A collaborative platform for management of chronic diseases via guideline-driven individualized care plans

Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans. We also report the results of usability studies carried out in four pilot sites by patients and clinicians

Asynchronous digital health interventions for reviewing asthma: a mixed-methods systematic review protocol

INTRODUCTION: People living with asthma require regular reviews to address their concerns and questions, assess control, review medication, and support self-management. However, practical barriers to attending face-to-face consultations might limit routine reviews. Reviewing asthma using asynchronous digital health interventions could be convenient for patients and an efficient way of maintaining communication between patients and healthcare professionals and improving health outcomes. We, therefore, aim to conduct a mixed-methods systematic review to assess the effectiveness of reviewing asthma by asynchronous digital health interventions and explore the views of patients and healthcare professionals about the role of such interventions in delivering asthma care. METHODS: We will search MEDLINE, Embase, Scopus, PsycInfo, CINAHL, and Cochrane Library from 2001 to present without imposing any language restrictions. We are interested in studies of asynchronous digital health interventions used either as a single intervention or contributing to mixed modes of review. Two review authors will independently screen titles and abstracts, and retrieve potentially relevant studies for full assessment against the eligibility criteria and extract data. Disagreements will be resolved by discussion with the review team. We will use 'Downs and Black' checklist, 'Critical Appraisal Skills Programme', and 'Mixed Methods Appraisal Tool' to assess methodological quality of quantitative, qualitative, and mixed-methods studies respectively. After synthesising quantitative (narrative synthesis) and qualitative (thematic synthesis) data separately, we will integrate them following methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions. CONCLUSION: The findings of this review will provide insights into the role of asynchronous digital health interventions in the routine care of people living with asthma. TRIAL REGISTRATION: Systematic review registration: PROSPERO registration number: CRD42022344224

Living Sweet: a Multi-Functional Mobile-Phone Application Strategy for Adults with Uncontrolled Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus (T2DM), one of the most common chronic diseases, is increasing worldwide, and once diagnosed, lifetime self-management is critical to maintain glycemic control (Vermeire et al., 2005; American Diabetes Association (ADA), 2018). Management of T2DM has been acknowledged as challenging due to the need for strict lifestyle adaptations. From a public health perspective, uncontrolled diabetes leads to increased healthcare costs, secondary complications, and ultimately severe disabilities (ADA, 2018). The purpose of this evidencebased practice (EBP) project was to evaluate the effectiveness of a diabetes-specific mobile health application (MHA) on glycated-hemoglobin (HbA1C), self-care perception (SCP), and self-care behaviors (SCB). The Iowa model was used to guide this project in primary care settings in Northwest Indiana. A retrospective chart review determined that a high number adults had uncontrolled T2DM. A protocol was developed and implemented over an 8-week period. A within group design was used for pre and post-intervention evaluation of the HbA1C and SCP using paired-samples t tests. Statistically significant differences were noted in pre- HbA1C (M = 9.95; SD = 1.07) compared to post-HbA1C (M = 8.21; SD = 1.10) (t = 6.674, df = 17, *p \u3c 0.05), and in pre-SCP (M = 34.6; SD = 10.5) compared to post-SCP (M = 42.6; SD = 8.09) (t = -4.403, df = 17, *p \u3c 0.05). A statistically significant difference in project-specific pre and post- intervention SCBs were found with the behaviors of checking glucose (Z = 2.389, *p \u3c .05), recording glucose (Z = 2.666, *p \u3c .05), and medication adherence (Z = 2.313, *p \u3c .05). There was not a statistically significant difference in the perception of activity engagement (Z = 1.718, p \u3e .05). Results indicated that a MHA intervention had a statistically and clinically significant impact on HbA1C, SCP, and SCBs with the exception of activity engagement

