Impact of patient engagement on the design of a mobile health technology for cardiac surgery

Objective The aims of this study were to describe the impact of patient engagement on the initial design and content of a mobile health (mHealth) technology that supports enhanced recovery protocols (ERPs) for cardiac surgery. Methods Engagement occurred at the level of consultation and took the form of an advisory panel. Patients that underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and consented to be contacted about future research, and their caregivers, were approached for participation. A qualitative exploration was undertaken to determine advisory panel members key messages about, and the impact of, patient engagement on mHealth technology design and content. Results Ten individuals participated in the advisory panel. Key design-specific messages centered around access, tracking, synchronization, and reminders. Key content-specific messages centered around roles of cardiac surgery team members and medical terms, educational videos, information regarding cardiac surgery procedures, travel before/after surgery, nutrition (i.e., what to eat), medications (i.e., drug interactions), resources (i.e., medical devices), and physical activity (i.e., addressing fears and providing information, recommendations, and instructions). These key messages were a rich source of information for mHealth technology developers and were incorporated as supported by the existing capabilities of the underlying technology platform. Conclusions Patient engagement facilitated the development of a mHealth technology whose design and content were driven by the lived experiences of cardiac surgery patients and caregivers. The result was a detail-oriented and patient-centered mHealth technology that helps to empower and inform patients and their caregivers about the patient journey across the perioperative period of cardiac surgery.

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Patient Engagement in the Design of a Mobile Health App That Supports Enhanced Recovery Protocols for Cardiac Surgery: Development Study (Preprint)

10.2196/preprints.26597 ◽

2020 ◽

Author(s):

Anna M Chudyk ◽

Sandra Ragheb ◽

David Kent ◽

Todd A Duhamel ◽

Carole Hyra ◽

...

Keyword(s):

Cardiac Surgery ◽

Mobile Health ◽

Patient Engagement ◽

Enhanced Recovery ◽

Perioperative Period ◽

End Users ◽

Advisory Panel ◽

Patient Centered ◽

Recovery Protocols ◽

The Impact

BACKGROUND Despite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. OBJECTIVE The aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. METHODS Engagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. RESULTS The advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. CONCLUSIONS Patient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users.

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Patient Engagement in the Design of a Mobile Health App That Supports Enhanced Recovery Protocols for Cardiac Surgery: Development Study

JMIR Perioperative Medicine ◽

10.2196/26597 ◽

2021 ◽

Vol 4 (2) ◽

pp. e26597

Author(s):

Anna M Chudyk ◽

Sandra Ragheb ◽

David Kent ◽

Todd A Duhamel ◽

Carole Hyra ◽

...

Keyword(s):

Cardiac Surgery ◽

Mobile Health ◽

Patient Engagement ◽

Enhanced Recovery ◽

Perioperative Period ◽

End Users ◽

Advisory Panel ◽

Patient Centered ◽

Recovery Protocols ◽

The Impact

Background Despite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. Objective The aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. Methods Engagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. Results The advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. Conclusions Patient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users.

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Effectiveness of Mobile Health Interventions on Diabetes and Obesity Treatment and Management: Systematic Review of Systematic Reviews (Preprint)

10.2196/preprints.15400 ◽

2019 ◽

Author(s):

Youfa Wang ◽

Jungwon Min ◽

Jacob Khuri ◽

Hong Xue ◽

Bo Xie ◽

...

Keyword(s):

