Home Based Palliative Medicine—Implementing and Sustaining—Lessons Learned (FR403)

BACKGROUND Recent literature supports the efficacy and efficiency of telemedicine in improving various health outcomes, despite the wide variability in results. OBJECTIVE Understanding site-specific issues in the implementation of telemedicine trials for broader replication and generalizability of results is needed. Lessons can be learned from existing trials, and a blueprint can guide researchers to conduct these challenging studies using telemedicine more efficiently and effectively. METHODS This viewpoint presents relevant challenges and solutions for conducting multi-site telemedicine trials using seven ongoing and completed studies funded by the Patient Centered Outcomes Research Institute (PCORI) portfolio of large multi-site trials to highlight the challenges in implementing telemedicine trials. RESULTS Implementation challenges related to clinical, informatics, regulatory, legal, quality and billing were identified and described. CONCLUSIONS Lessons learned from these studies were used to create a blueprint of key aspects to consider for the design and implementation of multi-site telemedicine trials. CLINICALTRIAL NCT02358135: Improving Specialty-Care Delivery in Chronic Skin Diseases (PI: AWArmstrong) NCT02396576: Using Telehealth to Deliver Developmental, Behavioral, and Mental Health Services in Primary Care Settings for Children in Underserved Areas (PI: TRCoker) NCT02038959: Connect.Parkinson (PI: RDorsey) NCT04000971: C3FIT (Coordinated, Collaborative, Comprehensive, Family-based, Integrated, Technology-enabled Care) Stroke Care Trial (PI: KGaines) NCT03694431: Noninferiority Comparative Effectiveness Trial of Home-Based Palliative Care (HomePal) Trial (PI: HNguyen, KMularski) NCT04153864: SUMMIT (Scaling Up Maternal Mental healthcare by Increasing access to Treatments) Trial (PI: DRSingla) NCT03985800: Specialty Medical Homes to Improve Outcomes for Patients with Inflammatory Bowel Disease (IBD) and Behavioral Health Conditions Trial (PI: ESzigethy)

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Lessons Learned in Delivering an Intervention to Engage Family in Home-based Upper Extremity Therapy

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2020.09.087 ◽

2020 ◽

Vol 101 (11) ◽

pp. e31

Author(s):

Sarah Blanton ◽

Patricia Clark ◽

Theresa McLaughlin ◽

Heather Stewart ◽

Sandra Dunbar

Keyword(s):

Upper Extremity ◽

Lessons Learned ◽

Home Based

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Didactic, Technological, and Social Challenges in Portuguese Higher Education During the Pandemic Confinement

Handbook of Research on Developing a Post-Pandemic Paradigm for Virtual Technologies in Higher Education - Advances in Educational Technologies and Instructional Design ◽

10.4018/978-1-7998-6963-4.ch005 ◽

2021 ◽

pp. 92-113

Author(s):

Cecília Vieira Guerra ◽

Maria José Loureiro ◽

Susana Senos

Keyword(s):

Higher Education ◽

Distance Education ◽

Lessons Learned ◽

Online Questionnaire ◽

Pedagogical Content ◽

Social Challenges ◽

Home Based ◽

Internet Connections ◽

Portuguese Higher Education ◽

Physical Spaces

This chapter presents testimonials of 12 national experts in the field of educational technology concerning the main didactic, technological, and social challenges they faced throughout the “emergency remote teaching” that occurred during the COVID-19 pandemic confinement. All experts are professors in Portuguese universities or polytechnic institutions, and they are acquainted with the “distance education” modality. An online questionnaire was applied to these 12 professors in order to collect their opinions about the main challenges during this period. Based on a content analysis technique, the results revealed several technological (e.g., unpredictability of internet connections), didactic (e.g., the teachers' lack of technological pedagogical content knowledge), and social challenges (e.g., the lack of proper physical spaces at home). Based on the lessons learned from this worldwide pandemic emergency, and critically reflecting about it, recommendations are suggested for future action to “distance education” in higher education.

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Living goals: Prepare to die.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.157 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 157-157

Author(s):

Zankhana Mehta ◽

Susan Smith ◽

Jane Henrichs ◽

Andrea Berger ◽

Loreen Comstock ◽

...

