Web-Based Psychoeducational Intervention for Persons With Schizophrenia and Their Supporters: One-Year Outcomes

Abstract Background Heart failure (HF) contemporary management has significantly improved over the past two decades leading to better survival. How application of the contemporary HF management guidelines affects the risk of death estimated by available web-based risk scores is not elucidated. Objective To assess changes in mortality risk prediction after a after a 12-month management period in a multidisciplinary HF Clinic. Methods Out of 1,689 consecutive patients with HF admitted at our ambulatory HF Clinic from May 2006 to November 2018, those who completed one year follow-up were considered for the study. Patients without NTproBNP measurement or with more than 3 missing variables for risk estimation were excluded. Three contemporary web-based HF risk scores were evaluated: MAGGIC-HF, Seattle HF Model (SHFM) and the Barcelona Bio-HF Calculator containing NTproBNP (BCN Bio-HF). Risk of all-cause death at one year and at 3 years were calculated at baseline and re-evaluated after 12-month management in a multidsisciplinary HF Clinic. Wilcoxon paired data test was used to compare changes in mortality risk estimation over time and test equality of matched pairs for comparing estimated change among tools. 442 patients used to derive the Barcelona Bio-HF Calculator were excluded for discrimination purposes. Results 1,157 patients were included (age 65.7±12.7 years, 70.4% men). A significant reduction in mortality risk estimation was observed with the three HF risk scores evaluated at 12-months (Table). The BCN Bio-HF model showed significantly different changes in risk estimation, fact that indeed was partnered with numerically better discrimination. AUC at 1 and 3 years, respectively, were: BCN Bio-HF (0.773 and 0.775), MAGGIC HF (0.686 and 0.748) and SHFM (0.773 and 0.739). Conclusions The three web-based risk scores evaluated showed a significant reduction in mortality risk estimation after 12 month management in a multidisciplinary HF Clinic. The BCN Bio-HF score showed higher reduction in estimated risk, together with better discrimination, likely because it incorporates contemporary treatment and use of biomarkers. Funding Acknowledgement Type of funding source: None

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A Web-Based Communication Platform to Improve Home Care Services in Norway (DigiHelse): Pilot Study (Preprint)

10.2196/preprints.14780 ◽

2019 ◽

Author(s):

Linn Nathalie Støme ◽

Tron Moger ◽

Kristian Kidholm ◽

Kari J Kværner

Keyword(s):

Pilot Study ◽

Home Care ◽

Rate Ratio ◽

Care Service ◽

Behavioral Data ◽

Home Care Service ◽

Early Assessment ◽

Web Based ◽

Digital Platform ◽

One Year

BACKGROUND Home care service in Norway is struggling to meet the increasing demand for health care under restricted budget constraints, although one-fourth of municipal budgets are dedicated to health services. The integration of Web-based technology in at-home care is expected to enhance communication and patient involvement, increase efficiency and reduce cost. DigiHelse is a Web-based platform designed to reinforce home care service in Norway and is currently undergoing a development process to meet the predefined needs of the country’s municipalities. Some of the main features of the platform are digital messages between residents and the home care service, highlighting information on planned and completed visits, the opportunity to cancel visits, and notifications for completed visits. OBJECTIVE This study aimed to test the usability and economic feasibility of adopting DigiHelse in four districts in Oslo by applying registry and behavioral data collected throughout a one-year pilot study. Early health technology assessment was used to estimate the potential future value of DigiHelse, including the predictive value of behavior data. METHODS Outcome measures identified by stakeholder insights and scenario drafting in the project’s concept phase were used to assess potential socioeconomic benefits. Aggregated data were collected to assess changes in health consumption at baseline, and then 15 and 52 weeks after DigiHelse was implemented. The present value calculation was updated with data from four intervention groups and one control group. A quasi-experimental difference-in-difference design was applied to estimate the causal effect. Descriptive behavioral data from the digital platform was applied to assess the usability of the platform. RESULTS Over the total study period (52 weeks), rates increased for all outcome estimates: the number of visits (rate ratio=1.04; <italic>P</italic>=.10), unnecessary trips (rate ratio=1.37; <italic>P</italic>=.26), and phone calls (rate ratio=1.24; <italic>P</italic>=.08). A significant gap was found between the estimated value of DigiHelse in the concept phase and after the one-year pilot. In the present pilot assessment, costs are expected to exceed potential savings by €67 million (US $75 million) over ten years, as compared to the corresponding concept estimates of a potential gain of €172.6 million (US $193.6 million). Interestingly, behavioral data from the digital platform revealed that only 3.55% (121/3405) of recipients actively used the platform after one year. CONCLUSIONS Behavioral data provides a valuable source for assessing usability. In this pilot study, the low adoption rate may, at least in part, explain the inability of DigiHelse to perform as expected. This study points to an early assessment of behavioral data as an opportunity to identify inefficiencies and direct digital development. For DigiHelse, insight into why the recipients in Oslo have not made greater use of the Web-based platform seems to be the next step in ensuring the right improvement measures for the home care service.

