Patient-facing Information Technology Implementations in Healthcare
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ItemOptimizing Real-Time Wellness Intervention Studies in Healthcare Shift Workers: Outcomes from a Prospective, Single-subject Design Study of a Digital Sleep Aid( 2022-01-04)Sleep disorders associated with shift work impair alertness and increase risk of chronic physical and mental health disease. Though studying sleep aids in at-risk populations such as shift workers is critical to improving wellness, implementing robust studies to evaluate wellness interventions in live populations can be particularly challenging. We performed a prospective, single-subject design study in which we assessed the effect of noise-masking earbuds on sleep quality, sleepiness, and stress level in health care shift workers. Despite being gifted the technology at the end of the study, we faced poor participant accrual and study retention. Additionally, robust analysis of our intervention’s impact on post-shift alertness was underpowered due to variable participant scheduling. In order to make meaningful advances in improving wellness among such groups, studies emphasizing objective outcome measures while minimizing participant obligation to study protocols are ideal. Here, we discuss our experience studying a digital sleep intervention in a real-time setting and propose solutions for improving subject accrual, retention and methods for objective data collection in studies performed in a live shift worker population.
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ItemIs Telehealth Better Used to Treat Patients or Help Other Physicians Treat Patients? An Agent-Based Modeling Study of Healthcare Provision( 2022-01-04)Telehealth, the delivery of medical care remotely, is hoped to increase access to specialty services and improve health care utilization. Physicians can provide telehealth to each other (e.g. specialist to generalist) or to patients. Specialists often treat complex patients who can be adequately cared for only in academic hospitals, suggesting that providing specialty services via telehealth will reallocate rather than reduce system utilization. Here I use agent-based modeling to simulate telehealth’s effects on clinical outcomes and system utilization in medical toxicology. I found that toxicologist-physician consultation increased patient health and decreased cost. Toxicologist-patient telehealth increased cost and system utilization but did not improve health. The effects were sensitive to patient complexity and the clinical efficacy of the toxicologist. Within the limitations of using simulated data and an incomplete model, these results suggest that telehealth is more cost-effective when used to provide toxicologist access to general physicians than to the public.
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ItemFeasibility and Acceptability of a Wrist-worn Transdermal Alcohol Biosensor to Collect Data in the Field( 2022-01-04)Transdermal alcohol monitoring allows for continuous, non-invasive, objective, and remote measurement of alcohol consumption. We evaluated feasibility and acceptability of participant use of the BACtrack Skyn biosensor bracelet in daily life. Heavy drinkers (n=20) wore the Skyn and self-reported drinking behavior for 7 days, followed by an individual interview. Recruitment and retention benchmarks were met, supporting feasibility. Participants provided both positive and constructive feedback on the Skyn during interviews, and usability of the bracelet was deemed “good”. Most missing data were inconsequential (<5 mins), with data available 85% of the time participants were asked to wear it. Missing data was largely expected and due to bracelet removal during bathing or charging. Overall, results indicate promise in our ability to integrate this tool into research and/or clinical practice, passively and objectively monitoring alcohol use in participants and/or patients with minimal burden.
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ItemAssessing Patient Experience and Orientation in the Emergency Department with Virtual Windows( 2022-01-04)Patients have benefitted from increasingly sophisticated diagnostic and therapeutic innovations over the years. However, the design of the physical hospital environment has garnered less attention. This may negatively impact a patient’s experience and health. In areas of the hospital, such as the emergency department (ED), patients may spend hours, or even days, in a windowless environment. Studies have highlighted the importance of natural light and imagery, as they are essential in providing important stimuli to regulate circadian rhythm and orientation, and to mitigate the onset of certain medical conditions. In hospital locations where standard windows may be infeasible, the use of a virtual window may simulate the benefits of an actual window. In this pilot study, we assessed patient experience and orientation with virtual windows in the ED. We demonstrated that virtual windows are an acceptable technology that may improve patient experience and orientation.
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