19,278 research outputs found
The Value of Information Technology-Enabled Diabetes Management
Reviews different technologies used in diabetes disease management, as well as the costs, benefits, and quality implications of technology-enabled diabetes management programs in the United States
Recommended from our members
Interventions to improve hand hygiene compliance in patient care
Background
Health careâassociated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. This is an update of a previously published review.
Objectives
To assess the shortâ and longâterm success of strategies to improve compliance to recommendations for hand hygiene, and to determine whether an increase in hand hygiene compliance can reduce rates of health careâassociated infection.
Search methods
We conducted electronic searches of the Cochrane Register of Controlled Trials, PubMed, Embase, and CINAHL. We conducted the searches from November 2009 to October 2016.
Selection criteria
We included randomised trials, nonârandomised trials, controlled beforeâafter studies, and interrupted time series analyses (ITS) that evaluated any intervention to improve compliance with hand hygiene using soap and water or alcoholâbased hand rub (ABHR), or both.
Data collection and analysis
Two review authors independently screened citations for inclusion, extracted data, and assessed risks of bias for each included study. Metaâanalysis was not possible, as there was substantial heterogeneity across studies. We assessed the certainty of evidence using the GRADE approach and present the results narratively in a 'Summary of findings' table.
Main results
This review includes 26 studies: 14 randomised trials, two nonârandomised trials and 10 ITS studies. Most studies were conducted in hospitals or longâterm care facilities in different countries, and collected data from a variety of healthcare workers. Fourteen studies assessed the success of different combinations of strategies recommended by the World Health Organization (WHO) to improve hand hygiene compliance. Strategies consisted of the following: increasing the availability of ABHR, different types of education for staff, reminders (written and verbal), different types of performance feedback, administrative support, and staff involvement. Six studies assessed different types of performance feedback, two studies evaluated education, three studies evaluated cues such as signs or scent, and one study assessed placement of ABHR. Observed hand hygiene compliance was measured in all but three studies which reported product usage. Eight studies also reported either infection or colonisation rates. All studies had two or more sources of high or unclear risks of bias, most often associated with blinding or independence of the intervention.
Multimodal interventions that include some but not all strategies recommended in the WHO guidelines may slightly improve hand hygiene compliance (five studies; 56 centres) and may slightly reduce infection rates (three studies; 34 centres), low certainty of evidence for both outcomes.
Multimodal interventions that include all strategies recommended in the WHO guidelines may slightly reduce colonisation rates (one study; 167 centres; low certainty of evidence). It is unclear whether the intervention improves hand hygiene compliance (five studies; 184 centres) or reduces infection (two studies; 16 centres) because the certainty of this evidence is very low.
Multimodal interventions that contain all strategies recommended in the WHO guidelines plus additional strategies may slightly improve hand hygiene compliance (six studies; 15 centres; low certainty of evidence). It is unclear whether this intervention reduces infection rates (one study; one centre; very low certainty of evidence).
Performance feedback may improve hand hygiene compliance (six studies; 21 centres; low certainty of evidence). This intervention probably slightly reduces infection (one study; one centre) and colonisation rates (one study; one centre) based on moderate certainty of evidence.
Education may improve hand hygiene compliance (two studies; two centres), low certainty of evidence.
Cues such as signs or scent may slightly improve hand hygiene compliance (three studies; three centres), low certainty of evidence.
Placement of ABHR close to point of use probably slightly improves hand hygiene compliance (one study; one centre), moderate certainty of evidence.
