Telemedicine Commons^™

Design And Feasibility Of A Text Messaging Intervention To Prevent Indoor Tanning Among Young Adult Women: A Pilot Study, William Douglas Evans, Darren Mays

Prevention and Community Health Faculty Publications

Background: Although skin cancer is largely preventable, it affects nearly 1 of 5 US adults. There is a need for research on how to optimally design persuasive public health indoor tanning prevention messages.

Objective: The objective of our study was to examine whether framed messages on indoor tanning behavioral intentions delivered through short message service (SMS) text messaging would produce (1) positive responses to the messages, including message receptivity and emotional response; (2) indoor tanning efficacy beliefs, including response efficacy and self-efficacy; and (3) indoor tanning risk beliefs.

Methods: We conducted a pilot study of indoor tanning prevention messages delivered …

Decreasing Patient Cost And Travel Time Through Pediatric Rheumatology Telemedicine Visits., Elizabeth A. Kessler, Ashley K. Sherman, Mara L. Becker

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: There is a critical shortage of pediatric rheumatologists in the US. Substantial travel to clinics can impose time and monetary burdens on families. The aim of this study was to evaluate the cost of in-person pediatric rheumatology visits for families and determine if telemedicine clinics resulted in time and cost savings. Factors associated with interest in telemedicine were also explored.

METHODS: Surveys were offered to parents and guardians of patients in Pediatric Rheumatology follow-up clinics in Kansas City, Missouri, the primary site of in-person care, and at a telemedicine outreach site 160 miles away, in Joplin, Missouri. Survey questions …

Cardiomems™ In Lvad Patients: A Case Series, Maya Guglin, Bennet George, Sarah Branam, Amanda Hart

The VAD Journal

Patients with a left ventricular assist device (LVAD) commonly encounter issues with volume status post-implant. Volume overload can result from incomplete compensation of left ventricular failure or from right ventricular failure. The CardioMEMS™ intracardiac hemodynamic monitoring device is an area of growing interest regarding the management of chronic congestive heart failure, however, its utility has not been serially investigated in patients with an LVAD. We present a case series of patients with ventricular assist devices care for at our institution in which the CardioMEMS™ device aided in the management of volume status and pump performance.

Using Foreign Virtual Patients With Medical Students In Germany: Are Cultural Differences Evident And Do They Impede Learning?, Jens Walldorf, Tina Jähnert, Norman B. Berman, Martin R. Fischer

Dartmouth Scholarship

Learning with virtual patients (VPs) is considered useful in medical education for fostering clinical reasoning. As the authoring of VPs is highly demanding, an international exchange of cases might be desirable. However, cultural differences in foreign VPs might hamper learning success.

Use Of Telehealth In Nhsc Grantee Sites, Patricia Pittman, Clese Erikson, Xiaoli Wu, Emily Bass

Health Workforce Research Center Publications

Telehealth has long been viewed as an important pathway for increasing access to care for underserved populations, while providing high quality care at low cost. The spread of telehealth in the United States, however, has been hampered by a range of reimbursement, equipment costs, and licensure barriers. In this study we examined the extent to which telehealth is being used in settings that are among the locations most in need: the National Health Service Corps (NHSC) approved grantee sites. Key Questions

1. To what extent and how are NHSC using telehealth and telemedicine services?
2. What are the barriers to adoption and …

Perceptions Of Electronic Health Records Effects On Staffing, Workflow, & Productivity In Community Health Centers, Leah E. Masselink, Clese Erikson

Health Workforce Research Center Publications

Significant Federal investments under the Health Information Technology for Economic and Clinical Health Act of 2009 and the Affordable Care Act have motivated many community health centers (CHCs) to implement electronic health records (EHRs) in the past few years. Evidence suggests that EHR implementation causes significant changes in how primary care clinicians spend their time and may be associated with changes in staff and facility level productivity. However, the mechanisms to explain these changes were mostly speculative. The goals of this project were to understand how, from the perspective of clinicians, support staff, and administrators, CHCs’ implementation of EHRs has …

Pilot Study Of A Web-Delivered Multicomponent Intervention For Rural Teens With Poorly Controlled Type 1 Diabetes, Amy H. Lansing, Catherine Stanger, Alan Budney, Ann S. Christiano, Samuel Casella

Dartmouth Scholarship

Objective. The purpose of this study was to examine the feasibility and effectiveness of a web-delivered multicomponent behavioral and family-based intervention targeting self-regulation and self-monitoring of blood glucose levels (SMBG) and glycemic control (HbA1c) in teens with type 1 diabetes (T1DM) living in rural US. Methods. 15 teens with poorly controlled T1DM participated in a 25-week web-delivered intervention with two phases, active treatment (weekly treatment sessions and working memory training program) and maintenance treatment (fading of treatment sessions). Results. Almost all (13 of 15) participants completed at least 14 of 15 treatment sessions and at least 20 of 25 working …

