View the latest research publications from members of the Partners Connected Health team.
Text to Move: A Randomized Controlled Trial of a Text-Messaging Program to Improve Physical Activity Behaviors in Patients With Type 2 Diabetes Mellitus
Stephen Agboola, MPH, MD; Kamal Jethwani, MPH, MD; Lenny Lopez, MPH, MDiv, MD; Meghan Searl, PhD; Sandra O’Keefe, MPH; Joseph Kvedar, MDRead More...
Telemedicine and Patient Safety
Stephen Agboola, MD, MPH; Joseph Kvedar, MDRead More...
A paradigm shift is ongoing in the health care sector. The traditional model of episodic and hospital-based care is being replaced by a patient-centric approach, in which patients are constantly connected to their health care providers. This shift is driven by the need to optimize the performance of the health care system and enabled by advances in technology.
Read the full paper on the Agency for Healthcare and Research Quality website by clicking here.
Telemedical Education: Training Digital Natives in Telemedicine
Akhilesh S Pathipati, BA ; Tej D Azad, BA ; Kamal Jethwani, MPH, MDRead More...
This article discusses the role of telemedicine in the current healthcare delivery practices and highlights the importance of introducing telemedicine as a part of the medical school curricula.
Telemedicine plays an important role in the delivery of medical care, and will become increasingly prominent going forward. Current medical students are among the first generation of “digital natives” who are well versed in the incorporation of technology into social interaction. These students are well positioned to apply advances in communications to patient care. Even so, providers require training to effectively leverage these opportunities. Therefore, we recommend introducing telemedicine training into medical school curricula and propose a model for incorporation.
Digital Health and Patient Safety
Stephen O. Agboola, MBBS, MPH; David W. Bates, MD, MSc; Joseph C. Kvedar, MDRead More...
This Viewpoint discusses the increasing adoption of digital health technology and how it may be helpful for policy makers, health care administrators, and clinical leaders.
There is a pressing need to optimize performance of the US health care system. This need coincides with a substantial and ongoing remarkable increase in technological innovations with implications for digital health, most notably the advent of mobile computing and communications. Currently, the adoption of digital health—which, in this Viewpoint, refers to the use of advanced electronic communication and monitoring technologies to exchange health information—by clinicians, health care organizations, and patients is increasing.Less
A Multimodal mHealth Intervention (FeatForward) to Improve Physical Activity Behavior in Patients with High Cardiometabolic Risk Factors: Rationale and Protocol for a Randomized Controlled Trial
Stephen Agboola, MD MPH; Ramya Sita Palacholla, MD MPH; Amanda Centi, PhD; Joseph Kvedar, MD; Kamal Jethwani, MD MPH.Read More...
Physical inactivity is one of the leading risk factors contributing to the rising rates of chronic diseases and has been associated with deleterious health outcomes in patients with chronic disease conditions. We developed a mobile phone app, FeatForward, to increase the level of physical activity in patients with cardiometabolic risk (CMR) factors. This intervention is expected to result in an overall improvement in patient health outcomes.
The objective of this study is to evaluate the effect of a mobile phone–based app, FeatForward, on physical activity levels and other CMR factors in patients with chronic conditions.
The study will be implemented as a 2-arm randomized controlled trial with 300 adult patients with chronic conditions over a 6-month follow-up period. Participants will be assigned to either the intervention group receiving the FeatForward app and standard care versus a control group who will receive only usual care. The difference in physical activity levels between the control group and intervention group will be measured as the primary outcome. We will also evaluate the effect of this intervention on secondary measures including clinical outcome changes in global CMR factors (glycated hemoglobin, fasting blood glucose, blood pressure, waist circumference, Serum lipids, C-reactive protein), health-related quality of life, health care usage, including attendance of scheduled clinic visits and hospitalizations, usability, and satisfaction, participant engagement with the FeatForward app, physician engagement with physician portal, and willingness to engage in physical activity. Instruments that will be used in evaluating secondary outcomes include the Short-Form (SF)-12, app usability and satisfaction questionnaires, physician satisfaction questionnaire. The intention-to-treat approach will be used to evaluate outcomes. All outcomes will be measured longitudinally at baseline, midpoint (3 months), and 6 months. Our primary outcome, physical activity, will be assessed by mixed-model analysis of variance with intervention assignment as between-group factor and time as within-subject factor. A similar approach will be used to analyze continuous secondary outcomes while categorical outcomes will be analyzed by chi-square test.
The study is still in progress and we hope to have the results by the end of 2016.
The mobile phone–based app, FeatForward, could lead to significant improvements in physical activity and other CMR factors in patients.
More information can be found at JMIR Publications.Less
A Remote Medication Monitoring System for Chronic Heart Failure Patients to Reduce Readmissions: A Two-Arm Randomized Pilot Study
Timothy M Hale, PhD ; Kamal Jethwani, MPH, MD ; Manjinder Singh Kandola, AB ; Fidencio Saldana, MPH, MD ; Joseph C Kvedar, MD.Read More...
Heart failure (HF) is a chronic condition affecting nearly 5.7 million Americans and is a leading cause of morbidity and mortality. With an aging population, the cost associated with managing HF is expected to more than double from US $31 billion in 2012 to US $70 billion by 2030. Readmission rates for HF patients are high—25% are readmitted at 30 days and nearly 50% at 6 months. Low medication adherence contributes to poor HF management and higher readmission rates. Remote telehealth monitoring programs aimed at improved medication management and adherence may improve HF management and reduce readmissions.
The primary goal of this randomized controlled pilot study is to compare the MedSentry remote medication monitoring system versus usual care in older HF adult patients who recently completed a HF telemonitoring program. We hypothesized that remote medication monitoring would be associated with fewer unplanned hospitalizations and emergency department (ED) visits, increased medication adherence, and improved health-related quality of life (HRQoL) compared to usual care.
Participants were randomized to usual care or use of the remote medication monitoring system for 90 days. Twenty-nine participants were enrolled and the final analytic sample consisted of 25 participants. Participants completed questionnaires at enrollment and closeout to gather data on medication adherence, health status, and HRQoL. Electronic medical records were reviewed for data on baseline classification of heart function and the number of unplanned hospitalizations and ED visits during the study period.
Use of the medication monitoring system was associated with an 80% reduction in the risk of all-cause hospitalization and a significant decrease in the number of all-cause hospitalization length of stay in the intervention arm compared to usual care. Objective device data indicated high adherence rates (95%-99%) among intervention group participants despite finding no significant difference in self-reported adherence between study arms. The intervention group had poorer heart function and HRQoL at baseline, and HRQoL declined significantly in the intervention group compared to controls.
The MedSentry medication monitoring system is a promising technology that merits continued development and evaluation. The MedSentry medication monitoring system may be useful both as a standalone system for patients with complex medication regimens or used to complement existing HF telemonitoring interventions. We found significant reductions in risk of all-cause hospitalization and the number of all-cause length of stay in the intervention group compared to controls. Although HRQoL deteriorated significantly in the intervention group, this may have been due to the poorer HF-functioning at baseline in the intervention group compared to controls. Telehealth medication adherence technologies, such as the MedSentry medication monitoring system, are a promising method to improve patient self-management,the quality of patient care, and reduce health care utilization and expenditure for patients with HF and other chronic diseases that require complex medication regimens.
Trial Registration: ClinicalTrials.gov NCT01814696; https://clinicaltrials.gov/ct2/show/study/NCT01814696 (Archived by WebCite® at http://www.webcitation.org/6giqAVhno)
More information can be found at JMIR Publications.Less