Use and usability of the Dr. Bart app and its relation with health care utilization and clinical outcomes in people with knee and/or hip osteoarthritis

2021 ◽  
Vol 29 ◽  
pp. S422
Author(s):  
T. Pelle ◽  
J. van der Palen ◽  
F. de Graaf ◽  
F. van den Hoogen ◽  
K. Bevers ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Clinical Outcomes ◽  
Hip Osteoarthritis ◽  
Care Utilization

FRI0629-HPR USE AND USABILITY OF THE DR. BART APP AND ITS RELATION WITH CLINICAL OUTCOMES IN PEOPLE WITH KNEE AND/OR HIP OSTEOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 919.1-919
Author(s):  
T. Pelle ◽  
J. Van der Palen ◽  
F. Van den Hoogen ◽  
K. Bevers ◽  
C. Van den Ende
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Central Element ◽  
Hip Osteoarthritis ◽  
Theoretical Framework ◽  
Self Management ◽  
Care Utilization ◽  
Considerable Proportion

Background:Self-management is of paramount importance in non-surgical treatment of knee and/or hip osteoarthritis(OA). Modern technologies offer the possibility to support self-management 24/7. We developed an e-self-management application (dr. Bart app) for people with knee and/or hip OA.Objectives:To document the use of the dr. Bart app and its relation with health care utilization and clinical outcomes in people with knee and/or hip OA.Methods:For this study we used back end data of the first 26 weeks from the intervention group (N=214) of a RCT (total included 427) examining the effectiveness of the dr. Bart app. Participants were included based on self-reported knee and/or hip OA. In figure 1 the theoretical framework of the dr. Bart app is presented. A central element of the dr. Bart app is that the app proposes a selection of 72 preformulated goals for health behaviours based on the ‘tiny habits method’1(e.g. today I rise 12 times from my chair to train my leg muscles). The proposals are tailored to user characteristics and related to four themes that are core elements in the non-surgical management of OA. After a user completes one or more of the selected goals, a new selection is proposed by dr. Bart. A user can work on 3 goals simultaneously. Goals can be completed more than once by the same user. To assess the association between intensity of use of the app and health care utilization and clinical outcomes, we calculated Spearman rank correlation coefficients.Figure 1.Theoretical framework of the dr. Bart app.Results:171 / 214 participants (80 %) logged in at least once whilst 151 (71%) chose at least one goal and 114 (53 %) completed at least one goal during the 26 weeks. Of those who chose at least one goal, 56 participants (37 %) continued to log in up to 26 weeks, 12 (8 %) continued to select new goals from the offered goals and 37 (25 %) continued to complete goals (Figure 2). Preformulated goals regarding the themes activity (e.g. performing an exercise from the exercises library of the app) and nutrition (e.g. eat 2 pieces of fruit today) were found to be most popular by users. We found no correlations between intensity of use and health care utilization and clinical outcomes.Figure 2.Percentage of active users (N=151) over time.Conclusion:A considerable proportion of persons with knee and/or hip OA persistently used the app up to 26 weeks. Patients appear to have preferences for goals related to activity and nutrition, rather than for goals related to vitality and education. We found no relation between intensity of use of the dr. Bart app and health care utilization and clinical outcomes.References:[1] Fogg GJ: A behavior model for persuasive design. In: Proceedings of the 4thinternational Conference on Persuasive Technology: 2009: ACM; 2009: 40.Disclosure of Interests:None declared

Negative Pressure Wound Therapy After Abdominal Body Contouring: A Comparative Matched Analysis of Outcomes and Cost

2021 ◽  
pp. 229255032110196
Author(s):  
Martin P. Morris ◽  
Adrienne N. Christopher ◽  
Viren Patel ◽  
Ginikanwa Onyekaba ◽  
Robyn B. Broach ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Clinical Outcomes ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Body Contouring ◽  
Emergency Department Visits ◽  
Smoking History ◽  
Care Utilization ◽  
Wound Therapy

