NR505-61331 Week 5 Research Summary Assignment LT

NR505-61331 Week 5 Research Summary Assignment LT

PICOT Question: 

  1. P I C O T designate

P – In-patient diagnosed with CHF

I – Implementing telehealth monitor (TM) in the home

C – On-site visitations from the home healthcare nurses

O – Prevention of re-hospitalizations

T- Over a 2-month time period

  1. PICOT sentence: In-patient diagnosed with CHF (Population) what is the effect of implementing of telehealth monitor (TM) in the home (Intervention) in comparison to on-site visitations from the home healthcare nurses (Comparison) on in the prevention of re-hospitalizations (Outcome) over a 2-month time period (Time). 

NR505-61331 Week 5 Research Summary Assignment LT

Article 1

ReferenceLin, M., Yuan, W., Huang, T., Zhang, H., Mai, J., & Wang, J. (2017). Clinical effectiveness of telemedicine for chronic heart failure: a systematic review and meta-analysis. Journal Of Investigative Medicine65(5), 899-911. https://doi.org/10.1136/jim-2016-000199
PurposeThe purpose of the paper is to find the impact of telemedicine care or home-based telemonitoring compared to standard care in reducing CHF-related health care admission and all-cause mortality. 
MethodSystemic review study and meta-analysis were used. However, this is an updated analysis of randomized control trials conducted in 2016. A PRISMA flow chart was used to filter the research works. The data were analyzed by using the standardized difference in means along with I2 statistics to check heterogeneity. 
ParticipantsA total of 911 studies were selected, but after inclusion and exclusion criteria along with abstract review and title analysis, 39 articles were selected for meta-analysis. 
Data CollectionOnly randomized controlled trials (RCTs) were used to conduct the analyses. Data was collected from articles published from 1998 to 2016. Cochrane Library, EMBASE, MEDLINE, and CINAHL Plus were used along with keywords such as chronic heart failure (CHF), remote monitoring, telemedicine, health information systems, telehealth, internet, and telemonitoring.
FindingsThe review found that CHF-related stay, hospital admission, and all-cause mortality were significantly less in the teletransmission group and telephone-supported care group compared to the control group. 
Limitations The study did not analyze the outcomes relevant to CHF and quality of life. Also, the study is a meta-analysis of an RCT article, not an RCT. 
Relevance Even though it is a meta-analysis study, the article is highly relevant as it highlights that telemonitoring significantly reduces mortality rate, admission rate, and CHF diagnosis. Also, it highlights the need to consider disease-specific outcomes, quality of life, and bias control. 

Article 2

NR505-61331 Week 5 Research Summary Assignment LT

ReferenceKoehler, J., Stengel, A., Hofmann, T., Wegscheider, K., Koehler, K., & Sehner, S. et al. (2020). Telemonitoring in patients with chronic heart failure and moderate depressed symptoms: results of the Telemedical Interventional Monitoring in Heart Failure (TIM‐HF) study. European Journal Of Heart Failure23(1), 186-194. https://doi.org/10.1002/ejhf.2025
PurposeThe purpose of the paper is to analyze the effects of the Telemedical Interventional Monitoring in Heart Failure (TIMHF) system in monitoring CHF and depression symptoms in patients with CHF. 
Research MethodA randomized and prospective multicenter clinical trial method was used for the study where patients were included based on inclusion and exclusion criteria. The study was conducted in a multicenter hospital in Germany. A repeated measure mixed model was used along with the grade scale tool of the Patient Health Questionnaire (PHQ9) to determine the CHF caused depressions. The patients were assigned randomly. 
ParticipantsA total of 710 participants were selected from 165 cardiology units. 
Data CollectionTwo groups were created, which included the control group and TM group. The data was collected from the telemonitoring system, which was installed at the homes to monitor blood pressure, a 3‐lead electrocardiogram, and weight. 
FindingsThe result showed that there was a significant difference between the groups when it came to the quality of life and ease of monitoring CHF. Patients on TM showed improved PHQ-9 scores.
Limitations The statistical regression analysis could have led to changes in the baseline. Bias is present where physicians neglected severely clinically depressed participants. 
Relevance The study is relevant to the PICOT as t analyzes both qualities of life due to CHF and depression symptoms in patients with TM. 

