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1 Effects of e-Health to Maintain Health Among Older Adults with Congestive Heart Failure (CHF): Randomized Controlled Trial Machiko R. Tomita, Ph.D. Department.

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Presentation on theme: "1 Effects of e-Health to Maintain Health Among Older Adults with Congestive Heart Failure (CHF): Randomized Controlled Trial Machiko R. Tomita, Ph.D. Department."— Presentation transcript:

1 1 Effects of e-Health to Maintain Health Among Older Adults with Congestive Heart Failure (CHF): Randomized Controlled Trial Machiko R. Tomita, Ph.D. Department of Rehabilitation Science University at Buffalo Presented at NYSOTA Conference Buffalo, NY September 27-29, 2007 Funded by the National Institute of Aging

2 2 What is e-Health? eHealth is a method utilizing emerging interactive technologies to address the limited capacity of the health care system to provide health behavior change and chronic disease management interventions. - Health e-Technologies Initiative Ahern, D., Kreslake, J., Phalen J. What is eHealth: Perspectives on the evolution of eHealth research. J. Med Internet Res 2006;8(1):e4

3 3 What is emerging interactive technology?

4 4 What does “the limited capacity of the health care system” mean and why older adults? Increase in the number of older adults: 36.3 million in 2004 (12.4%) and 55 million in 2020 (16.4%). Administration on Aging. A profile of Older Americans 2005 Administration on Aging. A profile of Older Americans 2005 Of the more than half-million licensed physicians practicing in the US, fewer than 9,000 have met qualifying criteria in geriatrics--which amounts to roughly 1 geriatrician to every 4,000 older adults presently. American Medical Directors Association, is the fastest growing segment for Internet use.

5 5 Background Telemedicine: health care provides to monitor patients progress for a short period of time. – VA, VNA, E-health research: Type 2 Diabetes –Limited use of e-health –Short period –Intervention was provided without knowledge of behavioral change –Identification of users

6 6 What is CHF?

7 7 Major Symptoms of CHF Edema –Legs and ankles –Abdomen –lung DyspneaFatigueDepression Weight gain

8 8 Examples of leg/ankle edema

9 9 for CHF Treatment for CHF Medications to help remove fluid such as diuretics or to make the heart work better such as beta blockers, vasodilators, etc. modifications, such as reducing salt, water, and cholesterol intake Dietary modifications, such as reducing salt, water, and cholesterol intake, such as smoking cessation, alcohol intake limitation Lifestyle changes, such as smoking cessation, alcohol intake limitation Exercise Health Behavior Change Support using e-health

10 10 Why CHF ? Prevalence: 5.0 million Americans (1.8%) %, %, % New CHF cases: 550,000 Death: 300,000/year On average, patients die within 5 years Hospitalization rates: the leading diagnosis-related group (DRG) among hospitalized patients older than 65 years. Approximately 30-40% of patients with CHF are hospitalized every year. Readmission rates:50% Approximately 5-10% of hospital costs Health care cost for CHF: $38.1 billion. Source: The National Heart, Lung, and Blood Institute (NHLBI)

11 11 Purpose of the Study The purpose of this study was to conduct a pilot study with a randomized controlled trial to change CHF patients’ health behaviors through use of e-health providing four types of support: Instrumental, informational, emotional, and appraisal.

12 12 Conceptual Model: Social Network and Social Support, Transtheoretical Model, & Uses and Gratifications Emotional Support Personal Factors Instrumental Support Informational support Appraisal Support Family and Friends PrecontemplationcontemplationPreparationActionMaintenance E-health

13 13 Use of E-health in the Study Use of E-health in the Study Informational support for knowledge Created a public website with tailored CHF and health activity information in a senior friendly format with quiz.

14 14 Use of E-health in the Study Use of E-health in the Study Instrumental support for monitoring health Created a secure website for daily record of vital signs and health activities in a short form that can be woven into a daily routine. –BP/pulse, and weight –Medication compliance –Dietary and Alcohol intake, and Smoking –Types of and Amount of Exercise –Swelling and fatigue –Health change from the previous day

15 15 Use of E-health in the Study Use of E-health in the Study Appraisal support for assurance Regular feedback and reinforcement of health status from a health professional team via e- mail and telephone. Emotional Support Next presenttation

16 16 Research Questions 1. Do patients with CHF use e-health, when e-health technology is available? 2. Do patients with CHF gain relevant knowledge when they use e-health technology? 3. Do patients with CHF engage in healthy behaviors when they use e-health technology? 4. Do patients with CHF maintain their health/function/QoL better when using e-health technology? 5. What is the outcome of healthcare utilization? 6. What are the subjective opinions regarding e-health use?

17 17 Differential Expectation Home-basedNHDeath Time Symptoms Health care utilization ControlTreatment

18 18 Methods-Study Design Randomized controlled repeated measures design with the intervention duration of 18 months. Randomized controlled repeated measures design with the intervention duration of 18 months. * This presentation is at the 12 th month. Init.6mo.12mo.18mo. RTOXOXO(X)O RCOOOO

19 19 Methods - Subjects –Inclusion criteria: NY Heart Association Classification of 2 or 3 and past record of hospitalization or emergency visits due to CHF. –Sample size: 16 each for Treatment and Control. Due to a higher attrition rate, 24 were recruited for the control group. –Convenience sampling method was used to recruit participants from 3 hospitals and 2 HMOs in WNY.