Glycemic Control ◽

Systematic Reviews ◽

Mobile Health ◽

Weight Reduction ◽

Text Messaging ◽

Meta Analysis ◽

Obesity Treatment ◽

Future Research ◽

The Impact ◽

Diabetes And Obesity

BACKGROUND Diabetes and obesity have become epidemics and costly chronic diseases. The impact of mobile health (mHealth) interventions on diabetes and obesity management is promising; however, studies showed varied results in the efficacy of mHealth interventions. OBJECTIVE This review aimed to evaluate the effectiveness of mHealth interventions for diabetes and obesity treatment and management on the basis of evidence reported in reviews and meta-analyses and to provide recommendations for future interventions and research. METHODS We systematically searched the PubMed, IEEE Xplore Digital Library, and Cochrane databases for systematic reviews published between January 1, 2005, and October 1, 2019. We analyzed 17 reviews, which assessed 55,604 original intervention studies, that met the inclusion criteria. Of those, 6 reviews were included in our meta-analysis. RESULTS The reviews primarily focused on the use of mobile apps and text messaging and the self-monitoring and management function of mHealth programs in patients with diabetes and obesity. All reviews examined changes in biomarkers, and some reviews assessed treatment adherence (n=7) and health behaviors (n=9). Although the effectiveness of mHealth interventions varied widely by study, all reviews concluded that mHealth was a feasible option and had the potential for improving patient health when compared with standard care, especially for glycemic control (−0.3% to −0.5% greater reduction in hemoglobin A1c) and weight reduction (−1.0 kg to −2.4 kg body weight). Overall, the existing 6 meta-analysis studies showed pooled favorable effects of these mHealth interventions (−0.79, 95% CI −1.17 to −0.42; I2=90.5). CONCLUSIONS mHealth interventions are promising, but there is limited evidence about their effectiveness in glycemic control and weight reduction. Future research to develop evidence-based mHealth strategies should use valid measures and rigorous study designs. To enhance the effectiveness of mHealth interventions, future studies are warranted for the optimal formats and the frequency of contacting patients, better tailoring of messages, and enhancing usability, which places a greater emphasis on maintaining effectiveness over time.

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A Clinical Observational Study on the Application of Enhanced Recovery After Laparoscopic Pancreaticoduodenectomy

10.21203/rs.3.rs-616980/v1 ◽

2021 ◽

Author(s):

Rui Liao ◽

Ping Che ◽

Jun-Cai Li ◽

Jie Chen ◽

Xiong Yan

Keyword(s):

Enhanced Recovery ◽

Operation Time ◽

Perioperative Period ◽

Medical Costs ◽

Time Frame ◽

Laparoscopic Pancreaticoduodenectomy ◽

Readmission Rates ◽

Retrospective Clinical Study ◽

Previously Treated ◽

The Impact

Abstract Background: The safety and feasibility of enhanced recovery after surgery (ERAS) for laparoscopic pancreaticoduodenectomy (LPD) are unclear. The aim of this retrospective clinical study was to evaluate the impact of ERAS protocols for LPD.Methods: Between March 2016 and December 2018, a total of 34 consecutive patients with ERAS for LPD were prospectively enrolled and compared with 68 consecutive patients previously treated for non-ERAS after LPD during an equal time frame. The intraoperative and postoperative data were collected and comparatively analyzed. Results: The mean length of postoperative hospital stay (15.8±3.4 and 23.1±5.1 days, P<0.001) and total medical costs (¥14.3±4.8 x104 and ¥15.8±4.9 x104, P=0.017) were reduced significantly in ER group than those in non-ER group. The operation time (462.7±117.0 vs 450.9±109.8 min, P=0.627) and intraoperative blood loss (523.5±270.0 vs 537.5±241.8 mL, P=0.800) were similar in the two groups. The complications of patients with ERAS protocols were not increased (P>0.05). No difference in mortality and readmission rates was found.Conclusions: The ERAS is safe and effective in the perioperative period of LPD. It could effectively reduce the length of postoperative stay and medical costs, and does not increase the incidence of postoperative complications.

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Cost of Waiting on an Orthopaedic Waiting List: a scoping review

Asia Pacific Journal of Health Management ◽

10.24083/apjhm.v12i2.79 ◽

2017 ◽

Vol 12 (2) ◽

pp. 42-54 ◽

Cited By ~ 3

Author(s):

Joanne Morris ◽

Asterie Twizeyemariya ◽

Karen Grimmer

Keyword(s):