Authors' conclusions
With the identified variability in certainty of evidence, interventions, and methods, there remains an urgent need to undertake methodologically robust research to explore the effectiveness of multimodal versus simpler interventions to increase hand hygiene compliance, and to identify which components of multimodal interventions or combinations of strategies are most effective in a particular context
The effect of feedback to general practitioners on quality of care for people with type 2 diabetes. A systematic review of the literature
<p>Abstract</p> <p>Background</p> <p>There have been numerous efforts to improve and assure the quality of treatment and follow-up of people with Type 2 diabetes (PT2D) in general practice. Facilitated by the increasing usability and validity of guidelines, indicators and databases, feedback on diabetes care is a promising tool in this aspect. Our goal was to assess the effect of feedback to general practitioners (GPs) on the quality of care for PT2D based on the available literature.</p> <p>Methods</p> <p>Systematic review searches were conducted using October 2008 updates of Medline (Pubmed), Cochrane library and Embase databases. Additional searches in reference lists and related articles were conducted. Papers were included if published in English, performed as randomized controlled trials, studying diabetes, having general practice as setting and using feedback to GPs on diabetes care. The papers were assessed according to predefined criteria.</p> <p>Results</p> <p>Ten studies complied with the inclusion criteria. Feedback improved the care for PT2D, particularly process outcomes such as foot exams, eye exams and Hba1c measurements. Clinical outcomes like lowering of blood pressure, Hba1c and cholesterol levels were seen in few studies. Many process and outcome measures did not improve, while none deteriorated. Meta analysis was unfeasible due to heterogeneity of the studies included. Two studies used electronic feedback.</p> <p>Conclusion</p> <p>Based on this review, feedback seems a promising tool for quality improvement in diabetes care, but more research is needed, especially of electronic feedback.</p
Development and Implementation of a Computer-Generated Reminder System for Diabetes Preventive Care
Conference PaperBiomedical Informatic
Integrating Technology to Support and Maintain Glycemic Control in People With Diabetes
Presented to the Faculty
of the University of Alaska Anchorage
in Partial Fulfillment of the Requirements
for the Degree of
MASTER OF SCIENCEType II diabetes is a chronic disease state that leads to increased morbidity and mortality and
impacts the lives of millions of Americans. This quality improvement project explored the use
of a free smartphone application, Glucose Buddy, in aiding people with Type II diabetes to
achieve and maintain glycemic control. The project was conducted through the involvement of
patients at the Creekside Family Health Clinic in Ketchikan, Alaska over a three month time
period. Pre-intervention hemoglobin A1c (HA1c) was compared with post-intervention HA1c.
The project, due to the small sample size and high withdraw rate, was not statistically significant.
However, there was clinical significance as it showed a decrease in HA1c levels in 60% of the
participants.Abstract / Introduction / Literature Review and Synthesis / Problem Statement / Research Question / Methodology / Results / Limitations / Conclusions / Outcomes / Impact on Practice / Dissemination / References / Appendix A / Appendix B / Appendix C / Appendix
Systematic review of communication technologies to promote access and engagement of young people with diabetes into healthcare
Background: Research has investigated whether communication technologies (e.g. mobile telephony, forums,
email) can be used to transfer digital information between healthcare professionals and young people who live
with diabetes. The systematic review evaluates the effectiveness and impact of these technologies on
communication.
Methods: Nine electronic databases were searched. Technologies were described and a narrative synthesis of all
studies was undertaken.
Results: Of 20,925 publications identified, 19 met the inclusion criteria, with 18 technologies assessed. Five
categories of communication technologies were identified: video-and tele-conferencing (n = 2); mobile telephony
(n = 3); telephone support (n = 3); novel electronic communication devices for transferring clinical information (n =
10); and web-based discussion boards (n = 1). Ten studies showed a positive improvement in HbA1c following the
intervention with four studies reporting detrimental increases in HbA1c levels. In fifteen studies communication
technologies increased the frequency of contact between patient and healthcare professional. Findings were
inconsistent of an association between improvements in HbA1c and increased contact. Limited evidence was
available concerning behavioural and care coordination outcomes, although improvement in quality of life, patientcaregiver
interaction, self-care and metabolic transmission were reported for some communication technologies.
