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The 2001 Institute of Medicine report indicted that the US healthcare system fails to provide high-quality care, and offered 6 aims of improvement that would redesign the delivery of care for the 21st century. This study compared the use of Department of Veterans Affairs (VA) inpatient and outpatient services of cancer patients enrolled in a Cancer...
Context in source publication
Context 1
... services exam- ined were broadly categorized as preventable service use and cancer-related service use. Tables 1 and 2 present a detailed operational definition and clinical example of each pre- ventable service and cancer-related service. A brief summary of each category and a sample is included next. ...
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Emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) are common among older adults. The high-intensity telemedicine model of care has been proposed as an innovative approach to expand access to acute illness care, thereby preventing ED visits. The aim of this study was to assess the effect of a high-intensity telemedici...
Objective
Overweight/obesity and excess weight gain during pregnancy are associated with adverse maternal and neonatal outcomes. Few interventions have been effective in limiting gestational weight gain among women with overweight or obesity. This pilot, randomized clinical trial compared treatment as usual (TAU) to a lifestyle modification program...
Citations
... Health system barriers include lack of resources to coordinate complex, multidisciplinary care and lack of follow up of incidentally discovered liver cancers. The importance of cancer care coordinators has been recognized for other malignancies [11,[16][17][18][19] but has not been demonstrated previously for HCC. Our study demonstrates that a cancer care coordination system comprised of automated flagging of imaging suspicious for HCC, nurse navigators, and MDTB can have a significant impact on timeliness of care in addition to clinical HCC screening guidelines. ...
Introduction:
Hepatocellular carcinoma (HCC) requires complex care coordination. Patient safety may be compromised with untimely follow-up of abnormal liver imaging. This study evaluated whether an electronic case-finding and tracking system improved timeliness of HCC care.
Methods:
An electronic medical record-linked abnormal imaging identification and tracking system was implemented at a Veterans Affairs Hospital. This system reviews all liver radiology reports, generates a queue of abnormal cases for review, and maintains a queue of cancer care events with due dates and automated reminders. This is a pre-/post-intervention cohort study to evaluate whether implementation of this tracking system reduced time between HCC diagnosis and treatment and time between first liver image suspicious for HCC, specialty care, diagnosis, and treatment at a Veterans Hospital. Patients diagnosed with HCC in the 37 months before tracking system implementation were compared to patients diagnosed with HCC in the 71 months after its implementation. Linear regression was used to calculate mean change in relevant intervals of care adjusted for age, race, ethnicity, BCLC stage, and indication for first suspicious image.
Results:
There were 60 patients pre-intervention and 127 post-intervention. In the post-intervention group, adjusted mean time from diagnosis to treatment was 36 days shorter (p = 0.007), time from imaging to diagnosis 51 days shorter (p = 0.21), and time from imaging to treatment 87 days shorter (p = 0.05). Patients whose imaging was performed for HCC screening had the greatest improvement in time from diagnosis to treatment (63 days, p = 0.02) and from first suspicious image to treatment (179 days, p = 0.03). The post-intervention group also had a greater proportion of HCC diagnosed at earlier BCLC stages (p<0.03).
Conclusions:
The tracking system improved timeliness of HCC diagnosis and treatment and may be useful for improving HCC care delivery, including in health systems already implementing HCC screening.
... A provision of proper coaching or strategies for FCR from the healthcare providers would have lowered the level of FCR [14]. Additionally, whole-person care and tailored patient education for lifestyle modi cation may reduce the development of comorbidities and prevent late adverse effects after cancer diagnosis [34]. ...
Background: This study aimed to evaluate factors related to the fear of cancer recurrence (FCR) in stomach cancer survivors.
Methods: A total of 363 stomach cancer survivors were divided into three groups according to the Korean version of the FCR Index (FCRI). We compared the socio-demographic and cancer-related factors, communication within the medical team during treatment, care coordination, social support, physical symptoms, psychological distress, and health-related quality of life (HRQoL), and health promotion and disease prevention activity, which was defined as second primary cancer screening, osteoporosis evaluation, supplementary drug intake, dietary pattern, regular exercise, and smoking cessation, according to the levels of FCRI using the linear regression analysis after adjusting for age, sex, stage, time since diagnosis, family cancer diagnosis, and comorbidities.