Quality Of Life ◽

Musculoskeletal Disorders ◽

Health Management ◽

Data Extraction ◽

Indirect Costs ◽

Waiting List ◽

Future Research ◽

Patient Journey ◽

The Impact

Background: Approximately 30% Australians suffer from arthritis and other musculoskeletal disorders. From 2003-2033 there is a predicted 223% increase in expenditure on health management of musculoskeletal disorders. There is evidence of increasing prevalence of orthopaedic complaints, in longer waiting lists for specialist consultations in public hospital outpatient clinics. Little is known about the costs and ramifications of waiting for orthopaedic consultations. Aim: Establish what is known about the direct and indirect costs of being placed on a waiting list for an orthopaedic consultation. Method: Patient and Outcome search strategy of Medline, Embase, Pubmed, NHS Economic evaluation database (NHS-EED) from each database inception date. Handsearching of reference lists of included papers alsooccurred. A realist synthesis framework underpinned the review, using a ubiquitous patient journey to map available literature on the impact of waiting. Hierarchy of evidence was reported using NHMRC criteria andarticles critically appraised using either the PEDRo or CASP criteria (relevant to the design). A purpose-built data extraction instrument was developed. Results: We identified 786 studies, of which 139 were relevant, including a systematic review (Hoogeboom et al) with 15 included articles which were added to the list of eligible papers (and the review itself deleted), leaving 153 included articles; 17 were relevant to the review. Fourteen papers reported on quality of life and four reported on costs, two of these papers reported on both and all were of low to moderate quality. The research was not based on a comprehensive understanding of the stages of waiting, and there were inconclusive outcomes for quality of life and cost. Conclusion: There is scant evidence of the impact on quality of life and costs of waiting for orthopaedic outpatient appointments. Future research should aim for improved methodological quality and use patientfocused quality of life measures, and validated measures of cost. Abbreviations: NHMRC – National Health and Medical Research Council; PROMS – Patient Related Outcome Measures; QoL – Quality of Life; WOMAC – Western Ontario and McMaster Universities Osteoarthritis Index; YLD – Years Lived With Disability

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Effect of Mechanical Ventilation During Cardiopulmonary Bypass On End-Expiratory Lung Volume in The Perioperative Period of Cardiac Surgery

10.21203/rs.3.rs-1039929/v1 ◽

2021 ◽

Author(s):

Lea Trancart ◽

Nathalie Rey ◽

Vincent Scherrer ◽

Véronique Wurtz ◽

Fabrice Bauer ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Lung Volume ◽

Perioperative Period ◽

Tertiary Teaching ◽

Significant Difference ◽

Residual Capacity ◽

Tertiary Teaching Hospital ◽

The Impact

Abstract Background Many studies explored the impact of ventilation during cardiopulmonary bypass period. However, its effect on Functional residual capacity or End Expiratory Lung Volume (EELV) has not been specifically studied. Our objective was to compare the effect of two ventilation strategies during cardiopulmonary bypass (CPB) on EELV. Methods observational monocenter study in a tertiary teaching hospital. Adult patients undergoing on-pump cardiac surgery by sternotomy were included and ventilated on the GE Carescape R860® ventilator. Maintenance of ventilation during CPB was left to the discretion of the medical team, with division between "ventilated" and "non-ventilated" groups afterwards. Iterative per and postoperative measurements of EELV were carried out by nitrogen washin-washout technique. Results 40 patients were included, 20 in each group. EELV was not significantly different between the ventilated versus non-ventilated groups at the end of surgery (1796±586ml vs. 1844±524ml; p=1). No significant difference between the two groups was observed on oxygenation, duration of mechanical ventilation, need postoperative respiratory support, occurrence of pneumopathy and radiographic atelectasis. Conclusion Maintaining mechanical ventilation during CPB does not seem to allow a better preservation of EELV in our population.

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Expanding Enhanced Recovery Protocols for Cardiac Surgery to Include the Patient Voice: a Scoping Review Protocol

10.21203/rs.3.rs-50682/v1 ◽

2020 ◽

Author(s):

Nebojša Oravec ◽

Rakesh C. Arora ◽

Brian Bjorklund ◽

April Gregora ◽

Caroline Monnin ◽

...

Keyword(s):