Harnessing Teams And Technology To Improve Outcomes In Infants With Single Ventricle., Girish S. Shirali, Lori A. Erickson, Johnathan Apperson, Kathy Goggin, David D. Williams, Kimberly J. Reid, Andrea Bradley-Ewing, Dawn Tucker, Michael Bingler, John Spertus, Leslie Rabbitt, Richard Stroup

Manuscripts, Articles, Book Chapters and Other Papers

Infants with single ventricle require staged cardiac surgery, with stage I typically performed shortly after birth, stage II at 4 to 6 months of age, and stage III at 3 to 5 years of age. There is a high risk of interstage mortality and morbidity after infants are discharged from the hospital between stages I and II. Traditional home monitoring requires caregivers to record measurements of weight and oxygen saturation into a binder and requires families to assume a surveillance role. We have developed a tablet PC-based solution that provides secure and nearly instantaneous transfer of patient information to a …

User Acceptance Of Neurology Telemedicine Technology In The Emergency Department, Teresa W. Mcneil

Applied Research Projects

There is currently a significant shortage of trained neurologists in the country. In addition to the shortfall of neurologists, there is an increasing need for this specialty due to an aging population, increase in the incident of neurologic diseases and an increasing demand for healthcare (Freeman, 2013). The development of tele neurology technology has been shown to help address these problems. As with any new technology there are multiple barriers to overcome, one of those being user acceptance of the technology. A survey of users of the telemedicine product VGo was conducted at Hunt Regional Medical Center to access the …

Testing The Feasibility Of Remote Patient Monitoring In Prenatal Care Using A Mobile App And Connected Devices: A Prospective Observational Trial, Kathryn Marko, Jill M. Krapf, Andrew C. Meltzer, Julia Oh, Nihar Ganju, Anjali Martinez, Sheetal Sheth, Nancy D. Gaba

Obstetrics and Gynecology Faculty Publications

BACKGROUND:

Excessive weight gain and elevated blood pressure are significant risk factors for adverse pregnancy outcomes such as gestational diabetes, premature birth, and preeclampsia. More effective strategies to facilitate adherence to gestational weight gain goals and monitor blood pressure may have a positive health benefit for pregnant women and their babies. The impact of utilizing a remote patient monitoring system to monitor blood pressure and weight gain as a component of prenatal care has not been previously assessed.

OBJECTIVE:

The objective of this study is to determine the feasibility of monitoring patients remotely in prenatal care using a mobile phone …

The Smart Heart Self-Care First Pilot Program, Samantha Mancuso

DNP Projects

Purpose: The Smart Heart Self-Care First Pilot Program (SHSCF) offers a transitional care intervention focusing on the self-care of hospitalized heart failure patients who are discharged home. It utilizes assessment, communication and education components to encourage behavior modification (improved self-care) through telehealth methodology.

Background and Significance: Heart failure related admissions, as a primary or secondary diagnosis, are among the leading causes of hospitalizations in the United States (Emory Healthcare, 2016). Surprisingly, of those patients discharged with a primary diagnosis of heart failure, 20% are readmitted to the hospital within thirty days (Feltner et. al, 2014). Heart failure related re-hospitalizations highlight …

Developing And Pretesting A Text Messaging Program For Health Behavior Change, Lorien C. Abroms, Robyn Whittaker, Caroline Free, Judith Mendel Van Alstyne, Jennifer M. Schindler-Ruwisch

Prevention and Community Health Faculty Publications

Background: A growing body of evidence demonstrates that text messaging-based programs (short message service [SMS]) on mobile phones can help people modify health behaviors. Most of these programs have consisted of automated and sometimes interactive text messages that guide a person through the process of behavior change.

Objective: This paper provides guidance on how to develop text messaging programs aimed at changing health behaviors.

Methods: Based on their collective experience in designing, developing, and evaluating text messaging programs and a review of the literature, the authors drafted the guide. One author initially drafted the guide and the others provided input …

Smartphone Mobile Application To Enhance Diagnosis Of Skin Cancer: A Guide For The Rural Practitioner, Shane E. Cook, Louis C. Palmer Md, Franklin D. Shuler Md, Phd

MIIR Faculty Research

Primary care physicians occupy a vital position to impact many devastating conditions, especially those dependent upon early diagnosis, such as skin cancer. Skin cancer is the most common cancer in the United States and despite improvements in skin cancer therapy, patients with a delay in diagnosis and advanced disease continue to have a grave prognosis. Due to a variety of barriers, advanced stages of skin cancer are more prominent in rural populations. In order to improve early diagnosis four things are paramount: increased patient participation in prevention methods, establishment of screening guidelines, increased diagnostic accuracy of malignant lesions, and easier …

Preventive Maintenance Decision Modeling In Health And Service Systems, Mahboubeh Madadi

Graduate Theses and Dissertations

This dissertation focuses on the preventive maintenance decision modeling in healthcare and service systems. In the first part of this dissertation, some issues in preventive health decisions for breast cancer are addressed, and in the second part, the required characteristics for preventive maintenance of an unreliable queuing system are derived.

