دورية أكاديمية
أعرض في EDS

Interactive Digital Health Tools to Engage Patients and Caregivers in Discharge Preparation: Implementation Study.

التفاصيل البيبلوغرافية
العنوان: Interactive Digital Health Tools to Engage Patients and Caregivers in Discharge Preparation: Implementation Study.
المؤلفون: Fuller TE; Brigham and Women's Hospital, Boston, MA, United States., Pong DD; Brigham and Women's Hospital, Boston, MA, United States., Piniella N; Brigham and Women's Hospital, Boston, MA, United States., Pardo M; Brigham and Women's Hospital, Boston, MA, United States., Bessa N; Brigham and Women's Hospital, Boston, MA, United States.; Harvard Medical School, Boston, MA, United States., Yoon C; Brigham and Women's Hospital, Boston, MA, United States., Boxer RB; Brigham and Women's Hospital, Boston, MA, United States.; Harvard Medical School, Boston, MA, United States., Schnipper JL; Brigham and Women's Hospital, Boston, MA, United States.; Harvard Medical School, Boston, MA, United States., Dalal AK; Brigham and Women's Hospital, Boston, MA, United States.; Harvard Medical School, Boston, MA, United States.
المصدر: Journal of medical Internet research [J Med Internet Res] 2020 Apr 28; Vol. 22 (4), pp. e15573. Date of Electronic Publication: 2020 Apr 28.
نوع المنشور: Journal Article; Research Support, U.S. Gov't, P.H.S.
اللغة: English
بيانات الدورية: Publisher: JMIR Publications Country of Publication: Canada NLM ID: 100959882 Publication Model: Electronic Cited Medium: Internet ISSN: 1438-8871 (Electronic) Linking ISSN: 14388871 NLM ISO Abbreviation: J Med Internet Res Subsets: MEDLINE
أسماء مطبوعة: Publication: <2011- > : Toronto : JMIR Publications
Original Publication: [Pittsburgh, PA? : s.n., 1999-
مواضيع طبية MeSH: Caregivers/*standards , Electronic Health Records/*standards , Patient Discharge/*trends, Adult ; Female ; Humans ; Male ; Surveys and Questionnaires
مستخلص: Background: Poor discharge preparation during hospitalization may lead to adverse events after discharge. Checklists and videos that systematically engage patients in preparing for discharge have the potential to improve safety, especially when integrated into clinician workflow via the electronic health record (EHR).
Objective: This study aims to evaluate the implementation of a suite of digital health tools integrated with the EHR to engage hospitalized patients, caregivers, and their care team in preparing for discharge.
Methods: We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify pertinent research questions related to implementation. We iteratively refined patient and clinician-facing intervention components using a participatory process involving end users and institutional stakeholders. The intervention was implemented at a large academic medical center from December 2017 to July 2018. Patients who agreed to participate were coached to watch a discharge video, complete a checklist assessing discharge readiness, and request postdischarge text messaging with a physician 24 to 48 hours before their expected discharge date, which was displayed via a patient portal and bedside display. Clinicians could view concerns reported by patients based on their checklist responses in real time via a safety dashboard integrated with the EHR and choose to open a secure messaging thread with the patient for up to 7 days after discharge. We used mixed methods to evaluate our implementation experience.
Results: Of 752 patient admissions, 510 (67.8%) patients or caregivers participated: 416 (55.3%) watched the video and completed the checklist, and 94 (12.5%) completed the checklist alone. On average, 4.24 concerns were reported per each of the 510 checklist submissions, most commonly about medications (664/2164, 30.7%) and follow-up (656/2164, 30.3%). Of the 510 completed checklists, a member of the care team accessed the safety dashboard to view 210 (41.2%) patient-reported concerns. For 422 patient admissions where postdischarge messaging was available, 141 (33.4%) patients requested this service; of these, a physician initiated secure messaging for 3 (2.1%) discharges. Most patient survey participants perceived that the intervention promoted self-management and communication with their care team. Patient interview participants endorsed gaps in communication with their care team and thought that the video and checklist would be useful closer toward discharge. Clinicians participating in focus groups perceived the value for patients but suggested that low awareness and variable workflow regarding the intervention, lack of technical optimization, and inconsistent clinician leadership limited the use of clinician-facing components.
Conclusions: A suite of EHR-integrated digital health tools to engage patients, caregivers, and clinicians in discharge preparation during hospitalization was feasible, acceptable, and valuable; however, important challenges were identified during implementation. We offer strategies to address implementation barriers and promote adoption of these tools.
Trial Registration: ClinicalTrials.gov NCT03116074; https://clinicaltrials.gov/ct2/show/NCT03116074.
(©Theresa E Fuller, Denise D Pong, Nicholas Piniella, Michael Pardo, Nathaniel Bessa, Catherine Yoon, Robert B Boxer, Jeffrey Lawrence Schnipper, Anuj K Dalal. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 28.04.2020.)
