    2016-01-01

    Home-based rehabilitation (HBR) has been shown to improve the lives of people living with a wide range of chronic diseases in resource-rich settings. This may also be a particularly effective strategy in resource-poor settings, where access to institution-based rehabilitation is limited. This review aimed to summarise and discuss the evidence related to the effectiveness of home-based rehabilitation (HBR) interventions designed specifically for adults living with HIV. A scoping review methodology was employed, involving systematic search techniques and appraisal of appropriate evidence. English-language journal articles that assessed the quality of life or functional ability outcomes of HBR interventions for adults living with HIV were considered for this review. Out of an initial 1 135 publications retrieved from the search of databases, six articles met this review's inclusion criteria. While this review highlights the scarcity of empirical evidence related to HBR interventions for adults living with HIV, the findings of these six articles are that HBR is a safe management option that may confer a number of physical and psychological benefits for this population. Future research on HBR interventions should include a wider range of assessment measures, including cost-benefit analyses and specific tools designed to assess the functional ability and participation in activities of daily living of participants involved in these programmes. In particular, more research on HBR is required in resource-poor environments, such as sub-Saharan Africa where HIV is endemic, to assess whether this is a feasible strategy that is both effective and practical in the areas that may need it most. PMID:27002360

  5. "Willing but unwilling": attitudinal barriers to adoption of home-based health information technology among older adults.

    PubMed

    Young, Rachel; Willis, Erin; Cameron, Glen; Geana, Mugur

    2014-06-01

    While much research focuses on adoption of electronic health-care records and other information technology among health-care providers, less research explores patient attitudes. This qualitative study examines barriers to adoption of home-based health information technology, particularly personal electronic health records, among older adults. We conducted in-depth interviews (30-90 min duration) with 35 American adults, aged 46-72 years, to determine their perceptions of and attitudes toward home-based health information technology. Analysis of interview data revealed that most barriers to adoption fell under four themes: technological discomfort, privacy or security concerns, lack of relative advantage, and perceived distance from the user representation. Based on our findings, systems to promote home-based health information technology should incorporate familiar computer applications, alleviate privacy and security concerns, and align with older adults' active and engaged self-image.

  6. "It is always HIV/AIDS and TB": Home-based carers' perspectives on epilepsy in Cape Town, South Africa.

    PubMed

    Keikelame, Mpoe Johannah; Swartz, Leslie

    2016-01-01

    The study highlights the complex cultural religious factors affecting epilepsy and a need for integrated home-based care services. Two focus group discussions exploring home-based carers' (HBCs) perspectives on epilepsy were conducted using a semi-structured focus group interview guide, which was based on Kleinman's explanatory model framework. The audio-recorded data were transcribed verbatim, and a thematic analysis was done. The three main themes were epilepsy names and metaphors, religious beliefs about the cause and treatment of epilepsy, and HBCs' perceived roles and strategies for engaging in epilepsy care. Findings provide some insights for research, policy, and practice. PMID:27258583

  7. Being Human: A Qualitative Interview Study Exploring Why a Telehealth Intervention for Management of Chronic Conditions Had a Modest Effect

    PubMed Central

    Drabble, Sarah J; Foster, Alexis; Horspool, Kimberley; Edwards, Louisa; Thomas, Clare; Salisbury, Chris

    2016-01-01

    Background Evidence of benefit for telehealth for chronic conditions is mixed. Two linked randomized controlled trials tested the Healthlines Service for 2 chronic conditions: depression and high risk of cardiovascular disease (CVD). This new telehealth service consisted of regular telephone calls from nonclinical, trained health advisers who followed standardized scripts generated by interactive software. Advisors facilitated self-management by supporting participants to use Web-based resources and helped to optimize medication, improve treatment adherence, and encourage healthier lifestyles. Participants were recruited from primary care. The trials identified moderate (for depression) or partial (for CVD risk) effectiveness of the Healthlines Service. Objective An embedded qualitative study was undertaken to help explain the results of the 2 trials by exploring mechanisms of action, context, and implementation of the intervention. Methods Qualitative interview study of 21 staff providing usual health care or involved in the intervention and 24 patients receiving the intervention. Results Interviewees described improved outcomes in some patients, which they attributed to the intervention, describing how components of the model on which the intervention was based helped to achieve benefits. Implementation of the intervention occurred largely as planned. However, contextual issues in patients’ lives and some problems with implementation may have reduced the size of effect of the intervention. For depression, patients’ lives and preferences affected engagement with the intervention: these largely working-age patients had busy and complex lives, which affected their ability to engage, and some patients preferred a therapist-based approach to the cognitive behavioral therapy on offer. For CVD risk, patients’ motivations adversely affected the intervention whereby some patients joined the trial for general health improvement or from altruism, rather than

  8. Cost-effectiveness of telehealth for patients with raised cardiovascular disease risk: evidence from the Healthlines randomised controlled trial

    PubMed Central

    Dixon, Padraig; Edwards, Louisa; Thomas, Clare; Gaunt, Daisy; Foster, Alexis; Large, Shirley; Montgomery, Alan A

    2016-01-01

    Objectives To investigate the cost-effectiveness of a telehealth intervention for primary care patients with raised cardiovascular disease (CVD) risk. Design A prospective within-trial patient-level economic evaluation conducted alongside a randomised controlled trial. Setting Patients recruited through primary care, and intervention delivered via telehealth service. Participants Adults with a 10-year CVD risk ≥20%, as measured by the QRISK2 algorithm, with at least 1 modifiable risk factor. Intervention A series of up to 13 scripted, theory-led telehealth encounters with healthcare advisors, who supported participants to make behaviour change, use online resources, optimise medication and improve adherence. Participants in the control arm received usual care. Primary and secondary outcome measures Cost-effectiveness measured by net monetary benefit at the end of 12 months of follow-up, calculated from incremental cost and incremental quality-adjusted life years (QALYs). Productivity impacts, participant out-of-pocket expenditure and the clinical outcome were presented in a cost-consequences framework. Results 641 participants were randomised—325 to receive the telehealth intervention in addition to usual care and 316 to receive only usual care. 18% of participants had missing data on either costs, utilities or both. Multiple imputation was used for the base case results. The intervention was associated with incremental mean per-patient National Health Service (NHS) costs of £138 (95% CI 66 to 211) and an incremental QALY gain of 0.012 (95% CI −0.001 to 0.026). The incremental cost-effectiveness ratio was £10 859. Net monetary benefit at a cost-effectiveness threshold of £20 000 per QALY was £116 (95% CI −58 to 291), and the probability that the intervention was cost-effective at this threshold value was 0.77. Similar results were obtained from a complete case analysis. Conclusions There is evidence to suggest that the Healthlines telehealth

  9. Rational Protocols

    NASA Astrophysics Data System (ADS)

    Cachin, Christian

    Security research continues to provide a plethora of new protocols and mechanisms; these solutions patch either existing vulnerabilities found in practical systems or solve hypothetical security problems in the sense that the problem is often conceived at the same time when the first solution is proposed. Yet only a very small fraction of this research is relevant to ordinary users in the sense that they are willing to actually deploy the technology.

  10. Cost-effectiveness of telehealth for patients with depression: evidence from the Healthlines randomised controlled trial

    PubMed Central

    Hollinghurst, Sandra; Edwards, Louisa; Thomas, Clare; Foster, Alexis; Davies, Ben; Gaunt, Daisy; Montgomery, Alan A.; Salisbury, Chris

    2016-01-01

    Background Depression is a prevalent long-term condition that is associated with substantial resource use. Telehealth may offer a cost-effective means of supporting the management of people with depression. Aims To investigate the cost-effectiveness of a telehealth intervention (‘Healthlines') for patients with depression. Method A prospective patient-level economic evaluation conducted alongside a randomised controlled trial. Patients were recruited through primary care, and the intervention was delivered via a telehealth service. Participants with a confirmed diagnosis of depression and PHQ-9 score ≥10 were recruited from 43 English general practices. A series of up to 10 scripted, theory-led, telephone encounters with health information advisers supported participants to effect a behaviour change, use online resources, optimise medication and improve adherence. The intervention was delivered alongside usual care and was designed to support rather than duplicate primary care. Cost-effectiveness from a combined health and social care perspective was measured by net monetary benefit at the end of 12 months of follow-up, calculated from incremental cost and incremental quality-adjusted life years (QALYs). Cost–consequence analysis included cost of lost productivity, participant out-of-pocket expenditure and the clinical outcome. Results A total of 609 participants were randomised – 307 to receive the Healthlines intervention plus usual care and 302 to receive usual care alone. Forty-five per cent of participants had missing quality of life data, 41% had missing cost data and 51% of participants had missing data on either cost or utility, or both. Multiple imputation was used for the base-case analysis. The intervention was associated with incremental mean per-patient National Health Service/personal social services cost of £168 (95% CI £43 to £294) and an incremental QALY gain of 0.001 (95% CI −0.023 to 0.026). The incremental cost-effectiveness ratio

  11. Future Telehealth and Telecare Reference Design based on IoT Technologies: From Remote Monitoring to Smart Collaborative Services with Decision Support.

    PubMed

    Gerdes, Martin; Reichert, Frank; Pettersen Nytun, Jan; Fensli, Rune

    2015-01-01

    The demographic changes are producing aging societies across the world, resulting in greater demands on the health and care systems due to age-related disabilities and chronic diseases. Efficient telehealth and telecare services are needed to control the corresponding expenditures, by supporting increased collaboration between different professional and involving informal health care providers, and by empowering the patients to manage their health and well-being. Emerging trial systems for remote patient monitoring present preliminary solutions not exempt of certain limitations. We propose a future eHealth reference system architecture and core components, aiming at secure, smarter and more collaborative telehealth and telecare services. The implicit cooperation between the so-far separated domains of consumer well-being services and public telehealth and telecare services will be beneficial for all parties.

  12. Home-Based Preventive Parenting Intervention for at-Risk Infants and Their Families: An Open Trial

    PubMed Central

    Bagner, Daniel M.; Rodríguez, Gabriela M.; Blake, Clair A.; Rosa-Olivares, Jose

    2014-01-01

    The purpose of this study was to examine the feasibility, acceptability, and initial outcome of a home-based adaptation of Parent-Child Interaction Therapy for at-risk infants with externalizing behavior problems. Seven 12- to 15-month-old infants and their families were recruited at a large pediatric primary care clinic to participate in a home-based parenting intervention to prevent subsequent externalizing behavior problems. Home-based assessments were conducted at baseline, postintervention, and a 4- to 6-month follow-up. Six of the 7 (86%) families completed the intervention, and all completers reported high satisfaction with the intervention. All of the mothers demonstrated significant improvements and statistically reliable changes in their interactions with their infant, and most reported clinically significant and statistically reliable changes in infant behavior problems. The current study provides preliminary support for the use of this brief, home-based parenting intervention in addressing behavior problems as early as possible to improve access to an intervention for at-risk infants and their families. Successes and challenges with the development and implementation of this intervention are discussed along with directions for future research and clinical practice. PMID:25414568

  13. ¡Miranos! (Look at Us! We Are Healthy!): Home-Based and Parent Peer-Led Childhood Obesity Prevention.

    PubMed

    Sosa, Erica T; Parra-Medina, Deborah; He, Meizi; Trummer, Virginia; Yin, Zenong

    2016-09-01

    Parent interventions for childhood obesity prevention have traditionally experienced low participation rates or used passive methods such as newsletters. In contrast, the ¡Miranos! intervention home-based activities included parent-led face-to-face meetings delivered after school, take-home bags with educational materials, and scavenger hunt games to deliver health information to Head Start families regarding nutrition, physical activity, and healthy growth promotion for their preschooler. This study employed a quasi-experimental design with three intervention centers (two that received only center-based activities and one that received center- and home-based activities) and one comparison center. Data were collected on participating Head Start children and their parents/guardians and included parent attendance, parent health message recall through intercept interviews, parent knowledge through pre- and posttests, and family supportive behaviors and child health behaviors through a parent questionnaire. Parents/guardians that received both center- and home-based activities significantly increased knowledge scores (t = 2.50, degrees of freedom = 123, p < .05) and family supportive behaviors from baseline to follow-up (t = 2.12, degrees of freedom = 122, p < .05). This study demonstrates the effects home-based interventions can have when coupled with center-based activities and implemented in the center at the end of the school day. PMID:26895848

  14. Effects of Pharmacist-Led Patient Education on Diabetes-Related Knowledge and Medication Adherence: A Home-Based Study

    ERIC Educational Resources Information Center

    Chow, Ee Pin; Hassali, Mohamed Azmi; Saleem, Fahad; Aljadhey, Hisham

    2016-01-01

    Objective: Patient education is key to the management of acute and chronic conditions. However, the majority of such educational interventions have been reported from health-care settings. In contrast, this study aims to evaluate whether a home-based intervention can result in better understanding about type 2 diabetes mellitus and can increase…

  15. Potential predictors of functional outcomes after home-based constraint-induced therapy for children with cerebral palsy.

    PubMed

    Chen, Chia-ling; Lin, Keh-chung; Kang, Lin-ju; Wu, Ching-yi; Chen, Hsieh-ching; Hsieh, Yu-wei

    2014-01-01

    OBJECTIVE. Our objective was to identify predictors for treatment outcomes after home-based constraint-induced therapy (CIT) in children with cerebral palsy (CP). METHOD. Forty-three children (aged 4-12 yr) with CP were treated with individualized CIT at home for 4 wk. Potential predictors were age, sex, affected hand, and upper-extremity motor capacity measured by the Peabody Developmental Motor Scale, 2nd edition (PDMS-2). Outcomes were the Pediatric Motor Activity Log (PMAL) Amount of Hand Use and Quality of Hand Use subscales and the Functional Independence Measure for Children (WeeFIM). RESULTS. A higher PDMS-2 Visual-Motor Integration subscale score predicted a better WeeFIM score after home-based CIT (adjusted R² = .35). Younger age predicted better performance on the PMAL Amount of Hand Use and Quality of Hand Use subscales (adjusted R² = .06-.08) after home-based CIT. CONCLUSION. The potential predictors may allow occupational therapy practitioners to target those children who will benefit most after home-based constraint-induced therapy.

  16. The Impact of Perceived Stress, Social Support, and Home-Based Physical Activity on Mental Health among Older Adults

    ERIC Educational Resources Information Center

    Kwag, Kyung Hwa; Martin, Peter; Russell, Daniel; Franke, Warren; Kohut, Marian

    2011-01-01

    This study investigated how perceived stress, social support, and home-based physical activity affected older adults' fatigue, loneliness, and depression. We also explored whether social support and physical activity mediated the relationships between stress and mental health problems. The data of 163 older participants were analyzed in this…

  17. Home-Based Child Development Interventions for Preschool Children from Socially Disadvantaged Families. Campbell Systematic Reviews. 2012:1

    ERIC Educational Resources Information Center

    Miller, Sarah; Maguire, Lisa K.; Macdonald, Geraldine

    2011-01-01

    The purpose of this research is to determine the effects of home-based programmes aimed specifically at improving developmental outcomes for preschool children from socially disadvantaged families. The authors searched the following databases between 7 October and 12 October 2010: Cochrane Central Register of Controlled Trials (CENTRAL) (2010,…

  18. Mobile and Home-based Vendors’ Contributions to the Retail Food Environment in Rural South Texas Mexican-origin Settlements

    PubMed Central

    Valdez, Zulema; Dean, Wesley R; Sharkey, Joseph R

    2012-01-01

    A growing concern with high rates of obesity and overweight among immigrant minority populations in the U.S. has focused attention on the availability and accessibility to healthy foods in such communities. Small-scale vending in rural, impoverished and underserved areas, however, is generally overlooked; yet, this type of informal activity and source for food is particularly important in such environs, or “food desserts,” where traditional forms of work and mainstream food outlets are limited or even absent. This exploratory study investigates two types of small-scale food vending that take place in rural colonias, or Mexican-origin settlements along the South Texas border with Mexico: mobile and home-based. Using a convenience sample of 23 vendors who live and work in Texas colonias, this study identifies the characteristics associated with mobile and home-based food vendors and their businesses and its contributions to the rural food environment. Findings reveal that mobile and home-based vending provides a variety of food and beverage options to colonia residents, and suggests that home-based vendors contribute a greater assortment of food options, including some healthier food items, than mobile food vendors, which offer and sell a limited range of products. Findings may contribute to the development of innovative policy solutions and interventions aimed at increasing healthy food options or reducing health disparities in immigrant communities. PMID:22531289

  19. A Correlational Study of Telework Frequency, Information Communication Technology, and Job Satisfaction of Home-Based Teleworkers

    ERIC Educational Resources Information Center

    Webster-Trotman, Shana P.

    2010-01-01

    In 2008, 33.7 million Americans teleworked from home. The Telework Enhancement Act (S. 707) and the Telework Improvements Act (H.R. 1722) of 2009 were designed to increase the number of teleworkers. The research problem addressed was the lack of understanding of factors that influence home-based teleworkers' job satisfaction. Job dissatisfaction…

  20. Mobile and home-based vendors' contributions to the retail food environment in rural South Texas Mexican-origin settlements.

    PubMed

    Valdez, Zulema; Dean, Wesley R; Sharkey, Joseph R

    2012-10-01

    A growing concern with high rates of obesity and overweight among immigrant minority populations in the US has focused attention on the availability and accessibility to healthy foods in such communities. Small-scale vending in rural, impoverished and underserved areas, however, is generally overlooked; yet, this type of informal activity and source for food is particularly important in such environs, or "food desserts," where traditional forms of work and mainstream food outlets are limited or even absent. This exploratory study investigates two types of small-scale food vending that take place in rural colonias, or Mexican-origin settlements along the South Texas border with Mexico: mobile and home-based. Using a convenience sample of 23 vendors who live and work in Texas colonias, this study identifies the characteristics associated with mobile and home-based food vendors and their businesses and its contributions to the rural food environment. Findings reveal that mobile and home-based vending provides a variety of food and beverage options to colonia residents, and suggests that home-based vendors contribute a greater assortment of food options, including some healthier food items, than mobile food vendors, which offer and sell a limited range of products. Findings may contribute to the development of innovative policy solutions and interventions aimed at increasing healthy food options or reducing health disparities in immigrant communities.

  1. Science and Pre-School Children with Special Educational Needs: Aspects of Home-Based Teaching Sessions

    ERIC Educational Resources Information Center

    Bennington, Andrea

    2004-01-01

    This article focuses upon the role of the peripatetic pre-school teacher for children who have special educational needs. It explores the key issues involved in home-based teaching; the importance of developing meaningful partnerships with parents; early intervention; and the significance of play in promoting learning for young children. The…

  2. Caregiver Attitudes toward Disabled Elderly Family Members and Institutional Placement in a Home-Based Behavioral Treatment Program.

    ERIC Educational Resources Information Center

    Rankin, Eric; And Others

    Although the effectiveness of home-based, behaviorally-oriented treatment programs with the elderly and their families has been well documented, assessment of caregivers' attitudes toward those programs remains rare. To assess the relationship between outcome measures and client and principal caregiver characteristics, 21 client-caregiver dyads,…

  3. 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…

  4. SKI*HI Home-Based Programming for Children Who Are Deaf or Hard of Hearing: Recent Research Findings.

    ERIC Educational Resources Information Center

    Strong, Carol J.; And Others

    1994-01-01

    Data relating to 2,768 children served by the SKI*HI model of early, home-based programming for children with hearing impairments revealed that SKI*HI children, on average, were identified by 18 months of age, had higher rates of language development during intervention than prior to intervention, and had greater language gains than expected based…

  5. Long-Term Outcomes of Children and Youth Accessing Residential or Intensive Home-Based Treatment: Three Year Follow up

    ERIC Educational Resources Information Center

    Preyde, M.; Frensch, K.; Cameron, G.; White, S.; Penny, R.; Lazure, K.

    2011-01-01

    In this study the long-terms outcomes of children and youth with severe mental health problems receiving residential treatment (RT) or an intensive home-based treatment (IHT) were reported. RT is 24-hour mental health intervention in a highly supervised and structured group living setting where individualized and related therapies are provided.…

  6. Evaluation of the routine use of amoxicillin as part of the home-based treatment of severe acute malnutrition

    Technology Transfer Automated Retrieval System (TEKTRAN)

    To determine whether the inclusion of amoxicillin correlates with better recovery rates in the home-based treatment of severe acute malnutrition with ready-to-use therapeutic food. This retrospective cohort study compared data from the treatment of two groups of children in Malawi aged 6-59 months w...

  7. [De-institutionalization of mental health and care practices in the context of home-based care].

    PubMed

    Amorim, Ana Karenina de Melo Arraes; Dimenstein, Magda

    2009-01-01

    In Brazil, the home-based care services (HCS) are considered strategic and essential in the de-institutionalization process of patients who passed years in psychiatric hospitals and lost their family and social links. However, this service faces a series of problems and challenges in the wider context of health care. This article seeks to analyze some of these problems and challenges based on the experience of the home-based care service in Natal RN and on the literature in this field. Proposed on the basis of the idea that the encounters between insanity and city are potent destructors of the ' asylum logic' , these home-based care services put in question the current healthcare model, claiming to destruct the rigid and hegemonic forms of residence and care. The aim of this article is to discuss this ' asylum logic' that surpasses the limits of the concrete insane asylum penetrating some daily practices of the substitute services, taking advantage of the weak articulation between the mental health services. The lack of a strong connection between the home-based care service and the psychosocial care center allows this logic to operate through day-by-day bio-political devices. Thus, we discuss the risks of this logic taking over and indicate some possibilities of avoiding this, defending a care model allowing for potent meetings with the city and for the construction of ' affectionate networks' producing life and liberty.

  8. A Mobile Cloud-Based Parkinson’s Disease Assessment System for Home-Based Monitoring

    PubMed Central

    Petitti, Diana B

    2015-01-01

    Background Parkinson’s disease (PD) is the most prevalent movement disorder of the central nervous system, and affects more than 6.3 million people in the world. The characteristic motor features include tremor, bradykinesia, rigidity, and impaired postural stability. Current therapy based on augmentation or replacement of dopamine is designed to improve patients’ motor performance but often leads to levodopa-induced adverse effects, such as dyskinesia and motor fluctuation. Clinicians must regularly monitor patients in order to identify these effects and other declines in motor function as soon as possible. Current clinical assessment for Parkinson’s is subjective and mostly conducted by brief observations made during patient visits. Changes in patients’ motor function between visits are hard to track and clinicians are not able to make the most informed decisions about the course of therapy without frequent visits. Frequent clinic visits increase the physical and economic burden on patients and their families. Objective In this project, we sought to design, develop, and evaluate a prototype mobile cloud-based mHealth app, “PD Dr”, which collects quantitative and objective information about PD and would enable home-based assessment and monitoring of major PD symptoms. Methods We designed and developed a mobile app on the Android platform to collect PD-related motion data using the smartphone 3D accelerometer and to send the data to a cloud service for storage, data processing, and PD symptoms severity estimation. To evaluate this system, data from the system were collected from 40 patients with PD and compared with experts’ rating on standardized rating scales. Results The evaluation showed that PD Dr could effectively capture important motion features that differentiate PD severity and identify critical symptoms. For hand resting tremor detection, the sensitivity was .77 and accuracy was .82. For gait difficulty detection, the sensitivity was .89

  9. Transaction Cost Analysis of In-Clinic Versus Telehealth Consultations for Chronic Pain: Preliminary Evidence for Rapid and Affordable Access to Interdisciplinary Collaborative Consultation

    PubMed Central

    Theodore, Brian R.; Whittington, Jan; Towle, Cara; Tauben, David J.; Endicott-Popovsky, Barbara; Cahana, Alex; Doorenbos, Ardith Z.