Background: Studies that have previously validated the use of incisional negative pressure wound therapy (iNPWT) after body contouring procedures (BCP) have provided limited data regarding associated health care utilization and cost. We matched 2 cohorts of patients after BCP with and without iNPWT and compared utilization of health care resources and post-operative clinical outcomes. Methods: Adult patients who underwent abdominoplasty and/or panniculectomy between 2015 and 2020 by a single surgeon were identified. Patients were propensity score matched by body mass index (BMI), gender, smoking history, diabetes mellitus, hypertension, and incision type. Primary outcomes included time to final drain removal, outpatient visits, homecare visits, emergency department visits, and cost. Secondary outcomes included surgical site occurrences (SSO), surgical site infections, reoperations, and revisions. Results: One hundred sixty-six patients were eligible, and 40 were matched (20 with iNPWT and 20 without iNPWT) with a median age of 47 years and BMI of 32 kg/m2. There were no differences in demographics or intraoperative details (all P > .05). No significant differences were found between the cohorts in terms of health care utilization measures or clinical outcomes (all P > .05). Direct cost was significantly greater in the iNPWT cohort ( P = .0498). Inpatient length of stay and procedure time were independently associated with increased cost on multivariate analysis (all P < .0001). Conclusion: Consensus guidelines recommend the use of iNPWT in high-risk patients, including abdominal BCP. Our results show that iNPWT is associated with equivalent health care utilization and clinical outcomes, with increased cost. Additional randomized controlled trials are needed to further elucidate the cost utility of this technique in this patient population.

scholarly journals Approaches to Evaluations of Virtual Care in Primary Care

2022 ◽  
Vol 2 (1) ◽  
pp. es0358
Author(s):  
Daphne Hui ◽  
Bert Dolcine ◽  
Hannah Loshak
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Clinical Outcomes ◽  
Care Utilization ◽  
Cost Analyses ◽  
Virtual Care ◽  
Primary Care Health ◽  
Guidance Documents ◽  
Care Health

A literature search informed this Environmental Scan and identified 11 evaluations of virtual care in primary care health settings and 7 publications alluding to methods, standards, and guidelines (referred to as evaluation guidance documents in this report) being used in various countries to evaluate virtual care in primary care health settings. The majority of included literature was from Australia, the US, and the UK, with 2 evaluation guidance documents published by the Heart and Stroke Foundation of Canada. Evaluation guidance documents recommended using measurements that assess the effectiveness and quality of clinical care including safety outcomes, time and travel, financial and operational impact, participation, health care utilization, technology experience including feasibility, user satisfaction, and barriers and facilitators or measures of health equity. Evaluation guidance documents specified that the following key decisions and considerations should be integrated into the planning of a virtual care evaluation: refining the scope of virtual care services; selecting an appropriate meaningful comparator; and identifying opportune timing and duration for the evaluation to ensure the evaluation is reflective of real-world practice, allows for adequate measurement of outcomes, and is comprehensive, timely, feasible, non-complex, and non–resource-intensive. Evaluation guidance documents highlighted that evaluations should be systematic, performed regularly, and reflect the stage of virtual care implementation to encompass the specific considerations associated with each stage. Additionally, evaluations should assess individual virtual care sessions and the virtual care program as a whole. Regarding economic components of virtual care evaluations, the evaluation guidance documents noted that costs or savings are not limited to monetary or financial measures but can also be represented with time. Cost analyses such as cost-benefit and cost-utility estimates should be performed with a specific emphasis on selecting an appropriate perspective (e.g., patient or provider), as that influences the benefits, effects, and how the outcome is interpreted. Two identified evaluations assessed economic outcomes through cost analyses in the perspective of the patient and provider. Evidence suggests that, in some circumstances, virtual care may be more cost-effective and reduces the cost per episode and patient expenses (e.g., travel and parking costs) compared to in-person care. However, virtual care may increase the number of individuals treated, which would increase overall health care spending. Four identified evaluations assessed health care utilization. The evidence suggests that virtual care reduces the duration of appointments and may be more time-efficient compared to in-person care. However, it is unclear if virtual care reduces the use of medical resources and the need for follow-up appointments, hospital admissions, and emergency department visits compared to in-person care. Five identified evaluations assessed participation outcomes. Evidence was variable, with some evidence reporting that virtual care reduced attendance (e.g., reduced attendance rates) and other evidence noting improved attendance (e.g., increased completion rate and decreased cancellations and no-show rates) compared to in-person care. Three identified evaluations assessed clinical outcomes in various health contexts. Some evidence suggested that virtual care improves clinical outcomes (e.g., in primary care with integrated mental health services, symptom severity decreased) or has a similar effect on clinical outcomes compared to in-person care (e.g., use of virtual care in depression elicited similar results with in-person care). Three identified evaluations assessed the appropriateness of prescribing. Some studies suggested that virtual care improves appropriateness by increasing guideline-based or guideline-concordant antibiotic management, or elicits no difference with in-person care.

