Aims:Used as integrated tools,technology may improve access and outcomes of care.A new intervention that integrates multiple technologies called mI SMART has been developed,implemented,and evaluated by Nurse Practitio...Aims:Used as integrated tools,technology may improve access and outcomes of care.A new intervention that integrates multiple technologies called mI SMART has been developed,implemented,and evaluated by Nurse Practitioners.The aim of this paper is to present the initial effectiveness of a webbased,structure of sensors and mobile devices designed to overcome the known health determinant of access to care for rural,chronically ill patients by using technology.Methods:The study was conducted at a community primary-care clinic that provides free healthcare to impoverished adults.Adults with at least one chronic condition,a minimum of 3rd grade reading level,and without dementia/psychosis were recruited.Participants were given a Nexus7 tablet and Bluetooth self-monitoring devices.The intervention lasted for 12 weeks.Blood glucose,blood pressure,and weight were collected using the provided Bluetooth devices and means were evaluated with paired-samples ttests before and after the intervention.Results:Thirty participants were majority female,white,married,high-school educated or less,earning less than$20,000 per annum,and had multiple chronic conditions.Pre-intervention glucose,systolic blood pressure,diastolic blood pressure,weight and Body Mass Index were all reduced after the 12-week intervention.Conclusions:The mI SMART intervention is efficacious for use in improvised adults living in rural areas with multiple chronic conditions.As previously reported,the intervention was also shown to be feasible and acceptable to patients.The next step is a larger randomized controlled trial.展开更多
The purpose of this systematic review is to identify evidence of the appropriate dose of telehealth intervention services provided to community dwelling adults experiencing chronic illness or disability related to eff...The purpose of this systematic review is to identify evidence of the appropriate dose of telehealth intervention services provided to community dwelling adults experiencing chronic illness or disability related to effectiveness, quality, safety, and cost. Academic Search Complete, CINAHL, MEDLINE, Cochrane, and JBI were searched using combinations of “telehealth or telemedicine or telemonitoring or telepractice or telenursing or telecare AND chronic illness or chronic disease”. Of the identified 449 articles, 47 articles met the inclusion criteria. Most study designs were quasi-experimental one group pre-test post-test (N = 16) with few Randomized Controlled Trials (N = 12). Twenty-three published articles studied the effect of telehealth for one chronic condition (49.9%) while 24 (51.1%) examined the effectiveness of telehealth for multiple chronic conditions. Measurement of telehealth outcomes varied and included efficacy, healthcare utilization, quality, adherence, cost, and safety. No standard measure of dose could be extrapolated. Length of intervention was measured and reported differently in each study. The dose of telehealth services that improve care effectiveness, quality, safety, and cost is still unknown for community dwelling adults experiencing chronic illness. The findings from this systematic review do indicate that longer duration of telehealth services (51 weeks), regardless of modality, produced positive outcomes as opposed to those with shorter durations (37 - 38 weeks) that produced neutral or mixed results. Collecting and reporting data related to clinical workflow such as dose of intervention specific to disease and type of modality is recommended. Rigorous study design including standard measurement at the RCT and Comparative Effectiveness level is still needed.展开更多
Background: An opportunity to improve care of multiple chronic conditions for those living in rural areas of the country may exist through the use of technology. Integrating technology interventions into existing rura...Background: An opportunity to improve care of multiple chronic conditions for those living in rural areas of the country may exist through the use of technology. Integrating technology interventions into existing rural health systems allows for increased access to healthcare services and augments self-management ability for patients. However, questions remain about acceptability and feasibility of technology use in rural populations. The purpose of this paper is to present the feasibility of mI-SMART, a HIPAA compliant, web-based, structure of mHealth sensors and mobile devices designed to overcome the known health determinant of access to care for rural, chronically ill patients by using technology. Methods: The study was conducted at a primary-care clinic that provided healthcare at no or low cost to low income adults. Inclusion criteria encompassed adults, with at least one chronic condition, having at least 3rd grade reading level, without having dementia/psychosis. Each participant was given a Nexus7 tablet and Bluetooth self-monitoring devices. Feasibility was evaluated in four ways and acceptability was evaluated with post-intervention questionnaires. Results: Thirty participants [mean age: 52 years (SD: 10.0, range: 29 - 74)] were majority female (70%), white (70%), married (60%), high-school educated or less (56.7%), impoverished (less than $20,000 per annum (56.7%), with multiple chronic conditions (96.7%)). During the trial, all participants were able to transmit data. No error messages were due to the mI-SMART system. Errors were user related and solved with technical support. Mean number of self-monitor transmissions was 219.7 [(SD: 197.4), range: 1 - 733]. Participants logged into the system an average of 163. 