scholarly journals Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Healthcare Professionals, Patients, and Family Members (Preprint)

2020 ◽  
Author(s):  
Tobias Kowatsch ◽  
Theresa Schachner ◽  
Samira Harperink ◽  
Filipe Barata ◽  
Ullrich Dittler ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Disease Management ◽  
Family Member ◽  
Working Alliance ◽  
Healthcare Professionals ◽  
Chronic Disease Management ◽  
Family Members ◽  
Inhalation Technique ◽  
Conversational Agents ◽  
Behavioral Skills

BACKGROUND Successful management of chronic diseases requires a trustful collaboration between healthcare professionals, patients, and family members. Scalable conversational agents (CAs), designed to assist healthcare professionals, may play a significant role in supporting this collaboration in a scalable way by reaching out into the everyday lives of patients and their family members. Until now, however, it has not been clear whether CAs, in such a role, would be accepted and whether they can support this multi-stakeholder collaboration. OBJECTIVE With asthma in children representing a relevant target of chronic disease management, this work has two objectives: (1) To describe the design of MAX, a CA-delivered asthma intervention that supports healthcare professionals targeting child-parent teams in their everyday lives; (2) To assess the (a) reach of MAX, (b) CA-patient working alliance, (c) acceptance of MAX, (d) intervention completion rate, (e) cognitive and behavioral outcomes, and (f) human effort and responsiveness of healthcare professionals in primary and secondary care settings. METHODS MAX was designed to increase cognitive skills (i.e. knowledge about asthma) and behavioral skills (i.e. inhalation technique) in 10-15-year-olds with asthma and enables support by a health professional and a family member. To this end, three design goals guided the development: (1) To build a CA-patient working alliance; (2) To offer hybrid (human- and CA-supported) ubiquitous coaching; (3) To provide an intervention with a high experiential value. An interdisciplinary team of computer scientists, asthma experts, and young patients with their parents developed the intervention collaboratively. The CA communicates with healthcare professionals via email, with patients via a mobile chat app and with a family member via SMS. A single-arm feasibility study in primary and secondary care settings was conducted to assess MAX. RESULTS Results indicate an overall positive evaluation of MAX with respect to its reach (49.5% (49 out of 99) of recruited and eligible patient-family member teams participated), a strong patient-CA working alliance, and a high acceptance by all relevant stakeholders. Moreover, MAX led to improved cognitive and behavioral skills and an intervention completion rate of 75.5%. Family members supported the patients in 269 out of 275 (97.8%) coaching sessions. Most of the conversational turns (99.5%) were conducted between patients and the CA as opposed to between patient and healthcare professional, thus indicating the scalability of MAX. In addition, it took healthcare professionals less than four minutes to assess the inhalation technique and three days to deliver that feedback to the patients. Several suggestions for improvement were made. CONCLUSIONS For the first time, this work provides evidence that CAs, designed as mediating social actors involving healthcare professionals, patients and family members, are not only accepted in such a “team player” role, but also show potential to improve health-relevant outcomes in chronic disease management.

scholarly journals Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study

10.2196/25060 ◽  
2021 ◽  
Vol 23 (2) ◽  
pp. e25060
Author(s):  
Tobias Kowatsch ◽  
Theresa Schachner ◽  
Samira Harperink ◽  
Filipe Barata ◽  
Ullrich Dittler ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Disease ◽  
Disease Management ◽  
Family Member ◽  
Working Alliance ◽  
Health Care Professionals ◽  
Chronic Disease Management ◽  
Family Members ◽  
Conversational Agent ◽  
Conversational Agents

Background Successful management of chronic diseases requires a trustful collaboration between health care professionals, patients, and family members. Scalable conversational agents, designed to assist health care professionals, may play a significant role in supporting this collaboration in a scalable way by reaching out to the everyday lives of patients and their family members. However, to date, it remains unclear whether conversational agents, in such a role, would be accepted and whether they can support this multistakeholder collaboration. Objective With asthma in children representing a relevant target of chronic disease management, this study had the following objectives: (1) to describe the design of MAX, a conversational agent–delivered asthma intervention that supports health care professionals targeting child-parent teams in their everyday lives; and (2) to assess the (a) reach of MAX, (b) conversational agent–patient working alliance, (c) acceptance of MAX, (d) intervention completion rate, (e) cognitive and behavioral outcomes, and (f) human effort and responsiveness of health care professionals in primary and secondary care settings. Methods MAX was designed to increase cognitive skills (ie, knowledge about asthma) and behavioral skills (ie, inhalation technique) in 10-15-year-olds with asthma, and enables support by a health professional and a family member. To this end, three design goals guided the development: (1) to build a conversational agent–patient working alliance; (2) to offer hybrid (human- and conversational agent–supported) ubiquitous coaching; and (3) to provide an intervention with high experiential value. An interdisciplinary team of computer scientists, asthma experts, and young patients with their parents developed the intervention collaboratively. The conversational agent communicates with health care professionals via email, with patients via a mobile chat app, and with a family member via SMS text messaging. A single-arm feasibility study in primary and secondary care settings was performed to assess MAX. Results Results indicated an overall positive evaluation of MAX with respect to its reach (49.5%, 49/99 of recruited and eligible patient-family member teams participated), a strong patient-conversational agent working alliance, and high acceptance by all relevant stakeholders. Moreover, MAX led to improved cognitive and behavioral skills and an intervention completion rate of 75.5%. Family members supported the patients in 269 out of 275 (97.8%) coaching sessions. Most of the conversational turns (99.5%) were conducted between patients and the conversational agent as opposed to between patients and health care professionals, thus indicating the scalability of MAX. In addition, it took health care professionals less than 4 minutes to assess the inhalation technique and 3 days to deliver related feedback to the patients. Several suggestions for improvement were made. Conclusions This study provides the first evidence that conversational agents, designed as mediating social actors involving health care professionals, patients, and family members, are not only accepted in such a “team player” role but also show potential to improve health-relevant outcomes in chronic disease management.

