scholarly journals Evaluating the Impact of a Web-Based Risk Assessment System (CareSage) and Tailored Interventions on Health Care Utilization: Protocol for a Randomized Controlled Trial

10.2196/10045 ◽  
2018 ◽  
Vol 7 (5) ◽  
pp. e10045 ◽  
Author(s):  
Ramya Sita Palacholla ◽  
Nils C Fischer ◽  
Stephen Agboola ◽  
Mariana Nikolova-Simons ◽  
Sharon Odametey ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Health Care ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Assessment System ◽  
Care Utilization ◽  
Web Based ◽  
Randomized Controlled ◽  
Tailored Interventions ◽  
The Impact

scholarly journals Evaluating the Impact of a Web-Based Risk Assessment System (CareSage) and Tailored Interventions on Health Care Utilization: Protocol for a Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Ramya Sita Palacholla ◽  
Nils C Fischer ◽  
Stephen Agboola ◽  
Mariana Nikolova-Simons ◽  
Sharon Odametey ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Health Care ◽  
High Risk ◽  
Controlled Trial ◽  
Study Groups ◽  
Emergency Department Visits ◽  
Assessment System ◽  
Care Utilization ◽  
Value Based Care ◽  
The Impact

BACKGROUND Soaring health care costs and a rapidly aging population, with multiple comorbidities, necessitates the development of innovative strategies to deliver high-quality, value-based care. OBJECTIVE The goal of this study is to evaluate the impact of a risk assessment system (CareSage) and targeted interventions on health care utilization. METHODS This is a two-arm randomized controlled trial recruiting 370 participants from a pool of high-risk patients receiving care at a home health agency. CareSage is a risk assessment system that utilizes both real-time data collected via a Personal Emergency Response Service and historical patient data collected from the electronic medical records. All patients will first be observed for 3 months (observation period) to allow the CareSage algorithm to calibrate based on patient data. During the next 6 months (intervention period), CareSage will use a predictive algorithm to classify patients in the intervention group as “high” or “low” risk for emergency transport every 30 days. All patients flagged as “high risk” by CareSage will receive nurse triage calls to assess their needs and personalized interventions including patient education, home visits, and tele-monitoring. The primary outcome is the number of 180-day emergency department visits. Secondary outcomes include the number of 90-day emergency department visits, total medical expenses, 180-day mortality rates, time to first readmission, total number of readmissions and avoidable readmissions, 30-, 90-, and 180-day readmission rates, as well as cost of intervention per patient. The two study groups will be compared using the Student t test (two-tailed) for normally distributed and Mann Whitney U test for skewed continuous variables, respectively. The chi-square test will be used for categorical variables. Time to event (readmission) and 180-day mortality between the two study groups will be compared by using the Kaplan-Meier survival plots and the log-rank test. Cox proportional hazard regression will be used to compute hazard ratio and compare outcomes between the two groups. RESULTS We are actively enrolling participants and the study is expected to be completed by end of 2018; results are expected to be published in early 2019. CONCLUSIONS Innovative solutions for identifying high-risk patients and personalizing interventions based on individual risk and needs may help facilitate the delivery of value-based care, improve long-term patient health outcomes and decrease health care costs. CLINICALTRIAL ClinicalTrials.gov NCT03126565; https://clinicaltrials.gov/ct2/show/NCT03126565 (Archived by WebCite at http://www.webcitation.org/6ymDuAwQA).

Effectiveness of a web-based medication adherence tool with patient centered communication: Results of a clustered randomized controlled trial (Preprint)

2019 ◽  
Author(s):  
Jan van Lieshout ◽  
Joyca Lacroix ◽  
Aart van Halteren ◽  
Martina Teichert
Keyword(s):  
Randomized Controlled Trial ◽  
Medication Adherence ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Community Pharmacies ◽  
Web Based ◽  
Randomized Controlled ◽  
Tailored Interventions ◽  
Increased Risk

BACKGROUND Growing numbers of people use medication for chronic conditions; non-adherence is common, leading to poor disease control. A newly developed web-based tool to identify an increased risk for non-adherence with related potential individual barriers might facilitate tailored interventions and improve adherence. OBJECTIVE To assess the effectiveness of the newly developed tool to improve medication adherence. METHODS A cluster randomized controlled trial assessed the effectiveness of this adherence tool in patients initiating cardiovascular or oral blood glucose lowering medication. Participants were included in community pharmacies. They completed an online questionnaire comprising an assessments of their risk for medication non-adherence and subsequently of barriers to adherence. In pharmacies belonging to the intervention group, individual barriers displayed in a graphical profile on a tablet were discussed by pharmacists and patients at high non-adherence risk in face to face meetings and shared with their general practitioners and practice nurses. Tailored interventions were initiated by the healthcare providers. Barriers of control patients were not presented or discussed and these patients received usual care. The primary outcome was the difference in medication adherence at 8 months follow-up between patients with an increased non-adherence risk from intervention and control group, calculated from dispensing data. RESULTS Data from 492 participants in 15 community pharmacies were available for analyses (intervention 253, 7 pharmacies; control 239, 8 pharmacies). The intervention had no effect on medication adherence (-0.01; 95%CI -0.59 – 0.57; P= .96), neither in the post hoc per protocol analysis (0.19; 95%CI -0.50 – 0.89; P=.58). CONCLUSIONS This study showed no effectiveness of a risk stratification and tailored intervention addressing personal barriers for medication adherence. Various potential explanations for lack of effect were identified. These explanations relate for instance to high medication adherence in the control group, study power and fidelity. Process evaluation should elicit possible improvements and inform the redesign of intervention and implementation. CLINICALTRIAL The Netherlands National Trial Register: NTR5186. Date: May 18, 2015 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5186)

scholarly journals Web-based Weight Management Programs in an Integrated Health Care Setting: A Randomized, Controlled Trial*