    2015-01-01

    Objectives With ever increasing mandates to reduce costs and increase the quality of pain management, health care institutions are faced with the challenge of adopting innovative technologies and shifting workflows to provide value-based care. Transaction cost economic analysis can provide comparative evaluation of the consequences of these changes in the delivery of care. The aim of this study was to establish proof-of-concept using transaction cost analysis to examine chronic pain management in-clinic and through telehealth. Methods Participating health care providers were asked to identify and describe two comparable completed transactions for patients with chronic pain: one consultation between patient and specialist in-clinic and the other a telehealth presentation of a patient’s case by the primary care provider to a team of pain medicine specialists. Each provider completed two on-site interviews. Focus was on the time, value of time, and labor costs per transaction. Number of steps, time, and costs for providers and patients were identified. Results Forty-six discrete steps were taken for the in-clinic transaction, and 27 steps were taken for the telehealth transaction. Although similar in costs per patient ($332.89 in-clinic vs. $376.48 telehealth), the costs accrued over 153 business days in-clinic and 4 business days for telehealth. Time elapsed between referral and completion of initial consultation was 72 days in-clinic, 4 days for telehealth. Conclusions U.S. health care is moving toward the use of more technologies and practices, and the information provided by transaction cost analyses of care delivery for pain management will be important to determine actual cost savings and benefits. PMID:25616057

  10. The magnitude, share and determinants of unpaid care costs for home-based palliative care service provision in Toronto, Canada.

    PubMed

    Chai, Huamin; Guerriere, Denise N; Zagorski, Brandon; Coyte, Peter C

    2014-01-01

    With increasing emphasis on the provision of home-based palliative care in Canada, economic evaluation is warranted, given its tremendous demands on family caregivers. Despite this, very little is known about the economic outcomes associated with home-based unpaid care-giving at the end of life. The aims of this study were to (i) assess the magnitude and share of unpaid care costs in total healthcare costs for home-based palliative care patients, from a societal perspective and (ii) examine the sociodemographic and clinical factors that account for variations in this share. One hundred and sixty-nine caregivers of patients with a malignant neoplasm were interviewed from time of referral to a home-based palliative care programme provided by the Temmy Latner Centre for Palliative Care at Mount Sinai Hospital, Toronto, Canada, until death. Information regarding palliative care resource utilisation and costs, time devoted to care-giving and sociodemographic and clinical characteristics was collected between July 2005 and September 2007. Over the last 12 months of life, the average monthly cost was $14 924 (2011 CDN$) per patient. Unpaid care-giving costs were the largest component - $11 334, accounting for 77% of total palliative care expenses, followed by public costs ($3211; 21%) and out-of-pocket expenditures ($379; 2%). In all cost categories, monthly costs increased exponentially with proximity to death. Seemingly unrelated regression estimation suggested that the share of unpaid care costs of total costs was driven by patients' and caregivers' sociodemographic characteristics. Results suggest that overwhelming the proportion of palliative care costs is unpaid care-giving. This share of costs requires urgent attention to identify interventions aimed at alleviating the heavy financial burden and to ultimately ensure the viability of home-based palliative care in future. PMID:23758771

  11. A feasibility study of home-based contingency management with adolescent smokers of rural Appalachia.

    PubMed

    Reynolds, Brady; Harris, Millie; Slone, Stacey A; Shelton, Brent J; Dallery, Jesse; Stoops, William; Lewis, Russell

    2015-12-01

    Cigarette smoking among adolescents remains a significant public health concern. This problem is compounded in regions such as rural Appalachia where rates of smoking are consistently higher than national averages and access to treatments is limited. The current research evaluated a home-based contingency management program completed over the Internet with adolescent smokers recruited from rural Appalachia. Participants (N = 62) submitted 3 video recordings per day showing their breath carbon monoxide (CO) levels using a handheld CO monitor. Participants were assigned to either an active treatment condition (AT; n = 31) in which reductions in breath CO were reinforced or a control treatment condition (CT; n = 31) in which providing timely video recordings were reinforced with no requirement to reduce breath CO. Results revealed that participants in the AT condition reduced their breath CO levels significantly more so during treatment than participants in the CT condition. Within-group comparisons revealed that participants in both conditions significantly reduced their breath CO, self-reported smoking, and nicotine dependence ratings during treatment. However, only participants in the AT condition significantly reduced urinary cotinine levels during treatment, and only participants in this condition maintained all reductions until 6-week post treatment. Participants in the CT condition only maintained self-reported smoking reductions until posttreatment assessments. These results support the feasibility and initial efficacy of this incentive-based approach to smoking cessation with adolescent smokers living in rural locations.

  12. Self directed home based electrical muscle stimulation training improves exercise tolerance and strength in healthy elderly.

    PubMed

    Caulfield, Brian; Prendergast, Ann; Rainsford, Gary; Minogue, Conor

    2013-01-01

    Advancing age is associated with a gradual decline in muscle strength, exercise tolerance and subsequent capacity for activities of daily living. It is important that we develop effective strategies to halt this process of gradual decline in order to enhance functional ability and capacity for independent living. To achieve this, we must overcome the challenge of sustaining ongoing engagement in physical exercise programmes in the sedentary elderly population, particularly those who experience barriers to exercise participation. Recent developments in electrical muscle stimulation technology could provide a potential solution. In this pilot case-control study we investigated the effects of a self-directed home based programme of electrical muscle stimulation training on muscle strength and exercise tolerance in a group of 16 healthy elderly volunteers (10f, 6m). Study participants completed 30 separate 1-hour electrical muscle stimulation sessions at home over a 6-week period. We observed significant improvements in quadriceps muscle strength and 6-minute walk distance, suggesting that this form of electrical muscle stimulation training has promise as an exercise modality in the elderly population.

  13. A feasibility study of home-based contingency management with adolescent smokers of rural Appalachia.

    PubMed

    Reynolds, Brady; Harris, Millie; Slone, Stacey A; Shelton, Brent J; Dallery, Jesse; Stoops, William; Lewis, Russell

    2015-12-01

    Cigarette smoking among adolescents remains a significant public health concern. This problem is compounded in regions such as rural Appalachia where rates of smoking are consistently higher than national averages and access to treatments is limited. The current research evaluated a home-based contingency management program completed over the Internet with adolescent smokers recruited from rural Appalachia. Participants (N = 62) submitted 3 video recordings per day showing their breath carbon monoxide (CO) levels using a handheld CO monitor. Participants were assigned to either an active treatment condition (AT; n = 31) in which reductions in breath CO were reinforced or a control treatment condition (CT; n = 31) in which providing timely video recordings were reinforced with no requirement to reduce breath CO. Results revealed that participants in the AT condition reduced their breath CO levels significantly more so during treatment than participants in the CT condition. Within-group comparisons revealed that participants in both conditions significantly reduced their breath CO, self-reported smoking, and nicotine dependence ratings during treatment. However, only participants in the AT condition significantly reduced urinary cotinine levels during treatment, and only participants in this condition maintained all reductions until 6-week post treatment. Participants in the CT condition only maintained self-reported smoking reductions until posttreatment assessments. These results support the feasibility and initial efficacy of this incentive-based approach to smoking cessation with adolescent smokers living in rural locations. PMID:26280592

  14. Prevalence and risk factors of respiratory symptoms among home-based garment workers in Bangkok, Thailand.

    PubMed

    Chumchai, Pornlert; Silapasuwan, Pimpan; Wiwatwongkasem, Chukiat; Arphorn, Sara; Suwan-Ampai, Plernpit

    2015-05-01

    This study aimed to determine the prevalence and risk factors associated with respiratory symptoms. A cross-sectional study with random sampling method was employed and 300 home-based garment workers (HBGWs) were recruited. Risk factors, including personal factors; knowledge, health preventive behaviors, and skill of self-health surveillance, working condition, and respiratory symptoms were assessed. Data were collected using self-reported questionnaires. Prevalence of respiratory symptom was 22.3%. Majority of participants were female (78%). Mean age and working experience were 37.38 years (SD = 10.70) and 13.58 years (SD = 8.71), respectively. Allergic respiratory symptoms (odds ratio [OR] = 16.5; 95% confidence interval [CI] = 8.61-31.7) and garment dust exposure (OR = 12.3; 95% CI = 6.49-23.3) were significantly associated with respiratory symptoms (P < .001). Logistic regression analysis indicated history of allergic predicted the respiratory symptoms (OR = 12.96; 95% CI = 4.24-39.55). HBGWs who had serious allergic symptoms and high exposure to dust were at risk of respiratory symptoms. Therefore, preventive program for garment dust exposure among HBGWs is needed.

  15. A novel BCI-controlled pneumatic glove system for home-based neurorehabilitation.

    PubMed

    Coffey, Aodhán L; Leamy, Darren J; Ward, Tomás E

    2014-01-01

    Commercially available devices for Brain-Computer Interface (BCI)-controlled robotic stroke rehabilitation are prohibitively expensive for many researchers who are interested in the topic and physicians who would utilize such a device. Additionally, they are cumbersome and require a technician to operate, increasing the inaccessibility of such devices for home-based robotic stroke rehabilitation therapy. Presented here is the design, implementation and test of an inexpensive, portable and adaptable BCI-controlled hand therapy device. The system utilizes a soft, flexible, pneumatic glove which can be used to deflect the subject's wrist and fingers. Operation is provided by a custom-designed pneumatic circuit. Air flow is controlled by an embedded system, which receives serial port instruction from a PC running real-time BCI software. System tests demonstrate that glove control can be successfully driven by a real-time BCI. A system such as the one described here may be used to explore closed loop neurofeedback rehabilitation in stroke relatively inexpensively and potentially in home environments.

  16. Automated Cognitive Health Assessment From Smart Home-Based Behavior Data.

    PubMed

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

    2016-07-01

    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 behavior in the home and predicting clinical 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 clinical scores. CAAB uses statistical features that describe characteristics of a resident's daily activity performance to train machine learning algorithms that predict the clinical scores. We evaluate the performance of CAAB utilizing smart home sensor data collected from 18 smart homes over two years. We obtain a statistically significant correlation ( r=0.72) between CAAB-predicted and clinician-provided cognitive scores and a statistically significant correlation ( r=0.45) between CAAB-predicted and clinician-provided mobility scores. These prediction results suggest that it is feasible to predict clinical scores using smart home sensor data and learning-based data analysis.

  17. The web-rhetoric of companies offering home-based personal health monitoring.

    PubMed

    Nordgren, Anders

    2012-06-01

    In this paper I investigate the web-rhetoric of companies offering home-based personal health monitoring to patients and elderly people. Two main rhetorical methods are found, namely a reference to practical benefits and a use of prestige words like "quality of life" and "independence". I interpret the practical benefits in terms of instrumental values and the prestige words in terms of final values. I also reconstruct the arguments on the websites in terms of six different types of argument. Finally, I articulate a general critique of the arguments, namely that the websites neglect the context of use of personal health monitoring technologies. Whether or not a technology is good depends on the use of the technology by a particular individual in a particular context. The technology is not good-or bad-in itself. I support this critique with a number of more specific arguments such as the risk for reduced personal contact. For some elderly people social contact with care providers is more valuable than the independent living made possible by remote monitoring, for others independence is more important.

  18. Engaging military parents in a home-based reintegration program: a consideration of strategies.

    PubMed

    Ross, Abigail M; DeVoe, Ellen R

    2014-02-01

    For more than a decade, the long wars in Afghanistan and Iraq have placed tremendous and cumulative strain on U.S. military personnel and their families. The high operational tempo, length, and number of deployments-and greater in-theater exposure to threat-have resulted in well-documented psychological health concerns among service members and veterans. In addition, there is increasing and compelling evidence describing the significant deleterious impact of the deployment cycle on family members, including children, in military-connected families. However, rates of engagement and service utilization in prevention and intervention services continue to lag far below apparent need among service members and their families, because of both practical and psychological barriers. The authors describe the dynamic and ultimately successful process of engaging military families with young children in a home-based reintegration program designed to support parenting and strengthen parent-child relationships as service member parents move back into family life. In addition to the integration of existing evidence-based engagement strategies, the authors applied a strengths-based approach to working with military families and worked from a community-based participatory foundation to enhance family engagement and program completion. Implications for engagement of military personnel and their loved ones are discussed.

  19. CHOICES: promoting early access to end-of-life care through home-based transition management.

    PubMed

    Stuart, Brad; D'Onofrio, Carol N; Boatman, Susanne; Feigelman, Glen

    2003-08-01

    CHOICES is a comprehensive home-based care coordination program designed to bridge the gap between home health and hospice for Medicare + Choice enrollees with advanced chronic illness in San Francisco's East Bay region. Key elements of the program include physician education, enrollment of patients with high disease burden who may not be terminally ill, co-management of care with the primary physician, and an advanced practice clinical team that provides comprehensive in-home assessments, a flexible mix of life-prolonging and palliative care that evolves with disease progression, focused education and advance planning, and caregiver support. During a 42-month demonstration, 208 patients were enrolled in the program. Eighty percent had a non-cancer diagnosis; 40% were people of color. After an 8-month follow-up, 44% of the study cohort had died in the program or after transfer to hospice, 51% had been discharged, and 5% remained active. Median length of stay for decedents was 260 days. Preliminary evidence supports the program's feasibility and acceptability to patients, families, physicians, and agency partners. However, the uncertain future of Medicare + Choice and of managed care may jeopardize the program's sustainability. Policymakers and taxpayers will need to determine how to care for the growing number of chronically ill elderly who wish to remain at home as illness advances. The care needs of these patients and their families may overwhelm a health system organized around hospital treatment of acute illness.

  20. Evaluation of bluetooth low power for physiological monitoring in a home based cardiac rehabilitation program.

    PubMed

    Martin, Timothy; Ding, Hang; D'Souza, Matthew; Karunanithi, Mohan

    2012-01-01

    Cardiovascular disease (CVD) is the leading cause of mortality in Australia, and places large burdens on the healthcare system. To assist patients with CVDs in recovering from cardiac events and mediating cardiac risk factors, a home based cardiac rehabilitation program, known as the Care Assessment Platform (CAP), was developed. In the CAP program, patients are required to manually enter health information into their mobile phones on a daily basis. The manual operation is often subject to human errors and is inconvenient for some elderly patients. To improve this, an automated wireless solution has been desired. The objectives of this paper are to investigate the feasibility of implementing the newly released Bluetooth 4.0 (BT4.0) for the CAP program, and practically evaluate BT4.0 communications between a developed mobile application and some emulated healthcare devices. The study demonstrated that BT4.0 addresses usability, interoperability and security for healthcare applications, reduces the power consumption in wireless communication, and improves the flexibility of interface for software development. This evaluation study provides an essential mobile BT4.0 framework to incorporate a large range of healthcare devices for clinical assessment and intervention in the CAP program, and hence it is useful for similar development and research work of other mobile healthcare solutions.

  1. Childhood burns in Ghana: epidemiological characteristics and home-based treatment.

    PubMed

    Forjuoh, S N; Guyer, B; Smith, G S

    1995-02-01

    The objectives of this research were to study the epidemiological characteristics and home-based treatment of childhood burns in the Ashanti Region of Ghana. Children aged 0-5 years with a burn history were identified through a community-based, multisite survey. A standard questionnaire was administered to mothers of 630 of these children to elicit information on their sociodemographic characteristics and the circumstances of the burn event. Ninety-two per cent of the burns occurred in the home, particularly in the kitchen (51 per cent) and the house yard (36 per cent), with most of them happening in the late morning and around the evening meal. The main causes of the burns were scalds (45 per cent), contact with a hot object (34 per cent) and flame (20 per cent). 'Cool' water was applied to the burned area in 30 per cent of cases. Otherwise, treatment with a traditional preparation was the most popular first-aid choice. Since a considerable proportion of burns happened between meals when children 'play with fire' in the house yard, the provision of alternative play activities and community play areas may reduce the incidence of burns to these children. Secondly, we recommend that education on first-aid management of burns be intensified, with special emphasis on alternatives to the use of traditional preparations. PMID:7718113

  2. Evaluation of the home-based maternal record: a WHO collaborative study.

    PubMed Central

    Shah, P. M.; Selwyn, B. J.; Shah, K.; Kumar, V.

    1993-01-01

    Thirteen centres in eight countries (Egypt, India, Pakistan, Philippines, Senegal, Sri Lanka, Democratic Yemen and Zambia) participated in the WHO collaborative study to evaluate the home-based maternal record (HBMR). The evaluation showed that use of the HBMR had a favourable impact on utilization of health care services and continuity of the health care of women during their reproductive period. When adapted to local risk conditions, their cut-off points and the available resources, the HBMR succeeded in promoting self-care by mothers and their families and in enhancing the timely identification of at-risk cases that needed referral and special care. The introduction of the HBMR increased the diagnosis and referral of at-risk pregnant women and newborn infants, improved family planning and health education, led to an increase in tetanus toxoid immunization, and provided a means of collecting health information in the community. The HBMR was liked by mothers, community health workers and other health care personnel because, by using it, the mothers became more involved in looking after their own health and that of their babies. Apart from local adaptation of the HBMR, the training and involvement of health personnel (including those at the second and tertiary levels) from the start of the HBMR scheme influenced its success in promoting maternal and child health care. It also improved the collection of community-based data and the linking of referral networks. PMID:8261557

  3. Better access, quality, and cost for clinically complex veterans with home-based primary care.

    PubMed

    Edes, Thomas; Kinosian, Bruce; Vuckovic, Nancy H; Nichols, Linda Olivia; Becker, Margaret Mary; Hossain, Monir

    2014-10-01

    In successfully reducing healthcare expenditures, patient goals must be met and savings differentiated from cost shifting. Although the Department of Veterans Affairs (VA) Home Based Primary Care (HBPC) program for chronically ill individuals has resulted in cost reduction for the VA, it is unknown whether cost reduction results from restricting services or shifting costs to Medicare and whether HBPC meets patient goals. Cost projection using a hierarchical condition category (HCC) model adapted to the VA was used to determine VA plus Medicare projected costs for 9,425 newly enrolled HBPC recipients. Projected annual costs were compared with observed annualized costs before and during HBPC. To assess patient perspectives of care, 31 veterans and caregivers were interviewed from three representative programs. During HBPC, Medicare costs were 10.8% lower than projected, VA plus Medicare costs were 11.7% lower than projected, and combined hospitalizations were 25.5% lower than during the period without HBPC. Patients reported high satisfaction with HBPC team access, education, and continuity of care, which they felt contributed to fewer exacerbations, emergency visits, and hospitalizations. HBPC improves access while reducing hospitalizations and total cost. Medicare is currently testing the HBPC approach through the Independence at Home demonstration. PMID:25333529

  4. Home-based clinical video teleconferencing care: Clinical considerations and future directions.

    PubMed

    Morland, Leslie A; Poizner, Jeffrey M; Williams, Kathryn E; Masino, Tonya T; Thorp, Steven R

    2015-01-01

    Clinical video teleconferencing (CVT) is a treatment delivery modality that can be used to provide services to clinical populations that experience barriers to accessing mental health care. Recently, home-based CVT (HBCVT) has been developed in order to deliver treatment via CVT to patients in their homes. A number of clinical considerations, including the appropriate clinical population and individual patient factors, need to be taken into account when delivering CVT. Particular challenges can exist when setting up the home environment for HBCVT. Concerns about maintaining patient privacy while living in shared spaces, ensuring adequate CVT technology in the patient's home, and conducting risk management remotely are important to consider when delivering treatment via CVT. Since treatments delivered via CVT are often conducted across state lines, novel ethical and legal issues such as privacy laws, licensing of providers, prescribing practices, and insurance reimbursements need to be addressed when conducting services via these modalities. Future research on HBCVT will provide researchers and clinicians with information regarding which patients are most appropriate for treatment delivered via this modality and help further develop evidence for the cost-effectiveness of CVT and HBCVT clinical practice guidelines.

  5. Increasing live donor kidney transplantation: a randomized controlled trial of a home-based educational intervention.

    PubMed

    Rodrigue, J R; Cornell, D L; Lin, J K; Kaplan, B; Howard, R J

    2007-02-01

    With the shortage of deceased donor kidneys and the superior clinical outcomes possible with live donor kidney transplantation (LDKT), more patients should seriously consider LDKT. However, little is known about how best to educate patients and their family members about LDKT. We evaluated the effectiveness of a home-based (HB) educational program in increasing LDKT. Patients were randomized to clinic-based (CB) education alone (CB, n = 69) or CB plus HB education (CB+HB, n = 63). Compared to CB, more patients in the CB+HB group had living donor inquiries (63.8% vs. 82.5%, p = 0.019) and evaluations (34.8% vs. 60.3%, p = 0.005) and LDKTs (30.4% vs. 52.4%, p = 0.013). Assignment to the CB+HB group, White race, more LDKT knowledge, higher willingness to discuss LDKT with others, and fewer LDKT concerns were predictors of having LDKT (p-values < 0.05). Both groups demonstrated an increase in LDKT knowledge after the CB education, but CB+HB led to an additional increase in LDKT knowledge (p < 0.0001) and in willingness to discuss LDKT with others (p < 0.0001), and a decrease in LDKT concerns (p < 0.0001). Results indicate that an HB outreach program is more effective in increasing LDKT rates than CB education alone. PMID:17173659

  6. Can Home-Based HIV Rapid Testing Reduce HIV Disparities Among African Americans in Miami?

    PubMed

    Kenya, Sonjia; Okoro, Ikenna S; Wallace, Kiera; Ricciardi, Michael; Carrasquillo, Olveen; Prado, Guillermo

    2016-09-01

    Sixty percent of African Americans have had an HIV test, yet this population disproportionately contributes to AIDS mortality, suggesting that testing is not occurring early enough to achieve optimal outcomes. OraQuick, the first Food and Drug Administration-approved home-based HIV rapid test (HBHRT) could potentially increase testing rates. We assessed whether community health workers (CHWs) paired with HBRHT could improve HIV screening and health care access among African Americans in Miami, Florida. In October-November 2013, 60 African Americans were enrolled and randomized to the experimental condition, which received CHW assistance to complete HBHRT, or the control condition, which were instructed to complete HBHRT independently. Intervention participants were significantly (p ≤ .05) more likely than control participants to complete HBHRT and, if positive, get linked to HIV care (100% vs. 83%) χ(2) (1, N = 60) = 5.46, p ≤ .02. We concluded that CHW-assisted HBHRT may be a promising strategy to improve HIV testing and care among African Americans. PMID:27091604

  7. Evaluation of bluetooth low power for physiological monitoring in a home based cardiac rehabilitation program.

    PubMed

    Martin, Timothy; Ding, Hang; D'Souza, Matthew; Karunanithi, Mohan

    2012-01-01

    Cardiovascular disease (CVD) is the leading cause of mortality in Australia, and places large burdens on the healthcare system. To assist patients with CVDs in recovering from cardiac events and mediating cardiac risk factors, a home based cardiac rehabilitation program, known as the Care Assessment Platform (CAP), was developed. In the CAP program, patients are required to manually enter health information into their mobile phones on a daily basis. The manual operation is often subject to human errors and is inconvenient for some elderly patients. To improve this, an automated wireless solution has been desired. The objectives of this paper are to investigate the feasibility of implementing the newly released Bluetooth 4.0 (BT4.0) for the CAP program, and practically evaluate BT4.0 communications between a developed mobile application and some emulated healthcare devices. The study demonstrated that BT4.0 addresses usability, interoperability and security for healthcare applications, reduces the power consumption in wireless communication, and improves the flexibility of interface for software development. This evaluation study provides an essential mobile BT4.0 framework to incorporate a large range of healthcare devices for clinical assessment and intervention in the CAP program, and hence it is useful for similar development and research work of other mobile healthcare solutions. PMID:22797030

  8. Increasing live donor kidney transplantation: a randomized controlled trial of a home-based educational intervention.

    PubMed

    Rodrigue, J R; Cornell, D L; Lin, J K; Kaplan, B; Howard, R J

    2007-02-01

    With the shortage of deceased donor kidneys and the superior clinical outcomes possible with live donor kidney transplantation (LDKT), more patients should seriously consider LDKT. However, little is known about how best to educate patients and their family members about LDKT. We evaluated the effectiveness of a home-based (HB) educational program in increasing LDKT. Patients were randomized to clinic-based (CB) education alone (CB, n = 69) or CB plus HB education (CB+HB, n = 63). Compared to CB, more patients in the CB+HB group had living donor inquiries (63.8% vs. 82.5%, p = 0.019) and evaluations (34.8% vs. 60.3%, p = 0.005) and LDKTs (30.4% vs. 52.4%, p = 0.013). Assignment to the CB+HB group, White race, more LDKT knowledge, higher willingness to discuss LDKT with others, and fewer LDKT concerns were predictors of having LDKT (p-values < 0.05). Both groups demonstrated an increase in LDKT knowledge after the CB education, but CB+HB led to an additional increase in LDKT knowledge (p < 0.0001) and in willingness to discuss LDKT with others (p < 0.0001), and a decrease in LDKT concerns (p < 0.0001). Results indicate that an HB outreach program is more effective in increasing LDKT rates than CB education alone.