20 20 Consort Flow Chart

21 21 Methods - Procedures –Random assignment of participants. –Interview at participants’ home. –Health behavior goal set –Notification to the primary physician –Step by step patient training For Treatment group, provision of BP monitor, pedometer, bath scale, computer with Internet connection, desk, chair, and lamp were provided Computer training. 2 websites introduction. Introduction of tailored exercise protocol.

22 22 Methods - Procedures –Regular feed back for their health behavior record from a health professional team. – and phone contact for consultation and encouragement –Control group, monetary compensation.

23 23 Demographic Information Control (n=19) Treatment (n=13) Age 76.4 (6.8) 74.0 (8.0) Gender (F) 12 (63.2%) 9 (69.2%) Race (Minority) 2 (10.5%) 3 (23.1%) Education (High School or less) 10 (52.6%) 10 (46.2%) Living Status (Alone) 8 (42.1%) 7 (53.8%) Home (Own) 8 (57.9%) 7 (53.3%) Income (< $10000) ( - $30000) ( - $30000) ( >$30000) ( >$30000) 8 (42.1%) 7 (36.8%) 4 (21.1%) 8 (61.5%) 5 (38.5%) 2 (14.3%)

24 24 Result : RQ1. Use of e-health Use of e-health technology –100% of treatment people went to the publicly available web site at least once a month. M=3.5 times/month –100% of treatment people recorded their health activities in the secured website. On average, 85% of 355 days –Reason for nonuse was not staying home (visit family, went to FL, a hospital or rehab facilities).

25 25 Result: RQ 2. Knowledge Gain Knowledge question: 20 items ( 0 – 55 ) Knowledge question: 20 items ( 0 – 55 )

26 26 Result: RQ 3. Commitment to Exercise- Breathing

27 27 Result: RQ 3. Commitment to Exercise- Walking

28 28 Result: RQ 4. Health/Functional Outcome- Blood Pressure

29 29 Result: RQ 4. Health/ Functional Outcome-BMI

30 30 Result: RQ 4. Health/Functional Outcome- FIM Motor

31 31 Result: RQ 4. Health/Functional Outcome- IADL Total

32 32 Result: RQ 4. Health/Functional Outcome- CHF Symptoms

33 33 Result: RQ 6. Quality of Life

34 34 Result: RQ 5. Healthcare Utilization- Emergency Room Visits

35 35 Result: RQ 5. Healthcare Utilization- Hospital Stay

36 36 Result: RQ 5. Healthcare Utilization- Nursing Home Stay

37 37 Result: RQ 5. Healthcare Use and Living Status Above Cramer’s V =.356 (p=.409) Left Cramer’s V=.443, (P=.020) In the study DiedNHAL Quit- CHF Other C (24) T (16) In the Study Lost due to CHF Lost due to other reason C (24) 1950 T (16) 1303

38 38 Result: RQ 6. Evaluation of e-health How much did you learn about healthy behaviors? A lot 84.6%Some 15.4% A lot 84.6%Some 15.4% How satisfied are you with the program? Very much 84.6% Somewhat 15.4% Very much 84.6% Somewhat 15.4% How is your CHF condition compared with one year ago? How is your CHF condition compared with one year ago? Better 92.3%Same 7.7% How helpful was it for you to do the exercises? Helpful 92.3% Not much 7.7% Helpful 92.3% Not much 7.7% How confident are you in dealing with CHF due to the program? Confident 100% Do you recommend this program to your friend with CHF? Yes 100% Yes 100% Which part did you like most? Monitoring myself for increased awareness (4) Improved health (3) Monitoring myself for increased awareness (4) Improved health (3) Support/people (3) Exercise (2) Computer use (1) Website (1) Support/people (3) Exercise (2) Computer use (1) Website (1) Which part did you dislike most? Exercise when I don’t feel like doing (1) Entering data of exercise part (1) Exercise when I don’t feel like doing (1) Entering data of exercise part (1) None (11) None (11)

39 39 Summary and Conclusion Successful –Health behavior change occurred and was sustained due to patients’ heightened awareness of their own health behaviors and confidence in managing illness. Reasons –Interventions were guided by theories and implemented strategically in every step. Contribution –The social network and social support theory was extend to technology use –E-health can be effective among older adults, if feedback is available from a health care professional.

40 40Acknowledgement Bruce J. Naughton, MD Bin-Min Tsai, MS, OTR Jim Peron Kathy Stanton, RN, MSN Nadine Fisher, Ed.D Neeraj Kumar, PT, MS Greg Wilding, Ph.D. Kay Sackett, RS, Ed.D Michael Noe, MD Aki Tomita, BS Mike Schlicht, MS Michael Sciortino, JD Kaleida Health Niagara Memorial Hospital Blue Cross/Blue Shield, Univera PCI, Clear Ahead Full Circle Dept. of Family Medicine Dept. of Rehab. Science Center for Assistive Technology Aging & Technology Research Dept of Rehab. Science Dept of Biostatistics School of Nursing Dept. of Social Preventative Medicine Dept. of Computer Engineering at UIUC SPHHP (IT Support) SPHHP (Web-master) (Patient recruitment) (Both, Patient recruitment,) Web Server Maintenance, HIPPA-website Filming


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