Obesity ◽  
2006 ◽  
Vol 14 (2) ◽  
pp. 266-272 ◽  
Author(s):  
Kendra Rothert ◽  
Victor J. Strecher ◽  
Laurie A. Doyle ◽  
William M. Caplan ◽  
Jodi S. Joyce ◽  
...  
Keyword(s):  
Health Care ◽  
Randomized Controlled Trial ◽  
Weight Management ◽  
Care Setting ◽  
Controlled Trial ◽  
Integrated Health Care ◽  
Health Care Setting ◽  
Web Based ◽  
Randomized Controlled ◽  
Weight Management Programs

scholarly journals Randomized controlled trial of geriatric consultation versus standard care in older adults with hematologic malignancies

Haematologica ◽  
2021 ◽  
Author(s):  
Clark DuMontier ◽  
Hajime Uno ◽  
Tammy Hshieh ◽  
Guohai Zhou ◽  
Richard Chen ◽  
...  
Keyword(s):  
Older Adults ◽  
Randomized Controlled Trial ◽  
Standard Care ◽  
Controlled Trial ◽  
Hematologic Malignancies ◽  
Care Utilization ◽  
Goals Of Care ◽  
Randomized Controlled ◽  
Geriatric Consultation ◽  
The Impact

We conducted a randomized controlled trial in older adults with hematologic malignancies to determine the impact of geriatrician consultation embedded in our oncology clinic alongside standard care. From February 2015 to May 2018, transplant-ineligible patients age ii75 years who presented for initial consultation for lymphoma, leukemia, or multiple myeloma at Dana-Farber Cancer Institute (Boston, MA) were eligible. Pre-frail and frail patients, classified based on phenotypic and deficitaccumulation approaches, were randomized to receive either standard oncologic care with or without consultation with a geriatrician. The primary outcome was 1-year overall survival. Secondary outcomes included unplanned care utilization within 6 months of follow-up and documented end of life (EOL) goals of care discussions. Clinicians were surveyed as to their impressions of geriatric consultation. One hundred sixty patients were randomized to either geriatric consultation plus standard care (n = 60) or standard care alone (n = 100). Median age was 80.4 years (SD = 4.2). Of those randomized to geriatric consultation, 48 (80%) completed at least one visit with a geriatrician. Consultation did not improve survival at one year compared to standard care (difference: 2.9%, 95% CI = -9.5% to 15.2%, p = 0.65), and did not significantly reduce the incidence of ED visits, hospitalizations, or days in hospital. Consultation did improve the odds of having EOL goals of care discussions (odds ratio = 3.12, 95% CI = 1.03 to 9.41) and was valued by surveyed hematologiconcology clinicians, with 62.9%-88.2% rating consultation as useful in the management of several geriatric domains.

scholarly journals Patients and Professionals as Partners in Hypertension Care: Qualitative Substudy of a Randomized Controlled Trial Using an Interactive Web-Based System Via Mobile Phone (Preprint)

2020 ◽  
Author(s):  
Ulrika Andersson ◽  
Ulrika Bengtsson ◽  
Agneta Ranerup ◽  
Patrik Midlöv ◽  
Karin Kjellgren
Keyword(s):  
Health Care ◽  
Randomized Controlled Trial ◽  
Mobile Phone ◽  
Controlled Trial ◽  
Lifestyle Changes ◽  
Hypertension Management ◽  
Web Based ◽  
Randomized Controlled ◽  
Use Of Technology ◽  
Web Based System

BACKGROUND The use of technology has the potential to support the patient´s active participation regarding treatment of hypertension. This might lead to changes in the roles of the patient and health care professional and affect the partnership between them. OBJECTIVE The aim of this qualitative study was to explore the partnership between patients and health care professionals and the roles of patients and professionals in hypertension management when using an interactive web-based system for self-management of hypertension via the patient’s own mobile phone. METHODS Focus group interviews were conducted with 22 patients and 15 professionals participating in a randomized controlled trial in Sweden aimed at lowering blood pressure (BP) using an interactive web-based system via mobile phones. The interviews were audiorecorded and transcribed and analyzed using thematic analysis. RESULTS Three themes were identified: the technology, the patient, and the professional. The technology enabled documentation of BP treatment, mainly for sharing knowledge between the patient and the professional. The patients gained increased knowledge of BP values and their relation to daily activities and treatment. They were able to narrate about their BP treatment and take a greater responsibility, inspired by new insights and motivation for lifestyle changes. Based on the patient’s understanding of hypertension, professionals could use the system as an educational tool and some found new ways of communicating BP treatment with patients. Some reservations were raised about using the system, that it might be too time-consuming to function in clinical practice and that too much measuring could result in stress for the patient and an increased workload for the professionals. In addition, not all professionals and patients had adopted the instructions regarding the use of the system, resulting in less realization of its potential. CONCLUSIONS The use of the system led to the patients taking on a more active role in their BP treatment, becoming more of an expert of their BP. When using the system as intended, the professionals experienced it as a useful resource for communication regarding BP and lifestyle. Patients and professionals described a consultation on more equal grounds. The use of technology in hypertension management can promote a constructive and person-centered partnership between patient and professional. However, implementation of a new way of working should bring benefits and not be considered a burden for the professionals. To establish a successful partnership, both the patient and the professional need to be motivated toward a new way of working. CLINICALTRIAL ClinicalTrials.gov NCT03554382; https://clinicaltrials.gov/ct2/show/NCT03554382

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