Results: An average of 7.3 years have passed since diagnosis. The highest FCRI group was younger or had a high percentage of family cancer diagnosis. Satisfaction for communication and care coordination, social support, HRQoL, and physical symptoms, such as fatigue, pain, and insomnia, were negatively associated with the FCR of stomach cancer survivors. Anxiety and depression were positively associated with the FCR. However, FCR was not associated with sex, time since diagnosis, cancer stage, treatment modality, socioeconomic status, or health promotion and disease prevention activity.
Conclusions: FCR in stomach cancer survivors was associated with physical, psychological, and HRQoL factors rather than socio-demographic or cancer–related factors. Understanding the association between HRQoL, physical and psychosocial factors, and FCR may advance survivorship care for stomach cancer survivors.
... The outpatient service use increased with medication therapy, and inpatient service use increased with surgery therapy and radiation/chemotherapy. Previous studies also pointed out that cancer treatment played a pivotal role in activating health service utilization [32,33]. Chumbler and colleagues illustrated that living with cancer was associated with an increased frequency of visiting doctors and using hospitalization [32]. ...
... Previous studies also pointed out that cancer treatment played a pivotal role in activating health service utilization [32,33]. Chumbler and colleagues illustrated that living with cancer was associated with an increased frequency of visiting doctors and using hospitalization [32]. Chumbler explained that cancer treatment induced symptoms/complications such as body pain, nausea, fatigue, and mental disorders, therefore patients prefer to visit doctors frequently in outpatient sectors to manage the symptoms. ...
... Chumbler explained that cancer treatment induced symptoms/complications such as body pain, nausea, fatigue, and mental disorders, therefore patients prefer to visit doctors frequently in outpatient sectors to manage the symptoms. Correspondingly, inpatient service use increased when those outpatients were referred to ward [32]. Additionally, clinical research regarding cancer patients' self-report symptoms has also indicated that routine cancer treatment resulted in symptoms that precipitated emergency room visits and hospital admissions [33]. ...
Background:
This study aims (1) to assess socioeconomic disparities in healthcare use and catastrophic health expenditure (CHE) among cancer patients in China, which is defined as the point at which annual household health payments exceeded 40% of non-food household consumption expenditure, and (2) to examine the association of different treatments for cancers with health service utilization and CHE.
Methods:
We used nationally representative data from the China Health and Retirement Longitudinal Study in 2015 with 17,018 participants in which 381 with doctor-diagnosed cancer. The main treatments for cancer included the Chinese traditional medicine (TCM), western modern medicine (refers to taking western modern medications excluding TCM and other treatments for cancers), surgery, and radiation/chemotherapy. Concentration curve was used to assess economic-related disparities in healthcare and CHE. Multivariate regression models were used to examine the impact of the cancer treatment on health service use and incidence of CHE.
Results:
The main cancer treatments and health service use were more concentrated among the rich patients than among the poor patients in 2015. There was a positive association between the treatment of cancer and outpatient visit (Adjusted Odds Ratio (AOR) = 2.492, 95% CI = 1.506, 4.125), inpatient visit (AOR = 1.817, 95% CI = 1.098, 3.007), as well as CHE (AOR = 2.744, 95% CI = 1.578, 4.772). All cancer therapies except for medication treatments were associated with a higher incidence of CHE, particularly the surgery therapy (AOR = 6.05, 95% CI = 3.393, 27.866) in urban areas.
Conclusion:
Disparities in treatment and health service utilization among Chinese cancer patients was largely determined by financial capability. The current insurance schemes are insufficient to address these disparities. A comprehensive health insurance policy of expanding the current benefits packages and strengthening the Public Medical Assistance System, are essential for Chinese adults with cancer.
... Although two out of six monitored symptoms were significantly different between groups, there were conflicting findings of significantly lower reports of fatigue and significantly higher reports of hand/foot syndrome in the intervention vs. control group. There was some evidence to suggest that symptom-monitoring interventions have the potential to reduce the unnecessary use of healthcare services by improving symptom management [36,37,56]. For example, a matched case-control study of 125 patients investigated the effects of a handheld device intervention by measuring patients' unexpected and expected use of cancer-related services over six months [37]. ...
