Thirty-day readmissions among patients with acute myocardial infarction (AMI) contribute to the US health care burden of preventable complications and costs. Digital health interventions (DHIs) may ...improve patient health care self-management and outcomes. We aimed to determine if patients with AMI using a DHI have lower 30-day unplanned all-cause readmissions than a historical control.
This nonrandomized controlled trial with a historical control, conducted at 4 US hospitals from 2015 to 2019, included 1064 patients with AMI (DHI n=200, control n=864). The DHI integrated a smartphone application, smartwatch, and blood pressure monitor to support guideline-directed care during hospitalization and through 30-days post-discharge via (1) medication reminders, (2) vital sign and activity tracking, (3) education, and (4) outpatient care coordination. The Patient Activation Measure assessed patient knowledge, skills, and confidence for health care self-management. All-cause 30-day readmissions were measured through administrative databases. Propensity score-adjusted Cox proportional hazard models estimated hazard ratios of readmission for the DHI group relative to the control group.
Following propensity score adjustment, baseline characteristics were well-balanced between the DHI versus control patients (standardized differences <0.07), including a mean age of 59.3 versus 60.1 years, 30% versus 29% Women, 70% versus 70% White, 54% versus 54% with private insurance, 61% versus 60% patients with a non ST-elevation myocardial infarction, and 15% versus 15% with high comorbidity burden. DHI patients were predominantly in the highest levels of patient activation for health care self-management (mean score 71.7±16.6 at 30 days). The DHI group had fewer all-cause 30-day readmissions than the control group (6.5% versus 16.8%, respectively). Adjusting for hospital site and a propensity score inclusive of age, sex, race, AMI type, comorbidities, and 6 additional confounding factors, the DHI group had a 52% lower risk for all-cause 30-day readmissions (hazard ratio, 0.48 95% CI, 0.26-0.88). Similar results were obtained in a sensitivity analysis employing propensity matching.
Our results suggest that in patients with AMI, the DHI may be associated with high patient activation for health care self-management and lower risk of all-cause unplanned 30-day readmissions. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03760796.
Objective
To determine signalment, injury type, trauma severity score, and outcome of feline trauma patients undergoing surgical (emergency room ER and operating room OR) and nonsurgical treatments ...in addition to time to surgery, specialty services involved, and cost in the OR surgery population.
Design
Retrospective evaluation of medical record and hospital trauma registry data on feline trauma cases.
Setting
University teaching hospital.
Animals
Two hundred and fifty‐one cats presenting for traumatic injury between May 2017 and July 2020.
Interventions
None.
Measurements and Main Results
Demographics and outcomes were compared for cats undergoing surgical intervention in an OR (12%, 31/251) or an ER (23%, 58/251) setting and feline trauma patients without surgical intervention (65%, 162/251). Between the 2 surgical groups, 99% survived to discharge compared to 73.5% of the nonsurgical group (P < 0.0001). For the OR surgical cohort, electronic medical records were reviewed to determine the specialty surgery service involved, time to and duration of anesthesia and surgery, and visit cost. The most common surgery services involved were orthopedics (41%, 12/29) and dentistry (38%, 11/29), and the most common surgeries performed were mandibular fracture stabilization (8/29) and internal fixation for long bone fractures (8/29). The ER surgical group had a significantly lower Animal Trauma Triage score than the OR group (P < 0.0001), but a significant difference was not found between OR surgical and nonsurgical groups (P = 0.0553). No difference in modified Glasgow Coma Scale score was found between any groups.
Conclusions
Surgical intervention in feline trauma patients appears to be associated with higher survival rates, but no difference in mortality was found across surgery services. OR surgical intervention, in particular, orthopedic surgery, was associated with increased length of hospitalization, increased cost, and increased use of blood products.