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Successful promotion of physical activity among students of medicine through motivational interview and Web-based intervention

PeerJ ◽

10.7717/peerj.9495 ◽

2020 ◽

Vol 8 ◽

pp. e9495 ◽

Cited By ~ 1

Author(s):

Dubravka Mandic ◽

Vesna Bjegovic-Mikanovic ◽

Dejana Vukovic ◽

Bosiljka Djikanovic ◽

Zeljka Stamenkovic ◽

...

Keyword(s):

Physical Activity ◽

Social Media ◽

Logistic Regression ◽

Motivational Interview ◽

Statistical Testing ◽

Intervention Period ◽

Web Based ◽

Low Level ◽

One Year ◽

Multicomponent Interventions

Background Regular physical activity supports healthy behavior and contributes to the reduction of preventable diseases. Students in their social transition period are the ideal groups for interventions. The higher education period, associated with demanding changes and poor time management, results in a low level of physical activity. In this age, social media usually are a suitable channel of communication and multicomponent interventions are the most desirable. It has not been sufficiently investigated how effective a Web-based approach is among university students when it comes to physical activity in the long-term period. We combined a Web-based approach with motivational interviews and tested these two interventions together and separate to assess their impact on improving the physical activity of medical students 1 year after the intervention. Methods All 514 first-year students at the Faculty of Medicine in Belgrade were invited to fill in a baseline questionnaire. Also, they underwent measurement of weight, height and waist circumference. After that, students selected a 6 months intervention according to their preference: Intervention through social media (Facebook) (Group 1) or combined with a motivational interview (Group 2). Group 3 consisted of students without any intervention. One year after completion of the 6 months intervention period, all students were invited to a second comprehensive assessment. Analyses were performed employing a wide range of statistical testing, including direct logistic regression, to identify determinants of increased physical activity measured by an average change of Metabolic Equivalent of Task (MET). This outcome measure was defined as the difference between the values at baseline and one year after completion of the 6 months intervention period. Results Due to a large number of potential determinants of the change of MET, three logistic regression models considered three groups of independent variables: basic socio-demographic and anthropometric data, intervention and willingness for change, and health status with life choices. The only significant model comprised parameters related to the interventions (p < 0.001). It accurately classified 73.5% of cases. There is a highly significant overall effect for type of intervention (Wald = 19.5, df = 2, p < 0.001) with high odds for the increase of physical activity. Significant relationship between time and type of intervention also existed (F = 7.33, p < 0.001, partial η2 = 0.091). The influence of both factors (time and interventions) led to a change (increase) in the dependent variable MET. Conclusion Our study confirmed the presence of low-level physical activity among students of medicine and showed that multicomponent interventions have significant potential for positive change. The desirable effects of the Web-based intervention are higher if an additional booster is involved, such as a motivational interview.

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A Web-Based Communication Platform to Improve Home Care Services in Norway (DigiHelse): Pilot Study

JMIR Formative Research ◽

10.2196/14780 ◽

2020 ◽

Vol 4 (1) ◽

pp. e14780

Author(s):

Linn Nathalie Støme ◽

Tron Moger ◽

Kristian Kidholm ◽

Kari J Kværner

Keyword(s):