Living Sweet: a Multi-Functional Mobile-Phone Application Strategy for Adults with Uncontrolled Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus (T2DM), one of the most common chronic diseases, is increasing worldwide, and once diagnosed, lifetime self-management is critical to maintain glycemic control (Vermeire et al., 2005; American Diabetes Association (ADA), 2018). Management of T2DM has been acknowledged as challenging due to the need for strict lifestyle adaptations. From a public health perspective, uncontrolled diabetes leads to increased healthcare costs, secondary complications, and ultimately severe disabilities (ADA, 2018). The purpose of this evidencebased practice (EBP) project was to evaluate the effectiveness of a diabetes-specific mobile health application (MHA) on glycated-hemoglobin (HbA1C), self-care perception (SCP), and self-care behaviors (SCB). The Iowa model was used to guide this project in primary care settings in Northwest Indiana. A retrospective chart review determined that a high number adults had uncontrolled T2DM. A protocol was developed and implemented over an 8-week period. A within group design was used for pre and post-intervention evaluation of the HbA1C and SCP using paired-samples t tests. Statistically significant differences were noted in pre- HbA1C (M = 9.95; SD = 1.07) compared to post-HbA1C (M = 8.21; SD = 1.10) (t = 6.674, df = 17, *p \u3c 0.05), and in pre-SCP (M = 34.6; SD = 10.5) compared to post-SCP (M = 42.6; SD = 8.09) (t = -4.403, df = 17, *p \u3c 0.05). A statistically significant difference in project-specific pre and post- intervention SCBs were found with the behaviors of checking glucose (Z = 2.389, *p \u3c .05), recording glucose (Z = 2.666, *p \u3c .05), and medication adherence (Z = 2.313, *p \u3c .05). There was not a statistically significant difference in the perception of activity engagement (Z = 1.718, p \u3e .05). Results indicated that a MHA intervention had a statistically and clinically significant impact on HbA1C, SCP, and SCBs with the exception of activity engagement

The impact of an EMR on the management of adult patients with type two diabetes by family physicians in ruralnewfoundland

PURPOSE This study was designed to determine whether the use of advanced features of an electronic medical record in a primary care setting could improve the process of delivering diabetes care in such a way as to produce improvements in diabetic outcome measures in adult type II diabetic patients. METHODS The study was a Retrospective Cohort Study conducted in primary care clinics that had an established electronic medical record following 307 adult patients with type II diabetes over the course of two years. The clinics had similarly trained primary care physicians, similar patient populations, and used common diabetic care guidelines. The advanced EMR features used during the diabetic study included a diabetic template, premade laboratory requisitions, appeared consultations, flow sheets, and patient alerts. The dependent variables measured included the process of the delivery of diabetic care and the measurement of diabetic outcomes. The process of care measures were: the frequency of visits specific for diabetes care, ordering of HbA1c and LDL cholesterol, the measurement of blood pressure, and the documentation of these activities. The outcome measures included glycemic, lipid and blood pressure control as measured by HbA1c, LDL and blood pressure levels. The two independent variables of interest in the study were the extent to which the advanced features EMR are use by the physician and the second any changes noted in the outcome measures. RESULTS The demographic information for the patients in this study was sex and age as well as baseline HbA1c, LDL, baseline systolic blood pressures, baseline diastolic blood pressures, and the number of visits that each patient had during the study period. The two groups were seen to be similar at baseline except for age and systolic blood pressure. The mean age of the intervention group was four years older than the control group and the comparison group had more people with systolic blood pressure at target. Age and systolic blood pressure were therefore controlled in the analysis. There was no difference in the two groups of patients in terms of measurements of HbA1c but there were differences in the frequency of measurements of LDL and blood pressures. Patients for whom the template was used during at least one clinical encounter, were 1.18 times more likely to have their LDL measured and 1.9 times more likely to have their blood pressure measured. Using logistics regression analysis there was a higher proportion of patients with an LDL at target in the intervention group. CONCLUSIONS The meaningful use of EMRs in primary care, is possible through a process of maturity by design; an individualized approach looking at the needs of a given physician(s) and their practice(s) most likely to aid EMRs in achieving their potential. The technology needs to support care by automation of clinical processes and work flow behind the computer screen in such a way as to not disrupt or significantly change the patient physician interaction and focus both of these individuals on managing meaningful clinical outcomes personalized to each patient