Conclusions: The breadth of study design and types of technologies reported make the magnitude of benefit and
their effects on health difficult to determine. While communication technologies may increase the frequency of
contact between patient and health care professional, it remains unclear whether this results in improved
outcomes and is often the basis of the intervention itself. Further research is needed to explore the effectiveness
and cost effectiveness of increasing the use of communication technologies between young people and
healthcare professionals
Use of m-Health Technology for Preventive Interventions to Tackle Cardiometabolic Conditions and Other Non-Communicable Diseases in Latin America- Challenges and Opportunities
In Latin America, cardiovascular disease (CVD) mortality rates will increase by an estimated 145% from 1990 to 2020. Several challenges related to social strains, inadequate public health infrastructure, and underfinanced healthcare systems make cardiometabolic conditions and non-communicable diseases (NCDs) difficult to prevent and control. On the other hand, the region has high mobile phone coverage, making mobile health (mHealth) particularly attractive to complement and improve strategies toward prevention and control of these conditions in low- and middle-income countries. In this article, we describe the experiences of three Centers of Excellence for prevention and control of NCDs sponsored by the National Heart, Lung, and Blood Institute with mHealth interventions to address cardiometabolic conditions and other NCDs in Argentina, Guatemala, and Peru. The nine studies described involved the design and implementation of complex interventions targeting providers, patients and the public. The rationale, design of the interventions, and evaluation of processes and outcomes of each of these studies are described, together with barriers and enabling factors associated with their implementation.Fil: Beratarrechea, Andrea Gabriela. Instituto de Efectividad ClĂnica y Sanitaria; Argentina. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; ArgentinaFil: Diez Canseco, Francisco. Universidad Peruana Cayetano Heredia; PerĂșFil: Irazola, Vilma. Instituto de Efectividad ClĂnica y Sanitaria; Argentina. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; ArgentinaFil: Miranda, Jaime. Universidad Peruana Cayetano Heredia; PerĂșFil: Ramirez Zea, Manuel. Institute of Nutrition of Central America and Panama; GuatemalaFil: Rubinstein, Adolfo Luis. Instituto de Efectividad ClĂnica y Sanitaria; Argentina. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; Argentin
An Electronic Health Record Type 2 Diabetes Management Program Implementation and Outcomes in a Rural Practice
Type 2 diabetes mellitus is a chronic disease affecting 26 million people in the United States or 8.3% of the population. The prevalence of diabetes is rapidly increasing and increases with age. Treatment guidelines for Type 2 diabetes mellitus have been developed by the American Diabetes Association (2015) to decrease mortality and morbidity in patients with the disease. Utilization of current guidelines is a major component of providing evidence-based care. With the advent and widespread usage of electronic health records (EHR), a vehicle for point-of-care inclusion of accepted standardized guidelines exists. Including a reminder alert system within an existing EHR triggers providers to comply with current guidelines. Implementation of such a reminder system within a rural family medicine practice increased compliance with established guidelines. The guidelines measured in this study were blood pressure measurement at last visit, measurement of glycosylated hemoglobin within the last six months, and prescribed statin pharmacologic therapy. Glycosylated hemoglobin measurement increased by 16%, blood pressure measurement improved by 13%, and treatment with statin therapy increased by 16%. Implications for practice are inclusion of other Type 2 diabetes mellitus guidelines into the reminder alert system. Expansion of this system to iv include other chronic diseases with accepted evidence based guidelines may be designed and implemented based on this project
Knowledge engineering complex decision support system in managing rheumatoid arthritis.
Background: The management of rheumatoid arthritis (RA) involves partially recursive attempts to make optimal treatment decisions that balance the risks of the treatment to the patient against the benefits of the treatment, while monitoring the patient closely for clinical response, as inferred from prior and residual disease activity, and unwanted drug effects, including abnormal laboratory findings. To the extent that this process is logical, based on best available evidence and determined by considered opinion, it should be amenable to capture within a Clinical Decision Support Systems (CDSSs). The formalisation of logical transformations and their execution by computer tools at point of patient encounter holds the promise of more efficient and consistent use of treatment rules and more reliable clinical decision making.
Research Setting: The early Rheumatoid Arthritis (eRA) clinic of the Royal Adelaide Hospital (RAH) with approximately 20 RA patient visits per week, and involving 160 patients with a median duration of treatment of more than 4.5 years.
Methods: The study applied a Knowledge Engineering approach to interpret the complexities of RA management, in order to implement a knowledge-based CDSS. The study utilised Knowledge Acquisition processes to elicit and explicitly define the RA management rules underpinning the development of the CDSS; the processes were (1) conducting a comprehensive literature review of RA management, (2) observing clinic consultations and (3) consulting with local clinical experts/leaders. Bayesâ
Theorem and Bayes Net were used to generate models for assessing contingent probabilities of unwanted events. A questionnaire based on 16 real patient cases was developed to test the concordance agreement between CDSS generated guidance in response to real-life clinical scenarios and decisions of rheumatologists in response to the scenarios.
Results: (1) Complex RA management rules were established which included (a) Rules for Changes in Dose/Agent and (b) Drug Toxicity Monitoring Rules. (2) A computer interpretable dynamic model for implementing the complex clinical guidance was found to be applicable. (3) A framework for a methotrexate (MTX) toxicity prediction model was developed, thereby allowing missing risk ratios (probabilities) to be identified. (4) Clinical decision-making processes and workflows were described.