Cardiac Surgery ◽

Lived Experience ◽

Scoping Review ◽

Enhanced Recovery ◽

Research Question ◽

Grey Literature ◽

Perioperative Period ◽

Added Value ◽

Cochrane Library ◽

Recovery Protocols

Abstract Background Cardiac surgery is becoming increasingly common in older, more vulnerable adults. A focus on timely and complete medical and functional recovery has led to the development of enhanced recovery protocols (ERPs) for a number of surgical procedures and subspecialties, including cardiac surgery (ERAS® Cardiac). An element that is often overlooked in the development and implementation of ERPs is the involvement of key stakeholder groups, including surgery patients and caregivers (e.g., family and/or friends). The aim of this study is to describe a protocol for a scoping review of cardiac patient and caregiver preferences and outcomes relevant to cardiac surgery ERPs. Methods Using Arskey and O’Malley’s six-stage framework for scoping review methodologies with adaptions from Levac et al., a scoping review of existing literature describing patient- and caregiver-identified preferences and outcomes as they relate to care received in the perioperative period of cardiac surgery will be undertaken. The search for relevant articles will be conducted using electronic databases (i.e., the Cochrane Library, Medline, PsycINFO, Scopus, and Embase), as well as through a search of the grey literature (e.g., CPG Infobase, Heart and Stroke Foundation, ProQuest Theses and Dissertations, Google Advanced and Prospero). Published and unpublished full-text articles written in English, published after the year 2000, and that relate to the research question will be included. Central to the design of this scoping review is our collaboration with two patient partners who possess lived experience as cardiac surgery patients. Discussion This review will identify strategies that can be integrated into ERPs for cardiac surgery which align with patient- and caregiver-defined values. Broadly, it is our goal to demonstrate the added value of patient engagement in research to aid in the success of system change processes.

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Harnessing Mobile Health Technology for Secondary Cardiovascular Disease Prevention in Older Adults: A Scientific Statement From the American Heart Association

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.0000000000000103 ◽

2021 ◽

Author(s):

Erica N. Schorr ◽

Adam D. Gepner ◽

Mary A. Dolansky ◽

Daniel E. Forman ◽

Linda G. Park ◽

...

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Medication Adherence ◽

Mobile Health ◽

Mobile Technologies ◽

Cvd Risk ◽

Privacy And Security ◽

Mhealth Technology ◽

Cvd Prevention ◽

The Impact

Secondary prevention of cardiovascular disease (CVD), the leading cause of morbidity and mortality, is critical to improving health outcomes and quality of life in our aging population. As mobile health (mHealth) technology gains universal leverage and popularity, it is becoming more user-friendly for older adults and an adjunct to manage CVD risk and improve overall cardiovascular health. With the rapid advances in mHealth technology and increasing technological engagement of older adults, a comprehensive understanding of the current literature and knowledge of gaps and barriers surrounding the impact of mHealth on secondary CVD prevention is essential. After a systematic review of the literature, 26 studies that used mHealth for secondary CVD prevention focusing on lifestyle behavior change and medication adherence in cohorts with a mean age of ≥60 years were identified. Improvements in health behaviors and medication adherence were observed, particularly when there was a short message service (ie, texting) component involved. Although mobile technologies are becoming more mainstream and are starting to blend more seamlessly with standard health care, there are still distinct barriers that limit implementation particularly in older adults, including affordability, usability, privacy, and security issues. Furthermore, studies on the type of mHealth that is the most effective for older adults with longer study duration are essential as the field continues to grow. As our population ages, identifying and implementing effective, widely accepted, cost-effective, and time-efficient mHealth interventions to improve CVD health in a vulnerable demographic group should be a top health priority.

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Effectiveness of Mobile Health Interventions on Diabetes and Obesity Treatment and Management: Systematic Review of Systematic Reviews

JMIR mhealth and uhealth ◽

10.2196/15400 ◽

2020 ◽

Vol 8 (4) ◽

pp. e15400 ◽

Cited By ~ 5

Author(s):

Youfa Wang ◽

Jungwon Min ◽

Jacob Khuri ◽

Hong Xue ◽

Bo Xie ◽

...

Keyword(s):

Glycemic Control ◽

Systematic Reviews ◽

Mobile Health ◽

Weight Reduction ◽

Text Messaging ◽

Meta Analysis ◽

Obesity Treatment ◽

Future Research ◽

The Impact ◽

Diabetes And Obesity

Background Diabetes and obesity have become epidemics and costly chronic diseases. The impact of mobile health (mHealth) interventions on diabetes and obesity management is promising; however, studies showed varied results in the efficacy of mHealth interventions. Objective This review aimed to evaluate the effectiveness of mHealth interventions for diabetes and obesity treatment and management on the basis of evidence reported in reviews and meta-analyses and to provide recommendations for future interventions and research. Methods We systematically searched the PubMed, IEEE Xplore Digital Library, and Cochrane databases for systematic reviews published between January 1, 2005, and October 1, 2019. We analyzed 17 reviews, which assessed 55,604 original intervention studies, that met the inclusion criteria. Of those, 6 reviews were included in our meta-analysis. Results The reviews primarily focused on the use of mobile apps and text messaging and the self-monitoring and management function of mHealth programs in patients with diabetes and obesity. All reviews examined changes in biomarkers, and some reviews assessed treatment adherence (n=7) and health behaviors (n=9). Although the effectiveness of mHealth interventions varied widely by study, all reviews concluded that mHealth was a feasible option and had the potential for improving patient health when compared with standard care, especially for glycemic control (−0.3% to −0.5% greater reduction in hemoglobin A1c) and weight reduction (−1.0 kg to −2.4 kg body weight). Overall, the existing 6 meta-analysis studies showed pooled favorable effects of these mHealth interventions (−0.79, 95% CI −1.17 to −0.42; I2=90.5). Conclusions mHealth interventions are promising, but there is limited evidence about their effectiveness in glycemic control and weight reduction. Future research to develop evidence-based mHealth strategies should use valid measures and rigorous study designs. To enhance the effectiveness of mHealth interventions, future studies are warranted for the optimal formats and the frequency of contacting patients, better tailoring of messages, and enhancing usability, which places a greater emphasis on maintaining effectiveness over time.