Optical antennas, subwavelength metallic structures resonating at visible frequencies, are a relatively new branch of antenna technology being applied in science, technology and medicine. Dynamically ...tuning the resonances of these antennas would increase their range of application and offer potential increases in plasmonic device efficiencies. Silver nanoantenna arrays were fabricated on a thin film of the phase change material vanadium dioxide (VO(2)) and the resonant wavelength of these arrays was modulated by increasing the temperature of the substrate above the critical temperature (approximately 68 °C). Depending on the array, wavelength modulation of up to 110 nm was observed.
Future changes to the hydrological cycle are projected in a warming world, and any shifts in drought risk may prove extremely consequential for natural and human systems. In addition to long-term ...moistening, drying, or warming trends, perturbations to the annual cycle of regional hydroclimate variables may also have substantial impacts. We analyze projected changes in several hydroclimate variables across the continental United States, along with shifts in the amplitude and phase of their annual cycles. We find that even in regions where no robust change in the annual mean is expected, coherent changes to the annual cycle are projected. In particular, we identify robust regional phase shifts toward earlier arrival of peak evaporation in the northern regions, and peak runoff and total soil moisture in the western regions. Changes in the amplitude of the annual cycle of total and surface soil moisture are also projected, and reflect changes to the annual cycle in surface water supply and demand. Whether changes become detectable above the background noise of internal variability depends strongly on the future scenario considered, and significant changes to the annual cycle are largely avoided in the lowest-forcing scenario.
Abstract
Mobile health (mHealth) interventions have demonstrated promise in improving outcomes by motivating patients to adopt and maintain healthy lifestyle changes as well as improve adherence to ...guideline-directed medical therapy. Early results combining behavioral economic strategies with mHealth delivery have demonstrated mixed results. In reviewing these studies, we propose that the success of a mHealth intervention links more strongly with how well it connects patients back to routine clinical care, rather than its behavior modification technique in isolation. This underscores the critical role of clinician-patient partnerships in the design and delivery of such interventions, while also raising important questions regarding long-term sustainability and scalability. Further exploration of our hypothesis may increase opportunities for multidisciplinary clinical teams to connect with and engage patients using mHealth technologies in unprecedented ways.
The climatic factors in the coastal areas are cogent in planning a stable and functional solar farm. 3D simulations relating the surface temperature, sunshine hour, and solar irradiance were adopted ...to see the effect of minute changes of other meteorological parameters on solar irradiance. This enabled the day-to-day solar radiation monitoring with the primary objective to examine the best technique for maximum power generation via solar option in coastal locations. The month of January had the highest turbulent features, showing the influence of weather and the poorest solar radiance due to low sunshine hour. Twenty-year weather parameters in the research area were simulated to express the systematic influence of weather of PV performance. A theoretical solar farm was illustrated to generate stable power supply with emphasis on the longevity of the PV module proposed by introducing an electronic concentrator pillar (CP). The pictorial and operational model of the solar farm was adequately explained.
Anthropogenic climate change is predicted to cause spatial and temporal shifts in precipitation patterns. These may be apparent in changes to the annual cycle of zonal mean precipitation P. Trends in ...the amplitude and phase of the P annual cycle in two long-term, global satellite datasets are broadly similar. Model-derived fingerprints of externally forced changes to the amplitude and phase of the P seasonal cycle, combined with these observations, enable a formal detection and attribution analysis. Observed amplitude changes are inconsistent with model estimates of internal variability but not attributable to the model-predicted response to external forcing. This mismatch between observed and predicted amplitude changes is consistent with the sustained La Niña–like conditions that characterize the recent slowdown in the rise of the global mean temperature. However, observed changes to the annual cycle phase do not seem to be driven by this recent hiatus. These changes are consistent with model estimates of forced changes, are inconsistent (in one observational dataset) with estimates of internal variability, and may suggest the emergence of an externally forced signal.
Acute myocardial infarction (AMI) is a common cause of hospital admissions, readmissions, and mortality worldwide. Digital health interventions (DHIs) that promote self-management, adherence to ...guideline-directed therapy, and cardiovascular risk reduction may improve health outcomes in this population. The "Corrie" DHI consists of a smartphone application, smartwatch, and wireless blood pressure monitor to support medication tracking, education, vital signs monitoring, and care coordination. We aimed to assess the cost-effectiveness of this DHI plus standard of care in reducing 30-day readmissions among AMI patients in comparison to standard of care alone.