... There was some evidence to suggest that symptom-monitoring interventions have the potential to reduce the unnecessary use of healthcare services by improving symptom management [36,37,56]. For example, a matched case-control study of 125 patients investigated the effects of a handheld device intervention by measuring patients' unexpected and expected use of cancer-related services over six months [37]. Findings showed that the intervention group had significantly lower use of unexpected care services and significantly higher use of most expected care services, however contrastingly, patients in the intervention group had significantly fewer expected clinic visits compared to controls. ...
Background
The shift from inpatient to outpatient cancer care means that patients are now required to manage their condition at home, away from regular supervision by clinicians. Subsequently, research has consistently reported that many patients with cancer have unmet information needs during their illness. Mobile devices, such as mobile phones and tablet computers, provide an opportunity to deliver information to patients remotely. To date, no systematic reviews have evaluated how mobile devices have been used specifically to help patients meet to their information needs.
Objective
A systematic review was conducted to identify studies that describe the use of mobile interventions to enable patients with cancer meet their cancer-related information needs in non-inpatient settings, and to describe the effects and feasibility of these interventions.
Methods
MEDLINE, Embase, and PsycINFO databases were searched up until January 2017. Search terms related to “mobile devices,” “information needs,” and “cancer” were used. There were no restrictions on study type in order to be as inclusive as possible. Study participants were patients with cancer undergoing treatment. Interventions had to be delivered by a mobile or handheld device, attempt to meet patients’ cancer-related information needs, and be for use in non-inpatient settings. Critical Appraisal Skills Programme checklists were used to assess the methodological quality of included studies. A narrative synthesis was performed and findings were organized by common themes found across studies.
Results
The initial search yielded 1020 results. We included 23 articles describing 20 studies. Interventions aimed to improve the monitoring and management of treatment-related symptoms (17/20, 85%), directly increase patients’ knowledge related to their condition (2/20, 10%), and improve communication of symptoms to clinicians in consultations (1/20, 5%). Studies focused on adult (17/20; age range 24-87 years) and adolescent (3/20; age range 8-18 years) patients. Sample sizes ranged from 4-125, with 13 studies having 25 participants or fewer. Most studies were conducted in the United Kingdom (12/20, 52%) or United States (7/20, 30%). Of the 23 articles included, 12 were of medium quality, 9 of poor quality, and 2 of good quality. Overall, interventions were reported to be acceptable and perceived as useful and easy to use. Few technical problems were encountered. Adherence was generally consistent and high (periods ranged from 5 days to 6 months). However, there was considerable variation in use of intervention components within and between studies. Reported benefits of the interventions included improved symptom management, patient empowerment, and improved clinician-patient communication, although mixed findings were reported for patients’ health-related quality of life and anxiety.
Conclusions
The current review highlighted that mobile interventions for patients with cancer are only meeting treatment or symptom-related information needs. There were no interventions designed to meet patients’ full range of cancer-related information needs, from information on psychological support to how to manage finances during cancer, and the long-term effects of treatment. More comprehensive interventions are required for patients to meet their information needs when managing their condition in non-inpatient settings. Controlled evaluations are needed to further determine the effectiveness of these types of intervention.
... Both interventions included health team alerting functionality for severe symptoms. Likewise, Chumbler et al [49] found a significant reduction in clinic visits and chemotherapy-related hospitalizations using a Cancer Care Coordination Home Telehealth approach. ...
Background
Cancer patients receiving chemotherapy have high symptom needs that can negatively impact quality of life and result in high rates of unplanned acute care visits. Remote monitoring tools may improve symptom management in this patient population.
Objective
This study aimed to design a prototype tool to facilitate remote management of chemotherapy-related toxicities.
Methods
User needs were assessed using a participatory, user-centered design methodology that included field observation, interviews, and focus groups, and then analyzed using affinity diagramming. Participants included oncology patients, caregivers, and health care providers (HCPs) including medical oncologists, oncology nurses, primary care physicians, and pharmacists in Ontario, Canada. Overarching themes informed development of a Web-based prototype, which was further refined over 2 rounds of usability testing with end users.
Results
Overarching themes were derived from needs assessments, which included 14 patients, 1 caregiver, and 12 HCPs. Themes common to both patients and HCPs included gaps and barriers in current systems, need for decision aids, improved communication and options in care delivery, secure access to credible and timely information, and integration into existing systems. In addition, patients identified missed opportunities, care not meeting their needs, feeling overwhelmed and anxious, and wanting to be more empowered. HCPs identified accountability for patient management as an issue. These themes informed development of a Web-based prototype (bridges), which included toxicity tracking, self-management advice, and HCP communication functionalities. Usability testing with 11 patients and 11 HCPs was generally positive; however, identified challenges included tool integration into existing workflows, need for standardized toxicity self-management advice, issues of privacy and consent, and patient-tailored information.