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Assessing the Impact of Patient-Facing Mobile Health Technology on Patient Outcomes: Retrospective Observational Cohort Study (Preprint)

10.2196/preprints.19333 ◽

2020 ◽

Author(s):

Courtenay R Bruce ◽

Patricia Harrison ◽

Tariq Nisar ◽

Charlie Giammattei ◽

Neema M Tan ◽

...

Keyword(s):

Length Of Stay ◽

Patient Outcomes ◽

Mobile Health ◽

Text Messages ◽

Categorical Variables ◽

Continuous Variables ◽

Readmission Rates ◽

Orthopedic Surgeons ◽

Mhealth Technology ◽

The Impact

BACKGROUND Despite the growth of and media hype about mobile health (mHealth), there is a paucity of literature supporting the effectiveness of widespread implementation of mHealth technologies. OBJECTIVE This study aimed to assess whether an innovative mHealth technology system with several overlapping purposes can impact (1) clinical outcomes (ie, readmission rates, revisit rates, and length of stay) and (2) patient-centered care outcomes (ie, patient engagement, patient experience, and patient satisfaction). METHODS We compared all patients (2059 patients) of participating orthopedic surgeons using mHealth technology with all patients of nonparticipating orthopedic surgeons (2554 patients). The analyses included Wilcoxon rank-sum tests, Kruskal-Wallis tests for continuous variables, and chi-square tests for categorical variables. Logistic regression models were performed on categorical outcomes and a gamma-distributed model for continuous variables. All models were adjusted for patient demographics and comorbidities. RESULTS The inpatient readmission rates for the nonparticipating group when compared with the participating group were higher and demonstrated higher odds ratios (ORs) for 30-day inpatient readmissions (nonparticipating group 106/2636, 4.02% and participating group 54/2048, 2.64%; OR 1.48, 95% CI 1.03 to 2.13; P=.04), 60-day inpatient readmissions (nonparticipating group 194/2636, 7.36% and participating group 85/2048, 4.15%; OR 1.79, 95% CI 1.32 to 2.39; P<.001), and 90-day inpatient readmissions (nonparticipating group 261/2636, 9.90% and participating group 115/2048, 5.62%; OR 1.81, 95% CI 1.40 to 2.34; P<.001). The length of stay for the nonparticipating cohort was longer at 1.90 days, whereas the length of stay for the participating cohort was 1.50 days (mean 1.87, SD 2 vs mean 1.50, SD 1.37; P<.001). Patients treated by participating surgeons received and read text messages using mHealth 83% of the time and read emails 84% of the time. Patients responded to 60% of the text messages and 53% of the email surveys. Patients were least responsive to digital monitoring questions when the hospital asked them to do something, and they were most engaged with emails that did not require action, including informational content. A total of 96% (558/580) of patients indicated high satisfaction with using mHealth technology to support their care. Only 0.40% (75/2059) patients opted-out of the mHealth technology program after enrollment. CONCLUSIONS A novel, multicomponent, pathway-driven, patient-facing mHealth technology can positively impact patient outcomes and patient-reported experiences. These technologies can empower patients to play a more active and meaningful role in improving their outcomes. There is a deep need, however, for a better understanding of the interactions between patients, technology, and health care providers. Future research is needed to (1) help identify, address, and improve technology usability and effectiveness; (2) understand patient and provider attributes that support adoption, uptake, and sustainability; and (3) understand the factors that contribute to barriers of technology adoption and how best to overcome them.

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