Article 3

ReferenceHale, T., Jethwani, K., Kandola, M., Saldana, F., & Kvedar, J. (2016). A remote medication monitoring system for chronic heart failure patients to reduce readmissions: a two-arm randomized pilot study. Journal Of Medical Internet Research18(4), e91. https://doi.org/10.2196/jmir.5256
PurposeThe purpose of the paper is to compare and evaluate the effects of the Med-Sentry remote monitoring system with usual care in older adult patients with CHF who recently completed the HF telemonitoring programs.
Research MethodIt is a randomized controlled pilot study. The participants were selected randomly and remote monitoring medication system was installed for them to monitor the effectiveness of the system for at least 90 days. All the participants were asked to complete the questionnaire. 
Participants29 participants were recruited, but data were obtained from only 25 participants. 
Data CollectionQuestionnaires were used to collect data related to health status, medication adherence, and HRQoL. The monitoring and data related to heart functionality, BP, and weight was collected from the TM system. 
FindingsThe use of a monitoring system for CHF was correlated with a reduction of 80% all-cause hospital admission risks and there was a highly significant decrease in all-cause hospitalization stay. The objective device and control data indicated that there were high adherence rates from 95% to 99% among the intervention, but no significant correlation was found in self-reported adherence between the two study arms. The UC group also had a poor heart function output and HRQoL value at the baseline along with HRQoL significantly value in the HF group.
Limitations The sample size was small. The power to evaluate the smaller differences at the closeout and baseline was low. Self-reported adherence report systems are not highly effective. 
Relevance The study is relevant as it indicated that monitoring systems with different study arms aid in determining the effectiveness of the system in reducing hospital admission and heart functionality of patients. 

Article 4

NR505-61331 Week 5 Research Summary Assignment LT

ReferenceIsaranuwatchai, W., Redwood, O., Schauer, A., Van Meer, T., Vallée, J., & Clifford, P. (2018). A remote patient monitoring intervention for patients with chronic obstructive pulmonary disease and chronic heart failure: a pre-post economic analysis of the smart program. JMIR Cardio2(2), e10319. https://doi.org/10.2196/10319
PurposeThe purpose of the paper is to evaluate all the benefits of implementing a Smart remote monitoring program concerning hospitalizations, ER visits, cost, and CHF and COPD condition economically. 
Research MethodA pre-post economic analysis study was used. The data collected for 3-months before the program was compared with data compared after 3-months of the program by using descriptive analysis. Further, 3-month follow-up, number of ER visits, client satisfaction, and clinical frailty score were analyzed with respect to costs by using Wilcoxon signed-rank test to determine the effectiveness of the program. 
ParticipantsA total of 74 participants with 57% female patients were selected. 
Data CollectionThe data was collected using AlayaCare app by both patients and nurses through the AlayaCarecloud service and RPM apps. 
Study FindingsThe study found that the implementation of a smart program increased patient satisfaction level to 91% from 70% as 97% of patients found it is easier to understand the need for ER visits based on smart system data. This reduced hospital ER visits from 68% to 35% and the cost associated with ER visits reduced to $1399 from $3842. 
Limitations The sample size is small. The study has a bias as patients were not assigned randomly. 
Relevance The study is relevant to the PICOT question as it highlights that TM systems reduce ER visits and costs among patients with CHF. 

Article 5

ReferenceJaana, M., & Sherrard, H. (2019). Rural-urban comparison of telehome monitoring for patients with chronic heart failure. Telemedicine And E-Health25(2), 101-108. https://doi.org/10.1089/tmj.2017.0303
PurposeThe purpose of the paper is to analyze the comparative use of TM or tele-home monitoring for patients with CHF in both rural and urban environments
Research MethodA cross-sectional study with chart reviews was used. Descriptive, bivariate, and multivariate analyses were conducted on data collected from the University of Ottawa Heart Institution. All the in-patients with CHF were directly referred for the TM program. The study examined and compared the effectiveness of TM among all the patients in rural and urban settings. The system used including data transmission, monitoring system, blood pressure monitoring, ECG, and weigh scales. By using standardized protocols, data transmission was carried out. 
ParticipantsA total of 57% urban and 43% rural population with patient count 240 participated. The mean sample age was 72 years with an average monitoring time of 108 days. Around 66% of patients had the condition of SHF or systolic heart failure. 
Data CollectionData were extracted from the monitoring tools based on their urban or rural status, process, demographic characteristics, outcomes of the care, and patient information. Further, chart reviews were used to collect data. All the transmitted data was connected to the telephone and cellular lines. 
FindingsThe study found that rural group patients did not have a documented reason for the ER visits compared to an urban group where documented reasons were mostly CHF. There were non-significant associations between the urban or rural status outcome measures and process in multivariate level analysis. Being followed-up by the family physician, a specialist, or nurse regularly as compared to specialists or the general practitioners, there was significantly higher diuretic adjustments and longer TM periods.
Limitations Qualitative data analysis on a process and patient outcome were not conducted. The study had a smaller sample size. Further, there was no risk assessment, patient coverage limitations, and increased adjustments in the study. 
RelevanceThe article is highly relevant as it assesses the impact of TM in both rural and urban areas and indicates that it is important to consider aspects such as impact specialist nurse and general practitioner while evaluating the results. 

