Technology-Enhanced Practice for Patients with Chronic Cardiac Disease: Home Implementation and Evaluation

Objective: This 3-year field experiment engaged 60 nurses and 282 patients in the design and evaluation of an innovative home-care nursing model, referred to as technology-enhanced practice (TEP). Methods: Nurses using TEP augmented the usual care with a web-based resource (HeartCareII) that provided patients with self-management information, self-monitoring tools, and messaging services. Results: Patients exposed to TEP demonstrated better quality of life and self-management of chronic heart disease during the first 4 weeks, and were no more likely than patients in usual care to make unplanned visits to a clinician or hospital. Both groups demonstrated the same long-term symptom management and achievements in health status. Conclusion: This project provides new evidence that the purposeful creation of patient-tailored web resources within a hospital portal is possible; that nurses have difficulty with modifying their practice routines, even with a highly-tailored web resource; and that the benefits of this intervention are more discernable in the early postdischarge stages of care

The Veterans Health Administration: Taking Home Telehealth Services to Scale Nationally

Since the 1990s, the Veterans Health Administration (VHA) has used information and communications technologies to provide high-quality, coordinated, and comprehensive primary and specialist care services to its veteran population. Within the VHA, the Office of Telehealth Services offers veterans a program called Care Coordination/Home Telehealth (CCHT) to provide routine noninstitutional care and targeted care management and case management services to veterans with diabetes, congestive heart failure, hypertension, post-traumatic stress disorder, and other conditions. The program uses remote monitoring devices in veterans' homes to communicate health status and to capture and transmit biometric data that are monitored remotely by care coordinators. CCHT has shown promising results: fewer bed days of care, reduced hospital admissions, and high rates of patient satisfaction. This issue brief highlights factors critical to the VHA's success -- like the organization's leadership, culture, and existing information technology infrastructure -- as well as opportunities and challenges

Monitoring Cardiovascular Disease-Patients with Mobile Computing Technologies

Physicians and healthcare networks have been slow to adopt electronic medical records and to integrate medical data with the ubiquitous mobile device. Mobile and wearable systems for continuous health monitoring constitute a key technology in helping the transition of health care to a more proactive and affordable healthcare. Cardiovascular Disease (CVD) includes dysfunctional conditions of the heart, arteries, and veins that supply oxygen to vital life-sustaining areas/organs of the body. CVD singly accounts for about 40% of all deaths worldwide. Over 80 per cent of CVD deaths take place in low- and middle-income countries. An estimated 17.5 million people died from cardiovascular disease in 2005, and expected to top 20 million per year by 2015. By 2030, more than 23 million people will die annually from CVDs. CVDs‘ patients face risks of recurrent acute cardiovascular events, hospital re-admission, and unfavourable quality of life. Heart Failure, (HF), leads to death if not properly managed and supervised. Current treatments for Congestive Heart Failure (CHF) provide a limited palliative outcome. New technologies are now pertinent to generate high-dimensional data that provide unprecedented opportunities for unbiased identification of biomarkers that can be used to optimize pre-operative planning, with the goal of avoiding costly post-operative complications and prolonged hospitalization. Due to the crucial role of remote monitoring for CVD patients, significant efforts from research communities and industry to propose and design a variety of CVD monitoring devices have become imperative. This paper builds a proof-of-concept and presents a cardiovascular monitoring system, Cardiovascular Disease Management System (CVDMS), for real-time information on patient‘s heart health status with respect to his/her heart beat in hemodynamics computation towards reducing re-admission incidence problem. Administered 485 questionnaires and interviewed 12 cardiologists, 45 physicians, and 23 pharmacists to gather details on vital CVD parameters. 469 of 485 questionnaires (96.70%) were validly completed and returned, while 16 (3.30%) were not. Searched internet databases and cognate texts for literature. A mobile CVDMS for HF was developed using UML, MySQL Server 5.0, Java servlets, Apache Tomcat 6.0 server, microcontroller, and Ozeki sms server. Patient completes a questionnaire on a J2ME platform-based computing device that measures the heartbeat rate. Biological signals acquired by CVDMS are processed by microcontroller. Pulses are counted within a space of one minute to know heartbeat rate per minute. The CVDMS application gets the heartbeat reading, and if the heart rate is abnormal, a trigger is set enabling the Ozeki SMS Gateway to send an alert to patient‘s next-of-kin and cardiologist. CVDMS guarantees individual patient‘s direct involvement to closely monitor changes in his/her vital signs and provide feedback to maintain an optimal health status. Medical personnel get alerted when life-threatening changes occur in establishing proper communication between patient and cardiologist via sms. Hemodynamics computation could be performed with the parameters obtained from the data supplied by CVDMS as a cardiovascular intervention to save many lives and improve quality of life. Keywords: artery stiffness; blood pressure; cardiologist; cardiovascular disease; heart attack; heart failure; hemodynamic volumetric parameters; hospital re-admission; hypertension; risk-factor

