Person: Jethwani, Kamal
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Jethwani
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Kamal
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Jethwani, Kamal
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Publication Healthcare utilization in older patients using personal emergency response systems: an analysis of electronic health records and medical alert data: Brief Description: A Longitudinal Retrospective Analyses of healthcare utilization rates in older patients using Personal Emergency Response Systems from 2011 to 2015(BioMed Central, 2017) Agboola, Stephen; Golas, Sara; Fischer, Nils; Nikolova-Simons, Mariana; op den Buijs, Jorn; Schertzer, Linda; Kvedar, Joseph; Jethwani, KamalBackground: Personal Emergency Response Systems (PERS) are traditionally used as fall alert systems for older adults, a population that contributes an overwhelming proportion of healthcare costs in the United States. Previous studies focused mainly on qualitative evaluations of PERS without a longitudinal quantitative evaluation of healthcare utilization in users. To address this gap and better understand the needs of older patients on PERS, we analyzed longitudinal healthcare utilization trends in patients using PERS through the home care management service of a large healthcare organization. Methods: Retrospective, longitudinal analyses of healthcare and PERS utilization records of older patients over a 5-years period from 2011–2015. The primary outcome was to characterize the healthcare utilization of PERS patients. This outcome was assessed by 30-, 90-, and 180-day readmission rates, frequency of principal admitting diagnoses, and prevalence of conditions leading to potentially avoidable admissions based on Centers for Medicare and Medicaid Services classification criteria. Results: The overall 30-day readmission rate was 14.2%, 90-days readmission rate was 34.4%, and 180-days readmission rate was 42.2%. While 30-day readmission rates did not increase significantly (p = 0.16) over the study period, 90-days (p = 0.03) and 180-days (p = 0.04) readmission rates did increase significantly. The top 5 most frequent principal diagnoses for inpatient admissions included congestive heart failure (5.7%), chronic obstructive pulmonary disease (4.6%), dysrhythmias (4.3%), septicemia (4.1%), and pneumonia (4.1%). Additionally, 21% of all admissions were due to conditions leading to potentially avoidable admissions in either institutional or non-institutional settings (16% in institutional settings only). Conclusions: Chronic medical conditions account for the majority of healthcare utilization in older patients using PERS. Results suggest that PERS data combined with electronic medical records data can provide useful insights that can be used to improve health outcomes in older patients.Publication Text to Move: A Randomized Controlled Trial of a Text-Messaging Program to Improve Physical Activity Behaviors in Patients With Type 2 Diabetes Mellitus(JMIR Publications Inc., 2016) Agboola, Stephen; Jethwani, Kamal; Lopez, Lenny; Searl, Meghan; O’Keefe, Sandra; Kvedar, JosephBackground: Text messages are increasingly being used because of the low cost and the ubiquitous nature of mobile phones to engage patients in self-care behaviors. Self-care is particularly important in achieving treatment outcomes in type 2 diabetes mellitus (T2DM).Objective: This study examined the effect of personalized text messages on physical activity, as measured by a pedometer, and clinical outcomes in a diverse population of patients with T2DM.Methods: Text to Move (TTM) incorporates physical activity monitoring and coaching to provide automated and personalized text messages to help patients with T2DM achieve their physical activity goals. A total of 126 English- or Spanish-speaking patients with glycated hemoglobin A1c (HbA1c) >7 were enrolled in-person to participate in the study for 6 months and were randomized into either the intervention arm that received the full complement of the intervention or a control arm that received only pedometers. The primary outcome was change in physical activity. We also assessed the effect of the intervention on HbA1c, weight, and participant engagement.Results: All participants (intervention: n=64; control: n=62) were included in the analyses. The intervention group had significantly higher monthly step counts in the third (risk ratio [RR] 4.89, 95% CI 1.20 to 19.92, P=.03) and fourth (RR 6.88, 95% CI 1.21 to 39.00, P=.03) months of the study compared to the control group. However, over the 6-month follow-up period, monthly step counts did not differ statistically by group (intervention group: 9092 steps; control group: 3722 steps; RR 2.44, 95% CI 0.68 to 8.74, P=.17). HbA1c decreased by 0.07% (95% CI –0.47 to 0.34, P=.75) in the TTM group compared to the control group. Within groups, HbA1c decreased significantly from baseline in the TTM group by –0.43% (95% CI –0.75 to –0.12, P=.01), but nonsignificantly in the control group by –0.21% (95% CI –0.49 to 0.06, P=.13). Similar changes were observed for other secondary outcomes.Conclusion: Personalized text messaging can be used to improve outcomes in patients with T2DM by employing optimal patient engagement measures.Publication Telemedical Education: Training Digital Natives in Telemedicine(JMIR Publications Inc., 2016) Pathipati, Akhilesh S; Azad, Tej D; Jethwani, KamalTelemedicine 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. We therefore recommend introducing telemedicine training into medical