Kristian Kidholm

• Professor in health care innovation
• Head of CIMT Research Unit at Odense University Hospital

Background Artificial intelligence (AI) has been deemed revolutionary in medicine; however, no AI tools have been implemented or validated in Danish general practice. General practice in Denmark has an excellent digitization system for developing and using AI. Nevertheless, there is a lack of involvement of general practitioners (GPs) in developing...

BACKGROUND Therapist-guided internet-delivered cognitive behavioral therapy (iCBT) has demonstrated efficacy and potential cost-effectiveness for treating depression, anxiety, and panic disorders in randomized controlled trials. However, evidence of its outcomes and costs in routine care settings on a national level remains limited. OBJECTIVE This...

Objectives To explore patients’ preferences regarding virtual consultations (via telephone or video) and to explore healthcare professionals’ assessment of whether virtual consultations can maintain the same clinical quality as in-person consultations for outpatient care. Methods A cross-sectional survey was conducted among patients with an in-per...

BACKGROUND Skin cancers are the most frequent types of cancer, and the incidence continues to rise. Teledermoscopy is a promising tool in the diagnostic process of potential skin cancer, and new technologies are constantly being developed. However, little information is available on how teledermoscopy affects physicians time consumption. OBJECTIVE...

The Danish healthcare system is currently undergoing a transformation towards increased use of virtual healthcare services. In this review, we propose a structured risk-stratified model to delineate the differences between homecare, homemonitoring, and hospital-at-home, while discussing their current status and addressing barriers hindering the wid...

BACKGROUND Atrial Fibrillation (AF) is a chronic cardiovascular condition with a lifetime risk of one in three, and a prevalence of 3% among adults. The prevalence of AF is predicted to more than double in the next 20 years due to better detection, increasing comorbidities, and an ageing population. Telerehabilitation has been developed to enhance...

Background Atrial fibrillation (AF) is a chronic cardiovascular condition with a lifetime risk of 1 in 3 and a prevalence of 3% among adults. AF’s prevalence is predicted to more than double during the next 20 years due to better detection, increasing comorbidities, and an aging population. Due to increased AF prevalence, telerehabilitation has bee...

BACKGROUND Artificial intelligence has been deemed revolutionary in medicine, but very few artificial intelligence solutions have been observed in Danish general practice. General practice in Denmark has an excellent system of digitization to develop and utilize artificial intelligence. However, a lack of involvement of general practitioners in the...

The aim of this study was to assess and evaluate the individual expectations and experiences regarding the implementation of digital pathology (DIPA) among clinical staff in two of the pathology departments in the Region of Southern Denmark before and during the implementation in their department. Seventeen semi-structured interviews based upon McK...

The rate of development and complexity of digital health interventions (DHIs) in recent years has to some extent outpaced the methodological development in economic evaluation and costing. Particularly, the choice of cost components included in intervention or program costs of DHIs have received scant attention. The aim of this study was to build a...

Background A small share of patients account for a large proportion of costs to the healthcare system in Denmark as in many Western countries. A telephone-based self-management support, proactive health support (PaHS), was suggested for prevention of hospitalisations for persons at risk of hospital admission. These persons have chronic diseases, un...

Objectives This study aimed to introduce a pilot program for hospital-based health technology assessment (HB-HTA) in China and present the participants’ experiences based on seven case studies from seven tertiary hospitals. Methods One-year pilot projects were initiated at the beginning of 2018. Seven pilot hospitals were closely followed from the...

Objectives Telemedicine may improve healthcare access and efficiency if it demands less clinician time than usual care. We sought to describe the degree to which telemedicine trials assess the effect of telemedicine on clinicians’ time and to discuss how including the time needed to treat (TNT) in health technology assessment (HTA) could affect the...

Aim To explore registered nurses' perspectives on challenges and facilitators to implementing a telephone‐based self‐management support (SMS) intervention (Proactive Health Support) as an everyday healthcare practice, during the early stages of implementation. Design Data were collected using a qualitative research design involving focus‐group int...