Norman Regional Health System: A City-Owned Public Trust Dedicated to Improving Performance

Describes successful strategies for providing recommended treatment on process-of-care measures, including board and administration support, order sets, concurrent review, performance feedback, transparency, and engaging nurses. Outlines lessons learned

Activity Theory Analysis of Heart Failure Self-Care

The management of chronic health conditions such as heart failure is a complex process emerging from the activity of a network of individuals and artifacts. This article presents an Activity Theory-based secondary analysis of data from a geriatric heart failure management study. Twenty-one patients' interviews and clinic visit observations were analyzed to uncover eight configurations of roles and activities involving patients, clinicians, and others in the sociotechnical network. For each configuration or activity pattern, we identify points of tension and propose guidelines for developing interventions for future computer-supported healthcare systems

Characteristics of patients with haematological and breast cancer (1996–2009) who died of heart failure-related causes after cancer therapy

Aims: To describe the characteristics and time to death of patients with breast or haematological cancer who died of heart failure (HF) after cancer therapy. Patients with an index admission for HF who died of HF-related causes (IAHF) and those with no index admission for HF who died of HF-related causes (NIAHF) were compared. Methods and results: We performed a linked data analysis of cancer registry, death registry, and hospital administration records (n = 15 987). Index HF admission must have occurred after cancer diagnosis. Of the 4894 patients who were deceased (30.6% of cohort), 734 died of HF-related causes (50.1% female) of which 279 (38.0%) had at least one IAHF (41.9% female) post-cancer diagnosis. Median age was 71 years [interquartile range (IQR) 62–78] for IAHF and 66 years (IQR 56–74) for NIAHF. There were fewer chemotherapy separations for IAHF patients (median = 4, IQR 2–9) compared with NIAHF patients (median = 6, IQR 2–12). Of the IAHF patients, 71% had died within 1 year of the index HF admission. There was no significant difference in HF-related mortality in IAHF patients compared with NIAHF (HR, 1.10, 95% CI, 0.94–1.29, P = 0.225). Conclusions: The profile of IAHF patients who died of HF-related causes after cancer treatment matched the current profile of HF in the general population (over half were aged ≥70 years). However, NIAHF were younger (62% were aged ≤69 years), female patients with breast cancer that died of HF-related causes before hospital admission for HF-related causes—a group that may have been undiagnosed or undertreated until death

Outcomes Assessment and Health Care Reform

Argues for the use of outcomes assessment in measuring cost-effectiveness and quality to capture the overall impact of multi-dimensional treatment strategies and to identify healthcare systems that both adopt appropriate technologies and perform well

Oklahoma Heart Hospital: Clinician Leaders Establish Culture of Quality

Describes strategies for a culture of quality, including a flat organizational structure, optimal nurse experience and ratios, standardization through care sets, technology-enabled feedback and assessment, and continuous improvement through new practices