  9. Evaluation of the home-based maternal record: a WHO collaborative study.

    PubMed

    Shah, P M; Selwyn, B J; Shah, K; Kumar, V

    1993-01-01

    Thirteen centres in eight countries (Egypt, India, Pakistan, Philippines, Senegal, Sri Lanka, Democratic Yemen and Zambia) participated in the WHO collaborative study to evaluate the home-based maternal record (HBMR). The evaluation showed that use of the HBMR had a favourable impact on utilization of health care services and continuity of the health care of women during their reproductive period. When adapted to local risk conditions, their cut-off points and the available resources, the HBMR succeeded in promoting self-care by mothers and their families and in enhancing the timely identification of at-risk cases that needed referral and special care. The introduction of the HBMR increased the diagnosis and referral of at-risk pregnant women and newborn infants, improved family planning and health education, led to an increase in tetanus toxoid immunization, and provided a means of collecting health information in the community. The HBMR was liked by mothers, community health workers and other health care personnel because, by using it, the mothers became more involved in looking after their own health and that of their babies. Apart from local adaptation of the HBMR, the training and involvement of health personnel (including those at the second and tertiary levels) from the start of the HBMR scheme influenced its success in promoting maternal and child health care. It also improved the collection of community-based data and the linking of referral networks.

  10. A Feasibility Study of Home-Based Contingency Management with Adolescent Smokers of Rural Appalachia

    PubMed Central

    Reynolds, Brady; Harris, Millie; Slone, Stacey A.; Shelton, Brent J.; Dallery, Jesse; Stoops, William; Lewis, Russell

    2015-01-01

    Cigarette smoking among adolescents remains a significant public health concern. This problem is compounded in regions such as rural Appalachia where rates of smoking are consistently higher than national averages and access to treatments is limited. The current research evaluated a home-based contingency management program completed over the Internet with adolescent smokers recruited from rural Appalachia. Participants (N = 62) submitted three video recordings per day showing their breath carbon monoxide (CO) levels using a handheld CO monitor. Participants were assigned to either an active treatment condition (AT: n = 31) in which reductions in breath CO were reinforced or a control treatment condition (CT: n = 31) in which providing timely video recordings were reinforced with no requirement to reduce breath CO. Results revealed that participants in the AT condition reduced their breath CO levels significantly more so during treatment than participants in the CT condition. Within-group comparisons revealed that participants in both conditions significantly reduced their breath CO, self-reported smoking, and nicotine dependence ratings during treatment. However, only participants in the AT condition significantly reduced urinary cotinine levels during treatment, and only participants in this condition maintained all reductions until six-week post treatment. Participants in the CT condition only maintained self-reported smoking reductions until post-treatment assessments. These results support the feasibility and initial efficacy of this incentive-based approach to smoking cessation with adolescent smokers living in rural locations. PMID:26280592

  11. Migration of a telehealth program to a e-education health program

    NASA Astrophysics Data System (ADS)

    Gomez, A.; Montano, L. F.; Amaro, L.; Aleman, B.

    It's presented the result of the experience of Telehealth in Mexico, inside a National program, in one Public Health Institution, which along nine years of using, has been fulfilled a retrospective and prospective analysis of future application, emphasising on the specification of characteristics of the application sites, with impact measures: Cost/Opportunity , Cost/Benefit , and Cost/Efficiency . Anticipating inversion and reorganization of the net when being convenient, as well as situate the distance medical attention, beyond the institutional technologic platforms. A fanlight of possibilities is already opened to e-education programs that support the preventive medicine, the self-care, and the distance medical education in all medical attention levels, enlarging it covering not only to doctors, paramedical and nurses but also to general population, making it more equable and covering the minorities like rural population, handicaps, and indigene population overall in development ways countries and identifying the impact measurements in the evaluation of the enabling given to; doctors, teachers, students and open population. Also is proposed a Latin American E-Education Net for Health.

  12. [The Telehealth Network of the Americas and its role in primary health care].

    PubMed

    Bill, Guillermo; Crisci, Carlos D; Canet, Tomislav

    2014-01-01

    The need to guarantee equitable access to health regardless of geographic, economic, or technological barriers motivated the Member States of the Organization of American States to create the Telehealth Network of the Americas, coordinated by the Inter-American Telecommunication Committee. The Network focuses on the use of new information and communications technology applied to health, based on the values of respect, equity, and solidarity and mandated by the philosophy of primary health. Its members include government agencies, nongovernmental organizations, university forums, hospital federations, and telecommunications companies, and it has already extended its reach to other continents and to different fields in which telemedicine is being used. Among its first achievements, it has implemented an innovative tool to be used in cases of disaster or limited geographic access. This mobile telemedicine station is housed in a portable case that includes a computer, various digital devices (otoscope, ophthalmoscope, microscope, dermatoscope), a high-resolution digital camera, an X-ray film viewer, and a satellite antenna. With this tool, it is possible to provide specialized support for rural physicians and primary health care workers located far from large urban centers. PMID:25211574

  13. Applying evidence-based medicine in telehealth: an interactive pattern recognition approximation.

    PubMed

    Fernández-Llatas, Carlos; Meneu, Teresa; Traver, Vicente; Benedi, José-Miguel

    2013-11-01

    Born in the early nineteen nineties, evidence-based medicine (EBM) is a paradigm intended to promote the integration of biomedical evidence into the physicians daily practice. This paradigm requires the continuous study of diseases to provide the best scientific knowledge for supporting physicians in their diagnosis and treatments in a close way. Within this paradigm, usually, health experts create and publish clinical guidelines, which provide holistic guidance for the care for a certain disease. The creation of these clinical guidelines requires hard iterative processes in which each iteration supposes scientific progress in the knowledge of the disease. To perform this guidance through telehealth, the use of formal clinical guidelines will allow the building of care processes that can be interpreted and executed directly by computers. In addition, the formalization of clinical guidelines allows for the possibility to build automatic methods, using pattern recognition techniques, to estimate the proper models, as well as the mathematical models for optimizing the iterative cycle for the continuous improvement of the guidelines. However, to ensure the efficiency of the system, it is necessary to build a probabilistic model of the problem. In this paper, an interactive pattern recognition approach to support professionals in evidence-based medicine is formalized. PMID:24185841

  14. Applying Evidence-Based Medicine in Telehealth: An Interactive Pattern Recognition Approximation

    PubMed Central

    Fernández-Llatas, Carlos; Meneu, Teresa; Traver, Vicente; Benedi, José-Miguel

    2013-01-01

    Born in the early nineteen nineties, evidence-based medicine (EBM) is a paradigm intended to promote the integration of biomedical evidence into the physicians daily practice. This paradigm requires the continuous study of diseases to provide the best scientific knowledge for supporting physicians in their diagnosis and treatments in a close way. Within this paradigm, usually, health experts create and publish clinical guidelines, which provide holistic guidance for the care for a certain disease. The creation of these clinical guidelines requires hard iterative processes in which each iteration supposes scientific progress in the knowledge of the disease. To perform this guidance through telehealth, the use of formal clinical guidelines will allow the building of care processes that can be interpreted and executed directly by computers. In addition, the formalization of clinical guidelines allows for the possibility to build automatic methods, using pattern recognition techniques, to estimate the proper models, as well as the mathematical models for optimizing the iterative cycle for the continuous improvement of the guidelines. However, to ensure the efficiency of the system, it is necessary to build a probabilistic model of the problem. In this paper, an interactive pattern recognition approach to support professionals in evidence-based medicine is formalized. PMID:24185841

  15. A large-scale operational study of home-based therapy with ready-to-use therapeutic food in childhood malnutriton in Malawi

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Home-based therapy with ready-to-use therapeutic food (RUTF) for the treatment of malnutrition has better outcomes in the research setting than standard therapy. This study examined outcomes of malnourished children aged 6-60 months enrolled in operational home-based therapy with RUTF. Children enro...

  16. Effects of Home-Based Constraint-Induced Therapy versus Dose-Matched Control Intervention on Functional Outcomes and Caregiver Well-Being in Children with Cerebral Palsy

    ERIC Educational Resources Information Center

    Lin, Keh-chung; Wang, Tien-ni; Wu, Ching-yi; Chen, Chia-ling; Chang, Kai-chieh; Lin, Yu-chan; Chen, Yi-ju

    2011-01-01

    This study compared home-based constraint-induced therapy (CIT) with a dose-matched home-based control intervention for children with cerebral palsy (CP). The differences in unilateral and bilateral motor performance, daily functions, and quality of parental well-being (i.e., the stress level of their parents) were evaluated. The study included 21…

  17. Home-Based Functional Electrical Stimulation for Long-Term Denervated Human Muscle: History, Basics, Results and Perspectives of the Vienna Rehabilitation Strategy

    PubMed Central

    Kern, Helmut

    2014-01-01

    We will here discuss the following points related to Home-based Functional Electrical Stimulation (h-b FES) as treatment for patients with permanently denervated muscles in their legs: 1. Upper (UMN) and lower motor neuron (LMN) damage to the lower spinal cord; 2. Muscle atrophy/hypertrophy versus processes of degeneration, regeneration, and recovery; 3. Recovery of twitch- and tetanic-contractility by h-b FES; 4. Clinical effects of h-b FES using the protocol of the “Vienna School”; 5. Limitations and perspectives. Arguments in favor of using the Vienna protocol include: 1. Increased muscle size in both legs; 2. Improved tetanic force production after 3-5 months of percutaneous stimulation using long stimulus pulses (> 100 msec) of high amplitude (> 80 mAmp), tolerated only in patients with no pain sensibility; 3. Histological and electron microscopic evidence that two years of h-b FES return muscle fibers to a state typical of two weeks denervated muscles with respect to atrophy, disrupted myofibrillar structure, and disorganized Excitation-Contraction Coupling (E-CC) structures; 4. The excitability never recovers to that typical of normal or reinnervated muscles where pulses less than 1 msec in duration and 25 mAmp in intensity excite axons and thereby muscle fibres. It is important to motivate these patients for chronic stimulation throughout life, preferably standing up against the load of the body weight rather than sitting. Only younger and low weight patients can expect to be able to stand-up and do some steps more or less independently. Some patients like to maintain the h-b FES training for decades. Limitations of the procedure are obvious, in part related to the use of multiple, large surface electrodes and the amount of time patients are willing to use for such muscle training. PMID:26913127

  18. Home-Based and Facility-Based Directly Observed Therapy of Tuberculosis Treatment under Programmatic Conditions in Urban Tanzania

    PubMed Central

    Hella, Jerry; Maroa, Thomas; Kisandu, Shadrack; Chiryamkubi, Magreth; Said, Khadija; Mhalu, Grace; Mkopi, Abdallah; Mutayoba, Beatrice; Reither, Klaus; Gagneux, Sébastien; Fenner, Lukas

    2016-01-01

    Introduction Decentralization of Directly Observed Treatment (DOT) for tuberculosis (TB) to the community (home-based DOT) has improved the coverage of TB treatment and reduced the burden to the health care facilities (facility-based DOT). We aimed to compare TB treatment outcomes in home-based and facility-based DOT under programmatic conditions in an urban setting with a high TB burden. Methodology A retrospective analysis of a cohort of adult TB patients (≥15 years) routinely notified between 2010 and 2013 in two representative TB sub-districts in the Temeke district, Dar es Salaam, Tanzania. We assessed differences in treatment outcomes by calculating Risk Ratios (RRs). We used logistic regression to assess the association between DOT and treatment outcomes. Results Data of 4,835 adult TB patients were analyzed, with a median age of 35 years, 2,943 (60.9%) were men and TB/HIV co-infection prevalence of 39.9%. A total of 3,593 (74.3%) patients were treated under home-based DOT. Patients on home-based DOT were more likely to die compared to patients on facility-based DOT (RR 2.04, 95% Confidence Interval [95% CI]: 1.52–2.73), and more likely to complete TB treatment (RR 1.14, 95% CI: 1.06–1.23), but less likely to have a successful treatment outcome (RR 0.94, 95% CI: 0.92–0.97). Home-based DOT was preferred by women (adjusted Odds Ratio [aOR] 1.55, 95% CI: 1.34–1.80, p<0.001), older people (aOR 1.01 for each year increase, 95% CI: 1.00–1.02, p = 0.001) and patients with extra-pulmonary TB (aOR 1.45, 95% CI: 1.16–1.81, p = 0.001), but less frequently by patients on a retreatment regimen (aOR 0.12, 95% CI: 0.08–0.19, p<0.001). Conclusions/significance TB patients under home-based DOT had more frequently risk factors of death such as older age, HIV infection and sputum smear-negative TB, and had higher mortality compared to patients under facility-based DOT. Further operational research is needed to monitor the implementation of DOT under

  19. The Effect of Home-based Daily Journal Writing in Korean Adolescents with Smartphone Addiction.

    PubMed

    Lee, Hyuk; Seo, Min Jae; Choi, Tae Young

    2016-05-01

    Despite the benefits of smartphones, many adverse effects have emerged. However, to date, there was no particular approach to treat or prevent smartphone addiction. The aim of this study was to evaluate the therapeutic effectiveness of a home-based daily journal of smartphone use (HDJ-S) in Korean adolescents. Three hundred thirty five middle school students participated in this study. The severity of smartphone addiction was measured using the Korean Smartphone Addiction Proneness Scale. The ability to control smartphone use was evaluated with the Motive Scale for Smartphone Regulation. We used the Parents' Concerns for Children's Smartphone Activities Scale to measure parental monitoring and supervision of adolescents' smartphone activities. The Korean Smartphone Addiction Proneness Scale classified subjects into high risk and non-high risk for smartphone addiction, according to total scores. Forty six participants (14%) were high risk for smartphone addiction. The high risk group performed the HDJ-S for two weeks, and the same scales were subsequently assessed. After performing the HDJ-S, the total scores of the Korean Smartphone Addiction Proneness Scale decreased significantly in the high risk group (P < 0.001). There was a significant increase in the total scores of the Parents' Concerns for Children's Smartphone Activities Scale in the high risk group between baseline and following two weeks of treatment (P < 0.05). The HDJ-S was effective for adolescents with smartphone addiction and increased the parents' concerns for their children's smartphone activities. We suggested that HDJ-S would be considered as a treatment and prevention for smartphone addiction.

  20. Efficacy of home-based kinesthesia, balance & agility exercise training among persons with symptomatic knee osteoarthritis.

    PubMed

    Rogers, Matthew W; Tamulevicius, Nauris; Semple, Stuart J; Krkeljas, Zarko

    2012-01-01

    The purpose of this study was to determine the efficacy of a home-based kinesthesia, balance and agility (KBA) exercise program to improve symptoms among persons age ≥ 50 years with knee osteoarthritis (OA). Forty-four persons were randomly assigned to 8-weeks, 3 times per week KBA, resistance training (RT), KBA + RT, or Control. KBA utilized walking agility exercises and single-leg static and dynamic balancing. RT used elastic resistance bands for open chain lower extremity exercises. KBA + RT performed selected exercises from each technique. Control applied inert lotion daily. Outcomes included the OA specific WOMAC Index of Pain, Stiffness, and Physical Function (PF), community activity level, exercise self-efficacy, self-report knee stability, and 15m get up & go walk (GUG). Thirty-three participants [70.7 (SD 8.5) years] completed the trial. Analysis of variance comparing baseline, mid-point, and follow-up measures revealed significant (p < 0.05) improvements in WOMAC scores among KBA, RT, KBA + RT, and Control, with no differences between groups. However, Control WOMAC improvements peaked at mid-point, whereas improvement in the exercise conditions continued at 8-weeks. There were no significant changes in community activity level. Only Control improved exercise self-efficacy. Knee stability was improved in RT and Control. GUG improved in RT and KBA+RT. These results indicate that KBA, RT, or a combination of the two administered as home exercise programs are effective in improving symptoms and quality of life among persons with knee OA. Control results indicate a strong placebo effect in the short term. A combination of KBA and RT should be considered as part of the rehabilitation program, but KBA or RT alone may be appropriate for some patients. Studies with more statistical power are needed to confirm or refute these results. Patient presentation, preferences, costs, and convenience should be considered when choosing an exercise rehabilitation approach

  1. The Effect of Home-based Daily Journal Writing in Korean Adolescents with Smartphone Addiction.

    PubMed

    Lee, Hyuk; Seo, Min Jae; Choi, Tae Young

    2016-05-01

    Despite the benefits of smartphones, many adverse effects have emerged. However, to date, there was no particular approach to treat or prevent smartphone addiction. The aim of this study was to evaluate the therapeutic effectiveness of a home-based daily journal of smartphone use (HDJ-S) in Korean adolescents. Three hundred thirty five middle school students participated in this study. The severity of smartphone addiction was measured using the Korean Smartphone Addiction Proneness Scale. The ability to control smartphone use was evaluated with the Motive Scale for Smartphone Regulation. We used the Parents' Concerns for Children's Smartphone Activities Scale to measure parental monitoring and supervision of adolescents' smartphone activities. The Korean Smartphone Addiction Proneness Scale classified subjects into high risk and non-high risk for smartphone addiction, according to total scores. Forty six participants (14%) were high risk for smartphone addiction. The high risk group performed the HDJ-S for two weeks, and the same scales were subsequently assessed. After performing the HDJ-S, the total scores of the Korean Smartphone Addiction Proneness Scale decreased significantly in the high risk group (P < 0.001). There was a significant increase in the total scores of the Parents' Concerns for Children's Smartphone Activities Scale in the high risk group between baseline and following two weeks of treatment (P < 0.05). The HDJ-S was effective for adolescents with smartphone addiction and increased the parents' concerns for their children's smartphone activities. We suggested that HDJ-S would be considered as a treatment and prevention for smartphone addiction. PMID:27134499

  2. Efficacy of home-based kinesthesia, balance & agility exercise training among persons with symptomatic knee osteoarthritis.

    PubMed

    Rogers, Matthew W; Tamulevicius, Nauris; Semple, Stuart J; Krkeljas, Zarko

    2012-01-01

    The purpose of this study was to determine the efficacy of a home-based kinesthesia, balance and agility (KBA) exercise program to improve symptoms among persons age ≥ 50 years with knee osteoarthritis (OA). Forty-four persons were randomly assigned to 8-weeks, 3 times per week KBA, resistance training (RT), KBA + RT, or Control. KBA utilized walking agility exercises and single-leg static and dynamic balancing. RT used elastic resistance bands for open chain lower extremity exercises. KBA + RT performed selected exercises from each technique. Control applied inert lotion daily. Outcomes included the OA specific WOMAC Index of Pain, Stiffness, and Physical Function (PF), community activity level, exercise self-efficacy, self-report knee stability, and 15m get up & go walk (GUG). Thirty-three participants [70.7 (SD 8.5) years] completed the trial. Analysis of variance comparing baseline, mid-point, and follow-up measures revealed significant (p < 0.05) improvements in WOMAC scores among KBA, RT, KBA + RT, and Control, with no differences between groups. However, Control WOMAC improvements peaked at mid-point, whereas improvement in the exercise conditions continued at 8-weeks. There were no significant changes in community activity level. Only Control improved exercise self-efficacy. Knee stability was improved in RT and Control. GUG improved in RT and KBA+RT. These results indicate that KBA, RT, or a combination of the two administered as home exercise programs are effective in improving symptoms and quality of life among persons with knee OA. Control results indicate a strong placebo effect in the short term. A combination of KBA and RT should be considered as part of the rehabilitation program, but KBA or RT alone may be appropriate for some patients. Studies with more statistical power are needed to confirm or refute these results. Patient presentation, preferences, costs, and convenience should be considered when choosing an exercise rehabilitation approach

  3. Characterisation methods for the hyperspectral sensor HySpex at DLR's calibration home base

    NASA Astrophysics Data System (ADS)

    Baumgartner, Andreas; Gege, Peter; Köhler, Claas; Lenhard, Karim; Schwarzmaier, Thomas

    2012-09-01

    The German Aerospace Center's (DLR) Remote Sensing Technology Institute (IMF) operates a laboratory for the characterisation of imaging spectrometers. Originally designed as Calibration Home Base (CHB) for the imaging spectrometer APEX, the laboratory can be used to characterise nearly every airborne hyperspectral system. Characterisation methods will be demonstrated exemplarily with HySpex, an airborne imaging spectrometer system from Norsk Elektro Optikks A/S (NEO). Consisting of two separate devices (VNIR-1600 and SWIR-320me) the setup covers the spectral range from 400 nm to 2500 nm. Both airborne sensors have been characterised at NEO. This includes measurement of spectral and spatial resolution and misregistration, polarisation sensitivity, signal to noise ratios and the radiometric response. The same parameters have been examined at the CHB and were used to validate the NEO measurements. Additionally, the line spread functions (LSF) in across and along track direction and the spectral response functions (SRF) for certain detector pixels were measured. The high degree of lab automation allows the determination of the SRFs and LSFs for a large amount of sampling points. Despite this, the measurement of these functions for every detector element would be too time-consuming as typical detectors have 105 elements. But with enough sampling points it is possible to interpolate the attributes of the remaining pixels. The knowledge of these properties for every detector element allows the quantification of spectral and spatial misregistration (smile and keystone) and a better calibration of airborne data. Further laboratory measurements are used to validate the models for the spectral and spatial properties of the imaging spectrometers. Compared to the future German spaceborne hyperspectral Imager EnMAP, the HySpex sensors have the same or higher spectral and spatial resolution. Therefore, airborne data will be used to prepare for and validate the spaceborne system

  4. Time providing care outside visits in a home-based primary care program

    PubMed Central

    Pedowitz, Elizabeth J.; Ornstein, Katherine A.; Farber, Jeffrey; DeCherrie, Linda V.