We evaluated the cost-effectiveness of 2-[¹⁸F]FDG-PET/CT compared to CE-CT for response monitoring in metastatic breast cancer (MBC) patients. The study included 300 biopsy-verified MBC patients treated at Odense University Hospital (Denmark). CE-CT was used in 144 patients, 83 patients underwent 2-[¹⁸F]FDG-PET/CT, and 73 patients received a combin...

Introduction A feared complication after total hip arthroplasty (THA) is prosthetic joint infection (PJI), associated with high morbidity and mortality. Prophylactic antibiotics can reduce the risk of PJI. However, there is no consensus on the dosages and current recommendations are based on a low evidence level. The objective is to compare the eff...

Background: Self-management support models adapted to accommodate the needs of each patient are complex interventions that should be evaluated for intervention mechanisms. In a national randomized controlled trial (RCT), we evaluated the efficacy of telephone-based self-management support that demonstrated improved health-related quality of life (...

Background The use of telemedicine services has increased worldwide during recent years as a result of national strategies for the digitalization of health care and the COVID-19 pandemic. However, health care professionals often express uncertainty regarding the evidence and effectiveness of telemedicine interventions. Therefore, the Centre for Inn...

BACKGROUND The World Health Organization defines end of life Palliative Care (PC) as ‘prevention and relief of suffering, by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual’. More than 20 million people worldwide are estimated of being in need of palliative care....

Background: Ageing populations and health-care staff shortages encourage efforts in primary care to recognise and prevent health deterioration and acute hospitalisation in community-dwelling older adults. The PATINA algorithm and decision-support tool alerts home-based-care nurses to older adults at risk of hospitalisation. The study aim was to te...

Background Increased digitalization of hospitals is a goal for national and regional health strategies. Since 2019, it has been an explicit goal to increase the use of virtual consultation with hospital patients. Two years after the start of the pandemic, virtual consultation for hospital patients has increased. At Odense University Hospital (OUH),...

Introduction Artificial intelligence (AI) is seen as one of the major disrupting forces in the future healthcare system. However, assessment of the value of these new technologies is still unclear and no agreed international HTA-based guideline exists. Therefore, a Model for ASsessing the value of AI (MAS-AI) in medical imaging was developed by a m...

Introduction The use of telemedicine services has increased worldwide during recent years because of national strategies for digitalization of health care and the coronavirus disease 2019 (COVID-19) pandemic. However, healthcare professionals often express uncertainty regarding the effectiveness of telemedicine interventions. The TELEMED database (...

Background Artificial intelligence (AI) is seen as one of the major disrupting forces in the future healthcare system. However, the assessment of the value of these new technologies is still unclear, and no agreed international health technology assessment-based guideline exists. This study provides an overview of the available literature in the va...

Background Persons with frequent hospital admissions have a disease burden that may exceed their self-management skills. The evidence base of telephone-based interventions to support self-management is poor with mixed results. The aim of this study is to evaluate the effect of Proactive Health Support (PaHS): telephone-based self-management support...

Objectives Artificial intelligence (AI) is seen as a major disrupting force in the future healthcare system. However, the assessment of the value of AI technologies is still unclear. Therefore, a multidisciplinary group of experts and patients developed a Model for ASsessing the value of AI (MAS-AI) in medical imaging. Medical imaging is chosen due...

BACKGROUND The use of telemedicine services has increased worldwide during recent years as a result of national strategies for the digitalization of health care and the COVID-19 pandemic. However, health care professionals often express uncertainty regarding the evidence and effectiveness of telemedicine interventions. Therefore, the Centre for Inn...

Objectives The COVID-19 pandemic has led to suggestions that cost-effectiveness analyses should adopt a broader perspective when estimating costs. This review aims to provide an overview of economic evaluations of interventions against viral pandemics in terms of the perspective taken, types of costs included, comparators, type of economic model, d...