References: J Hosp Med. 2017 Oct 18;12(12):1012-1016. (PMID: 29073310)
J Med Internet Res. 2019 Jul 18;21(7):e13336. (PMID: 31322123)
J Hosp Med. 2006 Nov;1(6):354-60. (PMID: 17219528)
J Hosp Med. 2017 Feb;12(2):110-117. (PMID: 28182809)
J Gerontol Nurs. 2017 Apr 1;43(4):15-22. (PMID: 28358972)
Arch Intern Med. 2011 Jul 25;171(14):1232-7. (PMID: 21788540)
Ann Intern Med. 2018 Jun 5;168(11):766-774. (PMID: 29710243)
JAMA Intern Med. 2014 Nov;174(11):1870-2. (PMID: 25264930)
J Am Geriatr Soc. 2013 Nov;61(11):1894-9. (PMID: 24116689)
J Am Med Inform Assoc. 2018 Feb 1;25(2):206-209. (PMID: 28633483)
Healthc Inf Manage. 1997 Winter;11(4):97-112. (PMID: 10177282)
J Biomed Inform. 2009 Apr;42(2):377-81. (PMID: 18929686)
Jt Comm J Qual Patient Saf. 2017 Aug;43(8):403-413. (PMID: 28738986)
J Am Med Inform Assoc. 2019 Jun 1;26(6):553-560. (PMID: 30903660)
J Am Med Inform Assoc. 2009 Nov-Dec;16(6):889-97. (PMID: 19717799)
J Gen Intern Med. 2003 Aug;18(8):646-51. (PMID: 12911647)
Crit Care Med. 2017 Aug;45(8):e806-e813. (PMID: 28471886)
Fed Regist. 2011 Aug 18;76(160):51476-846. (PMID: 21894648)
J Hosp Med. 2016 Dec;11(12):883-885. (PMID: 27378748)
J Gen Intern Med. 2005 Apr;20(4):317-23. (PMID: 15857487)
J Hosp Med. 2016 Sep;11(9):620-7. (PMID: 26917417)
CMAJ. 2004 Feb 3;170(3):345-9. (PMID: 14757670)
Jt Comm J Qual Patient Saf. 2017 Nov;43(11):606-610. (PMID: 29056181)
AMIA Annu Symp Proc. 2014 Nov 14;2014:486-95. (PMID: 25954353)
J Hosp Med. 2013 Aug;8(8):444-9. (PMID: 23554352)
J Hosp Med. 2016 Jun;11(6):407-12. (PMID: 26895238)
J Hosp Med. 2010 Sep;5(7):392-7. (PMID: 20578046)
Health Expect. 2018 Feb;21(1):41-56. (PMID: 28898930)
J Am Med Inform Assoc. 2017 Apr 1;24(e1):e178-e184. (PMID: 27539201)
JAMA Intern Med. 2013 Apr 22;173(8):632-8. (PMID: 23529115)
Appl Clin Inform. 2020 Jan;11(1):34-45. (PMID: 31940670)
J Am Med Inform Assoc. 2018 Dec 1;25(12):1626-1633. (PMID: 30346543)
J Am Med Inform Assoc. 2020 Feb 1;27(2):301-307. (PMID: 31794030)
Ann Intern Med. 2003 Feb 4;138(3):161-7. (PMID: 12558354)
Qual Quant. 2018;52(4):1893-1907. (PMID: 29937585)
Ann Intern Med. 2004 Oct 5;141(7):533-6. (PMID: 15466770)
J Gen Intern Med. 2015 Aug;30(8):1164-71. (PMID: 25822112)
J Am Med Inform Assoc. 2016 Jan;23(1):80-7. (PMID: 26239859)
J Hosp Med. 2014 Jun;9(6):396-9. (PMID: 24523051)
J Hosp Med. 2021 Jan;16(1):15-22. (PMID: 33357325)
Jt Comm J Qual Patient Saf. 2017 Dec;43(12):676-685. (PMID: 29173289)
J Hosp Med. 2010 Sep;5(7):385-91. (PMID: 20578045)
J Gen Intern Med. 2002 Mar;17(3):186-92. (PMID: 11929504)
Ann Intern Med. 2017 Dec 5;167(11):816-817. (PMID: 29059690)
معلومات مُعتمدة: R21 HS024751 United States HS AHRQ HHS
فهرسة مساهمة: Keywords: care transitions; health information technology; implementation science; patient engagement
سلسلة جزيئية: ClinicalTrials.gov NCT03116074
تواريخ الأحداث: Date Created: 20200429 Date Completed: 20201027 Latest Revision: 20240329
رمز التحديث: 20240329
مُعرف محوري في PubMed: PMC7218608
DOI: 10.2196/15573
PMID: 32343248
قاعدة البيانات: MEDLINE
الوصف
تدمد:1438-8871
DOI:10.2196/15573