school curricula and propose a model for incorporation.Publication The Feasibility and Impact of Delivering a Mind-Body Intervention in a Virtual World(Public Library of Science, 2012) Linton, Deborah A.; Bello, Heather E.; Senelly, Marco; Milik, Mariola T.; Baim, Margaret A.; Hoch, Daniel; Watson, Alice; Jethwani, Kamal; Fricchione, Gregory; Benson, Herbert; Kvedar, JosephIntroduction: Mind-body medical approaches may ameliorate chronic disease. Stress reduction is particularly helpful, but face-to-face delivery systems cannot reach all those who might benefit. An online, 3-dimensional virtual world may be able to support the rich interpersonal interactions required of this approach. In this pilot study, we explore the feasibility of translating a face-to-face stress reduction program into an online virtual setting and estimate the effect size of the intervention. Methods and Findings: Domain experts in virtual world technology joined with mind body practitioners to translate an existing 8 week relaxation response-based resiliency program into an 8-week virtual world-based program in Second Life™ (SL). Twenty-four healthy volunteers with at least one month's experience in SL completed the program. Each subject filled out the Perceived Stress Scale (PSS) and the Symptom Checklist 90- Revised (SCL-90-R) before and after taking part. Participants took part in one of 3 groups of about 10 subjects. The participants found the program to be helpful and enjoyable. Many reported that the virtual environment was an excellent substitute for the preferred face-to-face approach. On quantitative measures, there was a general trend toward decreased perceived stress, (15.7 to 15.0), symptoms of depression, (57.6 to 57.0) and anxiety (56.8 to 54.8). There was a significant decrease of 2.8 points on the SCL-90-R Global Severity Index (p<0.05). Conclusions: This pilot project showed that it is feasible to deliver a typical mind-body medical intervention through a virtual environment and that it is well received. Moreover, the small reduction in psychological distress suggests further research is warranted. Based on the data collected for this project, a randomized trial with less than 50 subjects would be appropriately powered if perceived stress is the primary outcome.Publication Assessing Hospital Readmission Risk Factors in Heart Failure Patients Enrolled in a Telemonitoring Program(Hindawi Publishing Corporation, 2013) Ronquillo, Jeremiah G.; Nieves, Regina; Chueh, Henry; Kvedar, Joseph; Jethwani, KamalThe purpose of this study was to validate a previously developed heart failure readmission predictive algorithm based on psychosocial factors, develop a new model based on patient-reported symptoms from a telemonitoring program, and assess the impact of weight fluctuations and other factors on hospital readmission. Clinical, demographic, and telemonitoring data was collected from 100 patients enrolled in the Partners Connected Cardiac Care Program between July 2008 and November 2011. 38% of study participants were readmitted to the hospital within 30 days. Ten different heart-failure-related symptoms were reported 17,389 times, with the top three contributing approximately 50% of the volume. The psychosocial readmission model yielded an AUC of 0.67, along with sensitivity 0.87, specificity 0.32, positive predictive value 0.44, and negative predictive value 0.8 at a cutoff value of 0.30. In summary, hospital readmission models based on psychosocial characteristics, standardized changes in weight, or patient-reported symptoms can be developed and validated in heart failure patients participating in an institutional telemonitoring program. However, more robust models will need to be developed that use a comprehensive set of factors in order to have a significant impact on population health.Publication Feasibility of a Clearing House for Improved Cooperation Between Telemedicine Networks Delivering Humanitarian Services: Acceptability to Network Coordinators(Co-Action Publishing, 2012) Wootton, Richard; Bonnardot, Laurent; Geissbuhler, Antoine; Jethwani, Kamal; Kovarik, Carrie; McGoey, Suzanne; Person, Donald A.; Vladzymyrskyy, Anton; Zolfo, MariaBackground: Telemedicine networks, which deliver humanitarian services, sometimes need to share expertise to find particular experts in other networks. It has been suggested that a mechanism for sharing expertise between networks (a ‘clearing house’) might be useful. Objective: To propose a mechanism for implementing the clearing house concept for sharing expertise, and to confirm its feasibility in terms of acceptability to the relevant networks. Design We conducted a needs analysis among eight telemedicine networks delivering humanitarian services. A small proportion of consultations (5–10%) suggested that networks may experience difficulties in finding the right specialists from within their own resources. With the assistance of key stakeholders, many of whom were network coordinators, various methods of implementing a clearing house were considered. One simple solution is to establish a central database holding information about consultants who have agreed to provide help to other networks; this database could be made available to network coordinators who need a specialist when none was available in their own network. Results: The proposed solution was examined in a desktop simulation exercise, which confirmed its feasibility and probable value. Conclusion: This analysis informs full-scale implementation of a clearing house, and an associated examination of its costs and benefits.