    2016-01-01

    Background/Objectives Homebound elderly patients with chronic medical illnesses face multiple barriers to care. Primary care physicians (PCPs) devote a significant amount of time to care apart from actual office visits, but there is little quantification of such time by physicians who provide primary care in the home. This article assesses exactly how much time physicians in a large home based primary care (HBPC) program spend providing care outside of home visits. Unreimbursed time, as well as patient and provider-related factors that may contribute to that increased time, are considered. Design Mount Sinai Visiting Doctors (MSVD) providers filled out research forms for every interaction involving care provision outside of home visits. Data collected included: length of interaction, mode, nature, and whom the interaction was with for 3 weeks. Setting/Participants MSVD is an academic home-visit program in Manhattan, NY. All PCPs in MSVD (n=14) agreed to participate. Measurements Time data were analyzed using a comprehensive estimate and conservative estimates to quantify unbillable time. Results Data on 1151 interactions for 537 patients were collected. An average 8.2 hours/week were spent providing non-home visit care for a full-time provider. Using the most conservative estimates, 3.6 hours/week was estimated to be unreimbursed per full-time provider. No significant differences in interaction times were found among dementia vs. non-dementia patients, new vs. non-new patients, and primary-panel vs. covered patients. Conclusion Findings suggest that HBPC providers spend substantial time providing care outside home visits, much of which goes unrecognized in the current reimbursement system. These findings may help guide practice development and creation of new payment systems for HBPC and similar models of care. PMID:24802078

  5. Behavior Change Following Implementation of Home-Based Life Saving Skills in Liberia, West Africa

    PubMed Central

    Lori, Jody R.; Amable, Elikem E.; Mertz, Sara G.; Moriarty, Kathleen

    2012-01-01

    Introduction Home-Based Life Saving Skills (HBLSS) has been fully integrated into Liberia’s long term plan to decrease maternal and newborn mortality and morbidity coordinated through the Ministry of Health and Social Welfare. The objective of this article is to disseminate evaluation data from project monitoring and documentation on translation of knowledge and skills obtained through HBLSS into behavior change at the community level. Methods One year after completion of HBLSS training, complication audits were conducted with 434 postpartum women in one rural county in Liberia. Results Sixty-two percent (n=269) of the women were attended during birth by either an HBLSS-trained traditional midwife or family member, while 38 percent (n=165) were attended by a traditional midwife or family member who did not receive HBLSS training. HBLSS trained birth attendants performed significantly more First Actions (lifesaving actions taught to be performed after every delivery) than the non HBLSS trained attendants. Fourteen percent of our sample (n=62) reported “too much bleeding” following the delivery. Of these women, approximately half (n=29) were attended by an HBLSS-trained traditional midwife or family member. There was a significant difference in Secondary Actions (those actions taught to be performed when a woman experiences “too much bleeding” following childbirth) that were reported to have been performed by HBLSS-trained attendants (mean = 5.26, SD = 1.88) and untrained attendants (mean = 2.73, SD = 1.97); p-value <.0001. Conclusion Our findings suggest HBLSS knowledge is being transferred into behavior change and used at the community-level by traditional midwives and family members. PMID:22954081

  6. The Effect of Home-based Daily Journal Writing in Korean Adolescents with Smartphone Addiction

    PubMed Central

    2016-01-01

    Despite the benefits of smartphones, many adverse effects have emerged. However, to date, there was no particular approach to treat or prevent smartphone addiction. The aim of this study was to evaluate the therapeutic effectiveness of a home-based daily journal of smartphone use (HDJ-S) in Korean adolescents. Three hundred thirty five middle school students participated in this study. The severity of smartphone addiction was measured using the Korean Smartphone Addiction Proneness Scale. The ability to control smartphone use was evaluated with the Motive Scale for Smartphone Regulation. We used the Parents’ Concerns for Children’s Smartphone Activities Scale to measure parental monitoring and supervision of adolescents’ smartphone activities. The Korean Smartphone Addiction Proneness Scale classified subjects into high risk and non-high risk for smartphone addiction, according to total scores. Forty six participants (14%) were high risk for smartphone addiction. The high risk group performed the HDJ-S for two weeks, and the same scales were subsequently assessed. After performing the HDJ-S, the total scores of the Korean Smartphone Addiction Proneness Scale decreased significantly in the high risk group (P < 0.001). There was a significant increase in the total scores of the Parents’ Concerns for Children’s Smartphone Activities Scale in the high risk group between baseline and following two weeks of treatment (P < 0.05). The HDJ-S was effective for adolescents with smartphone addiction and increased the parents’ concerns for their children’s smartphone activities. We suggested that HDJ-S would be considered as a treatment and prevention for smartphone addiction. PMID:27134499

  7. Assessment of Haptic Interaction for Home-Based Physical Tele-Therapy using Wearable Devices and Depth Sensors.

    PubMed

    Barmpoutis, Angelos; Alzate, Jose; Beekhuizen, Samantha; Delgado, Horacio; Donaldson, Preston; Hall, Andrew; Lago, Charlie; Vidal, Kevin; Fox, Emily J

    2016-01-01

    In this paper a prototype system is presented for home-based physical tele-therapy using a wearable device for haptic feedback. The haptic feedback is generated as a sequence of vibratory cues from 8 vibrator motors equally spaced along an elastic wearable band. The motors guide the patients' movement as they perform a prescribed exercise routine in a way that replaces the physical therapists' haptic guidance in an unsupervised or remotely supervised home-based therapy session. A pilot study of 25 human subjects was performed that focused on: a) testing the capability of the system to guide the users in arbitrary motion paths in the space and b) comparing the motion of the users during typical physical therapy exercises with and without haptic-based guidance. The results demonstrate the efficacy of the proposed system.

  8. The role of home-based information and communications technology interventions in chronic disease management: a systematic literature review.

    PubMed

    Gaikwad, Rekha; Warren, Jim

    2009-06-01

    This article presents a systematic literature review done to evaluate the feasibility and benefits of home-based information and communications technology enabled interventions for chronic disease management, with emphasis on their impact on health outcomes and costs. Relevant articles were retrieved from PubMed and evaluated using quality worksheets with pre-identified inclusion and exclusion criteria. Of the 256 articles retrieved, 27 were found to concord with the study criteria. Evaluation of the identified articles was conducted irrespective of study design, type of home-based intervention or chronic disease involved. The review demonstrates that HBIs applied to chronic disease management improve functional and cognitive patient outcomes and reduce healthcare spending. However, further research is needed to assess benefit in terms of evidence-based outcome indicators (that can provide a basis for meta-analysis), to confirm sustainable cost benefits, and to systematically collect data on physician satisfaction with patient management.

  9. Service Desk Calls in a Home-based Clinical Informatics Study: Supporting End Users in the Field.

    PubMed

    Valdez, Rs; Burke, Lj; Casper, Gr; Sturgeon, Ba; Rosmait, C; Palzkill, D; Hamann, D; Murphy, J; Brennan, Pf

    2012-01-01

    Home-based clinical informatics technologies are being developed to facilitate health care provision and management. Given the novelty of these technologies, end users such as patients and their formal and informal caregivers may require support during use. This paper presents a case study within the United States of the service desk calls generated over a 31-month period by patients enrolled in a large randomized field experiment, HeartCare II. This case study provides future deployers of home-based clinical information technologies with an understanding of the types of support that may be required during use. Our analysis reveals that calls to the service desk originated as a result of user problems, hardware problems, software problems, and internal communication problems among individuals involved in the delivery and use of the technology. Implications of these needs for support during use are also discussed. PMID:24199135

  10. Comparison of a Self-Directed and Therapist-Assisted Telehealth Parent-Mediated Intervention for Children with ASD: A Pilot RCT

    ERIC Educational Resources Information Center

    Ingersoll, Brooke; Wainer, Allison L.; Berger, Natalie I.; Pickard, Katherine E.; Bonter, Nicole

    2016-01-01

    This pilot RCT compared the effect of a self-directed and therapist-assisted telehealth-based parent-mediated intervention for young children with ASD. Families were randomly assigned to a self-directed or therapist-assisted program. Parents in both groups improved their intervention fidelity, self-efficacy, stress, and positive perceptions of…

  11. Home-Based Aerobic Interval Training Improves Peak Oxygen Uptake Equal to Residential Cardiac Rehabilitation: A Randomized, Controlled Trial

    PubMed Central

    Moholdt, Trine; Bekken Vold, Mona; Grimsmo, Jostein; Slørdahl, Stig Arild; Wisløff, Ulrik

    2012-01-01

    Aerobic capacity, measured as the peak oxygen uptake, is a strong predictor of survival in cardiac patients. Aerobic interval training (AIT), walking/running four times four minutes at 85–95% of peak heart rate, has proven to be effective in increasing peak oxygen uptake in coronary heart disease patients. As some patients do not attend organized rehabilitation programs, home-based exercise should be an alternative. We investigated whether AIT could be performed effectively at home, and compared the effects on peak oxygen uptake with that observed after a standard care, four-week residential rehabilitation. Thirty patients undergoing coronary artery bypass surgery were randomized to residential rehabilitation or home-based AIT. At six months follow-up, peak oxygen uptake increased 4.6 (±2.7) and 3.9 (±3.6) mL·kg−1 min−1 (both p<0.005, non-significant between-group difference) after residential rehabilitation and AIT, respectively. Quality of life increased significantly in both groups, with no statistical significant difference between groups. We found no evidence for a different treatment effect between patients randomized to home-based AIT compared to patients attending organized rehabilitation (95% confidence interval −1.8, 3.5). AIT patients reported good adherence to exercise training. Even though these first data indicate positive effects of home-based AIT in patients undergoing coronary artery bypass surgery, more studies are needed to provide supporting evidence for the application of this rehabilitation strategy. Trial Registration ClinicalTrials.gov NCT00363922 PMID:22815970

  12. Cost-Effectiveness of a Home Based Intervention for Secondary Prevention of Readmission with Chronic Heart Disease.

    PubMed

    Byrnes, Joshua; Carrington, Melinda; Chan, Yih-Kai; Pollicino, Christine; Dubrowin, Natalie; Stewart, Simon; Scuffham, Paul A

    2015-01-01

    The aim of this study is to consider the cost-effectiveness of a nurse-led, home-based intervention (HBI) in cardiac patients with private health insurance compared to usual post-discharge care. A within trial analysis of the Young @ Heart multicentre, randomized controlled trial along with a micro-simulation decision analytical model was conducted to estimate the incremental costs and quality adjusted life years associated with the home based intervention compared to usual care. For the micro-simulation model, future costs, from the perspective of the funder, and effects are estimated over a twenty-year time horizon. An Incremental Cost-Effectiveness Ratio, along with Incremental Net Monetary Benefit, is evaluated using a willingness to pay threshold of $50,000 per quality adjusted life year. Sub-group analyses are conducted for men and women across three age groups separately. Costs and benefits that arise in the future are discounted at five percent per annum. Overall, home based intervention for secondary prevention in patients with chronic heart disease identified in the Australian private health care sector is not cost-effective. The estimated within trial incremental net monetary benefit is -$3,116 [95% CI: -11,145, $4,914]; indicating that the costs outweigh the benefits. However, for males and in particular males aged 75 years and above, home based intervention indicated a potential to reduce health care costs when compared to usual care (within trial: -$10,416 [95% CI: -$26,745, $5,913]; modelled analysis: -$1,980 [95% CI: -$22,843, $14,863]). This work provides a crucial impetus for future research to understand for whom disease management programs are likely to benefit most. PMID:26657844

  13. Self-Administered, Home-Based SMART (Sensorimotor Active Rehabilitation Training) Arm Training: A Single-Case Report.

    PubMed

    Hayward, Kathryn S; Neibling, Bridee A; Barker, Ruth N

    2015-01-01

    This single-case, mixed-method study explored the feasibility of self-administered, home-based SMART (sensorimotor active rehabilitation training) Arm training for a 57-yr-old man with severe upper-limb disability after a right frontoparietal hemorrhagic stroke 9 mo earlier. Over 4 wk of self-administered, home-based SMART Arm training, the participant completed 2,100 repetitions unassisted. His wife provided support for equipment set-up and training progressions. Clinically meaningful improvements in arm impairment (strength), activity (arm and hand tasks), and participation (use of arm in everyday tasks) occurred after training (at 4 wk) and at follow-up (at 16 wk). Areas for refinement of SMART Arm training derived from thematic analysis of the participant's and researchers' journals focused on enabling independence, ensuring home and user friendliness, maintaining the motivation to persevere, progressing toward everyday tasks, and integrating practice into daily routine. These findings suggest that further investigation of self-administered, home-based SMART Arm training is warranted for people with stroke who have severe upper-limb disability.

  14. Home-based DIR/Floortime intervention program for preschool children with autism spectrum disorders: preliminary findings.

    PubMed

    Liao, Shu-Ting; Hwang, Yea-Shwu; Chen, Yung-Jung; Lee, Peichin; Chen, Shin-Jaw; Lin, Ling-Yi

    2014-11-01

    Improving parent-child interaction and play are important outcomes for children with autism spectrum disorder (ASD). Play is the primary occupation of children. In this pilot study conducted in Taiwan, we investigated the effects of the developmental, individual difference, and relationship-based (DIR)/Floortime home-based intervention program on social interaction and adaptive functioning of children with ASD. The participants were 11 children with ASD, ages from 45-69 months, and their mothers. Mothers were instructed the principles of the approach by an occupational therapist. All 11 children and their mothers completed the 10-week home-based intervention program, undergoing an average of 109.7 hr of intervention. Children made significant changes in mean scores for emotional functioning, communication, and daily living skills. Moreover, the mothers perceived positive changes in their parent-child interactions. The findings of this pilot study contribute to knowledge regarding the effects of home-based DIR/Floortime intervention program on increasing the social interaction and adaptive behaviors of children with ASD in Taiwan. PMID:24865120

  15. Anterior cruciate ligament reconstruction by using otogenous [correction of otogeneous] hamstring tendons with home-based rehabilitation.

    PubMed

    Ugutmen, E; Ozkan, K; Kilincoglu, V; Ozkan, F U; Toker, S; Eceviz, E; Altintas, F

    2008-01-01

    We investigated patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction using otogenous hamstring tendons with a cross-pin technique to compare a post-operative home-based rehabilitation programme with a clinic-based programme. ACL reconstruction was performed on 104 patients (103 male) by the same surgeon. The mean age of the patients was 31.5 years (range 18 - 43 years) and the mean time interval between injury and operation was 34.3 months. Patients were randomly allocated to either a home-based (n = 52) or clinic-based rehabilitation programme (n = 52). Mean follow-up was 31.1 months (range 12 - 66 months). Patients underwent a series of examinations before and after surgery in order to evaluate functional recovery of their injured knee. The results demonstrated that using otogeneous hamstring tendons for ACL reconstruction was safe and produced satisfactory results. The study also demonstrated that a home-based rehabilitation programme was as effective as a clinic-based programme.

  16. Impact of a Telehealth Program That Delivers Remote Consultation and Longitudinal Mentorship to Community HIV Providers

    PubMed Central

    Wood, Brian R.; Unruh, Kenton T.; Martinez-Paz, Natalia; Annese, Mary; Ramers, Christian B.; Harrington, Robert D.; Dhanireddy, Shireesha; Kimmerly, Lisa; Scott, John D.; Spach, David H.

    2016-01-01

    Background. To increase human immunodeficiency virus (HIV) care capacity in our region, we designed a distance mentorship and consultation program based on the Project ECHO (Extension for Community Healthcare Outcomes) model, which uses real-time interactive video to regularly connect community providers with a multidisciplinary team of academic specialists. This analysis will (1) describe key components of our program, (2) report types of clinical problems for which providers requested remote consultation over the first 3.5 years of the program, and (3) evaluate changes in participants′ self-assessed HIV care confidence and knowledge over the study period. Methods. We prospectively tracked types of clinical problems for which providers sought consultation. At baseline and regular intervals, providers completed self-efficacy assessments. We compared means using paired-samples t test and examined the statistical relationship between each survey item and level of participation using analysis of variance. Results. Providers most frequently sought consultation for changing antiretroviral therapy, evaluating acute symptomatology, and managing mental health issues. Forty-five clinicians completed a baseline and at least 1 repeat assessment. Results demonstrated significant increase (P < .05) in participants' self-reported confidence to provide a number of essential elements of HIV care. Significant increases were also reported in feeling part of an HIV community of practice and feeling professionally connected to academic faculty, which correlated with level of program engagement. Conclusions. Community HIV practitioners frequently sought support on clinical issues for which no strict guidelines exist. Telehealth innovation increased providers' self-efficacy and knowledge while decreasing professional isolation. The ECHO model creates a virtual network for peer-to-peer support and longitudinal mentorship, thus strengthening capacity of the HIV workforce. PMID

  17. Impact of Specialist Home-Based Palliative Care Services in a Tertiary Oncology Set Up: A Prospective Non-Randomized Observational Study

    PubMed Central

    Dhiliwal, Sunil R; Muckaden, Maryann

    2015-01-01

    Background: Home-based specialist palliative care services are developed to meet the needs of the patients in advanced stage of cancer at home with physical symptoms and distress. Specialist home care services are intended to improve symptom control and quality of life, enable patients to stay at home, and avoid unnecessary hospital admission. Materials and Methods: Total 690 new cases registered under home-based palliative care service in the year 2012 were prospectively studied to assess the impact of specialist home-based services using Edmonton symptom assessment scale (ESAS) and other parameters. Results: Out of the 690 registered cases, 506 patients received home-based palliative care. 50.98% patients were cared for at home, 28.85% patients needed hospice referral and 20.15% patients needed brief period of hospitalization. All patients receiving specialist home care had good relief of physical symptoms (P < 0.005). 83.2% patients received out of hours care (OOH) through liaising with local general practitioners; 42.68% received home based bereavement care and 91.66% had good bereavement outcomes. Conclusion: Specialist home-based palliative care improved symptom control, health-related communication and psychosocial support. It promoted increased number of home-based death, appropriate and early hospice referral, and averted needless hospitalization. It improved bereavement outcomes, and caregiver satisfaction. PMID:25709182

  18. The value of telehealth in the early detection of chronic obstructive pulmonary disease exacerbations: A prospective observational study.

    PubMed

    Hamad, Ghassan A; Crooks, Michael; Morice, Alyn H

    2016-06-01

    We aim to establish the value of telemonitoring in the early detection of chronic obstructive pulmonary disease exacerbations. We followed up patients undergoing chronic obstructive pulmonary disease telemonitoring for 4 months. We studied changes in the telemonitored data in the week prior to admission or to community chronic obstructive pulmonary disease exacerbation. A total of 183 patients were studied. In all, 30 chronic obstructive pulmonary disease-related hospital admissions and 68 chronic obstructive pulmonary disease community exacerbations were recorded. Changes in telehealth parameters occurred in 80 per cent (24/30) of admissions and 82 per cent (56/68) of community exacerbations. Although changes in telehealth data occurred in the majority of exacerbations, most individual symptoms was present in less than half the exacerbations and almost 20 per cent of exacerbations were not preceded by any change in telemonitoring data. Cough created significantly more alerts by those treated in the community (p = 0.008), whereas a drop in oxygen saturation created significantly more alerts pre-hospitalisation (p = 0.049). We conclude that further work is required to develop methods of identifying impending chronic obstructive pulmonary disease exacerbations with greater sensitivity and specificity.

  19. Meeting the Needs of Children with Medical Complexity Using a Telehealth Advanced Practice Registered Nurse Care Coordination Model

    PubMed Central

    Erickson, Mary; Lunos, Scott; Finkelstein, Stanley M.; Looman, Wendy; Celebreeze, Margaret; Garwick, Ann

    2015-01-01

    Effective care coordination is a key quality and safety strategy for populations with chronic conditions, including children with medical complexity (CMC). However, gaps remain in parent report of the need for care coordination help and receipt of care coordination help. New models must close this gap while maintaining family-centered focus. A three-armed randomized controlled trial conducted in an established medical home utilized an advanced practice registered nurse intervention based on Presler’s model of clinic-based care coordination. The model supported families of CMC across settings using telephone only or telephone and video telehealth care coordination. Effectiveness was evaluated from many perspectives and this paper reports on a subset of outcomes that includes family-centered care (FCC), need for care coordination help and adequacy of care coordination help received. FCC at baseline and end of study showed no significant difference between groups. Median FCC scores of 18.0–20.0 across all groups indicated high FCC within the medical home. No significant differences were found in the need for care coordination help within or between groups and over time. No significant difference was found in the adequacy of help received between groups at baseline. However, this indicator increased significantly over time for both intervention groups. These findings suggest that in an established medical home with high levels of FCC, families of CMC have unmet needs for care coordination help that are addressed by the APRN telehealth care coordination model. PMID:25424455

  20. The Malaysian Telehealth Flagship Application: a national approach to health data protection and utilisation and consumer rights.

    PubMed

    Mohan, Jai; Razali Raja Yaacob, Raja

    2004-03-31

    Telehealth refers to the integration of information, telecommunication, human-machine interface technologies and health technologies to deliver health care, to promote the heath status of the people and to create health. The Malaysian Telehealth Application will, on completion, provide every resident of the country an electronic Lifetime Health Record (LHR) and Lifetime Health Plan (LHP). He or she will also hold a smart card that will contain a subset of the data in the Lifetime Health Record. These will be the means by which Malaysians will receive "seamless continuous quality care" across a range of health facilities and health care providers, and by which Malaysia's health goal of a nation of "healthy individuals, families and communities" is achieved. The challenges to security and privacy in providing access to an electronic Lifetime Health Record at private and government health facilities and to the electronic Lifetime Health Plan at homes of consumers require not only technical mechanisms but also national policies and practices addressing threats while facilitating access to health data during health encounters in different care settings. Organisational policies establish the goals that technical mechanisms serve. They should outline appropriate uses and access to information, create mechanisms for preventing and detecting violations, and set sanctions for violations. Some interesting innovations have been used to address these issues against the background of the launching of the multimedia supercorridor (MSC) in Malaysia.

  1. Meeting the needs of children with medical complexity using a telehealth advanced practice registered nurse care coordination model.

    PubMed

    Cady, Rhonda G; Erickson, Mary; Lunos, Scott; Finkelstein, Stanley M; Looman, Wendy; Celebreeze, Margaret; Garwick, Ann

    2015-07-01

    Effective care coordination is a key quality and safety strategy for populations with chronic conditions, including children with medical complexity (CMC). However, gaps remain in parent report of the need for care coordination help and receipt of care coordination help. New models must close this gap while maintaining family-centered focus. A three-armed randomized controlled trial conducted in an established medical home utilized an advanced practice registered nurse intervention based on Presler's model of clinic-based care coordination. The model supported families of CMC across settings using telephone only or telephone and video telehealth care coordination. Effectiveness was evaluated from many perspectives and this paper reports on a subset of outcomes that includes family-centered care (FCC), need for care coordination help and adequacy of care coordination help received. FCC at baseline and end of study showed no significant difference between groups. Median FCC scores of 18.0-20.0 across all groups indicated high FCC within the medical home. No significant differences were found in the need for care coordination help within or between groups and over time. No significant difference was found in the adequacy of help received between groups at baseline. However, this indicator increased significantly over time for both intervention groups. These findings suggest that in an established medical home with high levels of FCC, families of CMC have unmet needs for care coordination help that are addressed by the APRN telehealth care coordination model.

  2. GOLIAH: A Gaming Platform for Home-Based Intervention in Autism - Principles and Design.

    PubMed

    Bono, Valentina; Narzisi, Antonio; Jouen, Anne-Lise; Tilmont, Elodie; Hommel, Stephane; Jamal, Wasifa; Xavier, Jean; Billeci, Lucia; Maharatna, Koushik; Wald, Mike; Chetouani, Mohamed; Cohen, David; Muratori, Filippo

    2016-01-01

    -child relationship. This pilot study shows the feasibility of using the developed gaming platform for home-based intensive intervention. However, the overall capability of the platform in delivering intervention needs to be assessed in a bigger open trial.