Pilot Study ◽

Home Care ◽

Rate Ratio ◽

Care Service ◽

Behavioral Data ◽

Home Care Service ◽

Early Assessment ◽

Web Based ◽

Digital Platform ◽

One Year

Background Home care service in Norway is struggling to meet the increasing demand for health care under restricted budget constraints, although one-fourth of municipal budgets are dedicated to health services. The integration of Web-based technology in at-home care is expected to enhance communication and patient involvement, increase efficiency and reduce cost. DigiHelse is a Web-based platform designed to reinforce home care service in Norway and is currently undergoing a development process to meet the predefined needs of the country’s municipalities. Some of the main features of the platform are digital messages between residents and the home care service, highlighting information on planned and completed visits, the opportunity to cancel visits, and notifications for completed visits. Objective This study aimed to test the usability and economic feasibility of adopting DigiHelse in four districts in Oslo by applying registry and behavioral data collected throughout a one-year pilot study. Early health technology assessment was used to estimate the potential future value of DigiHelse, including the predictive value of behavior data. Methods Outcome measures identified by stakeholder insights and scenario drafting in the project’s concept phase were used to assess potential socioeconomic benefits. Aggregated data were collected to assess changes in health consumption at baseline, and then 15 and 52 weeks after DigiHelse was implemented. The present value calculation was updated with data from four intervention groups and one control group. A quasi-experimental difference-in-difference design was applied to estimate the causal effect. Descriptive behavioral data from the digital platform was applied to assess the usability of the platform. Results Over the total study period (52 weeks), rates increased for all outcome estimates: the number of visits (rate ratio=1.04; P=.10), unnecessary trips (rate ratio=1.37; P=.26), and phone calls (rate ratio=1.24; P=.08). A significant gap was found between the estimated value of DigiHelse in the concept phase and after the one-year pilot. In the present pilot assessment, costs are expected to exceed potential savings by €67 million (US $75 million) over ten years, as compared to the corresponding concept estimates of a potential gain of €172.6 million (US $193.6 million). Interestingly, behavioral data from the digital platform revealed that only 3.55% (121/3405) of recipients actively used the platform after one year. Conclusions Behavioral data provides a valuable source for assessing usability. In this pilot study, the low adoption rate may, at least in part, explain the inability of DigiHelse to perform as expected. This study points to an early assessment of behavioral data as an opportunity to identify inefficiencies and direct digital development. For DigiHelse, insight into why the recipients in Oslo have not made greater use of the Web-based platform seems to be the next step in ensuring the right improvement measures for the home care service.

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Matching Clinicians to Operative Cases

Applied Clinical Informatics ◽

10.1055/s-0037-1618865 ◽

2013 ◽

Vol 04 (03) ◽

pp. 445-453

Author(s):

J. Wanderer ◽

A. Was

Keyword(s):

Risk Stratification ◽

Operating Room ◽

Web Tool ◽

Physical Status ◽

Billing Data ◽

Web Based ◽

Physical Status Classification ◽

Status Classification ◽

One Year ◽

The Web

Summary Background: Patient and surgical case complexity are important considerations in creating appropriate clinical assignments for trainees in the operating room (OR). The American Society of Anesthesiologists (ASA) Physical Status Classification System is the most commonly used tool to classify patient illness severity, but it requires manual evaluation by a clinician and is highly variable. A Risk Stratification System for surgical patients was recently published which uses administrative billing codes to calculate four Risk Stratification Indices (RSIs) and provides an objective surrogate for patient complexity that does not require clinical evaluation. This risk score could be helpful when assigning operating room cases. Objective: This is a technical feasibility study to evaluate the process and potential utility of incorporating an automatic risk score calculation into a web-based tool for assigning OR cases. Methods: We created a web service implementation of the RSI model for one-year mortality and automatically calculated the RSI values for patients scheduled to undergo an operation the following day. An analysis was conducted on data availability for the RSI model and the correlation between RSI values and ASA physical status. Results: In a retrospective analysis of 46,740 patients who received surgery in the year preceding the web tool implementation, RSI values were generated for 20,638 patients (44%). The Spear-man’s rank correlation coefficient between ASA physical status classification and one-year mortality RSI values was 0.404. Conclusions: We have shown that it is possible to create a web-based tool that uses existing billing data to automatically calculate risk scores for patients scheduled to undergo surgery. Such a risk scoring system could be used to match patient acuity to physician experience, and to provide improved patient and clinician experiences. The web tool could be improved by expanding the input database or utilizing procedure booking codes rather than billing data.

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LO33: Sharing and teaching electrocardiograms to minimize infarction

CJEM ◽

10.1017/cem.2020.89 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S19-S19

Author(s):

J. McLaren ◽

A. Taher ◽

L. Chartier

Keyword(s):

