scholarly journals Integrated displays to improve chronic disease management in ambulatory care: A SMART on FHIR application informed by mixed-methods user testing

2020 ◽  
Vol 27 (8) ◽  
pp. 1225-1234
Author(s):  
Rebecca L Curran ◽  
Polina V Kukhareva ◽  
Teresa Taft ◽  
Charlene R Weir ◽  
Thomas J Reese ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Chronic Disease ◽  
Disease Management ◽  
Cognitive Load ◽  
Chronic Disease Management ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
User Feedback ◽  
Chronic Obstructive ◽  
Recommended Care

Abstract Objective The study sought to evaluate a novel electronic health record (EHR) add-on application for chronic disease management that uses an integrated display to decrease user cognitive load, improve efficiency, and support clinical decision making. Materials and Methods We designed a chronic disease management application using the technology framework known as SMART on FHIR (Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources). We used mixed methods to obtain user feedback on a prototype to support ambulatory providers managing chronic obstructive pulmonary disease. Each participant managed 2 patient scenarios using the regular EHR with and without access to our prototype in block-randomized order. The primary outcome was the percentage of expert-recommended ideal care tasks completed. Timing, keyboard and mouse use, and participant surveys were also collected. User experiences were captured using a retrospective think-aloud interview analyzed by concept coding. Results With our prototype, the 13 participants completed more recommended care (81% vs 48%; P < .001) and recommended tasks per minute (0.8 vs 0.6; P = .03) over longer sessions (7.0 minutes vs 5.4 minutes; P = .006). Keystrokes per task were lower with the prototype (6 vs 18; P < .001). Qualitative themes elicited included the desire for reliable presentation of information which matches participants’ mental models of disease and for intuitive navigation in order to decrease cognitive load. Discussion Participants completed more recommended care by taking more time when using our prototype. Interviews identified a tension between using the inefficient but familiar EHR vs learning to use our novel prototype. Concept coding of user feedback generated actionable insights. Conclusions Mixed methods can support the design and evaluation of SMART on FHIR EHR add-on applications by enhancing understanding of the user experience.

scholarly journals Patients’ and healthcare providers’ perceptions and experiences of telehealth use and online health information use in chronic disease management for older patients with chronic obstructive pulmonary disease: a qualitative study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Yuyu Jiang ◽  
Pingping Sun ◽  
Zhongyi Chen ◽  
Jianlan Guo ◽  
Shanshan Wang ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Chronic Disease ◽  
Disease Management ◽  
Health Information ◽  
Pulmonary Disease ◽  
Older Patients ◽  
Chronic Disease Management ◽  
Online Health Information ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Background Telehealth and online health information provide patients with increased access to healthcare services and health information in chronic disease management of older patients with chronic diseases, addressing the challenge of inadequate health resources and promoting active and informed participation of older patients in chronic disease management. There are few qualitative studies on the application of telehealth and online health information to chronic disease management in older patients. Chronic obstructive pulmonary disease is one of the most common chronic diseases in older adults. Telehealth is widely used in the management of chronic obstructive pulmonary disease. The purpose of this study was to explore the perceptions and experiences of older patients and healthcare providers in the application of telehealth and online health information to chronic disease management of chronic obstructive pulmonary disease. Methods A qualitative descriptive study with data generated from 52 individual semi-structured interviews with 29 patients [Law of the People’s Republic of China on the protection of the rights and interests of older people (2018 Revised Version) = >60 years old] with chronic obstructive pulmonary disease and 23 healthcare providers. The inductive thematic analysis method was used for data analysis. Results Four themes and 16 sub-themes were identified in this study. Four themes included: faced with a vast amount of online health information, essential competencies and personality traits ensuring older patients’ participation and sustained use, user experience with the use of technology, being in a complex social context. Conclusion The ability of patients to understand health information should be fully considered while facilitating access to online health information for older patients. The role of health responsibility and user experience in older patients’ participation and sustained use of telehealth and online health information needs to be emphasised. In addition, the complex social context is a determining factor to be considered, particularly the complex impact of a reliance on offspring and social prejudice on the behaviour of older adults using telehealth and online health information.

