Electronic Decision Support for Cardiovascular High-Risk Patients Management in Tibet, China

MaoyiTian,¹JiakeChen,² LiqunXu,² HaoChen,³ RuilaiLi,¹KaWingCho,^1,4 YangfendWu,¹LijingL Yan,^1,5
1The George Institute for Global Health, Beijing, China, ²China Mobile Research Institute, Beijing, China, ³Beijing Hospital, Beijing, China ⁴Columbia University, New York, USA ⁵Northwestern University, Illinois, USA

Journal MTM 1:4S:21, 2012
DOI:10.7309/jmtm.44

Abstract

Background: An electronic decision support (EDS) system in the health sector is a computer or smartphone based application used to assist clinicians in medical decision making. Community healthcare workers (CHWs) who usually have little professional training may particularly benefit from EDS to better equip them for community-based chronic disease care. To our knowledge, there are no studies in China on EDS for CHWs.

Methods: We will incorporate an EDS component in a cluster-randomized controlled trial currently being conducted in 23 villages in 2 counties in Tibet, China whose aim is to develop, pilot test, and evaluate a guideline-based yet simplified cardiovascular management program delivered by CHWs (also called village “doctors”) for high cardiovascular risk patients.

The EDS system is a smartphone-based application that aims to help CHWs better follow up and manage their high cardiovascular risk patients on a monthly basis during the 12 months intervention period. The application consists of prompts regarding patient’s medical history, new conditions, medication use, lifestyle habits, physical examination findings, and appropriateness for prescribing two types of CVD risk lowering medications (aspirin and low- dose diuretics). These monthly records from the cellphone can easily be uploaded by CHWs to a central server to generate key performance indicators and provide performance feedback to the CHWs to improve the quality of their care.

Current Status: The EDS application were supplied to all CHWs between May and June 2012 and will be used for about one year. Interim process evaluation on EDS will be conducted by October 2012 with final data collection by May 2013.

Significance: As the first study with an EDS component for CHWs to manage cardiovascular high-risk patients in China, this project provides an opportunity to evaluate the feasibility and effectiveness of this innovative technology in capacity building and medical decision support.

A Computer Adaptive Testing (CAT) approach to Patient Reported Outcomes (PROs) for mobile devices

Michael Bass,¹Maria Varela Diaz^1
1Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University

Journal MTM 1:4S:20, 2012
DOI:10.7309/jmtm.43

Abstract

The NIH PROMIS system consists of validated measures and software for assessing a patient’s health status across physical, mental and social well-being domains.

Assessment Center, the accompanying software developed by PROMIS utilizes computer adaptive testing techniques that tailor respondent’s questions based on their previous responses. This results in reliable, flexible and precise scores with low patient burden when compared to traditional static PRO measures.

The software was written by developers at the Department of Medical Social Sciences (MSS) at Northwestern University Feinberg School of Medicine. It was initially designed as a turn-key solution for patient-reported outcomes research. In an effort to better target mobile devices, we have recently ‘wrapped’ the adaptive technology and workflow of Assessment Center in a REST API that permits developers and researchers to write applications for any connected mobile device.

This presentation will provide a background and history of the PROMIS measures, describe the REST API, demonstrate a smartphone application that utilizes the REST API and conclude with a look at the impact and future use of mobile applications that provide broader distribution of PROMIS tools.

Tailored SMS Messaging to Increase Exercise in Cancer Survivors: A Qualitative Pilot Study

Karen Basen-Engquist,¹Melissa Karlsten^1
1UT MD Anderson Cancer Center, Houston, TX, United States

Journal MTM 1:4S:19, 2012
DOI:10.7309/jmtm.42

Abstract

BACKGROUND: Exercise is recommended for cancer survivors, but we know little about increasing exercise in this population. Ecological momentary assessment (EMA) can help us understand behavioral processes by examining within day influences on behaviors. We used EMA to measure self-efficacy (SE) and positive and negative outcome expectations (OE+, OE-) each morning in order to tailor motivational exercise messages to participants and increase their daily moderate-vigorous intensity exercise minutes and steps.

METHOD:  Ten endometrial, breast and colorectal cancer survivors with a mean age of 58 (±9.2) participated in a 5-day pilot study, completing EMAs each morning and evening. Participants were provided with an Android smartphone with EMA and self-monitoring exercise applications and a pedometer. Based on the cumulative scores of SE, OE+, OE- and logic rules, up to 4 tailored, motivational messages based on Social Cognitive Theory (SCT) constructs were sent randomly throughout the day. Upon completion, a semi-structured individual interview was held to assess difficulties experienced, preferred features, and future directions.