  3. GOLIAH: A Gaming Platform for Home-Based Intervention in Autism – Principles and Design

    PubMed Central

    Bono, Valentina; Narzisi, Antonio; Jouen, Anne-Lise; Tilmont, Elodie; Hommel, Stephane; Jamal, Wasifa; Xavier, Jean; Billeci, Lucia; Maharatna, Koushik; Wald, Mike; Chetouani, Mohamed; Cohen, David; Muratori, Filippo

    2016-01-01

    parents–child relationship. This pilot study shows the feasibility of using the developed gaming platform for home-based intensive intervention. However, the overall capability of the platform in delivering intervention needs to be assessed in a bigger open trial. PMID:27199777

  4. GOLIAH: A Gaming Platform for Home-Based Intervention in Autism - Principles and Design.

    PubMed

    Bono, Valentina; Narzisi, Antonio; Jouen, Anne-Lise; Tilmont, Elodie; Hommel, Stephane; Jamal, Wasifa; Xavier, Jean; Billeci, Lucia; Maharatna, Koushik; Wald, Mike; Chetouani, Mohamed; Cohen, David; Muratori, Filippo

    2016-01-01

    -child relationship. This pilot study shows the feasibility of using the developed gaming platform for home-based intensive intervention. However, the overall capability of the platform in delivering intervention needs to be assessed in a bigger open trial. PMID:27199777

  5. Fragmented implementation of maternal and child health home-based records in Vietnam: need for integration

    PubMed Central

    Aiga, Hirotsugu; Nguyen, Vinh Duc; Nguyen, Cuong Dinh; Nguyen, Tho Thi Thi; Nguyen, Lien Thi Phuong

    2016-01-01

    Background Home-based records (HBRs) are globally implemented as the effective tools that encourage pregnant women and mothers to timely and adequately utilise maternal and child health (MCH) services. While availability and utilisation of nationally representative HBRs have been assessed in several earlier studies, the reality of a number of HBRs subnationally implemented in a less coordinated manner has been neither reported nor analysed. Objectives This study is aimed at estimating the prevalence of HBRs for MCH and the level of fragmentation of and overlapping between different HBRs for MCH in Vietnam. The study further attempts to identify health workers’ and mothers’ perceptions towards HBR operations and utilisations. Design A self-administered questionnaire was sent to the provincial health departments of 28 selected provinces. A copy of each HBR available was collected from them. A total of 20 semi-structured interviews with health workers and mothers were conducted at rural communities in four of 28 selected provinces. Results Whereas HBRs developed exclusively for maternal health and exclusively for child health were available in four provinces (14%) and in 28 provinces (100%), respectively, those for both maternal health and child health were available in nine provinces (32%). The mean number of HBRs in 28 provinces (=5.75) indicates over-availability of HBRs. All 119 minimum required items for recording found in three different HBRs under nationwide scale-up were also included in the Maternal and Child Health Handbook being piloted for nationwide scaling-up. Implementation of multiple HBRs is likely to confuse not only health workers by requiring them to record the same data on several HBRs but also mothers about which HBR they should refer to and rely on at home. Conclusions To enable both health workers and pregnant women to focus on only one type of HBR, province-specific HBRs for maternal and/or child health need to be nationally standardised

  6. Home-based music therapy - a systematic overview of settings and conditions for an innovative service in healthcare

    PubMed Central

    2010-01-01

    Background Almost every Western healthcare system is changing to make their services more centered around out-patient care. In particular, long-term or geriatric patients who have been discharged from the hospital often require home-based care and therapy. Therefore, several programs have been developed to continue the therapeutic process and manage the special needs of patients after discharge from hospital. Music therapy has also moved into this field of healthcare service by providing home-based music therapy (HBMT) programs. This article reviews and summarizes the settings and conditions of HBMT for the first time. Methods The following databases were used to find articles on home-based music therapy: AMED, CAIRSS, EMBASE, MEDLINE, PsychINFO, and PSYNDEX. The search terms were "home-based music therapy" and "mobile music therapy". Included articles were analyzed with respect to participants as well as conditions and settings of HBMT. Furthermore, the date of publication, main outcomes, and the design and quality of the studies were investigated. Results A total of 20 international publications, 11 clinical studies and nine reports from practice, mainly from the United States (n = 8), were finally included in the qualitative synthesis. Six studies had a randomized controlled design and included a total of 507 patients. The vast majority of clients of HBMT are elderly patients living at home and people who need hospice and palliative care. Although settings were heterogeneous, music listening programs played a predominant role with the aim to reduce symptoms like depression and pain, or to improve quality of life and the relationship between patients and caregivers as primary endpoints. Conclusions We were able to show that HBMT is an innovative service for future healthcare delivery. It fits with the changing healthcare system and its conditions but also meets the therapeutic needs of the increasing number of elderly and severely impaired people. Apart from

  7. Home-based versus centre-based cardiac rehabilitation: abridged Cochrane systematic review and meta-analysis

    PubMed Central

    Buckingham, S A; Taylor, R S; Jolly, K; Zawada, A; Dean, S G; Cowie, A; Norton, R J; Dalal, H M

    2016-01-01

    Objective To update the Cochrane review comparing the effects of home-based and supervised centre-based cardiac rehabilitation (CR) on mortality and morbidity, quality of life, and modifiable cardiac risk factors in patients with heart disease. Methods Systematic review and meta-analysis. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO and CINAHL were searched up to October 2014, without language restriction. Randomised trials comparing home-based and centre-based CR programmes in adults with myocardial infarction, angina, heart failure or who had undergone coronary revascularisation were included. Results 17 studies with 2172 patients were included. No difference was seen between home-based and centre-based CR in terms of: mortality (relative risk (RR) 0.79, 95% CI 0.43 to 1.47); cardiac events; exercise capacity (mean difference (MD) −0.10, −0.29 to 0.08); total cholesterol (MD 0.07 mmol/L, −0.24 to 0.11); low-density lipoprotein cholesterol (MD −0.06 mmol/L, −0.27 to 0.15); triglycerides (MD −0.16 mmol/L, −0.38 to 0.07); systolic blood pressure (MD 0.2 mm Hg, −3.4 to 3.8); smoking (RR 0.98, 0.79 to 1.21); health-related quality of life and healthcare costs. Lower high-density lipoprotein cholesterol (MD −0.07 mmol/L, −0.11 to −0.03, p=0.001) and lower diastolic blood pressure (MD −1.9 mm Hg, −0.8 to −3.0, p=0.009) were observed in centre-based participants. Home-based CR was associated with slightly higher adherence (RR 1.04, 95% CI 1.01 to 1.07). Conclusions Home-based and centre-based CR provide similar benefits in terms of clinical and health-related quality of life outcomes at equivalent cost for those with heart failure and following myocardial infarction and revascularisation. PMID:27738516

  8. The development of spatial capacity in piloting and dead reckoning by infant rats: use of the huddle as a home base for spatial navigation.

    PubMed

    Loewen, Irene; Wallace, Douglas G; Whishaw, Ian Q

    2005-05-01

    Two forms of spatial navigation, piloting using external cues and dead reckoning using self-movement cues, are manifest in the outward and homeward trips of adult rats exploring from a home base. Here, the development of these two forms of spatial behavior are described for rats aged 14-65 days using a new paradigm in which a huddle of pups or an artificial huddle, a small heat pad, served as a home base on an open circular table that the rats could explore. When moving away from both home bases, the travel distance, path complexity, and number of stops of outward trips from the home base increased progressively with age from postnatal day 16 through 22. When returning to the home bases, the return trips to the home base were always more direct and had high travel velocities even though travel distance increased with age for the longest trips. The results are discussed in relation to the ideas that: (1) the pups pilot on the outward portion of their excursion and dead reckon on the homeward portion of their excursion, and (2) the two forms of navigation and associated spatial capacity are interdependent and develop in parallel and in close association with locomotor skill.

  9. Acceptability of self-conducted home-based HIV testing among men who have sex with men in Brazil: data from an on-line survey

    PubMed Central

    Lippman, Sheri A.; Périssé, André R. S.; Veloso, Valdiléa G.; Sullivan, Patrick S.; Buchbinder, Susan; Sineath, R. Craig; Grinsztejn, Beatriz

    2014-01-01

    The Brazilian HIV/AIDS epidemic is concentrated among men who have sex with men (MSM), however HIV testing rates among MSM are not commensurate with their risk. Strategies to expand early diagnosis may include use of self-conducted home-based testing kits, which are now available for purchase in the US. In April 2011 we conducted a survey with Brazilian MSM using Facebook to assess HIV testing preferences and acceptability of home-based testing. Among 356 previously tested, HIV-negative MSM, 47% reported a preference for home-based testing, 27% preferred clinic-based testing, and 26% had no preference. Less frequent testers and those who had considered testing but failed to test were more likely to prefer home-based testing. Close to 90% reported that they would use self-test kits; 62% and 54% said they would use home-based testing to make choices about unprotected sex with regular and new partners, respectively. Concerns included difficulty to understand the tests (32%) and receiving results alone (23%). Overall, home-based testing may appeal to MSM and result in increased testing frequency. Research on feasibility and utilization of self-tests in practice is needed. PMID:24896048

  10. Evaluation of Candidate Measures for Home-Based Screening of Sleep Disordered Breathing in Taiwanese Bus Drivers

    PubMed Central

    Ting, Hua; Huang, Ren-Jing; Lai, Ching-Hsiang; Chang, Shen-Wen; Chung, Ai-Hui; Kuo, Teng-Yao; Chang, Ching-Haur; Shih, Tung-Sheng; Lee, Shin-Da

    2014-01-01

    Background: Sleepiness-at-the-wheel has been identified as a major cause of highway accidents. The aim of our study is identifying the candidate measures for home-based screening of sleep disordered breathing in Taiwanese bus drivers, instead of polysomnography. Methods: Overnight polysomnography accompanied with simultaneous measurements of alternative screening devices (pulse oximetry, ApneaLink, and Actigraphy), heart rate variability, wake-up systolic blood pressure and questionnaires were completed by 151 eligible participants who were long-haul bus drivers with a duty period of more than 12 h a day and duty shifting. Results: 63.6% of professional bus drivers were diagnosed as having sleep disordered breathing and had a higher body mass index, neck circumference, systolic blood pressure, arousal index and desaturation index than those professional bus drivers without evidence of sleep disordered breathing. Simple home-based candidate measures: (1) Pulse oximetry, oxygen-desaturation indices by ≥3% and 4% (r = 0.87∼0.92); (2) Pulse oximetry, pulse-rising indices by ≥7% and 8% from a baseline (r = 0.61∼0.89); and (3) ApneaLink airflow detection, apnea-hypopnea indices (r = 0.70∼0.70), based on recording-time or Actigraphy-corrected total sleep time were all significantly correlated with, and had high agreement with, corresponding polysomnographic apnea-hypopnea indices [(1) 94.5%∼96.6%, (2) 93.8%∼97.2%, (3) 91.1%∼91.3%, respectively]. Conversely, no validities of SDB screening were found in the multi-variables apnea prediction questionnaire, Epworth Sleepiness Scale, night-sleep heart rate variability, wake-up systolic blood pressure and anthropometric variables. Conclusions: The indices of pulse oximetry and apnea flow detection are eligible criteria for home-based screening of sleep disordered breathing, specifically for professional drivers. PMID:24803198

  11. Parent and Child Perceptions of a Self-Regulated, Home-Based Exercise Program for Children with Cystic Fibrosis

    PubMed Central

    Happ, Mary Beth; Hoffman, Leslie A.; Higgins, Linda W.; DiVirgilio, Dana; Orenstein, David M.

    2014-01-01

    Background Despite recognized benefits, many children with cystic fibrosis (CF) do not consistently participate in physical activities. There is little empirical literature regarding the feelings and attitudes of children with CF toward exercise programs, parental roles in exercise, or factors influencing exercise experiences during research participation. Objectives To describe the exercise experiences of children with CF and their parents during participation in a six-month program of self-regulated, home-based exercise. Methods This qualitative descriptive study nested within a randomized controlled trial of a self-regulated, home-based exercise program used serial semi-structured interviews conducted individually at two and six months with 11 purposively selected children with CF and their parent(s). Results Six boys and five girls, ages 10–16, and parents (nine mothers, four fathers) participated in a total of 44 interviews. Five major thematic categories describing child and parent perceptions and experience of the bicycle exercise program were identified in the transcripts: (a) motivators; (b) barriers; (c) effort/work; (d) exercise routine; (e) sustaining exercise. Research participation, parent-family participation, health benefits, and the child’s personality traits were primary motivators. Competing activities, priorities and responsibilities were the major barriers to implementing the exercise program as prescribed. Motivation waned and the novelty wore off for several (approximately half) parent-child dyads, who planned to decrease or stop the exercise program after the study ended. Discussion We identified motivators and barriers to a self-regulated, home-based exercise program for children with CF that can be addressed in planning future exercise interventions to maximize the health benefits for children with CF and the feasibility and acceptability to the children and their families. PMID:23995464

  12. What is the potential for social networks and support to enhance future telehealth interventions for people with a diagnosis of schizophrenia: a critical interpretive synthesis

    PubMed Central

    2013-01-01

    Background Digital technologies are increasingly directed at improved monitoring, management and treatment of mental health. However, their potential contribution to social networks and self-management support for people diagnosed with a serious mental illness has rarely been considered. This review and meta-synthesis aimed to examine the processes of engagement and perceived relevance and appropriateness of telehealth interventions for people with a diagnosis of schizophrenia. The review addresses three key questions. How is the use of digital communications technologies framed in the professional psychiatric literature? How might the recognised benefits of telehealth translate to people with a diagnosis of schizophrenia? What is the user perspective concerning Internet information and communication technologies? Methods A critical interpretive synthesis (CIS) of published findings from quantitative and qualitative studies of telehealth interventions for people with a diagnosis of schizophrenia. Results Most studies were of an exploratory nature. The professional discourse about the use of different technologies was overlain by concerns with surveillance and control, focusing on the Internet as a potential site of risk and danger. The critical synthesis of findings showed that the key focus of the available studies was on the delivery of existing traditional approaches (e.g. improving medications adherence, provision of medical information about the condition, symptom monitoring and cognitive behavioural therapy). Even though it was clear that the Internet has considerable potential in terms of accessing and utilising lay support, the potential of communication technologies in mobilising of resources for personal self-management or peer support was a relatively absent or hidden a focus of the available studies. Conclusions Based on an interpretive synthesis of available studies, people with a diagnosis of schizophrenia or psychosis use the Internet primarily for

  13. The Home-Based Occupational Therapy Intervention in the Alzheimer’s Disease Multiple Intervention Trial (ADMIT)

    PubMed Central

    Schmid, Arlene A.; Spangler-Morris, Carrie; Beauchamp, Rachel C.; Wellington, Miranda C.; Hayden, Whitney M.; Porterfield, Hannah S.; Ferguson, Denisha; Callahan, Christopher M.

    2015-01-01

    There is no way to prevent functional declines related to Alzheimer’s Disease (AD). The use of occupational therapy (OT) has been shown to be successful in managing some aspects of AD. We added home-based OT to evidence-based best practice for AD with the aim of delaying functional decline in people with AD. OT was delivered in the home to a caregiver dyad including the person with AD and her/his caregiver. This paper describes the OT intervention for the AD Multiple Intervention Trial, a parallel randomized controlled trial. We include baseline data on the 180 caregiver dyads. PMID:26997685

  14. Privacy and information security risks in a technology platform for home-based chronic disease rehabilitation and education

    PubMed Central

    2013-01-01

    Background Privacy and information security are important for all healthcare services, including home-based services. We have designed and implemented a prototype technology platform for providing home-based healthcare services. It supports a personal electronic health diary and enables secure and reliable communication and interaction with peers and healthcare personnel. The platform runs on a small computer with a dedicated remote control. It is connected to the patient’s TV and to a broadband Internet. The platform has been tested with home-based rehabilitation and education programs for chronic obstructive pulmonary disease and diabetes. As part of our work, a risk assessment of privacy and security aspects has been performed, to reveal actual risks and to ensure adequate information security in this technical platform. Methods Risk assessment was performed in an iterative manner during the development process. Thus, security solutions have been incorporated into the design from an early stage instead of being included as an add-on to a nearly completed system. We have adapted existing risk management methods to our own environment, thus creating our own method. Our method conforms to ISO’s standard for information security risk management. Results A total of approximately 50 threats and possible unwanted incidents were identified and analysed. Among the threats to the four information security aspects: confidentiality, integrity, availability, and quality; confidentiality threats were identified as most serious, with one threat given an unacceptable level of High risk. This is because health-related personal information is regarded as sensitive. Availability threats were analysed as low risk, as the aim of the home programmes is to provide education and rehabilitation services; not for use in acute situations or for continuous health monitoring. Conclusions Most of the identified threats are applicable for healthcare services intended for patients or

  15. A randomized controlled trial of telephone-mentoring with home-based walking preceding rehabilitation in COPD

    PubMed Central

    Cameron-Tucker, Helen Laura; Wood-Baker, Richard; Joseph, Lyn; Walters, Julia A; Schüz, Natalie; Walters, E Haydn

    2016-01-01

    Purpose With the limited reach of pulmonary rehabilitation (PR) and low levels of daily physical activity in chronic obstructive pulmonary disease (COPD), a need exists to increase daily exercise. This study evaluated telephone health-mentoring targeting home-based walking (tele-rehab) compared to usual waiting time (usual care) followed by group PR. Patients and methods People with COPD were randomized to tele-rehab (intervention) or usual care (controls). Tele-rehab delivered by trained nurse health-mentors supported participants’ home-based walking over 8–12 weeks. PR, delivered to both groups simultaneously, included 8 weeks of once-weekly education and self-management skills, with separate supervised exercise. Data were collected at three time-points: baseline (TP1), before (TP2), and after (TP3) PR. The primary outcome was change in physical capacity measured by 6-minute walk distance (6MWD) with two tests performed at each time-point. Secondary outcomes included changes in self-reported home-based walking, health-related quality of life, and health behaviors. Results Of 65 recruits, 25 withdrew before completing PR. Forty attended a median of 6 (4) education sessions. Seventeen attended supervised exercise (5±2 sessions). Between TP1 and TP2, there was a statistically significant increase in the median 6MWD of 12 (39.1) m in controls, but no change in the tele-rehab group. There were no significant changes in 6MWD between other time-points or groups, or significant change in any secondary outcomes. Participants attending supervised exercise showed a nonsignificant improvement in 6MWD, 12.3 (71) m, while others showed no change, 0 (33) m. The mean 6MWD was significantly greater, but not clinically meaningful, for the second test compared to the first at all time-points. Conclusion Telephone-mentoring for home-based walking demonstrated no benefit to exercise capacity. Two 6-minute walking tests at each time-point may not be necessary. Supervised exercise

  16. Home-based neuromuscular electrical stimulation improves exercise tolerance and health-related quality of life in patients with COPD

    PubMed Central

    Coquart, Jérémy B; Grosbois, Jean-Marie; Olivier, Cecile; Bart, Frederic; Castres, Ingrid; Wallaert, Benoit

    2016-01-01

    Background This retrospective, observational study of a routine clinical practice reports the feasibility and efficiency of home-based pulmonary rehabilitation (PR), including transcutaneous neuromuscular electrical stimulation (NMES) or usual endurance physical exercise (UEPE), on exercise tolerance, anxiety/depression, and health-related quality of life (HRQoL) in patients with COPD. Methods Seventy-one patients with COPD participated in home-based PR with NMES (Group NMES [GNMES]), while 117 patients participated in home-based PR with the UEPEs (Group UEPE [GUEPE]). NMES was applied for 30 minutes twice a day, every day. The endurance exercises in GUEPE began with a minimum 10-minute session at least 5 days a week, with the goal being 30–45 minutes per session. Three upper and lower limb muscle strengthening exercises lasting 10–15 minutes were also proposed to both the groups for daily practice. Moreover, PR in both the groups included a weekly 90-minute session based on an educational needs assessment. The sessions comprised endurance physical exercise for GUEPE, NMES for GNMES, resumption of physical daily living activities, therapeutic patient education, and psychosocial support to facilitate health behavior changes. Before and after PR, functional mobility and physical exercise capacity, anxiety, depression, and HRQoL were evaluated at home. Results The study revealed that NMES significantly improved functional mobility (−18.8% in GNMES and −20.6% in GUEPE), exercise capacity (+20.8% in GNMES and +21.8% in GUEPE), depression (−15.8% in GNMES and −30.1% in GUEPE), and overall HRQoL (−7.0% in GNMES and −18.5% in GUEPE) in the patients with COPD, regardless of the group (GNMES or GUEPE) or severity of airflow obstruction. Moreover, no significant difference was observed between the groups with respect to these data (P>0.05). Conclusion Home-based PR including self-monitored NMES seems feasible and effective for severely disabled COPD patients

  17. A randomized controlled trial of telephone-mentoring with home-based walking preceding rehabilitation in COPD

    PubMed Central

    Cameron-Tucker, Helen Laura; Wood-Baker, Richard; Joseph, Lyn; Walters, Julia A; Schüz, Natalie; Walters, E Haydn

    2016-01-01

    Purpose With the limited reach of pulmonary rehabilitation (PR) and low levels of daily physical activity in chronic obstructive pulmonary disease (COPD), a need exists to increase daily exercise. This study evaluated telephone health-mentoring targeting home-based walking (tele-rehab) compared to usual waiting time (usual care) followed by group PR. Patients and methods People with COPD were randomized to tele-rehab (intervention) or usual care (controls). Tele-rehab delivered by trained nurse health-mentors supported participants’ home-based walking over 8–12 weeks. PR, delivered to both groups simultaneously, included 8 weeks of once-weekly education and self-management skills, with separate supervised exercise. Data were collected at three time-points: baseline (TP1), before (TP2), and after (TP3) PR. The primary outcome was change in physical capacity measured by 6-minute walk distance (6MWD) with two tests performed at each time-point. Secondary outcomes included changes in self-reported home-based walking, health-related quality of life, and health behaviors. Results Of 65 recruits, 25 withdrew before completing PR. Forty attended a median of 6 (4) education sessions. Seventeen attended supervised exercise (5±2 sessions). Between TP1 and TP2, there was a statistically significant increase in the median 6MWD of 12 (39.1) m in controls, but no change in the tele-rehab group. There were no significant changes in 6MWD between other time-points or groups, or significant change in any secondary outcomes. Participants attending supervised exercise showed a nonsignificant improvement in 6MWD, 12.3 (71) m, while others showed no change, 0 (33) m. The mean 6MWD was significantly greater, but not clinically meaningful, for the second test compared to the first at all time-points. Conclusion Telephone-mentoring for home-based walking demonstrated no benefit to exercise capacity. Two 6-minute walking tests at each time-point may not be necessary. Supervised exercise

  18. Parent and caregiver perspectives on home-based newborn care in low-income settings: protocol for a systematic review of qualitative studies

    PubMed Central

    Bazzano, Alessandra N; Felker-Kantor, Erica; Kaji, Aiko; Saldanha, Lisa

    2016-01-01

    Introduction Newborn health and survival are closely linked to essential newborn care provided within the first days and weeks of an infant's life by parents and caregivers at home and within the community. Newborn care practices are often socially and culturally determined and have been explored in qualitative and formative research related to improving neonatal survival. We aim to provide a comprehensive review of qualitative studies on parent and caregiver experiences of newborn care practices with a view to identifying barriers and facilitators that may impact on newborn health. The rationale is that providing this information will be useful for intervention design and programme scale up for newborn survival. Methods and analysis We will systematically review qualitative studies reporting on newborn care practices. The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement will be used for reporting the stages of the review and dissemination. The search period will include all studies published from 2006 to 2016. Study selection will incorporate the ENTREQ and Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines and quality assessment will be completed using Critical Appraisal Skills Programme (CASP) guidelines. Pending the identification of sufficient data of good quality, we will conduct a full synthesis of the studies identified by the review. Ethics and dissemination The results will be disseminated through peer-reviewed publications, conference presentation and directly to organisations involved in newborn health. Formal ethical approval from the author's institution is not required, as no primary data or identifying data will be collected. Trial registration number CRD42016035674. PMID:27531737

  19. [Catheter-related infection in home-based parenteral nutrition: outcomes from the NADYA group and presentation of a new protocol].

    PubMed

    Cuerda, Compés C; Bretón, Lesmes I; Bonada Sanjaume, A; Planas Vila, M

    2006-01-01

    Hom parenteral nutrition (HPN) is a nutritional support modality that allows for the supply of parenteral nutrition bags to the patient's home. Since its first use in the late 60s, this therapy has allowed maintaining patients with intestinal failure alive that previously were doomed to death. In our country, this therapy is used by 2.15 patients pmp. According to the NADYA data, catheter-related infections account for 50% of all HPN-related complications. In larger series, infection rates are 0.5-2 infections/1000 days or 0.3-0.5 infections/patient/year. Most of them are produced by gram-positive organisms that migrate from the skin or from catheter connections to the tip. These infections are diagnosed by means of clinical data and with different microbiological cultures. When treating these infections, it is important to keep the catheter in place, and administering antibiotics through it, conventionally or with the antibioticolade technique.

  20. Home-based community health worker intervention to reduce pesticide exposures to farmworkers' children: A randomized-controlled trial.

    PubMed

    Salvatore, Alicia L; Castorina, Rosemary; Camacho, José; Morga, Norma; López, Jesús; Nishioka, Marcia; Barr, Dana B; Eskenazi, Brenda; Bradman, Asa

    2015-01-01

    We conducted a randomized-controlled trial of a home-based intervention to reduce pesticide exposures to farmworkers' children in Monterey County, California (n=116 families). The intervention consisted of three home-based educational sessions delivered by community health workers in Spanish. Measurements of organophosphate (OP) insecticide metabolites in child urine (n=106) and pesticides in home floor wipes (n=103) were collected before and after the intervention. Median child urinary dialkyl phosphate (DAP) metabolite levels were slightly lower among the intervention group children at follow-up compared with baseline, albeit nonsignificantly. DAP metabolite levels in the control group children were markedly higher at follow-up compared with baseline. In adjusted models, intervention participation was associated with a 51% decrease in total DAP metabolite levels. Carbaryl, chlorpyrifos, cypermethrin, dacthal, diazinon, malathion, and trans-permethrin were commonly detected in the floor wipes. In adjusted models, intervention participation was significantly associated with a 37% decrease in trans-permethrin floor wipe levels in homes, but not OP or other agricultural pesticides. In summary, intervention group children had slightly reduced pesticide exposures, whereas child exposures were higher among the control group. Additional intervention studies evaluating methods to reduce pesticide exposures to farmworker families and children are needed.