Educational Strategy ◽

Statistical Process ◽

Process Measures ◽

Web Based ◽

Pareto Chart ◽

Quality Metric ◽

Root Cause ◽

Local Feedback ◽

One Year ◽

The One

Background: Every 30-minute delay to ST-Elevation Myocardial Infarction (STEMI) reperfusion increases one-year mortality by 7.5%. A local audit found that the third of patient electrocardiograms (ECGs) not initially meeting classic STEMI criteria had an ECG-to-Activation (ETA) time of over 90 minutes, more than five times that of classic STEMIs. However, three quarters of “STEMI negative” ECGs met STEMI-equivalent patterns or rules for subtle occlusion, uncovering an opportunity for improvement. Aim Statement: We aimed to reduce ETA time, from initial emergency department (ED) ECG to activation of the cath lab, for patients whose ECGs did not meet classic STEMI criteria, by 30 minutes within one year (i.e. by Dec 2019). Measures & Design: We reviewed all ED Code STEMIs over a 35-month pre-intervention period. Root Cause analyses, including Ishikawa diagram and Pareto chart, led to our Plan-Do-Study-Act cycles: 1) a survey to engage our team; 2) a Grand Rounds presentation as an educational strategy; and 3) weekly web-based feedback to all ED physicians on STEMI-equivalents and subtle occlusions, using recent local cases. Our outcome measures were ETA times, stratified by ECGs not initially meeting STEMI criteria (primary) and those that did (secondary). Our process measures were the number of website visits and page views. Our balancing measure was the proportion of Code STEMIs without culprit lesion. We used Statistical Process Control (SPC) charts with usual special cause variation rules. Evaluation/Results: ETA time for the 37.5% of 56 ECGs that did not meet classic STEMI criteria decreased from 97.5 to 53.7 minutes (min), a 43.8-min absolute decrease (p = 0.037), while those meeting STEMI criteria remained the same (16.5 to 18.2min, p = 0.75). SPC charts did not show special cause variation. There were 2,634 page views (65.9/week) and 1,092 visits (27.3/week), in a group of 80 physicians—i.e. a third of the group each week. There was no change in Code STEMIs without culprit lesions (28.0 % to 23.3%, p = 0.41). Discussion/Impact: We reduced ETA time by 43.8min for the one third of patients with culprit lesions not initially meeting classic STEMI criteria, a magnitude associated with mortality impact. To do so, we used a multi-modal educational strategy including a novel web-based feedback approach to all ED physicians. Local feedback and education on this challenging-to-diagnose subgroup, guided by ETA time as a quality metric, could be replicated in other centres.

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One-year efficacy and safety of Web-based follow-up using cellular phone in type 1 diabetic patients under insulin pump therapy: the PumpNet study

Diabetes & Metabolism ◽

10.1016/j.diabet.2007.01.002 ◽

2007 ◽

Vol 33 (3) ◽

pp. 220-226 ◽

Cited By ~ 87

Author(s):

P.-Y. Benhamou ◽

V. Melki ◽

R. Boizel ◽

F. Perreal ◽

J.-L. Quesada ◽

...

Keyword(s):

Insulin Pump ◽

Cellular Phone ◽

Insulin Pump Therapy ◽

Diabetic Patients ◽

Pump Therapy ◽

Web Based ◽

One Year ◽

Type 1 Diabetic Patients

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Web-Based Psychoeducational Intervention for Postconcussion Symptoms: A Randomized Trial

Military Medicine ◽

10.7205/milmed-d-14-00388 ◽

2015 ◽

Vol 180 (2) ◽

pp. 192-200 ◽

Cited By ~ 13

Author(s):

Heather G. Belanger ◽

Fiona Barwick ◽

Marc A. Silva ◽

Tracy Kretzmer ◽

Kevin E. Kip ◽

...

Keyword(s):

Randomized Trial ◽

Psychoeducational Intervention ◽

Web Based ◽

Postconcussion Symptoms

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Cost Effectiveness of Therapist Delivered Cognitive Behavioural Therapy and Web-Based Self-Management in Irritable Bowel Syndrome: The ACTIB Randomised Trial

10.21203/rs.3.rs-34284/v1 ◽

2021 ◽

Author(s):

Paul McCrone ◽

Hazel Everitt ◽

Sabine Landau ◽

Paul Little ◽

Felicity L. Bishop ◽

...

Keyword(s):

Cost Effectiveness ◽

Service Use ◽

Randomised Trial ◽

Cost Effective ◽

Behavioural Therapy ◽

Treatment As Usual ◽

Web Based ◽

Life Years ◽

Irritable Bowel ◽

One Year

Abstract Background Telephone therapist delivered CBT (TCBT) and web-based CBT (WCBT) have been shown to be significantly more clinically effective than treatment as usual (TAU) at reducing IBS symptom severity and impact at 12 months in adults with refractory IBS. In this paper we assess the cost-effectiveness of the interventions. Methods Participants were recruited from 74 general practices and three gastroenterology centres in England. Interventions costs were calculated, and other service use and lost employment measured and costed for one-year post randomisation. Quality-adjusted life years (QALYs) were combined with costs to determine cost-effectiveness of TCBT and WCBT compared to TAU.Results TCBT cost £956 more than TAU (95% CI, £601 to £1435) and generated 0.0429 more QALYs. WCBT cost £224 more than TAU (95% CI, -£11 to £448) and produced 0.029 more QALYs. Compared to TAU, TCBT had an incremental cost per QALY of £22,284 while the figure for WCBT was £7724. After multiple imputation these ratios increased to £27,436 and £17,388 respectively. Including lost employment and informal care, TCBT had costs that were on average £866 lower than TAU (95% CI, -£1133 to £2957), and WCBT had costs that were £1028 lower than TAU (95% CI, -£448 to £2580).Conclusions TCBT and WCBT resulted in more QALYs and higher costs than TAU. Complete case analysis suggests both therapies are cost-effective from a healthcare perspective. Imputation for missing data reduces cost-effectiveness but WCTB remained cost-effective. If the reduced societal costs are included both interventions are likely to be more cost-effective.Trial registration ISRCTN44427879 (registered 18.11.13)

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