Introduction More than 10% of the population worldwide is affected by chronic kidney disease (CKD). Despite many promising indications regarding the use of mHealth education for patients with CKD, there is still little evidence regarding the feasibility, effectiveness outcomes and outcome measures. Therefore, we will conduct a scoping review to exa...

The Region of Southern Denmark is the first in Denmark to implement digital pathology (DIPA), starting at the end of 2020. The DIPA process involves changes in workflow, and the pathologist will have to diagnose based on digital whole slide imaging instead of through the traditional use of the conventional light microscope and glass slides. In addi...

Waste in research has been well documented, but initiatives to reduce it are scarce. Here, we share our initial experiences of implementing Lean thinking and visual management into hospital research units in the Region of Southern Denmark. A Transformation Guiding Team (TGT) anchored in the top management was established with participation from lea...

Introduction: The purpose of the study is to assess the effectiveness of video consultations in patients with type 1 diabetes mellitus (DM) treated with insulin pumps in the outpatient clinic. Methods and analysis: A 52 weeks' duration, open-label, randomised controlled trial will be conducted, enrolling 100 patients with type 1 DM currently tre...

Introduction Skin cancers are common in European populations and generate considerable costs. In Denmark, patients with suspicious skin lesions will usually consult their general practitioner who may refer the patient to a dermatologist or plastic surgeon if necessary. However, it is also possible for the general practitioner to take and send dermo...

We compared overall survival for metastatic breast cancer (MBC) patients monitored with CE-CT, FDG-PET/CT or a combination of them in an observational setting. Patients with biopsy-verified (recurrent or de novo) MBC (n = 300) who were treated at Odense university hospital (Denmark) and response monitored with FDG-PET/CT (n = 83), CE-CT (n = 144),...

Background: Increased use of telemedicine in the healthcare system is a political goal in Denmark. Although the number of hospital patients using interventions such as the video consultation has increased in recent years only a small proportion of the outpatient and inpatient visits involve telemedicine. The TELEMED database (https://telemedicine....

Purpose The aim of this study was to characterize the practice of telemediated training for patients with very severe Chronic Obstructive Pulmonary Disease (COPD) and to inform the development of clinical/professional practice. Methods Inspired by ethnographic methodology, participating observation, informal and formal interviews were conducted wi...

Aims: The aim of this study was to assess healthcare utilization costs of a dedicated outpatient clinic for patients with atrial fibrillation (AF). Methods: We conducted a registry-based retrospective study in patients with a first-time AF diagnosis from 2009 to 2011 (control group) and 2013 to 2015 (intervention group). The control group had ph...

Background The challenges imposed by ageing populations will confront health care systems in the years to come. Hospital owners are concerned about the increasing number of acute admissions of older citizens and preventive measures such as integrated care models have been introduced in primary care. Yet, acute admission can be appropriate and lifes...

Data from digitally administered patient reported outcomes (PROs) is used more and more in routine healthcare for long-term conditions as a part of daily clinical practice. This literature study reviews empirical studies of digital PRO to examine patients’ reasons for non-use of digitally administered PRO data in routine care. This scoping review s...

Patients with very severe chronic obstructive pulmonary disease (COPD) conduct their everyday lives under shortness of breath. The aim of this study was to explore telemediated exercise training to patients at home, with the conduct of everyday life as a theoretical framework. Based on ethnographic fieldwork involving a hospital, two municipalities...

Background: Colon capsule endoscopy (CCE) is a technology that might contribute to colorectal cancer (CRC) screening programs as a filter test between fecal immunological test and standard colonoscopies (SC). The aim was to systematically review the literature for studies investigating the diagnostic yield of 2nd generation CCE compared to SC. Me...

Introduction At Odense University Hospital (OUH) alternating-air mattresses (AAM) are used in the prevention of pressure ulcers (PU); however, static overlays might be more effective and have lower costs. To investigate the properties and consequences of using static overlays for prevention of PU at OUH, a hospital-based health technology assessmen...