  1. Effectiveness of home-based early intervention on the language development of children of mothers with mental retardation.

    PubMed

    Feldman, M A; Sparks, B; Case, L

    1993-01-01

    The authors evaluated the effects of a home-based parent training program for mothers with mental retardation on the language development of their children who were at risk for language delay. The participants, 28 mothers labelled mentally retarded with children under 28 months of age, initially showed significantly fewer positive mother-child interactions and child vocalizations and verbalizations than did a comparison group of 38 families with children of similar age whose mothers were not mentally retarded. The 28 mothers with low IQ were then matched on child entry age and randomly assigned to either an interaction training or attention-control group (this group received training in safety and emergency skills unrelated to interactions). Interaction training consisted of verbal instruction, modelling, feedback, and tangible reinforcement. After training, the training group scores were no longer lower than those of the comparison group of mothers without mental retardation and were also significantly higher than the scores of the attention-control group on all maternal positive interactions, child vocalizations, verbalizations, and language and social domains of the Bayley Scales of Infant Development. Speech emerged significantly sooner in the training group as compared to the control group. The training group parents and children maintained improvements up to 82 weeks following training, and the attention-control group, when subsequently trained, replicated the original training group results. Thus, home-based parent training increased positive maternal interactions of mothers with mental retardation, which facilitated language development in their young children.

  2. Personalized Home-based Interval Exercise Training May Improve Cardiorespiratory Fitness in Cancer Patients Preparing to Undergo Hematopoietic Cell Transplantation

    PubMed Central

    Wood, William A; Phillips, Brett; Smith-Ryan, Abbie E; Wilson, Doug; Deal, Allison M; Bailey, Charlotte; Meeneghan, Mathew; Reeve, Bryce B; Basch, Ethan M; Bennett, Antonia V; Shea, Thomas C; Battaglini, Claudio L

    2016-01-01

    Impaired cardiorespiratory fitness is associated with inferior survival in patients preparing to undergo hematopoietic cell transplantation (HCT). Exercise training based on short, higher-intensity intervals has the potential to efficiently improve cardiorespiratory fitness. We studied home-based interval exercise training (IET) in 40 patients prior to autologous (N=20) or allogeneic (N=20) HCT. Each session consisted of 5, three-minute intervals of walking, jogging, or cycling at 65-95% maximal heart rate (MHR) with 3 minutes of low intensity exercise (<65% MHR) between intervals. Participants were asked to perform sessions at least 3 times weekly. The duration of the intervention was at least 6 weeks, depending on each patient’s scheduled transplantation date. Cardiorespiratory fitness was assessed from a peak oxygen consumption test (VO2peak) and a 6 minute walk (6MWD) before and after the intervention period. For the autologous HCT cohort, improvements in VO2peak (p=0.12) and 6MWD (p=0.19) were not statistically significant. For the allogeneic cohort, the median VO2peak improvement was 3.7ml/kg*min (p=0.005) and the median 6MWD improvement was 34 meters (p=0.006). Home-based, interval exercise training can be performed prior to HCT and has the potential to improve cardiorespiratory fitness. PMID:26999467

  3. Adherence to a home-based exercise program and incidence of cardiovascular disease in type 2 diabetes patients.

    PubMed

    Shinji, S; Shigeru, M; Ryusei, U; Mitsuru, M; Shigehiro, K

    2007-10-01

    The aim of this study was to examine the association between adherence to a home-based exercise program and the incidence of cardiovascular disease (CVD) in patients with type 2 diabetes. We investigated 102 patients with type 2 diabetes aged 35 to 75 years, and followed them prospectively for 17.2 months. Before enrollment, all patients received a traditional exercise prescription. The exercise program consisted of a daily walking exercise at home for 20 - 30 minutes. Self-reported adherence to the exercise program and the incidence of CVD were confirmed by information obtained from telephone interviews. There were 38 dropouts among the patients in the exercise program. Dropouts were significantly younger than completers. The rate of obesity was significantly higher among the dropouts than among the completers. No differences were observed between the two groups for gender, history of CVD and other clinical characteristics. During the follow-up, we documented 8 new cases of CVD. The incidence of CVD during the follow-up was 1.56 percent among the program completers and 18.4 percent among the dropouts. Adherence to the home-based exercise was inversely related to the incidence of CVD (p < 0.01). These associations persisted after adjustment for age and other covariates. In conclusion, adherence to an exercise program is associated with a reduced incidence of CVD among patients with type 2 diabetes. PMID:17436204

  4. An assessment of food supplementation to chronically sick patients receiving home based care in Bangwe, Malawi : a descriptive study

    PubMed Central

    Bowie, Cameron; Kalilani, Linda; Marsh, Reg; Misiri, Humphrey; Cleary, Paul; Bowie, Claire

    2005-01-01

    Background The effect of food supplementation provided by the World Food Programme to patients and their families enrolled in a predominantly HIV/AIDS home based care programme in Bangwe Malawi is assessed. Methods The survival and nutritional status of patients and the nutritional status of their families recruited up to six months before a food supplementation programme started are compared to subsequent patients and their families over a further 12 months. Results 360 patients, of whom 199 died, were studied. Food supplementation did not improve survival but had an effect (not statistically significant) on nutritional status. Additional oil was given to some families; it may have improved survival but not nutritional status. Conclusion Food supplementation to HIV/AIDS home based care patients and their families does not work well. This may be because the intervention is too late to affect the course of disease or insufficiently targeted perhaps due to problems of distribution in an urban setting. The World Food Programme's emphasis on supplementary feeding for these families needs to be reviewed. PMID:15777483

  5. Personalized home-based interval exercise training may improve cardiorespiratory fitness in cancer patients preparing to undergo hematopoietic cell transplantation.

    PubMed

    Wood, W A; Phillips, B; Smith-Ryan, A E; Wilson, D; Deal, A M; Bailey, C; Meeneghan, M; Reeve, B B; Basch, E M; Bennett, A V; Shea, T C; Battaglini, C L

    2016-07-01

    Impaired cardiorespiratory fitness is associated with inferior survival in patients preparing to undergo hematopoietic cell transplantation (HCT). Exercise training based on short, higher intensity intervals has the potential to efficiently improve cardiorespiratory fitness. We studied home-based interval exercise training (IET) in 40 patients before autologous (N=20) or allogeneic (N=20) HCT. Each session consisted of five, 3 min intervals of walking, jogging or cycling at 65-95% maximal heart rate (MHR) with 3 min of low-intensity exercise (<65% MHR) between intervals. Participants were asked to perform sessions at least three times weekly. The duration of the intervention was at least 6 weeks, depending on each patient's scheduled transplantation date. Cardiorespiratory fitness was assessed from a peak oxygen consumption test (VO2peak) and a 6 min walk (6MWD) before and after the intervention period. For the autologous HCT cohort, improvements in VO2peak (P=0.12) and 6MWD (P=0.19) were not statistically significant. For the allogeneic cohort, the median VO2peak improvement was 3.7 ml/kg min (P=0.005) and the median 6MWD improvement was 34 m (P=0.006). Home-based IET can be performed before HCT and has the potential to improve cardiorespiratory fitness. PMID:26999467

  6. Feasibility of a Home-Based Speed of Processing Training Program in Middle-Aged and Older Adults With HIV.

    PubMed

    Cody, Shameka L; Fazeli, Pariya L; Vance, David E

    2015-08-01

    There has been much optimism over the positive impact of combination antiretroviral therapy (cART) on life expectancy for people with HIV; however, those aging with HIV fear potential day-to-day challenges associated with the development of cognitive deficits. The presence of cognitive deficits has generated major safety concerns because it has been shown to impact driving, mobility, and employment. Given the efficacy of a computerized speed of processing training program administered in the laboratory to older adults and adults with HIV, this study was designed to determine the feasibility of using a home-based speed of processing training program to improve cognitive function in middle-aged and older adults with HIV. In this within-subject pre-post experimental design, 20 middle-aged and older adults (i.e., age of 40+ years) with HIV were administered a brief neuropsychological assessment to gauge their baseline cognitive function before participating in a 10-hour home-based computerized cognitive remediation training program. In addition to self-reported cognitive gains, a 6-week posttest indicated significant improvements on the Useful Field of View, a measure of speed of processing and possible transfer to the Timed Instrumental Activities of Daily Living test, a measure of everyday functioning. These findings show that speed of processing training can successfully improve cognitive function in this vulnerable population even when administered in remote settings such as the privacy of one's home.

  7. The EU-project United4Health: User-Centred Design and Evaluation of a Collaborative Information System for a Norwegian Telehealth Service.

    PubMed

    Smaradottir, Berglind; Gerdes, Martin; Martinez, Santiago; Fensli, Rune

    2015-01-01

    This study presents the user-centred design and evaluation process of a Collaborative Information System (CIS), developed for a new telehealth service for remote monitoring of chronic obstructive pulmonary disease patients after hospital discharge. The CIS was designed based on the information gathered in a workshop, where target end-users described the context of use, a telehealth workflow and their preferred ways of interaction with the solution. Evaluation of the iterative refinements were made through user tests, semi-structured interviews and a questionnaire. A field trial reported results on the ease of use and user satisfaction during the interaction with the fully developed system. The implemented CIS was successfully deployed within the secured Norwegian Health Network. The research was a result of cooperation between international partners within the EU FP7 project United4Health.

  8. The validity and reliability of the World Health Organization Mental Disorders Checklist for use in a telehealth clinic in Hong Kong.

    PubMed

    Leung, Sau Fong; Chui, Caroline; Arthur, David; French, Peter; Lai, Alice; Lee, Wai Man; Wong, Daniel

    2005-06-01

    This research aimed to test the validity and reliability of the 'World Health Organization Mental Disorders Checklist' for use in a telehealth clinic in Hong Kong. The Checklist adopted four subscales: (i) depression; (ii) anxiety; (iii) alcohol use disorders; and (vi) functioning and disablement, and was translated from English into Chinese. It was validated by a panel of five experts to confirm its content validity (content validity index = 0.98) and cultural appropriateness in Hong Kong. The reliability of the checklist was supported by the findings of a test-retest procedure (Pearson correlation = 0.66-0.88, P < 0.01), internal consistency reliability (Cronbach's alpha = 0.54-0.83), and interrater reliability (Kendall's coefficient of concordance = 0.58-1.00, P < 0.01) involving a sample of 197 subjects from one telehealth clinic in Hong Kong.

  9. Design of the muscles in motion study: a randomized controlled trial to evaluate the efficacy and feasibility of an individually tailored home-based exercise training program for children and adolescents with juvenile dermatomyositis

    PubMed Central

    2012-01-01

    Background Juvenile dermatomyositis (JDM) is a rare, often chronic, systemic autoimmune disease of childhood, characterized by inflammation of the microvasculature of the skeletal muscle and skin. Prominent clinical features include significant exercise intolerance, muscle weakness, and fatigue. Despite pharmacological improvements, these clinical features continue to affect patients with JDM, even when the disease is in remission. Exercise training is increasingly utilized as a non-pharmacological intervention in the clinical management of (adult) patients with chronic inflammatory conditions; however no randomized controlled trials (RCT) have been performed in JDM. In the current study, the efficacy and feasibility of an exercise training program in patients with JDM will be examined. Methods/design Subjects (n = 30) will include 8–18 year olds diagnosed with JDM. The intervention consists of an individually tailored 12-weeks home-based exercise training program in which interval training on a treadmill is alternated with strength training during each session. The program is based on previous literature and designed with a defined frequency, intensity, time, and type of exercise (FITT principles). Primary outcome measures include aerobic exercise capacity, isometric muscle strength, and perception of fatigue. The study methodology has been conceived according to the standards of the CONSORT guidelines. The current study will be a multi-center (4 Dutch University Medical Centers) RCT, with the control group also entering the training arm directly after completion of the initial protocol. Randomization is stratified according to age and gender. Discussion The current study will provide evidence on the efficacy and feasibility of an individually tailored 12-week home-based exercise training program in youth with JDM. Trial registration Medical Ethics Committee of the University Medical Center Utrecht, the Netherlands: 11–336; Netherlands Trial Register

  10. Augmentation of special-needs services and information to students and teachers "ASSIST"--a telehealth innovation providing school-based medical interventions.

    PubMed

    Gallagher, Thomas E

    2004-10-01

    An innovative school-based telehealth technology was introduced in Hawaii with the purposes of: (1) evaluating students for medical/developmental conditions with educational implications, (2) providing a professionally-monitored Internet-based system of learning/development, and (3) delivering medically-based physical and occupational therapy at the students school. Electronically recorded satisfaction surveys from parents, teachers, and providers revealed significant improvement in all three areas. PMID:15570717

  11. Cost-effectiveness modelling of telehealth for patients with raised cardiovascular disease risk: evidence from a cohort simulation conducted alongside the Healthlines randomised controlled trial

    PubMed Central

    Dixon, Padraig; Ara, Roberta; Edwards, Louisa; Foster, Alexis

    2016-01-01

    Objectives To investigate the long-term cost-effectiveness (measured as the ratio of incremental NHS cost to incremental quality-adjusted life years) of a telehealth intervention for patients with raised cardiovascular disease (CVD) risk. Design A cohort simulation model developed as part of the economic evaluation conducted alongside the Healthlines randomised controlled trial. Setting Patients recruited through primary care, and intervention delivered via telehealth service. Participants Participants with a 10-year CVD risk ≥20%, as measured by the QRISK2 algorithm, and with at least 1 modifiable risk factor, individually randomised from 42 general practices in England. Intervention A telehealth service delivered over a 12-month period. The intervention involved a series of responsive, theory-led encounters between patients and trained health information advisors who provided access to information resources and supported medication adherence and coordination of care. Primary and secondary outcome measures Cost-effectiveness measured by net monetary benefit over the simulated lifetime of trial participants from a UK National Health Service perspective. Results The probability that the intervention was cost-effective depended on the duration of the effect of the intervention. The intervention was cost-effective with high probability if effects persisted over the lifetime of intervention recipients. The probability of cost-effectiveness was lower for shorter durations of effect. Conclusions The intervention was likely to be cost-effective under a lifetime perspective. Trial registration number ISRCTN27508731; Results. PMID:27670521

  12. An assessment of the telehealth needs and health-care priorities of Tanna Island: a remote, under-served and vulnerable population.

    PubMed

    Khazei, Afshin; Jarvis-Selinger, Sandra; Ho, Kendall; Lee, Anna

    2005-01-01

    We surveyed eight Canadian physicians who had each provided medical care for six months on the remote and under-served island of Tanna in Vanuatu. The most frequently encountered medical problems on Tanna were infectious diseases (tuberculosis, hepatitis, abscesses, malaria, pneumonia, typhoid fever, meningitis and skin infections). When physicians were asked about the top three health-care priorities, they ranked tuberculosis control, clean water and improved health-care delivery/communication between hospital and outposts as most important. The key issues were: (1) basic public health needs and infrastructure development are higher in priority than telehealth; (2) telehealth consultants must have knowledge pertinent to local conditions and resources available to the population; (3) electronic equipment suited to tropical environments is needed; (4) projects must be developed locally rather than internationally. Understanding how telehealth can provide support to health professionals under challenging conditions may assist with the health priorities in developing countries and potentially provide access to resources both locally and internationally.

  13. Telehealth for patients at high risk of cardiovascular disease: pragmatic randomised controlled trial

    PubMed Central

    O’Cathain, Alicia; Thomas, Clare; Edwards, Louisa; Gaunt, Daisy; Dixon, Padraig; Hollinghurst, Sandra; Nicholl, Jon; Large, Shirley; Yardley, Lucy; Fahey, Tom; Foster, Alexis; Garner, Katy; Horspool, Kimberley; Man, Mei-See; Rogers, Anne; Pope, Catherine; Montgomery, Alan A

    2016-01-01

    ), mean diastolic −2.8 (−4.0 to −1.6 mm Hg); weight −1.0 kg (−1.8 to −0.3 kg), and body mass index −0.4 ( −0.6 to −0.1) but not cholesterol −0.1 (−0.2 to 0.0), smoking status (adjusted odds ratio 0.4, 0.2 to 1.0), or overall cardiovascular risk as a continuous measure (−0.4, −1.2 to 0.3)). The intervention was associated with improvements in diet, physical activity, drug adherence, and satisfaction with access to care, treatment received, and care coordination. One serious related adverse event occurred, when a participant was admitted to hospital with low blood pressure. Conclusions This evidence based telehealth approach was associated with small clinical benefits for a minority of people with high cardiovascular risk, and there was no overall improvement in average risk. The Healthlines service was, however, associated with improvements in some risk behaviours, and in perceptions of support and access to care. Trial registration Current Controlled Trials ISRCTN 27508731. PMID:27252245

  14. User preferences and usability of iVitality: optimizing an innovative online research platform for home-based health monitoring

    PubMed Central

    van Osch, Mara; Rövekamp, AJM; Bergman-Agteres, Stephanie N; Wijsman, Liselotte W; Ooms, Sharon J; Mooijaart, Simon P; Vermeulen, Joan

    2015-01-01

    Background The iVitality online research platform has been developed to gain insight into the relationship between early risk factors (ie, poorly controlled hypertension, physical or mental inactivity) and onset and possibly prevention of dementia. iVitality consists of a website, a smartphone application, and sensors that can monitor these indicators at home. Before iVitality can be implemented, it should fit the needs and preferences of users, ie, offspring of patients with dementia. This study aimed to explore users’ motivation to participate in home-based health monitoring research, to formulate requirements based on users’ preferences to optimize iVitality, and to test usability of the smartphone application of iVitality. Methods We recruited 13 participants (aged 42–64 years, 85% female), who were offspring of patients with dementia. A user-centered methodology consisting of four iterative phases was used. Three semistructured interviews provided insight into motivation and acceptance of using iVitality (phase 1). A focus group with six participants elaborated on expectations and preferences regarding iVitality (phase 2). Findings from phase 1 and 2 were triangulated by two semistructured interviews (phase 3). Four participants assessed the usability of the smartphone application (phase 4) using a think aloud procedure and a questionnaire measuring ease and efficiency of use (scale 1–7; higher scores indicated better usability). Results All participants were highly motivated to contribute to dementia research. However, the frequency of home-based health monitoring should not be too high. Participants preferred to receive feedback about their measurements and information regarding the relationship between these measurements and dementia. Despite minor technical errors, iVitality was considered easy and efficient to use (mean score 5.50, standard deviation 1.71). Conclusion Offspring of patients with dementia are motivated to contribute to home-based

  15. The seven Cs of the high acceptability of home-based VCT: results from a mixed methods approach in Zambia.

    PubMed

    Jürgensen, Marte; Sandøy, Ingvild F; Michelo, Charles; Fylkesnes, Knut; Mwangala, Sheila; Blystad, Astrid

    2013-11-01

    HIV testing and counselling is a critical gateway to prevention and treatment. Yet, coverage remains insufficient, few couples are tested together and gender differences in access exist. We used an embedded mixed methods approach to investigate possible explanations for the high acceptance of home-based voluntary HIV counselling and testing (HB-VCT) in a pair-matched cluster-randomized trial in Zambia. A baseline survey included 1694 individuals in 36 clusters. Adults in 18 intervention clusters were offered HB-VCT by lay counsellors. Standard testing services were available in both trial arms. After the completion of the intervention, a follow-up survey was conducted in all trial clusters. In addition, 21 in-depth interviews and one focus group discussion were conducted with home-based VCT clients in the intervention arm. Informants favoured the convenience, confidentiality and credibility of HB-VCT. Counsellors were perceived as trustworthy owing to their closeness and conduct, and the consent process was experienced as convincing. Couple testing was selected by 70% of cohabiting couples and was experienced as beneficial by both genders. Levels of first-time testing (68% vs. 29%, p < 0.0001) and re-testing (94% vs. 74%, p < 0.0001) were higher in the intervention than in the control arm. Acceptance of HIV testing and counselling is dependent on stigma, trust and gender. The confidentiality of home-based VCT was essential for overcoming stigma-related barriers, and the selection of local counsellors was important to ensure trust in the services. The high level of couple counselling within HB-VCT may contribute to closing the gender gap in HIV testing, and has benefits for both genders and potentially for prevention of HIV transmission. The study demonstrates the feasibility of achieving high test coverage with an opt-in consent approach. The embedded qualitative component confirmed the high satisfaction with HB-VCT reported in the quantitative survey and was

  16. The seven Cs of the high acceptability of home-based VCT: results from a mixed methods approach in Zambia.

    PubMed

    Jürgensen, Marte; Sandøy, Ingvild F; Michelo, Charles; Fylkesnes, Knut; Mwangala, Sheila; Blystad, Astrid

    2013-11-01

    HIV testing and counselling is a critical gateway to prevention and treatment. Yet, coverage remains insufficient, few couples are tested together and gender differences in access exist. We used an embedded mixed methods approach to investigate possible explanations for the high acceptance of home-based voluntary HIV counselling and testing (HB-VCT) in a pair-matched cluster-randomized trial in Zambia. A baseline survey included 1694 individuals in 36 clusters. Adults in 18 intervention clusters were offered HB-VCT by lay counsellors. Standard testing services were available in both trial arms. After the completion of the intervention, a follow-up survey was conducted in all trial clusters. In addition, 21 in-depth interviews and one focus group discussion were conducted with home-based VCT clients in the intervention arm. Informants favoured the convenience, confidentiality and credibility of HB-VCT. Counsellors were perceived as trustworthy owing to their closeness and conduct, and the consent process was experienced as convincing. Couple testing was selected by 70% of cohabiting couples and was experienced as beneficial by both genders. Levels of first-time testing (68% vs. 29%, p < 0.0001) and re-testing (94% vs. 74%, p < 0.0001) were higher in the intervention than in the control arm. Acceptance of HIV testing and counselling is dependent on stigma, trust and gender. The confidentiality of home-based VCT was essential for overcoming stigma-related barriers, and the selection of local counsellors was important to ensure trust in the services. The high level of couple counselling within HB-VCT may contribute to closing the gender gap in HIV testing, and has benefits for both genders and potentially for prevention of HIV transmission. The study demonstrates the feasibility of achieving high test coverage with an opt-in consent approach. The embedded qualitative component confirmed the high satisfaction with HB-VCT reported in the quantitative survey and was

  17. A Home-Based Intervention to Reduce Depressive Symptoms and Improve Quality of Life in Older African Americans

    PubMed Central

    Gitlin, Laura N.; Harris, Lynn Fields; McCoy, Megan C.; Chernett, Nancy L.; Pizzi, Laura T.; Jutkowitz, Eric; Hess, Edward; Hauck, Walter W.