scholarly journals Optimizing Wellness in Chronic Obstructive Pulmonary Disease

2007 ◽  
Vol 14 (suppl a) ◽  
pp. 5A-22A
Author(s):  
Roger S Goldstein ◽  
Dina Brooks ◽  
Gordon T Ford
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Health Care ◽  
Chronic Disease ◽  
Disease Management ◽  
Pulmonary Disease ◽  
Chronic Disease Management ◽  
Health Agency ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Care System

Optimizing wellness in chronic obstructive pulmonary disease (COPD) is an emerging theme, in response to the substantial burden of COPD among Canadians. Population surveillance, from the Public Health Agency of Canada, as well as from international initiatives, such as the Burden of Obstructive Lung Disease (BOLD) study, has revealed the prevalence and regional disparities of a condition in which mortality, morbidity and health care resource use often reflect what was happening in the population more than 20 years previously. As COPD emerges to be an important women’s health issue, it raises questions as to how female mortality from COPD can rise at double the rate of breast cancer, why the COPD patient population is still predominantly male and whether women experience breathlessness differently than men.There is increasing awareness of the frequency and importance of assessing secondary impairments, such as muscle atrophy, an important prognostic indicator. The availability of pulmonary rehabilitation, despite its beneficial effects on exercise and quality of life, remains far behind the demand for services, a care gap unlikely to be filled by institutionally based programs. New models of chronic disease management require the health care system to proactively meet the needs of individuals with chronic conditions, rather than reacting to them through the acute care system. Such approaches occur best in partnership between health authorities and local municipalities. The present supplement includes several examples of this partnership, especially in Alberta and Saskatchewan. An increasing body of evidence supports the importance of exercise training, combined with selfmanagement, as a cornerstone of chronic disease management.

scholarly journals Vaccination Coverage with the Pneumococcal and Influenza Vaccine Among Persons with Chronic Diseases in Shanghai, China, 2017

2020 ◽  
Author(s):  
Yuheng Wang ◽  
Minna Cheng ◽  
Siyuan Wang ◽  
Fei Wu ◽  
Qinghua Yan ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Disease Management ◽  
Influenza Vaccination ◽  
Chronic Diseases ◽  
Vaccination Coverage ◽  
Rural Areas ◽  
Urban Areas ◽  
Chronic Disease Management ◽  
Pneumococcal Vaccination ◽  
Chronic Obstructive

Abstract Background: Adults with chronic conditions such as heart disease, diabetes, or lung disease are more likely to develop complications from a number of vaccine-preventable diseases, including influenza and pneumonia. In this study, we use the data from a chronic disease management information system in Shanghai to estimate vaccination coverage and characterize predictors of seasonal influenza and 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccination among people with chronic disease in Shanghai.Methods: The Shanghai Centers for Disease Control and Prevention have information systems related to chronic disease management, hospital records, and immunizations. Data from individuals with hypertension, diabetes and chronic obstructive pulmonary disease (COPD) were abstracted during July 2017. The main outcome was coverage of pneumococcal and influenza vaccination. Vaccination coverage was calculated across demographic groups. Significance in bivariate associations was assessed through Pearson’s chi-square tests, and in multivariable models through logistic regression models with a forward stepwise method to select variables.Results: In the sample of 2,531,227 individuals ≥15 years, 22.8% were vaccinated for pneumonia from January 2013 to July 2017, and the vaccination coverage of influenza in the 2016/17 influenza season was 0.4%. Vaccination coverage was highest in those 70-79 and lowest in those younger than 60. Compared to urban areas, uptake in rural areas was higher for pneumonia vaccination (OR: 2.43, 95% CI: 2.41, 2.45), but lower for influenza vaccination (OR: 0.55, 95% CI: 0.51, 0.59). Having a greater number of chronic diseases was associated with higher likelihood of pneumonia vaccination (3 vs 1: OR: 1.68, 95% CI: 1.64, 1.71), but this relationship was not statistically significant for influenza vaccination.Conclusions: We found low levels with of pneumococcal vaccination, and extremely low uptake of influenza vaccination among individuals with high risk conditions in Shanghai who should be priority groups targeted for vaccination. Interventions could be designed to target groups with low uptake – like younger adults, and individuals who have not yet retired.

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