1 [(SD: 169.7), range: 2 - 568] times and viewed an average of 1092.1 [(SD: 1205.6), range: 8 - 3851] intervention components. Over eighty-six percent of participants sent data for 12 weeks and 43.1% used the intervention for longer. Conclusions: The mI-SMART system is a feasible option for impoverished persons living in rural areas.展开更多
Background: The treatment of Multiple Chronic Conditions (MCC) is complex for both patients and providers. Used as integrated tools, technology may decrease complexity, remove the barrier of distance to obtain care, a...Background: The treatment of Multiple Chronic Conditions (MCC) is complex for both patients and providers. Used as integrated tools, technology may decrease complexity, remove the barrier of distance to obtain care, and improve outcomes of care. A new platform that integrates multiple technologies for primary health care called mI SMART (Mobile Improvement of Self-Management Ability through Rural Technology) has been developed. The purpose of this paper is to present to development of mI SMART, a nurse-led technology intervention for treating for MCC in primary care. Methods: The creation of mI SMART was guided by the model for developing complex nursing interventions. The model suggests a process for building and informing interventions with the intention of effectiveness, sustainability, and scalability. Each step in the model builds from and informs the previous step. Results: The process resulted in the integrated technologies of mI SMART. The system combines a HIPAA compliant, web-based, structure of mHealth sensors and mobile devices to treat and monitor multiple chronic conditions within an existing free primary care clinic. The mI SMART system allows patients to track diagnoses, medications, lab results, receive reminders for self-management, perform self-monitoring, obtain feedback in real time, engage in education, and attend visits through video conferencing. The system displays a record database to patients and providers that will be integrated into existing Electronic Health Records. Conclusion: By using the model for developing complex nursing interventions, a multifaceted solution to clinical problems was identified. Through modeling and seeking expert review, we have established a sustainable and scalable integrated nurse-led intervention that may increase access and improve outcomes for patients living in rural and underserved areas. The first trial of mI SMART has been completed and evaluated for feasibility, acceptability, and effectiveness in persons in rural areas living with multiple chronic conditions.展开更多
基金The time and research funding for Dr.Mallow to complete this work is supported by the Robert Wood Johnson Foundation Nurse Faculty Scholars Program Grant ID 72119.
文摘Aims:Used as integrated tools,technology may improve access and outcomes of care.A new intervention that integrates multiple technologies called mI SMART has been developed,implemented,and evaluated by Nurse Practitioners.The aim of this paper is to present the initial effectiveness of a webbased,structure of sensors and mobile devices designed to overcome the known health determinant of access to care for rural,chronically ill patients by using technology.Methods:The study was conducted at a community primary-care clinic that provides free healthcare to impoverished adults.Adults with at least one chronic condition,a minimum of 3rd grade reading level,and without dementia/psychosis were recruited.Participants were given a Nexus7 tablet and Bluetooth self-monitoring devices.The intervention lasted for 12 weeks.Blood glucose,blood pressure,and weight were collected using the provided Bluetooth devices and means were evaluated with paired-samples ttests before and after the intervention.Results:Thirty participants were majority female,white,married,high-school educated or less,earning less than$20,000 per annum,and had multiple chronic conditions.Pre-intervention glucose,systolic blood pressure,diastolic blood pressure,weight and Body Mass Index were all reduced after the 12-week intervention.Conclusions:The mI SMART intervention is efficacious for use in improvised adults living in rural areas with multiple chronic conditions.As previously reported,the intervention was also shown to be feasible and acceptable to patients.The next step is a larger randomized controlled trial.