scholarly journals Association between clinical outcomes and metformin use in adults with sickle cell disease and diabetes mellitus

2019 ◽  
Vol 3 (21) ◽  
pp. 3297-3306
Author(s):  
Sherif M. Badawy ◽  
Amanda B. Payne
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Sickle Cell Disease ◽  
Health Care Utilization ◽  
Clinical Outcomes ◽  
Care Utilization ◽  
Cell Disease ◽  
Clinical Events ◽  
Key Points ◽  
Clinical Benefits

Key Points Metformin use was associated with significantly fewer SCD-related health care utilization encounters and clinical events. Our findings provide the first evidence to suggest potential clinical benefits associated with metformin use in patients with SCD.

scholarly journals Pregnancy-Related Acute Kidney Injury in the United States: Clinical Outcomes and Health Care Utilization

2020 ◽  
Vol 51 (3) ◽  
pp. 216-226 ◽  
Author(s):  
Silvi Shah ◽  
Karthikeyan Meganathan ◽  
Annette L. Christianson ◽  
Kathleen Harrison ◽  
Anthony C. Leonard ◽  
...  
Keyword(s):  
Health Care ◽  
Acute Kidney Injury ◽  
Health Care Utilization ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
The United States ◽  
Care Utilization ◽  
Inpatient Mortality ◽  
Factors Associated ◽  
Race Ethnicity

Background: Acute kidney injury (AKI) during pregnancy is a public health problem and is associated with maternal and fetal morbidity and mortality. Clinical outcomes and health care utilization in pregnancy-related AKI, especially in women with diabetes, are not well studied. Methods: Using data from the 2006 to 2015 Nationwide Inpatient Sample, we identified 42,190,790 pregnancy-related hospitalizations in women aged 15–49 years. We determined factors associated with AKI, including race/ethnicity, and associations between AKI and inpatient mortality, and between AKI and cardiovascular (CV) events, during pregnancy-related hospitalizations. We calculated health care expenditures from pregnancy-related AKI hospitalizations. Results: Overall, the rate of AKI during pregnancy-related hospitalizations was 0.08%. In the adjusted regression analysis, a higher likelihood of AKI during pregnancy-related hospitalizations was seen in 2015 (OR 2.20; 95% CI 1.89–2.55) than in 2006; in older women aged 36–40 years (OR 1.49; 95% CI 1.36–1.64) and 41–49 years (OR 2.12; 95% CI 1.84–2.45) than in women aged 20–25 years; in blacks (OR 1.52; 95% CI 1.40–1.65) and Native Americans (OR 1.45; 95% CI 1.10–1.91) than in whites, and in diabetic women (OR 4.43; 95% CI 4.04–4.86) than in those without diabetes. Pregnancy-related hospitalizations with AKI were associated with a higher likelihood of inpatient mortality (OR 13.50; 95% CI 10.47–17.42) and CV events (OR 9.74; 95% CI 9.08–10.46) than were hospitalizations with no AKI. The median cost was higher for a delivery hospitalization with AKI than without AKI (USD 18,072 vs. 4,447). Conclusion: The rates of pregnancy-related AKI hospitalizations have increased during the last decade. Factors associated with a higher likelihood of AKI during pregnancy included older age, black and Native American race/ethnicity, and diabetes. Hospitalizations with pregnancy-related AKI have an increased risk of inpatient mortality and CV events, and a higher health care utilization than do those without AKI.

scholarly journals Comparative Value of Four Measures of Retention in Expert Care in Predicting Clinical Outcomes and Health Care Utilization in HIV Patients

PLoS ONE ◽  
2015 ◽  
Vol 10 (3) ◽  
pp. e0120953 ◽  
Author(s):  
Kelly R. Reveles ◽  
Timothy R. Juday ◽  
Matthew J. Labreche ◽  
Eric M. Mortensen ◽  
Jim M. Koeller ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Clinical Outcomes ◽  
Care Utilization ◽  
Hiv Patients

Long-term Clinical Outcomes and Health Care Utilization After Bariatric Surgery

2015 ◽  
Vol 262 (1) ◽  
pp. 86-92 ◽  
Author(s):  
David J. R. Morgan ◽  
Kwok M. Ho ◽  
Jon Armstrong ◽  
Edward Litton
Keyword(s):  
Bariatric Surgery ◽  
Health Care ◽  
Health Care Utilization ◽  
Clinical Outcomes ◽  
Care Utilization
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