Conclusions
Web-based tools integrating just-in-time self-management advice and HCP support into routine care may address gaps in systems for managing chemotherapy-related toxicities. Attention to the integration of new electronic tools into self-care by patients and practice was a strong theme for both patients and HCP participants and is a key issue that needs to be addressed for wide-scale adoption.
... The prevalence of chronic diseases, such as diabetes, cancer, cardiometabolic and respiratory conditions continues to pose a challenge for often overtaxed health care systems, requiring fundamental changes in the delivery and maintenance of patient care [1][2][3][4] . Telehealth (TH), defined as any medical activity involving an element of distance and use of a telecommunications strategy [5] , represents an approach which may enable patients with chronic medical conditions to seek disease specific information and support [6][7][8][9] , to be followed by clinicians more frequently and away from hospital settings [10][11][12] , reduce healthcare costs [13] , and to ultimately promote improved adherence to medical regimens resulting in improvement in health outcomes [14] . ...
Type 1 diabetes is a chronic illness with a high burden of care. While effective interventions and recommendations for diabetes care exist, the intensive nature of diabetes management makes compliance difficult. This is especially true in children and adolescents as they have unique psychosocial and diabetes needs. Despite the development of effective in-person interventions targeting improving self-management and ameliorating psychosocial difficulties there are still a number of barriers to implementing these interventions, namely time, cost, and access. Telehealth interventions allow for the dissemination of these interventions to a broader audience. Self-management and psychosocial telehealth interventions are reviewed with a special emphasis on mobile phone and internet based technology use. While efficacy has been demonstrated in a number of telehealth interventions with improved cost effectiveness over in-person interventions, many challenges remain including high participant attrition and difficulties with receiving reimbursement for services rendered. These and other challenges are discussed with recommendations for researchers and telehealth providers provided. Core tip: Type 1 diabetes is a chronic illness with a high burden of care. Despite the development of effective in-person interventions, telehealth interventions are necessary to improve access to and engagement in interventions to improve diabetes management. Mobile phone and internet based interventions appear to have the most potential to enact change. Challenges and recommendations for these telehealth interventions are provided.
... Despite positive outcomes, these interventions are hampered by the inability to respond to patients concerns in 'real time'. Furthermore systematic reviews in cancer and other chronic conditions conclude that research, in particular intervention studies, are a priority to guide practice to improve patient and family self-management (Chumbler et al., 2007a;Chumbler et al., 2007b). ...
... limb amputations, decreased emergency room visits and unplanned hospitalisations, fewer bed days of care, decreased nursing home admissions in the elderly, decreased overall costs to the health system and promoting positive behavioural change (Bartoli et al., 2009;Black et al., 2011;Cleland et al., 2005;Cueva, 2010). Despite these successes, there exists a paucity of appropriate telehealth systems for patients with cancer (Chumbler et al., 2007a(Chumbler et al., , 2007bKearney et al., 2009;Kearney et al., 2006), even though there is empirical evidence which substantiates their role in the delivery of supportive care to people living with the complexities of chronic health conditions. ...
This paper describes an ongoing study of the Advanced Symptom Management System (ASyMS) for patients receiving chemotherapy for breast or colorectal cancer. We begin by detailing the ASyMS work to date, providing an overview of research conducted in the field over the last ten years. The current study, ASyMS-III, is then presented, highlighting the study methodology, multi-site involvement, the outcomes being measured, and discussion of the tool. The paper concludes with reflections on the progress of the ASyMS-III study to date, and discusses potential directions for future research.
... For instance, telehealth technologies have been used to provide a wide range of diagnostic and home-monitoring services for management of chronic conditions in older adults. In-home health monitoring has been associated with improved outcomes for patients with several chronic conditions, including heart failure (Dansky & Vasey, 2009;Polisena et al., 2010;Shah, Der, Ruggerio, Heidenreich, & Massie, 1998), cancer (Chumbler et al., 2007), diabetes (Shea et al., 2009;Stone et al., 2010) as well as those with multiple chronic conditions (Darkins et al., 2008). Substantial progress in the field of robotics has also led to the integration of robotic assistive devices in the care of individuals with disabilities, promoting enhanced mobility, improved independence in activities of daily liv-ing (ADLs), and increased ability to communicate (Brose et al., 2010). ...