Finally, (5) a preliminary version of the CDSS which computed Rules for Changes in Dose/Agent and Drug Toxicity Monitoring Rules was implemented and tested. One hundred and twenty-eight decisions collected from the 8 participating rheumatologists established the ability of the CDSS to match decisions of clinicians accustomed to application of Rules for Changes in Dose/Agent; rheumatologists unfamiliar with the rules displayed lower concordance (0.7857 vs. 0.3929, P = 0.0027). Neither group of rheumatologists matched the performance of the CDSS in making decisions based on highly complex Drug Toxicity Monitoring Rules (0.3611 vs. 0.4167, P = 0.7215).
Conclusion: The study has made important contributions to the development of a CDSS suitable for routine use in the eRA clinic setting. Knowledge Acquisition processes were used to elicit domain knowledge, and to refine, validate and articulate eRA management rules, that came to form the knowledge base of the CDSS. The development of computer interpretable guideline models underpinned the CDSS development. The alignment of CDSS guidance in response to clinical scenarios with questionnaire responses of rheumatologists familiar with and accepting of the management rules (and divergence with responses by rheumatologists not familiar with the rules) indicates that the CDSS can be used to guide toward evidence-based considered opinion. The poor correlation between CDSS generated guidance regarding out of range blood results and response of rheumatologists to questions regarding toxicity scenarios, underlines the value of computer aided guidance when decisions involve greater complexity. It also suggests the need for attention to rule development and considered opinion in this area.
Discussion: Effective utilisation of extant knowledge is fundamental to knowledgebased systems in healthcare. CDSSs development for chronic disease management is a complex undertaking which is tractable using Knowledge Engineering and Knowledge Acquisition approaches coupled with modelling into computer interpretable algorithms. Complexities of drug toxicity monitoring were addressed using Bayesâ Theorem and Bayes Net for making probability based decisions under conditions of uncertainty. While for logistic reasons the system could not be developed to full implementation, preliminary analyses support the utility of the approach, both for intensifying treatment on a response contingent basis and also for complex drug toxicity monitoring. CDSSs are inherently suited to iterative refinements based on new knowledge including that arising from analyses of the data they capture during their use. This study has achieved important steps toward implementation and refinement.Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 201
Persuasive system design does matter: a systematic review of adherence to web-based interventions
Background: Although web-based interventions for promoting health and health-related behavior can be effective, poor adherence is a common issue that needs to be addressed. Technology as a means to communicate the content in web-based interventions has been neglected in research. Indeed, technology is often seen as a black-box, a mere tool that has no effect or value and serves only as a vehicle to deliver intervention content. In this paper we examine technology from a holistic perspective. We see it as a vital and inseparable aspect of web-based interventions to help explain and understand adherence.
Objective: This study aims to review the literature on web-based health interventions to investigate whether intervention characteristics and persuasive design affect adherence to a web-based intervention.
Methods: We conducted a systematic review of studies into web-based health interventions. Per intervention, intervention characteristics, persuasive technology elements and adherence were coded. We performed a multiple regression analysis to investigate whether these variables could predict adherence.
Results: We included 101 articles on 83 interventions. The typical web-based intervention is meant to be used once a week, is modular in set-up, is updated once a week, lasts for 10 weeks, includes interaction with the system and a counselor and peers on the web, includes some persuasive technology elements, and about 50% of the participants adhere to the intervention. Regarding persuasive technology, we see that primary task support elements are most commonly employed (mean 2.9 out of a possible 7.0). Dialogue support and social support are less commonly employed (mean 1.5 and 1.2 out of a possible 7.0, respectively). When comparing the interventions of the different health care areas, we find significant differences in intended usage (p = .004), setup (p < .001), updates (p < .001), frequency of interaction with a counselor (p < .001), the system (p = .003) and peers (p = .017), duration (F = 6.068, p = .004), adherence (F = 4.833, p = .010) and the number of primary task support elements (F = 5.631, p = .005). Our final regression model explained 55% of the variance in adherence. In this model, a RCT study as opposed to an observational study, increased interaction with a counselor, more frequent intended usage, more frequent updates and more extensive employment of dialogue support significantly predicted better adherence.
Conclusions: Using intervention characteristics and persuasive technology elements, a substantial amount of variance in adherence can be explained. Although there are differences between health care areas on intervention characteristics, health care area per se does not predict adherence. Rather, the differences in technology and interaction predict adherence. The results of this study can be used to make an informed decision about how to design a web-based intervention to which patients are more likely to adher
- âŠ