A Markov model was used to explore cost-effectiveness from the hospital perspective. The time horizon of the analysis was 1 year, with 30-day cycles, using inflation-adjusted cost data with no discount rate. Currencies were quantified in US dollars, and effectiveness was measured in quality-adjusted life-years (QALYs). The results were interpreted as an incremental cost-effectiveness ratio at a threshold of $100,000 per QALY. Univariate sensitivity and multivariate probabilistic sensitivity analyses tested model uncertainty.
The DHI reduced costs and increased QALYs on average, dominating standard of care in 99.7% of simulations in the probabilistic analysis. Based on the assumption that the DHI costs $2750 per patient, use of the DHI leads to a cost-savings of $7274 per patient compared with standard of care alone.
Our results demonstrate that this DHI is cost-saving through the reduction of risk for all-cause readmission following AMI. DHIs that promote improved adherence with guideline-based health care can reduce hospital readmissions and associated costs.
Abstract
Background
Cardiovascular disease (CVD) remains the leading cause of death globally, taking an estimated 18 million lives each year. Digital health interventions (DHI), such as wearables and ...smartphone applications, have shown promise in CVD detection, prevention, and management. However, there are scarce data regarding clinician perspectives on the utility of DHI and identification of key elements to support adoption in clinical practice.
Method
In this cross-sectional study, a web-based survey was administered to 107 clinicians directly involved in the care of cardiac inpatients across multiple academic health care systems in the United States, between January 2020 and March 2021. Participants (1) reported their perceptions of DHI impact on their ability to care for patients with CVD, (2) rated the importance of factors related to DHI adoption, and (3) shared perspectives on using DHI for secondary CVD prevention to support guideline-directed medical therapy in patients after acute myocardial infarction. Descriptive statistics were analyzed and summarized as frequencies with percentages.
Results
Among survey respondents, 41% were women; 22% specialized in cardiovascular medicine; and 31% were practicing attendings (Table). Overall, 92% (86/94) of respondents believed that DHI would be important in offering advantages in cardiovascular patient care (Figure). Increasing patient adherence was reported as the most important benefit of DHI adoption by 39% of clinicians, followed by improvement in the patient-clinician relationship (29%), enabling remote care (18%), and improving patient experience (14%). Clinicians under age 40 years old, cardiologists, and internists were the groups more likely to consider DHI important in remote patient care, disease monitoring, and tele-visits, as compared to clinicians over age 40 years old or in other clinical specialties.
Conclusion
Our results highlight clinician perspectives on the advantages of DHI and the potential for its adoption for secondary prevention of CVD.
Funding Acknowledgement
Type of funding sources: None. Table 1. Characteristics of RespondentsFigure 1. Clinician Survey
Increasing evidence suggests that digital health interventions (DHIs) are an effective tool to reduce hospital readmissions by improving adherence to guideline-directed therapy. We investigated ...whether sociodemographic characteristics influence use of a DHI targeting 30-day readmission reduction after acute myocardial infarction (AMI). Covariates included age, sex, race, native versus loaner iPhone, access to a Bluetooth-enabled blood pressure monitor, and disease severity as marked by treatment with CABG. Age, sex, and race were not significantly associated with DHI use before or after covariate adjustment (fully adjusted OR 0.98 (95%CI: 0.95–1.01), 0.6 (95%CI: 0.29–1.25), and 1.22 (95% CI: 0.60–2.48), respectively). Being married was associated with high DHI use (OR 2.12; 95% CI 1.02–4.39). Our findings suggest that DHIs may have a role in achieving equity in cardiovascular health given similar use by age, sex, and race. The presence of a spouse, perhaps a proxy for enhanced caregiver support, may encourage DHI use.
Graphical abstract
PDF