文摘The purpose of this systematic review is to identify evidence of the appropriate dose of telehealth intervention services provided to community dwelling adults experiencing chronic illness or disability related to effectiveness, quality, safety, and cost. Academic Search Complete, CINAHL, MEDLINE, Cochrane, and JBI were searched using combinations of “telehealth or telemedicine or telemonitoring or telepractice or telenursing or telecare AND chronic illness or chronic disease”. Of the identified 449 articles, 47 articles met the inclusion criteria. Most study designs were quasi-experimental one group pre-test post-test (N = 16) with few Randomized Controlled Trials (N = 12). Twenty-three published articles studied the effect of telehealth for one chronic condition (49.9%) while 24 (51.1%) examined the effectiveness of telehealth for multiple chronic conditions. Measurement of telehealth outcomes varied and included efficacy, healthcare utilization, quality, adherence, cost, and safety. No standard measure of dose could be extrapolated. Length of intervention was measured and reported differently in each study. The dose of telehealth services that improve care effectiveness, quality, safety, and cost is still unknown for community dwelling adults experiencing chronic illness. The findings from this systematic review do indicate that longer duration of telehealth services (51 weeks), regardless of modality, produced positive outcomes as opposed to those with shorter durations (37 - 38 weeks) that produced neutral or mixed results. Collecting and reporting data related to clinical workflow such as dose of intervention specific to disease and type of modality is recommended. Rigorous study design including standard measurement at the RCT and Comparative Effectiveness level is still needed.
文摘Background: An opportunity to improve care of multiple chronic conditions for those living in rural areas of the country may exist through the use of technology. Integrating technology interventions into existing rural health systems allows for increased access to healthcare services and augments self-management ability for patients. However, questions remain about acceptability and feasibility of technology use in rural populations. The purpose of this paper is to present the feasibility of mI-SMART, a HIPAA compliant, web-based, structure of mHealth sensors and mobile devices designed to overcome the known health determinant of access to care for rural, chronically ill patients by using technology. Methods: The study was conducted at a primary-care clinic that provided healthcare at no or low cost to low income adults. Inclusion criteria encompassed adults, with at least one chronic condition, having at least 3rd grade reading level, without having dementia/psychosis. Each participant was given a Nexus7 tablet and Bluetooth self-monitoring devices. Feasibility was evaluated in four ways and acceptability was evaluated with post-intervention questionnaires. Results: Thirty participants [mean age: 52 years (SD: 10.0, range: 29 - 74)] were majority female (70%), white (70%), married (60%), high-school educated or less (56.7%), impoverished (less than $20,000 per annum (56.7%), with multiple chronic conditions (96.7%)). During the trial, all participants were able to transmit data. No error messages were due to the mI-SMART system. Errors were user related and solved with technical support. Mean number of self-monitor transmissions was 219.7 [(SD: 197.4), range: 1 - 733]. Participants logged into the system an average of 163. 1 [(SD: 169.7), range: 2 - 568] times and viewed an average of 1092.1 [(SD: 1205.6), range: 8 - 3851] intervention components. Over eighty-six percent of participants sent data for 12 weeks and 43.1% used the intervention for longer. Conclusions: The mI-SMART system is a feasible option for impoverished persons living in rural areas.
文摘Background: The treatment of Multiple Chronic Conditions (MCC) is complex for both patients and providers. Used as integrated tools, technology may decrease complexity, remove the barrier of distance to obtain care, and improve outcomes of care. A new platform that integrates multiple technologies for primary health care called mI SMART (Mobile Improvement of Self-Management Ability through Rural Technology) has been developed. The purpose of this paper is to present to development of mI SMART, a nurse-led technology intervention for treating for MCC in primary care. Methods: The creation of mI SMART was guided by the model for developing complex nursing interventions. The model suggests a process for building and informing interventions with the intention of effectiveness, sustainability, and scalability. Each step in the model builds from and informs the previous step. Results: The process resulted in the integrated technologies of mI SMART. The system combines a HIPAA compliant, web-based, structure of mHealth sensors and mobile devices to treat and monitor multiple chronic conditions within an existing free primary care clinic. The mI SMART system allows patients to track diagnoses, medications, lab results, receive reminders for self-management, perform self-monitoring, obtain feedback in real time, engage in education, and attend visits through video conferencing. The system displays a record database to patients and providers that will be integrated into existing Electronic Health Records. Conclusion: By using the model for developing complex nursing interventions, a multifaceted solution to clinical problems was identified. Through modeling and seeking expert review, we have established a sustainable and scalable integrated nurse-led intervention that may increase access and improve outcomes for patients living in rural and underserved areas. The first trial of mI SMART has been completed and evaluated for feasibility, acceptability, and effectiveness in persons in rural areas living with multiple chronic conditions.