Adherence to cancer screening is the first issue that is addressed in this dissertation. Women’s adherence or compliance with mammography screening remained low in the recent years. In this dissertation, we first develop a design-based logistic regression model to quantify the probability of adherence to screening schedules based on women’s …

Understanding Technology Diffusion And Spatial Accessibility In The Home Healthcare Industry, Mehmet Serdar Kilinç

Graduate Theses and Dissertations

Home healthcare is becoming an important alternative to institutionalized care. It not only reduces costs but also increases health outcomes and patient satisfaction. However, the availability and efficiency of home healthcare services need to be improved as the aging population increases in the US. Hence, understanding home healthcare utilization and access are the essential steps to develop strategies ensuring effective and sustainable services to patients.

This research aims to study two main issues in the US home healthcare system: diffusion and long-term impacts of home telehealth and potential spatial accessibility of home healthcare services. Home telehealth is a promising technology …

Can Electronic Health Records Systems Support New Payment Methods For Health Centers?, Peter Shin, Feygele Jacobs, Jeffrey Barnes, James B. Welsh, Lisa Perry, Scott D. Morgan

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This study assessed the feasibility and usefulness of combining electronic health record (EHR) data with federal cost report data for the purposes of: 1) quantifying the provision of enabling services; and 2) for use as the basis of community health center payment rate-setting. The study used EHR data derived from the Center for Primary Care Informatics to isolate enabling services and perform the end-to-end analysis that might be required to develop or evaluate reimbursement rates. The study revealed that data extracted from federal cost reports combined with data from the EHR fall short of providing the information required to reasonably …

Know Your Audience: Predictors Of Success For A Patient-Centered Texting App To Augment Linkage To Hiv Care In Rural Uganda, Mark J. Siedner, Data Santorino, Jessica E. Haberer, David Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Despite investments in infrastructure and evidence for high acceptability, few mHealth interventions have been implemented in sub-Saharan Africa.

Objective: We sought to (1) identify predictors of uptake of an mHealth application for a low-literacy population of people living with HIV (PLWH) in rural Uganda and (2) evaluate the efficacy of various short message service (SMS) text message formats to optimize the balance between confidentiality and accessibility.

Methods: The trial evaluated the efficacy of a SMS text messaging app to notify PLWH of their laboratory results and request return to care for those with abnormal test results. Participants with a …

Telepsychiatric Assessment Of A Mariner Expressing Suicidal Ideation., Alexander Lee, Neal Sikka, Francis O'Connell, Allen Dyer, Keith Boniface, James Betz

Emergency Medicine Faculty Publications

This case report highlights the successful use of telepsychiatric consultation by secure video chat to remotely assess a mariner expressing suicidal ideation. As a result of this intervention, telemedicine providers initiated psychiatric stabilisation while the mariner was still aboard the vessel, determined that he was safe for repatriation under the care of qualified medical escorts, and facilitated admission to a psychiatric facility near his home in the United States. Mental health emergencies are a significant cause of morbidity and mortality among mariners. Telepsychiatry is a validated method of establishing a psychiatric diagnosis and disposition as well as assessing risk of …

The Development And Application Of An Oncology Therapy-Related Symptom Checklist For Adults (Trsc) And Children (Trsc-C) And E-Health Applications., Arthur R Williams, David D Williams, Phoebe D Williams, Farrokh Alemi, Hosai Hesham, Blaine Donley, Raya Kheirbek

Medicine Faculty Publications

BACKGROUND: Studies found that treatment symptoms of concern to oncology/hematology patients were greatly under-identified in medical records. On average, 11.0 symptoms were reported of concern to patients compared to 1.5 symptoms identified in their medical records. A solution to this problem is use of an electronic symptom checklist that can be easily accessed by patients prior to clinical consultations.

PURPOSE: Describe the oncology Therapy-Related Symptom Checklists for Adults (TRSC) and Children (TRSC-C), which are validated bases for e-Health symptom documentation and management. The TRSC has 25 items/symptoms; the TRSC-C has 30 items/symptoms. These items capture up to 80% of the …

Research Brief: "The Potential For Health-Related Uses Of Mobile Phones And Internet With Homeless Veterans: Results From A Multisite Survey", Institute For Veterans And Military Families At Syracuse University

Institute for Veterans and Military Families

This brief is about the use of mobile phones among homeless veterans for medical appointment reminders, and other health services provided by healthcare practitioners. In policy and practice, social workers and counselors should determine whether mobile communication would benefit homeless veterans with whom they work and should identify certain barriers to mobile communication that could exist; the VA should expand its mobile notification efforts and look for programs that reduce barriers to regular access to mobile communication. Suggestions for future research include expanding the sample of homeless veterans to include those who are living on the streets or in a …