Frailty has an insidious impact on multiple systems, resulting in increased disability, morbidity, and mortality among community-dwelling older adults. Notwithstanding the burden that frailty imposes on individuals, there is still a lack of consensus on its operational and conceptual definitions, leading research groups to invest efforts into developing a more comprehensive model of frailty. A number of screening models have been proposed to objectively measure the magnitude of the frailty process and to assess its long-term consequences. Each model incorporates a distinct set of physiological parameters stemming from the combination of a number of clinical domains. Emerging information technologies (ITs) could provide an effective, flexible, and integrative solution for monitoring and measuring the different aspects of the frailty construct in real-life settings. The purpose of this article is to discuss how various ITs can be used to measure the core characteristics of frailty identified from an integrative systematic review. We discuss the actual and potential integration of ITs in frailty research, strengths and limitations of various methods, and areas for future work.
... × Antonicelli et al. [22] × × × Aoki et al. [23] × × × Barnason et al. [24] × × Barnes et al. [17]/Buckland et al. [18] × × Barnett et al. [25] × × × Birati et al. [26] × × × × × × Boulos et al. [27] × Canady [28] × × Chumbler et al. [29] × × Conforti et al. [30] × × × × × Dang et al. [19]/Dang et al. [20] × Essén and Conrick [11] × × × Finkelstein et al. [31] × Hauck et al. [32] × Horton [33] × Jürgens and Tost [34] × × × Kielblock et al. [35] × × Kleinpell and Avitall [36] × Kollmann et al. [37] × Lamothe et al. [38] × Lavanya et al. [39] × × Liddy et al. [40] × × Lin et al. [41] × × Ricci et al. [42] p. 198). If the senior does not cancel the alert, it is escalated to a call center to send for help ([17], p. 198). ...
... To assess the current state of a senior's health and to recognize adverse conditions , some presented systems provide survey functionality. Chumbler et al., for example, have installed a telehealth program to monitor elderly patients at home, who were currently undergoing chemotherapy [29]. This telehealth system regularly surveys the patients using an automated cancer care dialogue ([29] ...
... Chumbler et al., for example, have installed a telehealth program to monitor elderly patients at home, who were currently undergoing chemotherapy [29]. This telehealth system regularly surveys the patients using an automated cancer care dialogue ([29] ...
Services for the elderly based on health-enabling technologies promise to contribute significantly to the efficiency and effectiveness of future health care. Due to this promise, over the last years the scientific community has designed a complex variety of these valuable innovations. A systematic overview of the developed services would help to better understand their opportunities and limitations.
To obtain a systematic overview of services for the elderly based on health-enabling technologies and to identify archetypical service categories.
We conducted a literature review using PubMed and retrieved 1447 publications. We stepwise reduced this list to 27 key publications that describe typical service archetypes.
We present six archetypical service categories, namely handling adverse conditions, assessing state of health, consultation and education, motivation and feedback, service ordering and social inclusion and describe their implementation in current research projects.
... Appropriate symptom management for cancer patients may also have a large-scale impact on preventing unnecessary service utilization (Hewitt et al., 2006). Using a matched case-control design to assess the impact of a telehealth symptom management program, Chumbler et al. (2007) found that cancer patients can successfully manage multiple complex symptoms at home while using fewer inpatient and outpatient services. With the growing use of telemedicine, it is important to identify factors that may influence patient adherence and satisfaction with this new type of health care delivery (Mair & Whitten, 2000). ...
Pain and depression are 2 of the most common and disabling cancer-related symptoms. In the Indiana Cancer Pain and Depression trial, 202 cancer patients with pain and/or depression were randomized to the intervention group and received centralized telecare management augmented by automated symptom monitoring (ASM). Over the 12-month trial, the average patient completed 2 ASM reports and 1 nurse call per month. Satisfaction with both ASM and care management was high regardless of patient characteristics or cancer type. Adherence was also generally good, although several predictors of fewer ASM reports and nurse calls were identified. Only a minority of ASM reports triggered a nurse call, suggesting the efficiency of coupling clinician-delivered telecare management with automated monitoring.
