Behavioral Phenotyping: A Tool for Personalized Medicine
Jethwani K, Kvedar J, Kvedar JC. Behavioral phenotyping: a tool for personalized medicine. Personalized Medicine. 2010;7(6):689-693.Read More...
In recent years, genetic mapping has been grabbing the headlines for its promise to revolutionize healthcare and provide us with a way to personalize medicine. Connected health uses objective data and automated feedback to monitor chronic illnesses and has demonstrated exciting possibilities too. This data can create phenotype maps that reveal acquired behaviors and individual responses to health programs. Health interventions can be personalized using a combination of these techniques to maximize the chances of success and minimize adverse reactions. Aggregating this data at a population level can help us leverage collective behavioral trends to alter health-related perceptions at a population level. This method of hyperpersonalization of medicine has proven its worth, and the focus should now shift to testing its feasibility and incorporation into clinical workflow.
It is Time to Talk About People: A Human-Centered Healthcare System
Searl MM, Borgi L, Chemali Z. It is time to talk about people: a human-centered healthcare system. Health Res Policy Syst. 2010 Nov 26;8:35. doi: 10.1186/1478-4505-8-35. PubMed PMID: 21110859.Read More...
Examining vulnerabilities within our current healthcare system we propose borrowing two tools from the fields of engineering and design: a) Reason's system approach 1 and b) User-centered design 23. Both approaches are human-centered in that they consider common patterns of human behavior when analyzing systems to identify problems and generate solutions. This paper examines these two human-centered approaches in the context of healthcare. We argue that maintaining a human-centered orientation in clinical care, research, training, and governance is critical to the evolution of an effective and sustainable healthcare system.
Text Messages as a Reminder Aid and Educational Tool in Adults and Adolescents with Atopic Dermatitis: A Pilot Study
Pena-Robichaux V, Kvedar JC, Watson AJ. Text messages as a reminder aid and educational tool in adults and adolescents with atopic dermatitis: a pilot study. Dermatol Res Pract. 2010;2010. pii: 894258. doi: 10.1155/2010/894258. Epub 2010 Sep 1. PubMed PMID: 20885940.Read More...
Optimal management of atopic dermatitis (AD) requires patients to adhere to self-care behaviors. Technologies, such as cell phones, have been widely adopted in the USA and have potential to reinforce positive health behaviors. We conducted a pilot study with 25 adolescents and adults age 14 years and older [mean 30.5 yrs, SD 13.4] with AD. Daily text messages (TMs) that provided medication reminders and AD education were sent for six weeks to participants. Our goals were to (1) measure changes in pre- and posttest scores in treatment adherence, self-care behaviors, disease severity, and quality of life and (2) assess the usability and satisfaction of the TM system. Significant improvements in treatment adherence, self-care behaviors, skin severity, and quality of life (P ≤ .001, .002, <.001, and .014, resp.) were noted postintervention. User feedback on the TM system was positive with 88% and 92% of participants reporting that the reminder TMs and educational TMs were helpful, respectively. In conclusion, study participants were receptive to using TMs as a reminder aid and educational tool. The positive trends observed are promising and lay the ground work for further studies needed to elucidate the full potential of this simple and cost-effective intervention.
Use of Remote Monitoring to Improve Outcomes in Patients with Heart Failure: A Pilot Trial
Kulshreshtha A, Kvedar JC, Goyal A, Halpern EF, Watson AJ. Use of remote monitoring to improve outcomes in patients with heart failure: a pilot trial. Int J Telemed Appl. 2010;2010:870959. doi: 10.1155/2010/870959. Epub 2010 May 19. PubMed PMID: 20508741.Read More...
Remote monitoring (RM) of homebound heart failure (HF) patients has previously been shown to reduce hospital admissions. We conducted a pilot trial of ambulatory, non-homebound patients recently hospitalized for HF to determine whether RM could be successfully implemented in the ambulatory setting. Eligible patients from Massachusetts General Hospital (n = 150) were randomized to a control group (n = 68) or to a group that was offered RM (n = 82). The participants transmitted vital signs data to a nurse who coordinated care with the physician over the course of the 6-month study. Participants in the RM program had a lower all-cause per person readmission rate (mean = 0.64, SD +/- 0.87) compared to the usual care group (mean = 0.73, SD +/- 1.51; P-value = .75) although the difference was not statistically significant. HF-related readmission rate was similarly reduced in participants. This pilot study demonstrates that RM can be successfully implemented in non-homebound HF patients and may reduce readmission rates.
A Randomized Trial to Evaluate the Efficacy of Online Follow-Up Visits in the Management of Acne
Watson AJ, Bergman H, Williams CM, Kvedar JC. A randomized trial to evaluate the efficacy of online follow-up visits in the management of acne. Arch Dermatol. 2010 Apr;146(4):406-11. doi: 10.1001/archdermatol.2010.29. PubMed PMID: 20404229.Read More...
To evaluate whether delivering acne follow-up care via an asynchronous, remote online visit (e-visit) platform produces equivalent clinical outcomes to office care.
A prospective, randomized controlled study.
Two teaching hospitals in Boston between September 2005 and May 2007.
A total of 151 patients with mild to moderate facial acne.
Subjects were asked to carry out 4 follow-up visits using either an e-visit platform or conventional office care. At 6-week intervals, subjects in the e-visit group were prompted to send images of their skin and an update, via a secure Web site, to their dermatologist. Dermatologists responded with advice and electronic prescriptions.
MAIN OUTCOME MEASURES:
The primary outcome measure was change in total inflammatory lesion count between the first and last visit. The major secondary outcomes were subject and dermatologist satisfaction with care and length of time to complete visits.
The mean age of subjects was 28 years; most were female (78%), white (65%), and college educated (69%). One hundred twenty-one of the initial 151 subjects completed the study. The decrease in total inflammatory lesion count was similar in the e-visit and office visit groups (6.67 and 9.39, respectively) (P = .49). Both subjects and dermatologists reported comparable satisfaction with care regardless of visit type (P = .06 and P = .16, respectively). Compared with office visits, e-visits were time saving for subjects and time neutral for dermatologists (4 minutes, 8 seconds vs 4 minutes, 42 seconds) (P = .57).
Delivering follow-up care to acne patients via an e-visit platform produced clinical outcomes equivalent to those of conventional office visits.
Innovation Networks for Improving Access and Quality Across the Healthcare Ecosystem
Carroll M, James JA, Lardiere MR, Proser M, Rhee K, Sayre MH, Shore JH, Ternullo J. Innovation networks for improving access and quality across the healthcare ecosystem. Telemed J E Health. 2010 Jan-Feb;16(1):107-11. doi: 10.1089/tmj.2009.0157. PubMed PMID: 20043702.Read More...
Partnerships between patient communities, healthcare providers, and academic researchers are key to stepping up the pace and public health impact of clinical and translational research supported by the National Institutes of Health. With emphasis shifting toward community engagement and faster translation of research advances into clinical practice, academic researchers have a vital stake in widening the use of health information technology systems and telehealth networks to support collaboration and innovation. However, limited interaction between academic institutions and healthcare providers hinders the ability to form and sustain the integrated networks that are needed to conduct meaningful community-engaged research that improves public health outcomes. Healthcare providers, especially those affiliated with smaller practices, will need sustainable infrastructure and real incentives to utilize such networks, as well as training and additional resources for ongoing technical assistance.