Barriers & Drivers to Use of Health IT by the Elderly, Chronically, & Underserved Prepared by Oregon...

Barriers & Drivers to Barriers & Drivers to Use of Health IT by the Use of Health IT by the Elderly, Chronically, & Elderly, Chronically, & UnderservedUnderserved

Prepared by OregonPrepared by OregonEvidence Based Practice Evidence Based Practice CenterCenter

Holly Jimison, Paul Gorman, Holly Jimison, Paul Gorman, Susan Woods, Peggy Susan Woods, Peggy Nygren, Miranda Walker, Nygren, Miranda Walker, Susan Norris, William HershSusan Norris, William Hersh

Background

•Better outcomes w/ self management•Diabetes - DCCT trial; warfarin; asthma

•Technologies facilitate process•home CBG, BP, INR, expanding array of

health IT

•Questions•Which Conditions? Which patients?

•Which Technologies? especially HIT

•What are barriers and drivers of use?

AHRQ Evidence Report

•Create analytic framework

•Define key questions

•Define inclusion, exclusion criteria

•Comprehensive literature search

•Quality assessment of studies

•Synthesis of results

Analytic Framework

Use of Use of Consumer Consumer

HITHIT


HITHIT

IntermediatIntermediate Outcomese Outcomes(self-efficacy, (self-efficacy, physiologic physiologic measures)measures)


Patient Patient OutcomesOutcomes(QoL, Cost, (QoL, Cost,

Satisfaction)Satisfaction)



PatientPatient(age, gender, (age, gender, health status, health status, literacy, etc.)literacy, etc.)


TechnologyTechnology(email, PDA, (email, PDA, cellphone, cellphone,

monitoring)monitoring)



SettingSetting(access to (access to

care, care, internet, internet,

reimbursemereimbursement)nt)




Key Question 1 - 4


HITHIT


HITHIT



















1111

Among elderly, chronically ill, and underserved Among elderly, chronically ill, and underserved populations,populations,

1.1.What is the current level of use of health IT?What is the current level of use of health IT?

2.2.What types are most useful and usable?What types are most useful and usable?

3.3.What barriers hinder use of interactive health What barriers hinder use of interactive health IT?IT?

4.4.What drivers facilitate use of interactive health What drivers facilitate use of interactive health IT?IT?

2222

3,43,43,43,4

Key Question 5


HITHIT


HITHIT



















5555

Among elderly, chronically ill, and underserved Among elderly, chronically ill, and underserved populations,populations,•Is interactive consumer health IT effective?Is interactive consumer health IT effective?•How does effectiveness vary among these How does effectiveness vary among these populations?populations?•How does effectiveness differ from general How does effectiveness differ from general population?population?

5555

Inclusion: Populations

elderlyelderly over 65

functional elderly

by life experience, health concerns

chronically ill

chronic condition

lasting more than one year ANDbenefits from ongoing management

impairment, limitation

impairment in body structure or functionproblems participating in life situations

underserved

underserved population

Bureau of Health Professions HRSA designated underserved population, region

underserved region

where individuals are inhibited in ability to receive services

Inclusion:Technologies•Direct active use by patient

•not just wearing a device

•Computer does some processing

•not just a conduit for information

•Patient receives tailored information

•advice, education, feedback

•Excluded

•telemonitoring, videoconferencing, general websites, FAQs

Information Provided to Client

Information Gathered

from Client

none

general

knowledge

population

specifi

c

informatio

n

disease

specifi

c

reco

mmendation

s

patient s

pecific

advice

state sp

ecific

instructi

on

none

demographic

habits and

risks health

conditio

ns

management

plancu

rrent

state

general websites

general websites

risk calculator tailored advice

risk calculator tailored advice

risk calculator

general advice

risk calculator

general advice

tailored reminding systems

tailored reminding systems

remote monitoring

remote monitoring

Spectrum of Information Interventions

disease forum

disease forum

interactive education

interactive education

disease FAQ

disease FAQ

practice guideline

practice guideline

self management systems

self management systems

•Published literature since 1990

•MEDLINE

•PsychINFO

•Cochrane Controlled Trials Register and Database of Systematic Reviews

•ERIC

•AARP Ageline

•Grey literature: conferences, technical reports,.

Literature Search

8522 abstracts/tit

les screened

Results: Literature Search

563papers

reviewed

129studies

included

•Many studies of use of interactive HIT in populations of interest: rural, elders, underserved

•but no comparison to general population

•Use of interactive HIT higher if perceived health benefit and trusted advice

•Access, ease of use, convenience key to wider use.

•Most frequently used functions are online peer group support and disease self-management tools.

•Anonymity, nonjudgmental nature of computer system an advantage with sensitive disorders

Major Findings: Use

Major Findings: Impact

•Effective HIT Provided Complete Loop:1.Monitoring of current patient status

2.Transmission of patient data to clinic or system

3.Interpretation by clinician, comparison to goals

4.Adjustment of management plan

5.Communication back to patient

6.Repeat cycle at intervals appropriate to condition

study conditionmonitor timing

feedback timing

feedback source

nature of informatio

n

Cho 2006RCT

Diabetes dailysemi

weeklyclinician

emailstate

specific

Kim 2007 RCT

Diabetes ≥ weekly ≥ weekly nurse SMSstate

specific

Green 2008 RCT

HTN daily biweeklypharmacis

tstate

specific

Kashem 2006 RCT

CHF ≥ weekly ≥ weeklynurse,

doctor, state

specific

LaFramboise 2003

RCTCHF daily daily nurse

state specific

Rasmussen 2005

RCTAsthma ≥ weekly ≥ weekly

physician with CDSS

state specific

Impact of Interactive HIT

Examples

•For Patients and Clinicians•These systems can help achieve better

outcomes in chronic conditions

•For Developers and Researchers•Usability issues must be resolved prior to

trials

•Need clarity, consistency of methods, measures

•For Policymakers•These systems help achieve better outcomes

•Practice environment does not support use

Implications

•Questions about technology •Optimal frequency of use by patient

•Optimal frequency of interaction with clinician

•Whether success requires revision of managment plan or just reminding

•Questions about populations•Direct comparison of elderly,

underserved, chronically ill with general population

Recommendations for Future

Research

Questions?

gormanp at ohsu.edu

Basic Research 1. Basic principles observed and reported

Feasibility 2. Technology Concept or Application formulated

Technology Development

3. Analytical and experimental function and/or characteristic proof-of-concept

4. Component and/or breadboard validation in laboratory

Technology Demonstration

5. Component and/or breadboard validation in relevant environment

6. System/subsystem model or prototype demonstration in relevant environment

System Development

7. System prototype demonstration in space environment

System Test & Operations

8. Actual system completed and ‘flight qualified’ through test and demonstration

9. Actual system ‘flight-proven’ through successful mission operations

NASA Techology Readiness Levels

Systematic Review is a Satellite View

Let’s you see the forest, obscures the trees

On The Ground You Need to Focus On the

Trees

Barriers & Drivers to Use of Health IT by the Elderly, Chronically, & Underserved Prepared by Oregon...

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