Addendum to Informatics for Health 2017: Advancing both science and practice

This article presents presentation and poster abstracts that were mistakenly omitted from the original publication

The New York City Health and Hospitals Corporation: Transforming a Public Safety Net Delivery System to Achieve Higher Performance

Describes the results of the public benefit corporation's improvement initiatives -- a common clinical information system for continuity, coordination on chronic disease management, teamwork and continuous innovation, and access to appropriate care

Study protocol: a double blind randomised control trial of high volume image guided injections in achilles and patellar tendinopathy in a young active population

Background: Chronic tendinopathy is a significant problem particularly in active populations limiting sporting and occupational performance. The prevalence of patellar tendinopathy in some sports is near 50% and the incidence of lower limb tendinopathy is 1.4% p.a. in the UK Military. Management includes isometric, eccentric, heavy slow resistance exercises and extracorporeal shockwave therapy (ESWT). Often these treatments are inadequate yet there is no good evidence for injection therapies and success rates from surgery can be as low as 50%. High Volume Image Guided Injection (HVIGI) proposes to strip away the neovascularity and disrupt the nerve ingrowth seen in chronic cases and has shown promising results in case series. This study aims to investigate the efficacy of HVIGI in a randomised controlled trial (RCT). Methods: RCT comparing 40ml HVIGI, with or without corticosteroid, with a 3ml local anaesthetic sham-control injection. Ninety-six participants will be recruited. Inclusion criteria: male, 18–55 years old, chronic Achilles or patellar tendinopathy of at least 6 months, failed conservative management including ESWT, and Ultrasound (US) evidence of neovascularisation, tendon thickening and echogenic changes. Outcome measures will be recorded at baseline, 6 weeks, 3, 6 and 12 months. Primary outcome measures include The Victoria Institute of Sport Assessments for Achilles and patellar tendinopathy (VISA-A and VISA-P) and VAS pain. Secondary outcome measures include Modified Ohberg score, maximum tendon diameter and assessment of hypoechoic appearance on US, and Functional Activity Assessment. Discussion: Despite previous interventional trials and reviews there is still insufficient evidence to guide injectable therapy for chronic tendinopathy that has failed conservative treatment. The scant evidence available suggests HVIGI has the greatest potential however there is no level one RCT evidence to support this. Investigating the efficacy of HVIGI against control in a RCT and separating the effect of HVIGI and corticosteroid will add high level evidence to the management of chronic tendinopathy resistant to conservative treatment

Atrial fibrillation self-management: a mobile telephone app scoping review and content analysis

Atrial fibrillation (AF) affects over 1.4 million people in the UK, resulting in a five-fold increased stroke risk and a three to four times greater risk of severe, disabling stroke. Atrial fibrillation, a chronic disease, requires monitoring, medication, and lifestyle measures. A self-management approach supported by mobile health (mHealth) may empower AF self-care. To assess the need to develop new mHealth self-management interventions for those with AF this review aimed to identify commercially available AF self-management apps, analyse, and synthesize (i) characteristics, (ii) functions, (iii) privacy/security, (iv) incorporated behaviour change techniques (BCTs), and (v) quality and usability. We searched app stores for ‘atrial fibrillation’ and ‘anticoagulation’, and included apps focused on AF self-management in the review. We examined app functions, privacy statements against best practice recommendations, the inclusion of BCTs using the App Behaviour Change Scale, and app quality/usability using the Mobile App Rating Scale. From an initial search of 555 apps, five apps were included in the review. Common functions were educational content, medication trackers, and communication with healthcare professionals. Apps contained limited BCTs, lacked intuitive functions and were difficult to use. Privacy policies were difficult to read. App quality rated from poor to acceptable and no app had been evaluated in a clinical trial. The review reports a lack of commercially available AF self-management apps of sufficient standard for use in healthcare settings. This highlights the need for clinically validated mHealth interventions incorporating evidence-based BCTs to support AF self-management