    2014-01-01

    Background Effective care models for treating older African Americans with depressive symptoms are needed. Objective To determine whether a home-based intervention alleviates depressive symptoms and improves quality of life in older African Americans. Design Parallel, randomized trial stratified by recruitment site. Interviewers assessing outcomes were blinded to treatment assignment. (ClinicalTrials.gov: NCT00511680) Setting A senior center and participants’ homes from 2008 to 2010. Patients African Americans aged 55 years or older with depressive symptoms. Intervention A multicomponent, home-based intervention delivered by social workers or a wait-list control group that received the intervention at 4 months. Measurements Self-reported depression severity at 4 months (primary outcome) and depression knowledge, quality of life, behavioral activation, anxiety, function, and remission at 4 and 8 months. Results Of 208 participants (106 and 102 in the intervention and wait-list groups, respectively), 182 (89 and 93, respectively) completed 4 months and 160 (79 and 81, respectively) completed 8 months. At 4 months, participants in the intervention group showed reduced depression severity (difference in mean change in Patient Health Questionnaire-9 score from baseline, −2.9 [95% CI, −4.6 to −1.2]; difference in mean change in Center for Epidemiologic Studies Depression Scale score from baseline, −3.7 [CI, −5.4 to −2.1]); improved depression knowledge, quality of life, behavioral activation, and anxiety (P < 0.001); and improved function (P = 0.014) compared with wait-list participants. More intervention than wait-list participants entered remission at 4 months (43.8% vs. 26.9%). After treatment, control participants showed benefits similar in magnitude to those of participants in the initial intervention group. Those in the initial intervention group maintained benefits at 8 months. Limitation The study had a small sample, short duration, and differential

  18. Effectiveness of a Telehealth Service Delivery Model for Treating Attention-Deficit/Hyperactivity Disorder: A Community-Based Randomized Controlled Trial

    PubMed Central

    Myers, Kathleen; Stoep, Ann Vander; Zhou, Chuan; McCarty, Carolyn A.; Katon, Wayne

    2015-01-01

    Objective To test the effectiveness of a telehealth service delivery model for the treatment of children with attention-deficit/hyperactivity disorder (ADHD) that provided pharmacological treatment and caregiver behavior training. Method The Children’s ADHD Telemental Health Treatment Study (CATTS) was a randomized controlled trial with 223 children referred by 88 primary care providers (PCPs) in 7 communities. Children randomized to the experimental telehealth service model received 6 sessions over 22 weeks of combined pharmacotherapy, delivered by child psychiatrists through videoconferencing, and caregiver behavior training, provided in person by community therapists who were supervised remotely. Children randomized to the control service delivery model received treatment with their PCPs augmented with a telepsychiatry consultation. Outcomes were diagnostic criteria for ADHD and oppositional defiant disorder (ODD) and role performance on the Vanderbilt ADHD Rating Scale (VADRS) completed by caregivers (VADRS-Caregivers) and teachers (VADRS-Teachers) and impairment on the Columbia Impairment Scale-Parent Version (CIS-P). Measures were completed at 5 assessments over 25 weeks. Results Children in both service models improved. Children assigned to the telehealth service model improved significantly more than children in the augmented primary care arm for VADRS-Caregiver criteria for inattention (χ2[4]=19.47, p<.001), hyperactivity (χ2[4]=11.91, p=0.02), combined ADHD (χ2[4]=14.90, p=0.005), ODD (χ2[4]=10.05, p=0.04), and VADRS-Caregiver role performance (χ2 [4]=12.40, p=0.01) and CIS-P impairment (χ2[4]=20.52, p<.001). For the VADRS-Teacher diagnostic criteria, children in the telehealth service model had significantly more improvement in hyperactivity (χ2[4]=11.28, p=0.02) and combined ADHD (χ2[4]=9.72, p=0.045). Conclusion The CATTS trial demonstrated the effectiveness of a telehealth service model to treat ADHD in communities with limited access to

  19. Occupational Safety, Health, and Well-being Among Home-based Workers in the Informal Economy of Thailand.

    PubMed

    Nankongnab, Noppanun; Silpasuwan, Pimpan; Markkanen, Pia; Kongtip, Pornpimol; Woskie, Susan

    2015-08-01

    The objective of this article is to provide a summary of the issues related to occupational safety and health and well-being among workers in the informal economy of Thailand, with a special emphasis on home-based workers. The reviewed literature includes documents and information sources developed by the International Labour Organization, the National Statistical Office of Thailand, peer-reviewed scientific publications, and master's theses conducted in Thailand. This work is part of a needs and opportunities analysis carried out by the Center for Work, Environment, Nutrition and Development--a partnership between Mahidol University and University of Massachusetts Lowell to identify the gaps in knowledge and research to support government policy development in the area of occupational and environmental health for workers in the informal economy. PMID:26059416

  20. Cardiac status assessment with a multi-signal device for improved home-based congestive heart failure management.

    PubMed

    Muehlsteff, Jens; Carvalho, Paulo; Henriques, Jorge; Paiva, Rui P; Reiter, Harald

    2011-01-01

    State-of-the-Art disease management for Congestive Heart Failure (CHF) patients is still based on easy-to-acquire measures such as heart rate (HR), weight and blood pressure (BP). However, these measures respond late to changes of the patient health status and provide limited information to personalize and adapt medication therapy. This paper describes our concept called "Cardiac Status Assessment" we have been investigating within the European project "HeartCycle" towards next-generation home-based disease management of CHF. In our concept we analyze non-invasive surrogate measures of the cardio-vascular function in particular systolic time intervals and pulse wave characteristics to estimate Cardiac Output (CO) and Systemic Vascular Resistance (SVR) both are established clinical measures. We discuss the underlying concept, a developed measurement system and first results. PMID:22254450

  1. Occupational Safety, Health, and Well-being Among Home-based Workers in the Informal Economy of Thailand.

    PubMed

    Nankongnab, Noppanun; Silpasuwan, Pimpan; Markkanen, Pia; Kongtip, Pornpimol; Woskie, Susan

    2015-08-01

    The objective of this article is to provide a summary of the issues related to occupational safety and health and well-being among workers in the informal economy of Thailand, with a special emphasis on home-based workers. The reviewed literature includes documents and information sources developed by the International Labour Organization, the National Statistical Office of Thailand, peer-reviewed scientific publications, and master's theses conducted in Thailand. This work is part of a needs and opportunities analysis carried out by the Center for Work, Environment, Nutrition and Development--a partnership between Mahidol University and University of Massachusetts Lowell to identify the gaps in knowledge and research to support government policy development in the area of occupational and environmental health for workers in the informal economy.

  2. The Team Approach to Home-Based Primary Care: Restructuring Care to Meet Patient, Program, and System Needs

    PubMed Central

    Reckrey, Jennifer M.; Soriano, Theresa A.; Hernandez, Cameron R.; DeCherrie, Linda V.; Chavez, Silvia; Zhang, Meng; Ornstein, Katherine

    2016-01-01

    Team-based models of care are an important way to meet the complex medical and psychosocial needs of the homebound. As part of a quality improvement project to address patient, program, and system needs, we restructured a portion of our large, physician-led academic home-based primary care practice into a team-based model. With support from an office-based nurse practitioner, a dedicated social worker, and a dedicated administrative assistant, physicians were able to care for a larger number of patients. Hospitalizations, readmissions, and patient satisfaction remained the same while physician panel size increased and physician satisfaction improved. Our Team Approach is an innovative way to improve interdisciplinary, team-based care though practice restructuring and serves as an example of how other practices can approach the complex task of caring for the homebound. PMID:25645568

  3. The team approach to home-based primary care: restructuring care to meet individual, program, and system needs.

    PubMed

    Reckrey, Jennifer M; Soriano, Theresa A; Hernandez, Cameron R; DeCherrie, Linda V; Chavez, Silvia; Zhang, Meng; Ornstein, Katherine

    2015-02-01

    Team-based models of care are an important way to meet the complex medical and psychosocial needs of the homebound. As part of a quality improvement project to address individual, program, and system needs, a portion of a large, physician-led academic home-based primary care practice was restructured into a team-based model. With support from an office-based nurse practitioner, a dedicated social worker, and a dedicated administrative assistant, physicians were able to care for a larger number of patients. Hospitalizations, readmissions, and patient satisfaction remained the same while physician panel size increased and physician satisfaction improved. The Team Approach is an innovative way to improve interdisciplinary, team-based care through practice restructuring and serves as an example of how other practices can approach the complex task of caring for the homebound.

  4. The team approach to home-based primary care: restructuring care to meet individual, program, and system needs.

    PubMed

    Reckrey, Jennifer M; Soriano, Theresa A; Hernandez, Cameron R; DeCherrie, Linda V; Chavez, Silvia; Zhang, Meng; Ornstein, Katherine

    2015-02-01

    Team-based models of care are an important way to meet the complex medical and psychosocial needs of the homebound. As part of a quality improvement project to address individual, program, and system needs, a portion of a large, physician-led academic home-based primary care practice was restructured into a team-based model. With support from an office-based nurse practitioner, a dedicated social worker, and a dedicated administrative assistant, physicians were able to care for a larger number of patients. Hospitalizations, readmissions, and patient satisfaction remained the same while physician panel size increased and physician satisfaction improved. The Team Approach is an innovative way to improve interdisciplinary, team-based care through practice restructuring and serves as an example of how other practices can approach the complex task of caring for the homebound. PMID:25645568

  5. An international randomized study of a home-based self-management program for severe COPD: the COMET

    PubMed Central

    Bourbeau, Jean; Casan, Pere; Tognella, Silvia; Haidl, Peter; Texereau, Joëlle B; Kessler, Romain

    2016-01-01

    Introduction Most hospitalizations and costs related to COPD are due to exacerbations and insufficient disease management. The COPD patient Management European Trial (COMET) is investigating a home-based multicomponent COPD self-management program designed to reduce exacerbations and hospital admissions. Design Multicenter parallel randomized controlled, open-label superiority trial. Setting Thirty-three hospitals in four European countries. Participants A total of 345 patients with Global initiative for chronic Obstructive Lung Disease III/IV COPD. Intervention The program includes extensive patient coaching by health care professionals to improve self-management (eg, develop skills to better manage their disease), an e-health platform for reporting frequent health status updates, rapid intervention when necessary, and oxygen therapy monitoring. Comparator is the usual management as per the center’s routine practice. Main outcome measures Yearly number of hospital days for acute care, exacerbation number, quality of life, deaths, and costs. PMID:27418817

  6. Educating Hispanic Women About Breast Cancer Prevention: Evaluation of a Home-Based Promotora-Led Intervention

    PubMed Central

    Coronado, Gloria D.; Espinoza, Noah; Islas, Ilda; Ibarra, Genoveva; Thompson, Beti

    2010-01-01

    Abstract Objectives Trained community health promoters (i.e., promotoras) conducted home-based group educational interventions (home health parties) to educate Hispanic women from the Lower Yakima Valley of Washington state about breast cancer and mammography screening. Methods Women aged 40–79 participating in the parties completed baseline and follow-up surveys 6 months postintervention (n = 70). Changes in general cancer knowledge, breast cancer screening practices, and intentions to be screened among participants from baseline to follow-up were measured using McNemar's test for marginal homogeneity to evaluate the effectiveness of the parties. Results The average age of the sample was 50.0 years (standard deviation [SD] 10.0), 84% reported less than an eighth grade education, and 54% were covered by the state's Basic Health Care Plan. Significant changes between baseline and follow-up were observed with respect to (1) believing that risk of cancer could not be reduced (41% vs. 15%, respectively, p = 0.001), (2) ever having a mammogram (83% vs. 91%, p = 0.014), (3) discussing a mammogram with a doctor (37% vs. 67%, p < 0.001), and (4) intending to have a mammogram within the next few months among women who did not report having a mammogram between baseline and follow-up (61% vs. 81%, p = 0.046). Conclusions Participation in home-based group educational interventions delivered by promotoras may be associated with improved breast cancer screening practices among Hispanic women. PMID:20849288

  7. Safety and efficacy of a 6-month home-based exercise program in patients with facioscapulohumeral muscular dystrophy

    PubMed Central

    Bankolé, Landry-Cyrille; Millet, Guillaume Y.; Temesi, John; Bachasson, Damien; Ravelojaona, Marion; Wuyam, Bernard; Verges, Samuel; Ponsot, Elodie; Antoine, Jean-Christophe; Kadi, Fawzi; Féasson, Léonard

    2016-01-01

    Abstract Background: Previous randomized controlled trials investigating exercise training programs in facioscapulohumeral muscular dystrophy (FSHD) patients are scarce and of short duration only. This study assessed the safety and efficacy of a 6-month home-based exercise training program on fitness, muscle, and motor function in FSHD patients. Methods: Sixteen FSHD patients were randomly assigned to training (TG) and control (CG) groups (both n = 8) in a home-based exercise intervention. Training consisted of cycling 3 times weekly for 35 minutes (combination of strength, high-intensity interval, and low-intensity aerobic) at home for 24 weeks. Patients in CG also performed an identical training program (CTG) after 24 weeks. The primary outcome was change in peak oxygen uptake (VO2 peak) measured every 6 weeks. The principal secondary outcomes were maximal quadriceps strength (MVC) and local quadriceps endurance every 12 weeks. Other outcome measures included maximal aerobic power (MAP) and experienced fatigue every 6 weeks, 6-minute walking distance every 12 weeks, and muscle characteristics from vastus lateralis biopsies taken pre- and postintervention. Results: The compliance rate was 91% in TG. Significant improvements with training were observed in the VO2 peak (+19%, P = 0.002) and MAP by week 6 and further to week 24. Muscle endurance, MVC, and 6-minute walking distance increased and experienced fatigue decreased. Muscle fiber cross-sectional area and citrate synthase activity increased by 34% (P = 0.008) and 46% (P = 0.003), respectively. Dystrophic pathophysiologic patterns were not exacerbated. Similar improvements were experienced by TG and CTG. Conclusions: A combined strength and interval cycling exercise-training program compatible with patients’ daily professional and social activities leads to significant functional benefits without compromising muscle tissue. PMID:27495097

  8. Sex-specific predictors of improved walking with step-monitored, home-based exercise in peripheral artery disease.

    PubMed

    Gardner, Andrew W; Parker, Donald E; Montgomery, Polly S

    2015-10-01

    The aim of this study was to determine whether baseline clinical characteristics and the duration and intensity of ambulation during our step-monitored home-based exercise program were predictive of changes in ambulatory outcomes at completion of the program in symptomatic patients with peripheral artery disease (PAD). Twenty-two men (ankle-brachial index (ABI) = 0.71 ± 0.19) and 24 women (ABI = 0.66 ± 0.23) completed the home exercise program, consisting of intermittent walking to mild-to-moderate claudication pain for 3 months. Ambulatory outcome measures were peak walking time (PWT) and claudication onset time (COT) during a treadmill test, and the distance recorded during a 6-minute walk distance test (6MWD). Men experienced significant increases (p<0.01) in COT, PWT, and 6MWD following the home exercise program, and women had significant increases in 6MWD (p<0.01) and PWT (p<0.05). In women, average exercise cadence during the home exercise sessions was the only predictor that entered the model for change in COT (p=0.082), and was the first predictor in the model for change in PWT (p=0.029) and 6MWD (p=0.006). In men, the ABI was the only predictor that entered the model for change in 6MWD (p=0.002), and ABI was a predictor along with metabolic syndrome in the model for change in COT (p=0.003). No variables entered the model for change in PWT. Faster ambulatory cadence during the step-monitored home-based exercise program may predict greater improvements in ambulatory function in women, whereas having less severe PAD and comorbid burden at baseline may predict greater improvements in ambulatory function in men. ClinicalTrials.gov Identifier: NCT00618670.

  9. Alternative parallel ring protocols

    NASA Technical Reports Server (NTRS)

    Mukkamala, R.; Foudriat, E. C.; Maly, Kurt J.; Kale, V.

    1990-01-01

    Communication protocols are know to influence the utilization and performance of communication network. The effect of two token ring protocols on a gigabit network with multiple ring structure is investigated. In the first protocol, a mode sends at most one message on receiving a token. In the second protocol, a mode sends all the waiting messages when a token is received. The behavior of these protocols is shown to be highly dependent on the number of rings as well as the load in the network.

  10. 3D False Color Computed Tomography for Diagnosis and Follow-Up of Permanent Denervated Human Muscles Submitted to Home-Based Functional Electrical Stimulation.

    PubMed

    Carraro, Ugo; Edmunds, Kyle J; Gargiulo, Paolo

    2015-03-11

    This report outlines the use of a customized false-color 3D computed tomography (CT) protocol for the imaging of the rectus femoris of spinal cord injury (SCI) patients suffering from complete and permanent denervation, as characterized by complete Conus and Cauda Equina syndrome. This muscle imaging method elicits the progression of the syndrome from initial atrophy to eventual degeneration, as well as the extent to which patients' quadriceps could be recovered during four years of home-based functional electrical stimulation (h-b FES). Patients were pre-selected from several European hospitals and functionally tested by, and enrolled in the EU Commission Shared Cost Project RISE (Contract n. QLG5-CT-2001-02191) at the Department of Physical Medicine, Wilhelminenspital, Vienna, Austria. Denervated muscles were electrically stimulated using a custom-designed stimulator, large surface electrodes, and customized progressive stimulation settings. Spiral CT images and specialized computational tools were used to isolate the rectus femoris muscle and produce 3D and 2D reconstructions of the denervated muscles. The cross sections of the muscles were determined by 2D Color CT, while muscle volumes were reconstructed by 3D Color CT. Shape, volume, and density changes were measured over the entirety of each rectus femoris muscle. Changes in tissue composition within the muscle were visualized by associating different colors to specified Hounsfield unit (HU) values for fat, (yellow: [-200; -10]), loose connective tissue or atrophic muscle, (cyan: [-9; 40]), and normal muscle, fascia and tendons included, (red: [41; 200]). The results from this analysis are presented as the average HU values within the rectus femoris muscle reconstruction, as well as the percentage of these tissues with respect to the total muscle volume. Results from this study demonstrate that h-b FES induces a compliance-dependent recovery of muscle volume and size of muscle fibers, as evidenced by the

  11. 3D False Color Computed Tomography for Diagnosis and Follow-Up of Permanent Denervated Human Muscles Submitted to Home-Based Functional Electrical Stimulation.

    PubMed

    Carraro, Ugo; Edmunds, Kyle J; Gargiulo, Paolo

    2015-03-11

    This report outlines the use of a customized false-color 3D computed tomography (CT) protocol for the imaging of the rectus femoris of spinal cord injury (SCI) patients suffering from complete and permanent denervation, as characterized by complete Conus and Cauda Equina syndrome. This muscle imaging method elicits the progression of the syndrome from initial atrophy to eventual degeneration, as well as the extent to which patients' quadriceps could be recovered during four years of home-based functional electrical stimulation (h-b FES). Patients were pre-selected from several European hospitals and functionally tested by, and enrolled in the EU Commission Shared Cost Project RISE (Contract n. QLG5-CT-2001-02191) at the Department of Physical Medicine, Wilhelminenspital, Vienna, Austria. Denervated muscles were electrically stimulated using a custom-designed stimulator, large surface electrodes, and customized progressive stimulation settings. Spiral CT images and specialized computational tools were used to isolate the rectus femoris muscle and produce 3D and 2D reconstructions of the denervated muscles. The cross sections of the muscles were determined by 2D Color CT, while muscle volumes were reconstructed by 3D Color CT. Shape, volume, and density changes were measured over the entirety of each rectus femoris muscle. Changes in tissue composition within the muscle were visualized by associating different colors to specified Hounsfield unit (HU) values for fat, (yellow: [-200; -10]), loose connective tissue or atrophic muscle, (cyan: [-9; 40]), and normal muscle, fascia and tendons included, (red: [41; 200]). The results from this analysis are presented as the average HU values within the rectus femoris muscle reconstruction, as well as the percentage of these tissues with respect to the total muscle volume. Results from this study demonstrate that h-b FES induces a compliance-dependent recovery of muscle volume and size of muscle fibers, as evidenced by the

  12. “It is always HIV/AIDS and TB”: Home-based carers’ perspectives on epilepsy in Cape Town, South Africa

    PubMed Central

    Keikelame, Mpoe Johannah; Swartz, Leslie

    2016-01-01

    The study highlights the complex cultural religious factors affecting epilepsy and a need for integrated home-based care services. Two focus group discussions exploring home-based carers’ (HBCs) perspectives on epilepsy were conducted using a semi-structured focus group interview guide, which was based on Kleinman's explanatory model framework. The audio-recorded data were transcribed verbatim, and a thematic analysis was done. The three main themes were epilepsy names and metaphors, religious beliefs about the cause and treatment of epilepsy, and HBCs’ perceived roles and strategies for engaging in epilepsy care. Findings provide some insights for research, policy, and practice. PMID:27258583

  13. The RTS2 protocol

    NASA Astrophysics Data System (ADS)

    Kubánek, Petr; Jelínek, Martin; French, John; Prouza, Michal; Vítek, Stanislav; Castro-Tirado, Alberto J.; Reglero, Victor

    2008-07-01

    Remote Telescope System 2nd version (RTS2) is an open source project aimed at developing a software environment to control a fully robotic observatory. RTS2 consists of various components, which communicate via an ASCII based protocol. As the protocol was from the beginning designed as an observatory control system, it provides some unique features, which are hard to find in the other communication systems. These features include advanced synchronisation mechanisms and strategies for setting variables. This presentation describes the protocol and its unique features. It also assesses protocol performance, and provides examples how the RTS2 library can be used to quickly build an observatory control system.

  14. A Novel, Self-Guided, Home-Based Intervention to Improve Condom Use among Young Men Who Have Sex with Men

    ERIC Educational Resources Information Center

    Emetu, Roberta E.; Marshall, Alexandra; Sanders, Stephanie A.; Yarber, William L.; Milhausen, Robin R.; Crosby, Richard A.; Graham, Cynthia A.

    2014-01-01

    Objective: This pilot study tested the efficacy of a brief, novel, theory-driven, self-guided, home-based intervention designed to promote condom use among young men who have sex with men (YMSM). Participants: Thirty YMSM were recruited from a large public US midwestern university during spring of 2012. Methods: The intervention was tested using a…

  15. Home-Based Parental Involvement in Young Children's Education: Examining the Effects of Maternal Education across U.S. Ethnic Groups

    ERIC Educational Resources Information Center

    Suizzo, Marie-Anne; Stapleton, Laura M.

    2007-01-01

    This study investigated the contributions of maternal education and ethnicity to three dimensions of home-based parental involvement in young children's education and development: parental expectations about educational attainment, children's activities at home and outside the home, and family routines. Controlling for family background variables…

  16. Determining the Reach of a Home-Based Physical Activity Program for Older Adults within the Context of a Randomized Controlled Trial

    ERIC Educational Resources Information Center

    Harden, Samantha M.; Fanning, Jason T.; Motl, Robert W.; McAuley, Edward; Estabrooks, Paul A.

    2014-01-01

    Determining the reach of physical activity (PA) programs is challenging due to inconsistent reporting across studies. The purpose of this study was to document multiple indicators of program reach for a 6-month, Digital Versatile Disc (DVD)-delivered home-based PA program. Radio, newspaper and direct mailing advertisements were tracked to…

  17. Monitoring the adequacy of catch-up growth among moderately malnourished children receiving home-based therapy using mid-upper arm circumference in Southern Malawi

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Each year more children die from moderate than severe malnutrition. Home-based therapy (HBT) using Ready-to-Use Therapeutic Foods (RUTF) has proven to successfully treat uncomplicated childhood malnutrition on an outpatient basis. This study attempts to discern if Mid-upper Arm Circumference (MUAC) ...

  18. Parent-Child Relationships and Family Functioning of Children and Youth Discharged from Residential Mental Health Treatment or a Home-Based Alternative

    ERIC Educational Resources Information Center

    Preyde, Michele; Cameron, Gary; Frensch, Karen; Adams, Gerald

    2011-01-01

    This report stems from a larger study on the outcomes of children and youth who accessed residential treatment or a home-based alternative. In this report an analysis of family descriptive information, the nature of family relationships, and indicators of family functioning for children and youth who have participated in children's mental health…

  19. Pollution Prevention through Peer Education: A Community Health Worker and Small and Home-Based Business Initiative on the Arizona-Sonora Border

    PubMed Central

    Moreno Ramírez, Denise; Ramírez-Andreotta, Mónica D.; Vea, Lourdes; Estrella-Sánchez, Rocío; Wolf, Ann Marie A.; Kilungo, Aminata; Spitz, Anna H.; Betterton, Eric A.

    2015-01-01

    Government-led pollution prevention programs tend to focus on large businesses due to their potential to pollute larger quantities, therefore leaving a gap in programs targeting small and home-based businesses. In light of this gap, we set out to determine if a voluntary, peer education approach led by female, Hispanic community health workers (promotoras) can influence small and home-based businesses to implement pollution prevention strategies on-site. This paper describes a partnership between promotoras from a non-profit organization and researchers from a university working together to reach these businesses in a predominately Hispanic area of Tucson, Arizona. From 2008 to 2011, the promotora-led pollution prevention program reached a total of 640 small and home-based businesses. Program activities include technical trainings for promotoras and businesses, generation of culturally and language appropriate educational materials, and face-to-face peer education via multiple on-site visits. To determine the overall effectiveness of the program, surveys were used to measure best practices implemented on-site, perceptions towards pollution prevention, and overall satisfaction with the industry-specific trainings. This paper demonstrates that promotoras can promote the implementation of pollution prevention best practices by Hispanic small and home-based businesses considered “hard-to-reach” by government-led programs. PMID:26371028

  20. Longitudinal comparison of a physiotherapist-led, home-based and group-based program for increasing physical activity in community-dwelling middle-aged adults.