NR505-61331 Week 5 Research Summary Assignment LT

Article 6

ReferenceKoulaouzidis, G., Barrett, D., Mohee, K., & Clark, A. (2018). Telemonitoring in subjects with newly diagnosed heart failure with reduced ejection fraction: From clinical research to everyday practice. Journal Of Telemedicine And Telecare25(3), 167-171. https://doi.org/10.1177/1357633×17751004
PurposeThe purpose of the paper is to evaluate whether TM implementation in patients who were newly diagnosed with heart failure with an ejection fraction less than 40% reduces readmission and death risks. 
Research MethodThe study is based on the retrospective design where patients were selected based on inclusion and exclusion criteria. TM group and usual care (UC) group were created and different aspects such as blood pressure, body weight, and heart rates were used by using the electronic sensor devices. 
ParticipantsA total of 124 patients were selected with a mean age of 68.6 years who underwent TF care. In this group, 78.2% of participants were male. There were 345 participants in the UC group with 68.5% male participants and the average age of all participants were 70.2 years. 
Data CollectionThe data was collected in real-time for 12-months from an online patient sign monitoring database. 
Study FindingsThe study found that the death rate from any of the causes in the TM group was 8.1% and it was 19% in the UC group. However, there was no significant difference when it comes to all-cause hospitalization, but the number of days in the hospital was high in the UC group. Also, patients in the HF group lived longer and stayed out of hospital longer compared to the UC group. 
Limitations The study has a bias, as patients were not assigned randomly. The sample of both groups varies in terms of age, size, and characteristics. 
Relevance The study is relevant to the PICOT question as it highlights that TM helps in keeping the patients out of the hospital. 

Article 7

ReferencePekmezaris, R., Schwartz, R., Taylor, T., DiMarzio, P., Nouryan, C., & Murray, L. et al. (2016). A qualitative analysis to optimize a telemonitoring intervention for heart failure patients from disparity communities. BMC Medical Informatics And Decision Making16(1). https://doi.org/10.1186/s12911-016-0300-9
PurposeThe purpose of the paper is to optimize the telehealth service utilization among Latino and African-American patients from the disparity communities. 
Research MethodIt is a qualitative analysis, which uses an ADAPT-ITT framework where a community-based participatory research approach was integrated. The study uses two focus groups by using the framework to engage the key stakeholders in the community in adopting the interventions. The third group uses HF or CHF telemonitoring system. Audio records and transcripts were used.
ParticipantsThe first group had 14 participants. The second group had 14 participants and the third focus group with TM equipment for HF monitoring had 4 participants. 
Data CollectionThe data was collected by using a survey, data from systems, and telephonic conversations. All the data was transcribed. 
FindingsThere were three major themes that were identified. The first theme highlighted was changes to the equipment increased usability such as the inclusion of the Spanish language. The second theme is changed to study structure to increase participant engagement in RCT studies. The third theme is reassurances related to identity protection, camera utilization to monitor patents and involvement of patients in the process. 
Limitations Very small sample size and generalizability are low as it is a qualitative analysis and it needs more data to understand the emerging themes. 
Relevance The study is relevant to the PICOT question as it identifies the issues in TM implementation such as identity protection, optimizing devices by including different languages, and perspective of patients in disparity communities. 