Keyword(s):

Palliative Medicine ◽

Timely Manner ◽

Median Length ◽

Serious Illness ◽

Home Based ◽

Hospice Patients ◽

One Year ◽

Seriously Ill Patients ◽

Surprise Question ◽

Seriously Ill

157 Background: Living Goals (LGs), a home-based program, is a collaboration between Geisinger Health Plan, Geisinger Home care and Hospice and Palliative Medicine. Program investigated an early intervention in those with serious illness and transition to hospice in a timely manner during FY 2015- 2017. Methods: LGs visits were led by a registered nurse after referral from physicians based on the surprise question (it would not be a surprise if this patient died within one year). Nurse facilitated end-of-life discussions and provided resources available for supportive care. LGs visits were free up to 10 visits to each patient. Results: 94 patients were enrolled in LGs from 128 referrals.59 (63%) patients transitioned to hospice and 41 (69%) were transitioned within first month of LGs visit averaging 1.4 visits. 59 patients enrolled in hospice. The median length of time between LG Start of care (SOC) and Hospice SOC is 9 days (IQR: 3-73).57 LGs patients discharged from hospice had a median length of stay (LOS) of 39 days (IQR: 10-85). For the subset of patients in FY 2015 (n = 13) median LOS was 26 days (IQR: 10-57)), in FY 2016 (n = 26) the median LOS was 27 days (IQR: 7-73), in FY 2017 (n = 18) the median LOS is 66 days (IQR: 28-144). In FY 2014, 513 hospice patients were discharged before initiation of LGs and the median LOS was 19 days (IQR: 6-61). As of now, there is a significantly longer stay for LG patients than FY 2014 hospice patients (p = 0.0130). Conclusions: This innovative home based program, appears to have a great potential in the future for delivering ongoing hospice and palliative needs to seriously ill patients.

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‘I’m doing it for myself’: Using a smartphone-based exercise service during the COVID-19 lockdown in the Faculty of Health Sciences, University of the Witwatersrand, South Africa

South African Journal of Sports Medicine ◽

10.17159/2078-516x/2021/v33i1a9053 ◽

2021 ◽

Vol 33 (1) ◽

pp. 1-6

Author(s):

Demitri Constantinou ◽

Georgia Torres ◽

Natalia Neophytou ◽

Peter Fourie ◽

Xenia Buntting ◽

...

Keyword(s):

South Africa ◽

Mobile Application ◽

Small Sample Size ◽

Smartphone Application ◽

Small Sample ◽

Lessons Learned ◽

Protective Effects ◽

Home Based ◽

Negative Effect ◽

The University

Background: Sufficient physical activity (PA) lowers poor health outcomes, with data showing these protective effects in populations under varying levels of lockdown during the COVID-19 pandemic. The advent of online PA programmes has created novel opportunities to offset the deleterious effects of inactivity. However, data are limited and the readiness and acceptance of such technology is unknown. These authors nevertheless noted an opportunity to investigate this approach based on promising emerging data at the time of the hard lockdown in South Africa. Objective: This exploratory study investigated the engagement and perceptions of a smartphone application to promote health and fitness in a sample of employees at a South African university. Methods: Employed members of staff (n=15) of the University of the Witwatersrand were recruited through email invitation during the hard Level 5 COVID-19 lockdown in 2020. Individualised home-based PA programmes were prescribed through a mobile application for a period of eight weeks. Researchers qualified in Biokinetics provided online supervision of the exercise sessions during the intervention. Participants were asked to complete a self-reported questionnaire about their use of the application. Thematic analysis was used to understand these responses. Results: Lack of motivation was perceived to have a negative effect on participation in the online PA programme. Only one participant reported using the mobile application consistently during the study period, while half of the participants reported having trouble with the usage of the application. The participants frequently mentioned the need for technical support and further engagement from the clinicians supervising the PA programme to ensure use and progression. Staff identified issues with connectivity and already having too many phone applications (apps) amongst the reasons for the technical difficulties. Conclusion: This study demonstrates the challenges and potential for the uptake of online PA interventions during COVID-19 and, despite its small sample size, the data provide important lessons learned that will be used as information in further investigations.