    PubMed

    Freene, Nicole; Waddington, Gordon; Davey, Rachel; Cochrane, Tom

    2015-01-01

    Few studies have compared the longer-term effects of physical activity interventions. Here we compare a 6-month physiotherapist-led, home-based physical activity program to a community group exercise program over 2 years. Healthy, sedentary community-dwelling 50-65 year olds were recruited to a non-randomised community group exercise program (G, n = 93) or a physiotherapist-led, home-based physical activity program (HB, n = 65). Outcomes included 'sufficient' physical activity (Active Australia Survey), minutes of moderate-vigorous physical activity (ActiGraph GT1M), aerobic capacity (2-min step-test), quality of life (SF-12v2), blood pressure, waist circumference, waist-to-hip ratio and body mass index. Outcome measures were collected at baseline, 6, 12, 18 and 24 months. Using intention-to-treat analysis, both interventions resulted in significant and sustainable increases in the number of participants achieving 'sufficient' physical activity (HB 22 v. 41%, G 22 v. 47%, P ≤ 0.001) and decreases in waist circumference (HB 90 v. 89 cm, G 93 v. 91 cm, P < 0.001) over 2 years. The home-based program was less costly (HB A$47 v. G $84 per participant) but less effective in achieving the benefits at 2 years. The physiotherapist-led, home-based physical activity program may be a low-cost alternative to increase physical activity levels for those not interested in, or unable to attend, a group exercise program.

  1. A Randomised Controlled Trial of Two Early Intervention Programs for Young Children with Autism: Centre-Based with Parent Program and Home-Based

    ERIC Educational Resources Information Center

    Roberts, Jacqueline; Williams, Katrina; Carter, Mark; Evans, David; Parmenter, Trevor; Silove, Natalie; Clark, Trevor; Warren, Anthony

    2011-01-01

    This study compares outcomes of early intervention programs for young children with autism; an individualised home-based program (HB), a small group centre-based program for children combined with a parent training and support group (CB) and a non-treatment comparison group (WL). Outcome measures of interest include social and communication skill…

  2. Pollution Prevention through Peer Education: A Community Health Worker and Small and Home-Based Business Initiative on the Arizona-Sonora Border.

    PubMed

    Ramírez, Denise Moreno; Ramírez-Andreotta, Mónica D; Vea, Lourdes; Estrella-Sánchez, Rocío; Wolf, Ann Marie A; Kilungo, Aminata; Spitz, Anna H; Betterton, Eric A

    2015-09-01

    Government-led pollution prevention programs tend to focus on large businesses due to their potential to pollute larger quantities, therefore leaving a gap in programs targeting small and home-based businesses. In light of this gap, we set out to determine if a voluntary, peer education approach led by female, Hispanic community health workers (promotoras) can influence small and home-based businesses to implement pollution prevention strategies on-site. This paper describes a partnership between promotoras from a non-profit organization and researchers from a university working together to reach these businesses in a predominately Hispanic area of Tucson, Arizona. From 2008 to 2011, the promotora-led pollution prevention program reached a total of 640 small and home-based businesses. Program activities include technical trainings for promotoras and businesses, generation of culturally and language appropriate educational materials, and face-to-face peer education via multiple on-site visits. To determine the overall effectiveness of the program, surveys were used to measure best practices implemented on-site, perceptions towards pollution prevention, and overall satisfaction with the industry-specific trainings. This paper demonstrates that promotoras can promote the implementation of pollution prevention best practices by Hispanic small and home-based businesses considered "hard-to-reach" by government-led programs. PMID:26371028

  3. COMPARISON OF HOME-BASED THERAPY WITH READY-TO-USE THERAPEUTIC FOOD WITH STANDARD THERAPY IN THE TREATMENT OF MALNOURISHED MALAWIAN CHILDREN: A CONTROLLED, CLINICAL EFFECTIVENESS TRIAL

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Childhood malnutrition is common in Malawi, and the standard treatment, which follows international guidelines, results in poor recovery rates. Higher recovery rates have been seen in pilot studies of home-based therapy with ready-to-use therapeutic food (RUTF). The objective was to compare the rec...

  4. Longitudinal comparison of a physiotherapist-led, home-based and group-based program for increasing physical activity in community-dwelling middle-aged adults.

    PubMed

    Freene, Nicole; Waddington, Gordon; Davey, Rachel; Cochrane, Tom

    2015-01-01

    Few studies have compared the longer-term effects of physical activity interventions. Here we compare a 6-month physiotherapist-led, home-based physical activity program to a community group exercise program over 2 years. Healthy, sedentary community-dwelling 50-65 year olds were recruited to a non-randomised community group exercise program (G, n = 93) or a physiotherapist-led, home-based physical activity program (HB, n = 65). Outcomes included 'sufficient' physical activity (Active Australia Survey), minutes of moderate-vigorous physical activity (ActiGraph GT1M), aerobic capacity (2-min step-test), quality of life (SF-12v2), blood pressure, waist circumference, waist-to-hip ratio and body mass index. Outcome measures were collected at baseline, 6, 12, 18 and 24 months. Using intention-to-treat analysis, both interventions resulted in significant and sustainable increases in the number of participants achieving 'sufficient' physical activity (HB 22 v. 41%, G 22 v. 47%, P ≤ 0.001) and decreases in waist circumference (HB 90 v. 89 cm, G 93 v. 91 cm, P < 0.001) over 2 years. The home-based program was less costly (HB A$47 v. G $84 per participant) but less effective in achieving the benefits at 2 years. The physiotherapist-led, home-based physical activity program may be a low-cost alternative to increase physical activity levels for those not interested in, or unable to attend, a group exercise program. PMID:26509205

  5. Home-Based Treatment of Disruptive Junior High School Students: An Analysis of the Differential Effects of Positive and Negative Consequences.

    ERIC Educational Resources Information Center

    Rosen, Lee A.; And Others

    1990-01-01

    Effects of 2 home-based treatments to reduce school problems among 10 disruptive intermediate school students were probed. Although the treatment using only positive reinforcement yielded no significant change, a mixed reinforcement treatment brought both a decrease in rates of referrals to the office and decrease in depression rates. (Author/PB)

  6. The Impact of Home-Based Child Care Provider Unionization on the Cost, Type, and Availability of Subsidized Child Care in Illinois

    ERIC Educational Resources Information Center

    Grindal, Todd; West, Martin R.; Willett, John B.; Yoshikawa, Hirokazu

    2015-01-01

    In February 2005, Illinois became the first U.S. state to grant home-based child care providers (HBCPs) the right to form a labor union in order to bargain collectively with the state government. This policy inspired similar efforts across the country and represents a potentially important direction for child care policy. To date, the implications…

  7. Pollution Prevention through Peer Education: A Community Health Worker and Small and Home-Based Business Initiative on the Arizona-Sonora Border.

    PubMed

    Ramírez, Denise Moreno; Ramírez-Andreotta, Mónica D; Vea, Lourdes; Estrella-Sánchez, Rocío; Wolf, Ann Marie A; Kilungo, Aminata; Spitz, Anna H; Betterton, Eric A

    2015-09-09

    Government-led pollution prevention programs tend to focus on large businesses due to their potential to pollute larger quantities, therefore leaving a gap in programs targeting small and home-based businesses. In light of this gap, we set out to determine if a voluntary, peer education approach led by female, Hispanic community health workers (promotoras) can influence small and home-based businesses to implement pollution prevention strategies on-site. This paper describes a partnership between promotoras from a non-profit organization and researchers from a university working together to reach these businesses in a predominately Hispanic area of Tucson, Arizona. From 2008 to 2011, the promotora-led pollution prevention program reached a total of 640 small and home-based businesses. Program activities include technical trainings for promotoras and businesses, generation of culturally and language appropriate educational materials, and face-to-face peer education via multiple on-site visits. To determine the overall effectiveness of the program, surveys were used to measure best practices implemented on-site, perceptions towards pollution prevention, and overall satisfaction with the industry-specific trainings. This paper demonstrates that promotoras can promote the implementation of pollution prevention best practices by Hispanic small and home-based businesses considered "hard-to-reach" by government-led programs.

  8. Home-Based Businesses: Implications for the Rural Economy of the South. The Rural South: Preparing for the Challenges of the 21st Century, No. 16.

    ERIC Educational Resources Information Center

    Brown, Pamela J.; Muske, Glenn

    In the face of changing agriculture, an aging population, and the outflow of citizens seeking livable wages, rural Southern communities are challenged with how to enhance their economies to insure long-term business viability. Home-based businesses are an effective aspect of rural economic development. They allow flexibility and choice of work…

  9. Mental health services for children and youth: a survey of physicians' knowledge, attitudes and use of telehealth services.

    PubMed

    Cloutier, Paula; Cappelli, Mario; Glennie, J Elizabeth; Keresztes, Christian

    2008-01-01

    Rural physicians in Ontario, whose practice included children, were surveyed on their awareness, attitudes and use of telemental health services for children and young people in their region. Of 95 rural physicians, 70 completed and returned the telehealth section of the survey (74% response rate). The survey comprised 14 questions. Only 27% of responders were aware of the available videoconferencing services. The proportion of physicians who reported having referred patients for the various mental health services through videoconferencing was 0-24%. The proportion of physicians who reported that they would refer patients through videoconferencing was 55-92%. Reduced travel time and care provided closer to home were seen as the primary benefits of referring patients to mental health services through videoconferencing. Unclear referral patterns and technology compromises were seen as limitations of referring patients to videoconferencing. Access to rural populations and improved access to patients were seen as benefits to practice, and undeveloped remuneration procedures as the primary limitation. Promotion may be important to successful implementation of telemental health services for children and young people.

  10. Safety and feasibility of a home-based six week resistance training program in juvenile idiopathic arthritis

    PubMed Central

    2013-01-01

    Background Juvenile idiopathic arthritis (JIA), among the most common chronic diseases of childhood, can be associated with attenuated physical activity levels, reduced fitness, decreased functionality and pain. This pilot study aimed to determine the safety, feasibility and effect of a six week resistance training program in children with JIA. Methods Youth (8-18 years) with JIA participated in a home-based resistance training program. Participants reported pain on an electronic diary once a day for one week prior to training, then once a day on non-exercise days and three times a day (before-exercise, after-exercise, and end-of-day) on exercise days for the subsequent six weeks of training. Secondary outcome measures included inflammation (assessed by ultrasound), muscle size (assessed by ultrasound), muscle strength (assessed by dynamometer) and functional ability (assessed by childhood health assessment questionnaire), measured at baseline and post-training. Participants were also instructed to wear an accelerometer one week prior to training to estimate baseline physical activity levels. Statistical analyses included safety (pain changes and any adverse events), feasibility (adherence to program and modifications made to exercises) and effect of program (differences in secondary measures pre and post training). An alpha level of p < 0.05 was accepted as significant. Results Seven participants completed an average of 12.7 ± 3.4 (range 8-17) exercise sessions out of a possible 18 (70.6%). No adverse events were reported and pain did not increase over the seven weeks. Secondary measures revealed a significant increase in vastus lateralis thickness from pre to post training (p < 0.05). End-of-day pain intensity was correlated to end-of-day stiffness, fatigue and mood (r = .864, r = .581, r = -.637, respectively, p < 0.001). Pain intensity was also correlated with ratings of perceived exertion of the exercise (r = 0.324, p < 0

  11. Effects of home-based exercise intervention on health-related quality of life for patients with ankylosing spondylitis: a meta-analysis.

    PubMed

    Liang, Hui; Zhang, Hua; Ji, Haiyan; Wang, Chunmei

    2015-10-01

    The objective of this paper was to objectively evaluate the effectiveness of home-based exercise interventions for improving health-related quality of life in patients with ankylosing spondylitis (AS). Databases including PubMed, Web of Science, EMBASE, Ovid-Medline, and The Cochrane Library were electronically searched published from inception through October 2014 involving home-based exercise intervention in AS patients. Studies that measured the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), depression and pain as outcomes were included. Studies involving patients with multiple diseases or received combinations of other interventions were excluded. Two independent investigators screened the identified articles, extracted the data, and assessed the methodological quality of the included studies. Qualitative descriptions were conducted, and quantitative analysis was performed with RevMan software (version 5.2). A total of six studies comprising 1098 participants were included in the study. Meta-analyses showed that home-based exercise interventions significantly reduced the BASFI scores (MD = -0.39, 95 % CI -0.57, -0.20, p = 0.001), BASDAI scores (MD = -0.50, 95 % CI -0.99, -0.02, p = 0.04), depression scores (MD = -2.31, 95 % CI -3.33, -1.30, p = 0.001), and for pain scores because of different evaluation methods among these studies; therefore, a subgroup analysis should be conducted for comparison. The results show that home-based exercise interventions can effectively improve the health-related quality of life in patients with AS. The benefit and clinical performance of home-based exercise care requires further investigation by a series of multicenter, large-sample size randomized controlled trails.

  12. Interpersonal Communication and Smoking Cessation in the Context of an Incentive-Based Program: Survey Evidence From a Telehealth Intervention in a Low-Income Population

    PubMed Central

    Parks, Michael J.; Slater, Jonathan S.; Rothman, Alexander J.; Nelson, Christina L.

    2016-01-01

    The tobacco epidemic disproportionately affects low-income populations, and telehealth is an evidence-based strategy for extending tobacco cessation services to underserved populations. A public health priority is to establish incentive-based interventions at the population level in order to promote long-term smoking cessation in low-income populations. Yet randomized clinical trials show that financial incentives tend to encourage only short-term steps of cessation, not continuous smoking abstinence. One potential mechanism for increasing long-term cessation is interpersonal communication (IPC) in response to population-level interventions. However, more research is needed on IPC and its influence on health behavior change, particularly in the context of incentive-based, population-level programs. This study used survey data gathered after a population-level telehealth intervention that offered $20 incentives to low-income smokers for being connected to Minnesota’s free quitline in order to examine how perceived incentive importance and IPC about the incentive-based program relate to both short-term and long-term health behavior change. Results showed that IPC was strongly associated with initial quitline utilization and continuous smoking abstinence as measured by 30-day point prevalence rates at 7-month follow-up. Perceived incentive importance had weak associations with both measures of cessation, and all associations were nonsignificant in models adjusting for IPC. These results were found in descriptive analyses, logistic regression models, and Heckman probit models that adjusted for participant recruitment. In sum, a behavioral telehealth intervention targeting low-income smokers that offered a financial incentive inspired IPC, and this social response was strongly related to utilization of intervention services as well as continuous smoking abstinence. PMID:26166678

  13. Interpersonal Communication and Smoking Cessation in the Context of an Incentive-Based Program: Survey Evidence From a Telehealth Intervention in a Low-Income Population.

    PubMed

    Parks, Michael J; Slater, Jonathan S; Rothman, Alexander J; Nelson, Christina L

    2016-01-01

    The tobacco epidemic disproportionately affects low-income populations, and telehealth is an evidence-based strategy for extending tobacco cessation services to underserved populations. A public health priority is to establish incentive-based interventions at the population level in order to promote long-term smoking cessation in low-income populations. Yet randomized clinical trials show that financial incentives tend to encourage only short-term steps of cessation, not continuous smoking abstinence. One potential mechanism for increasing long-term cessation is interpersonal communication (IPC) in response to population-level interventions. However, more research is needed on IPC and its influence on health behavior change, particularly in the context of incentive-based, population-level programs. This study used survey data gathered after a population-level telehealth intervention that offered $20 incentives to low-income smokers for being connected to Minnesota's free quitline in order to examine how perceived incentive importance and IPC about the incentive-based program relate to both short-term and long-term health behavior change. Results showed that IPC was strongly associated with initial quitline utilization and continuous smoking abstinence as measured by 30-day point prevalence rates at 7-month follow-up. Perceived incentive importance had weak associations with both measures of cessation, and all associations were nonsignificant in models adjusting for IPC. These results were found in descriptive analyses, logistic regression models, and Heckman probit models that adjusted for participant recruitment. In sum, a behavioral telehealth intervention targeting low-income smokers that offered a financial incentive inspired IPC, and this social response was strongly related to utilization of intervention services as well as continuous smoking abstinence.

  14. National Sample Assessment Protocols

    ERIC Educational Resources Information Center

    Ministerial Council on Education, Employment, Training and Youth Affairs (NJ1), 2012

    2012-01-01

    These protocols represent a working guide for planning and implementing national sample assessments in connection with the national Key Performance Measures (KPMs). The protocols are intended for agencies involved in planning or conducting national sample assessments and personnel responsible for administering associated tenders or contracts,…

  15. Feasibility of caregiver-directed home-based hand-arm bimanual intensive training: A brief report

    PubMed Central

    Ferre, Claudio L.; Brandão, Marina B.; Hung, Ya-Ching; Carmel, Jason B.; Gordon, Andrew M.

    2015-01-01

    Objective To determine feasibility of a home-based, intensive bimanual intervention with children with unilateral spastic cerebral palsy. Methods Eleven children (aged 29–54 months) received 90 hours of home hand-arm bimanual intensive therapy (H-HABIT) provided by their trained caregivers. Parenting stress levels and compliance were monitored using the Parenting Stress Index and daily logs. Quality of bimanual performance and changes in performance/satisfaction of functional goals were assessed using the Assisting Hand Assessment (AHA) and Canadian Occupational Performance Measure (COPM), respectively, at two pretreatment baseline sessions and two posttreatment sessions (immediate and six months). Results Ten children completed the study with caregivers completing on average 85.6 hours of H-HABIT. Daily logs indicated high caregiver compliance. Stress levels remained stable across the intervention. Children demonstrated significant improvements in the AHA and COPM. Conclusion H-HABIT is a feasible intervention for improving hand function and merits further investigation in a randomized-control trial. PMID:25180530

  16. Narratives of Violence, Pathology, and Empowerment: Mental Health Needs Assessment of Home-Based Female Sex Workers in Rural India.

    PubMed

    Sardana, Srishti; Marcus, Marina; Verdeli, Helen

    2016-08-01

    This study explores the narratives of psychological distress and resilience among a group of female sex workers who use residential spaces to attend to clients in rural India. The narratives reflect the lived experiences of these women. They describe the women's reasons for opting into sex work; guilt, shame, and stigma related to their sex worker status; experiences with intimate partner and domestic violence; health-related problems; communication with their family members about their sex worker status; mental health referral practices among the women; and elements of resilience and strength that they experience within themselves and within their community of fellow sex workers. The article also offers elements of our own experiences of recruiting the women to participate in the focus group, training local outreach workers in conducting focus group discussions, and forging a collaboration with a local community-based organization to highlight important barriers, challenges, and strategies for planning a group-based discussion to explore the mental health needs of home-based sex workers.

  17. Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with chronic obstructive pulmonary disease (COPD)

    PubMed Central

    Neder, J; Sword, D; Ward, S; Mackay, E; Cochrane, L; Clark, C

    2002-01-01

    Background: Passive training of specific locomotor muscle groups by means of neuromuscular electrical stimulation (NMES) might be better tolerated than whole body exercise in patients with severe chronic obstructive pulmonary disease (COPD). It was hypothesised that this novel strategy would be particularly effective in improving functional impairment and the consequent disability which characterises patients with end stage COPD. Methods: Fifteen patients with advanced COPD (nine men) were randomly assigned to either a home based 6 week quadriceps femoris NMES training programme (group 1, n=9, FEV1=38.0 (9.6)% of predicted) or a 6 week control period before receiving NMES (group 2, n=6, FEV1=39.5 (13.3)% of predicted). Knee extensor strength and endurance, whole body exercise capacity, and health related quality of life (Chronic Respiratory Disease Questionnaire, CRDQ) were assessed. Results: All patients were able to complete the NMES training programme successfully, even in the presence of exacerbations (n=4). Training was associated with significant improvements in muscle function, maximal and endurance exercise tolerance, and the dyspnoea domain of the CRDQ (p<0.05). Improvements in muscle performance and exercise capacity after NMES correlated well with a reduction in perception of leg effort corrected for exercise intensity (p<0.01). Conclusions: For severely disabled COPD patients with incapacitating dyspnoea, short term electrical stimulation of selected lower limb muscles involved in ambulation can improve muscle strength and endurance, whole body exercise tolerance, and breathlessness during activities of daily living. PMID:11923552

  18. Home-based administration of Sayana® Press: review and assessment of needs in low-resource settings.

    PubMed

    Keith, Bonnie; Wood, Siri; Tifft, Sara; Hutchings, Jane

    2014-05-01

    A new presentation of the subcutaneous (SC) injectable contraceptive depot medroxyprogesterone acetate (DMPA) increases the possibilities for home and self-administration of this popular contraceptive method. Sayana® Press is DMPA-SC in the prefilled Uniject™ injection system and consists of one dose that provides 3 months of contraceptive protection. Studies indicate that lay caregiver and self-injection of various medications, including other injectable presentations of DMPA-SC, are acceptable and effective. Introduction of Sayana® Press in developing countries could extend injectable contraceptive delivery safely and effectively beyond the clinic and, eventually, into the home, allowing lay caregiver or self-administration. Research needs for low-resource settings include assessing the acceptability and feasibility of self-injection with Sayana® Press. Feasibility studies necessary for implementing a sustainable home-based delivery program include assessment of training, health systems, policies, infrastructure needs and programmatic considerations to optimize women's ability to manage their self-injection schedule.

  19. Home-based nursing interventions improve knowledge of disease and management in patients with heart failure 1

    PubMed Central

    Azzolin, Karina de Oliveira; Lemos, Dayanna Machado; Lucena, Amália de Fátima; Rabelo-Silva, Eneida Rejane

    2015-01-01

    OBJECTIVE: to assess patient knowledge of heart failure by home-based measurement of two NOC Nursing Outcomes over a six-month period and correlate mean outcome indicator scores with mean scores of a heart failure Knowledge Questionnaire. METHODS: in this before-and-after study, patients with heart failure received four home visits over a six-month period after hospital discharge. At each home visit, nursing interventions were implemented, NOC outcomes were assessed, and the Knowledge Questionnaire was administered. RESULTS: overall, 23 patients received home visits. Mean indicator scores for the outcome Knowledge: Medication were 2.27±0.14 at home visit 1 and 3.55±0.16 at home visit 4 (P<0.001); and, for the outcome Knowledge: Treatment Regimen, 2.33±0.13 at home visit 1 and 3.59±0.14 at home visit 4 (P<0.001). The correlation between the Knowledge Questionnaire and the Nursing Outcomes Classification scores was strong at home visit 1 (r=0.7, P<0.01), but weak and non significant at visit 4. CONCLUSION: the results show improved patient knowledge of heart failure and a strong correlation between Nursing Outcomes Classification indicator scores and Knowledge Questionnaire scores. The NOC Nursing Outcomes proved effective as knowledge assessment measures when compared with the validated instrument. PMID:25806630

  20. ‘There’s no place like home’: perceptions of home-based HIV testing in Lesotho

    PubMed Central

    Mantell, J. E.; DiCarlo, A. L.; Remien, R. H.; Zerbe, A.; Morris, D.; Pitt, B.; Nkonyana, J. P.; Abrams, E. J.; El-Sadr, W.

    2014-01-01

    HIV testing has the potential to reduce HIV transmission by identifying and counseling individuals with HIV, reducing risk behaviors, linking persons with HIV to care and earlier treatment, and reducing perinatal transmission. In Lesotho, a high HIV prevalence country in which a large proportion of the population has never tested for HIV, home-based testing (HBT) may be an important strategy to increase HIV testing. We identified factors influencing acceptability of HIV prevention strategies among a convenience sample of 200 pregnant or post-partum Basotho women and 30 Basotho men. We first conducted cross-sectional surveys, followed by key informant interviews with all 30 men and focus group discussions with a sub-set of 62 women. In total, 82% of women reported positive perceptions of HBT; women and men viewed HBT as a potential way to increase testing among men and saw the home as a comfortable, supportive environment for testing and counseling couples and families together. Potential barriers to HBT uptake included concerns about confidentiality, privacy, coercion to test, conflict within the family and fear of HIV/AIDS-associated stigma. Participants emphasized community mobilization and education as important elements of HBT. PMID:24599266