scholarly journals The Linkages Between Reimbursement and Prevention: A Mixed-Methods Approach

2021 ◽  
Vol 9 ◽  
Author(s):  
Ellen Zwaagstra Salvado ◽  
Hilco J. van Elten ◽  
Erik M. van Raaij
Keyword(s):  
Mixed Methods ◽  
Chronic Disease ◽  
Disease Management ◽  
Healthcare Professionals ◽  
Chronic Disease Management ◽  
Preventive Services ◽  
Population Based ◽  
Rapid Review ◽  
Effective Prevention ◽  
Mixed Methods Approach

Background: The benefits of prevention are widely recognized; ranging from avoiding disease onset to substantially reducing disease burden, which is especially relevant considering the increasing prevalence of chronic diseases. However, its delivery has encountered numerous obstacles in healthcare. While healthcare professionals play an important role in stimulating prevention, their behaviors can be influenced by incentives related to reimbursement schemes.Purpose: The purpose of this research is to obtain a detailed description and explanation of how reimbursement schemes specifically impact primary, secondary, tertiary, and quaternary prevention.Methods: Our study takes a mixed-methods approach. Based on a rapid review of the literature, we include and assess 27 studies. Moreover, we conducted semi-structured interviews with eight Dutch healthcare professionals and two representatives of insurance companies, to obtain a deeper understanding of healthcare professionals' behaviors in response to incentives.Results: Nor fee-for-service (FFS) nor salary can be unambiguously linked to higher or lower provision of preventive services. However, results suggest that FFS's widely reported incentive to increase production might work in favor of preventive services such as immunizations but provide less incentives for chronic disease management. Salary's incentive toward prevention will be (partially) determined by provider-organization's characteristics and reimbursement. Pay-for-performance (P4P) is not always necessarily translated into better health outcomes, effective prevention, or adequate chronic disease management. P4P is considered disruptive by professionals and our results expose how it can lead professionals to resort to (over)medicalization in order to achieve targets. Relatively new forms of reimbursement such as population-based payment may incentivize professionals to adapt the delivery of care to facilitate the delivery of some forms of prevention.Conclusion: There is not one reimbursement scheme that will stimulate all levels of prevention. Certain types of reimbursement work well for certain types of preventive care services. A volume incentive could be beneficial for prevention activities that are easy to specify. Population-based capitation can help promote preventive activities that require efforts that are not incentivized under other reimbursements, for instance activities that are not easily specified, such as providing education on lifestyle factors related to a patient's (chronic) disease.

scholarly journals Social Support: a Key Variable for Health Promotion and Chronic Disease Management in Hispanic Patients with Rheumatic Diseases

2014 ◽  
Vol 7 ◽  
pp. CMAMD.S13849 ◽  
Author(s):  
Alyssa T. Brooks ◽  
Regina E. Andrade ◽  
Kimberly R. Middleton ◽  
Gwenyth R. Wallen
Keyword(s):  
Social Support ◽  
Health Promotion ◽  
Chronic Disease ◽  
Disease Management ◽  
Rheumatic Diseases ◽  
Chronic Disease Management ◽  
Family Members ◽  
Psychosocial Burden ◽  
Cross Sectional

Chronic diseases, including rheumatic diseases, can cause immense physical and psychosocial burden for patients. Many Hispanics suffering with arthritis face activity limitations. Social support, or the functional content of relationships, may be important to consider when examining treatment and outcomes for Hispanic individuals. Participants were recruited from an urban community health center (CHC) as part of a larger health behavior study. A cross-sectional, descriptive, mixed methods analysis was conducted to explore the role of social support in the sample. Only Hispanic/Latino patients (n = 46) were included in this analysis. Interviews were conducted in both English and Spanish. The majority of the sample (87%) perceived some presence of social support in their lives. The two most commonly cited types of social support were emotional and instrumental. The two most common sources of social support were family members other than spouses (52.2%) and spouses (32.6%). Body mass index (BMI) was significantly correlated with the number of perceived sources of support. The presence or absence and the role of social support in supporting optimal health outcomes should be considered for Hispanics with chronic rheumatic diseases. Involving family members and spouses in the plan of care for this population could facilitate health promotion and chronic disease management.

Sign in / Sign up

Export Citation Format

Share Document