Article 8

NR505-61331 Week 5 Research Summary Assignment LT

ReferenceJiang, X., Yao, J., & You, J. (2020). Telemonitoring versus usual care for elderly patients with heart failure discharged from the hospital in the united states: a cost-effectiveness analysis. JMIR Mhealth And Uhealth8(7), e17846. https://doi.org/10.2196/17846
PurposeThe purpose of the paper is to analyze the overall cost-effectiveness of the usual care without and with a telemonitoring-guided management system in the patients who had CHF condition and were discharged from the health care from different perspectives of healthcare providers in the US. 
Research MethodThe research uses an analytical design with a lifelong Markov model to analyze the economic and clinical outcomes of the telemonitoring-guided management system by analyzing a hypothetical cohort of patients who are 65-year or older with CHF condition. The study included NYHA classes of class I, class II, class III, and class IV. 
ParticipantsThe study included a literature search from 2001 to 2019. A total of 1538 hypothetical cohort participants with CHF were included in the study where 0.7% were in class I, 51.8% in class II, 47.2% in class III, and 0.3% in class IV. 
Data CollectionThe data was collected from 13 RCTs, which included 10,913 patients. 
FindingsThe study concluded that TM systems are cost-effective and the majority of patients with CHF preferred telemonitoring-guided management system. 
Limitations The study has a model with assumptions and increased uncertainty of data will result in lower outcomes. Also, this model is difficult to translate into practice. 
Relevance to PICOTThe study is relevant to the PICOT question as the main reason to include this study is it highlights that data obtained from RCTs and models provide a similar output indicating that RT is cost-effective. 

Article 9

ReferenceFrederix, I., Vanderlinden, L., Verboven, A., Welten, M., Wouters, D., & De Keulenaer, G. et al. (2018). The long-term impact of a six-month telemedical care program on mortality, heart failure readmissions, and healthcare costs in patients with chronic heart failure. Journal Of Telemedicine And Telecare25(5), 286-293. https://doi.org/10.1177/1357633×18774632
PurposeThe purpose of the paper is to analyze whether a six-month telemonitoring (TM) system reduces heart failure admissions, healthcare costs, and all-cause mortality in CHF patients at a long-term clinical follow-up compared to UC or usual care.  
Research MethodA randomized and prospective multicenter clinical trial method was used for the study where patients were included based on inclusion and exclusion criteria. TM and UC groups were assigned randomly and both the group received standard CHF care during a follow-up study. 
ParticipantsIn the beginning, 160 patients participated in the study. Later, 142 patients who were alive participated in the follow-up study and the study was finally evaluated at 78 months. 
Data CollectionData were extracted from the monitoring tools based on their groups, alive status, process, demographic characteristics, readmission, and patient information. 
FindingsCompared to UC, the initial care for the six-month TM system did not have a significant correlation with all-cause mortality. However, the TM group had a lower number of hospital days compared to the UC group. Also, there was no significant difference in health care cost. 
Limitations The study has a bias, as patients were not assigned randomly. The sample of both groups varies in terms of age, size, and characteristics. 
RelevanceThe study is relevant to the PICOT question as it highlighted the need to consider disease-specific outcomes, bias control, long-term intervention, and cost analysis compared to the UC group to determine the overall impact of the TM system. 

Article 10

Reference Williams, C., & Wan, T. (2016). A cost analysis of remote monitoring in a heart failure program. Home Health Care Services Quarterly35(3-4), 112-122. https://doi.org/10.1080/01621424.2016.1227009
PurposeThe purpose of the paper is to evaluate the cost per outcome after implementing remote monitoring services in a home healthcare environment. 
Research MethodA case-matched design through retrospective chart review study design was used. The study used TM systems installed at homes to collect the data and use the chi-square test to find the correlation between hospital readmissions and intervention. Further, an independent t-test was used to compare the agency cost and mean value of visits by skilled nurses. 
ParticipantsA total of 210 participants with heart failure conditions participated.
Data CollectionThe data were collected by chart reviews, questionnaires, and remote monitoring systems implemented at homes. 
FindingsThe study found that the cost per outcome increased by $153.46 for every hospital readmission. As a result, the remote monitoring system was economically not viable. 
Limitations The study has a bias as randomized control sampling was not used. Also, it is conducted in one unit and as a result, it has lower generalizability. 
Relevance The study is relevant to the PICOT question as it highlights the other side of TM systems. It is important to consider the potential economic viability to create a better system with a better study design to find whether TM systems are beneficial economically for both the short and long-term. 

NR505-61331 Week 5 Research Summary Assignment LT

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