RESULTS:  The daily exercise minutes and steps increased over the 5 days that participants used the program (p for linear trend = 0.018 and 0.055 for minutes of exercise and steps, respectively). Mean daily minutes of exercise increased from 19.4 on day 1 to 32.2 on day 5; mean daily steps increased from 5,957 to 7,085. 80% of participants said that they would be willing to use the program for 6 months or longer. Participants found the messages to be good reminders with useful content. Common themes included desiring a future version with goal setting, self-monitoring and feedback features.

CONCLUSION:  The preliminary data from this group of cancer survivors suggest that the use of technology to provide personalized motivational support for increasing exercise is an acceptable and feasible intervention and a formalized, expanded SMS-based exercise intervention should be developed.

Web-based Clinical Decision Support to Improve the Quality of Tobacco Use Treatment in Dental Clinics

Shelly Tseng,¹Jannat-Khan Hager^1
1New York University School of Medicine

Journal MTM 1:4S:18, 2012
DOI:10.7309/jmtm.41

Abstract

Smoking remains the leading cause of morbidity and mortality in the United States. Dental providers have a credible and central role in providing tobacco cessation services. Controlled trials have demonstrated the efficacy and effectiveness of dental office-based cessation interventions. Yet adherence to well established tobacco use treatment guidelines in dental care settings is suboptimal. Clinical decision support systems (CDSS) are promising strategies for increasing provider adherence to guideline recommended care. However, there are no studies examining the use of CDSS to improve adherence to clinical guidelines for treating tobacco use and dependence in dental practice. We developed a web-based CDSS that offers dentists a simple algorithm for assessing smokers’ readiness to quit and prescribing the appropriate cessation medication. The purpose of this Agency for Healthcare Research and Quality funded research is to 1) test the feasibility of integrating the system into routine dental practice, 2) assess the usability and acceptability of the CDSS among dental professionals, and 3) to examine the preliminary effectiveness of the CDSS in improving dental provider adherence to treatment guidelines. To assess Aims 1 and 2 we will use qualitative interviews conducted with five dental providers per study site (n=30) and will analyze data user data collected from the website. For Aim 3 we will conduct pre and post intervention interviews with patients, after they complete their dental visit, to assess improvements in adherence to tobacco use treatment guidelines and patient satisfaction with the CDSS print materials. Findings from two sites indicate that providers believe this is an easy to use system and is saving them time and improving their confidence when addressing tobacco use. We will present additional findings at the meeting. This web based program has the potential to enhance the quality and consistency of tobacco use treatment in this important setting.

mHealth: An Effective Education Channel for Hard-to-Reach Ethnic Minority Populations in Vietnam

Le NgocHue,¹LuongChi Thanh,²Tonvan der Velden,¹Le NgocBao,¹MarionMcNabb,^3
1Pathfinder Vietnam² Centre Health Information and Technology Institute, MOH ³Pathfinder International, Headquaters

Journal MTM 1:4S:17, 2012
DOI:10.7309/jmtm.40

Abstract

Lack of health knowledge and access primary health care services for hard-to-reach ethnic minorities is an issue in Vietnam. Recognizing unmet needs, Pathfinder International designed an innovative, culturally and linguistically appropriate mHealth intervention. The project was implemented in two provinces with the Ministry of Health’s (MOH) Central Health Information and Technology Institute (CHITI) as the main collaborating partner. Three messages in three languages were delivered through SMS and interactive voice response (IVR) channels, focusing on sexual and reproductive health (SRH), tobacco, and health insurance topics. The project measured client acceptance of the program to understand the value in MOH investing in scale up.

From November 2010 – 2011, two toll free numbers were created creating a database of 7,116 mobile phone subscribers. 2,313 subscribers received SRH messages; 2,073 received health insurance messages; and 2,730 received tobacco messages. The IVR system received 984 calls (67% male and 33% female). 547 SRH calls (56%), 143 health insurance calls (14%), and 294 tobacco calls (30%) were received. Of all IVR users, 44% were 15-24 year olds, highlighting youth as an important target group. Based on a rapid assessment, 57% of respondents reported increased adoption of safer sexual practices, 40% of smokers reported they smoked less and 13% reported they stopped smoking as a result of the program. 80-90% of IVR callers were outside of the target areas suggesting a broader reach of the intended intervention population. Key lessons learned include:

1. Government partnership and guidance is critical for ownership and sustainability in implementation, collaboration with mobile providers and developing appropriate marketing strategies.
2. Effective collaboration with multiple mobile operators is important for interoperability.
3. Further investigation of the IVR system to assess cost implications of callers outside of program areas.
4. Close follow up with government and other partners new to mHealth interventions is critical to buildcapacity and confidence to expand services.

Annexes:

1. Detailed description of recommendations
2. Final project report