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Sleep, Activity, and Well-Being In Persons With Dementia: Findings From the Healthy Patterns Trial

Innovation in Aging ◽

10.1093/geroni/igab046.2085 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 546-546

Author(s):

Nancy Hodgson ◽

Darina Petrovsky

Keyword(s):

Quality Of Life ◽

Neuropsychiatric Symptoms ◽

Community Outreach ◽

Well Being ◽

Lessons Learned ◽

Improve Quality ◽

Home Based ◽

Wake Patterns ◽

One Year

Abstract Irregular sleep-wake patterns are common in persons living with dementia (PLWD), pose a great burden to caregivers, and are the principal causes of distress and institutionalization of PLWD. A growing body of research supports the importance of activity-based interventions to reduce the frequency and intensity of sleep wake disruption, reduce neuropsychiatric symptoms, and improve quality of life. To date, there are no studies linking sleep disruption and well-being with the nature and timing of activity. This session focuses on lessons learned from the Healthy Patterns Study - a randomized trial of a home-based activity intervention in 200 dyads of PLWD and their caregivers (NCT03682185). Session 1 focuses on the main findings from the clinical trial. Session 2 focuses on the cultural adaptation of the timed activity protocol to improve quality of life (QOL), improve sleep and reduce neuropsychiatric symptoms in older Latinos Session 3 describes the community outreach efforts used over a one-year period to recruit a diverse sample of PLWD and their caregivers for the Healthy Patterns trial. Session 4 examine the relationship between caregiver mastery and neuropsychiatric symptoms in PLWD. Together these findings highlight the complex role of sleep and wake activity in promoting well-being in persons with dementia.

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Innovative telemonitoring system for cardiology: from science to routine operation

Applied Clinical Informatics ◽

10.4338/aci-2009-12-ra-0021 ◽

2010 ◽

Vol 01 (02) ◽

pp. 165-176 ◽

Cited By ~ 20

Author(s):

J. Morak ◽

R. Modre ◽

A. Kollmann ◽

C. Ebner ◽

FM. Fruhwald ◽

...

Keyword(s):

Heart Failure ◽

Data Transfer ◽

Body Weight Gain ◽

Near Field ◽

Well Being ◽

Lessons Learned ◽

Management Tool ◽

Home Based ◽

Daily Data ◽

Pressure Meter

Summary Objective: Results of the Austrian MOBITEL (MOBIle phone based TELemonitoring for heart failure patients) trial indicate that home-based telemonitoring improves outcome of chronic heart failure (CHF) patients and reduces both frequency and duration of hospitalizations. Based on lessons learned, we assessed the weak points to clear the way for routine operations. Methods: We analyzed the system with respect to recommendations of the ESC Guidelines and experiences gained throughout the trial to identify potential improvements. The following components have been identified: a patient terminal with highest usability, integrated way to document drug-intake and well-being, and automated event detection for worsening of CHF. As a consequence the system was extended by Near Field Communication (NFC) technology and by an event management tool. Results: Usability evaluation with 30 adults (14f, median 51y. IQR[45-65]) showed that 21 (8f) were able to immediately operate the system after reading a step-by-step manual. Eight (6f) needed one time demonstration and one man (80y) failed to operate the blood pressure meter. Routine operation of the revised system started in March 2009. Within 9 months, 15 patients (4f, median 74y. IQR[71-83], all NYHA-III) transmitted 17,149 items. 43 events were detected because of body weight gain of more then 2kg within 2 days. 49 therapy adjustments were documented. Three patients stopped using the system, two (1f) because of non-compliance and one (m, 82y) because of death. Overall, the rate of adherence to daily data transfer was 78%. Conclusion: First results confirm the applicability of the revised telemonitoring system in routine operation. Citation: Kastner P, MorakJ, Modre R, Kollmann A, Ebner C, Fruhwald FM, Schreier G. Innovative telemonitoring system for cardiology: from science to routine operation. Appl Clin Inf 2010; 1: 165–176 http://dx.doi.org/10.4338/ACI-2009-12-RA-0021

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