Background A small proportion of patients account for most of the healthcare costs. Previous studies of supportive interventions have several methodological limitations and results are mixed. This article describes the protocol for Proactive Health Support: a national randomized controlled trial of telephone-based self-management support (ClinicalT...

This study compared the costs of a mind-body intervention with usual care for individuals infected with HIV (Human Immunodeficiency Virus). Further, consequences on labour market attachment were explored. The cost analysis was nested in a randomized controlled trial conducted in 2015 at the Department of Infectious Diseases at Aarhus University Hos...

Introduction The project DigiHelse aims to support the municipality health in Norway by offering a digital communication platform to users of the home care service nationally. In a concept stage of innovation, an early assessment of the potential socioeconomic value of the project was carried out by means of stakeholder insight and scenario draftin...

Most theoretical approaches to evaluate implementation of EHR systems origins from the time when EHR systems replaced paper records. When staff and management have many years' experience in use of EHR, the approaches to implementation is different. In this protocol paper we review the main implementation theories and discuss the adequacy for planni...

BACKGROUND The home care service in Norway still struggles to meet an increasing demand of health care under restricted budgets constraints, although about one fourth of municipal budgets are dedicated health services DigiHelse is a web based platform designed to reinforce the home care service in Norway, and is currently undergoing a development p...

Background: Home care service in Norway is struggling to meet the increasing demand for health care under restricted budget constraints, although one-fourth of municipal budgets are dedicated to health services. The integration of Web-based technology in at-home care is expected to enhance communication and patient involvement, increase efficiency...

Introduction: Neonatal homecare (NH) can be used to provide parents the opportunity of bringing cardiopulmonary-stable preterm infants home for tube feeding and the establishment of breastfeeding supported by neonatal nurses visiting the home. However, home visits can be challenging for hospitals covering large regions, and, therefore, regular neo...

Zusammenfassung Hintergrund Der Begriff „Telemedizin“ beschreibt die Bereitstellung von medizinischen Dienstleistungen mit Hilfe von Informations- und Kommunikationstechnologien in einer Situation, in der die Beteiligten sich an unterschiedlichen Orten befinden. Während in Forschungsprojekten in Deutschland telemedizinische Anwendungen noch häufig...

Hospital innovation centres increasingly make decisions concerning early development of and investment in innovative medical technologies (IMTs). At present, decisions are often made without applying a formal early assessment process to ensure selection of the most promising candidates for further development. This paper conceptualises and presents...

Objectives Early assessment can assist in allocating resources for innovation effectively and produce the most beneficial technology for an institution. The aim of the present study was to identify methods and discuss the analytical approaches applied for the early assessment of innovation in a healthcare setting. Methods Knowledge synthesis based...

ON THE COSTS OF HOME-BASED TELEMEDICINE PROGRAMS: A COMMENT ON MICHAUD ET AL. - Volume 34 Issue 6 - Kristian Kidholm

Background: Hospitals increasingly make decisions about early development of and investment in innovative medical technologies (IMTs), but at present often without an early assessment of their potential to ensure selection of the most promising candidates for further development. This paper explores how early assessment is carried out in different...

Supplemental material for the publication: A qualitative exploration of early assessment of innovative medical technologies

This study compared the cost-effectiveness of telemonitoring with standard monitoring for patients with diabetic foot ulcers. The economic evaluation was nested within a pragmatic randomised controlled trial. A total of 374 patients were randomised to either telemonitoring or standard monitoring. Telemonitoring consisted of two tele-consultations i...

Telecommunication technologies have been used to bring healthcare expertise to the point of care since the 19th century. In 1878, The Lancet reported the use of the telephone to reduce unnecessary physician visits and, in 1910, a tele-stethoscope had already been described.1 During the mid-20th century, NASA (National Aeronautics and Space Administ...

Objectives: Hospital-based health technology assessment (HB-HTA) is becoming increasingly relevant because of its role in managing the introduction and withdrawal of health technologies. The organizational arrangement in which HB-HTA activities are conducted depends on several contextual factors, although the dominant models have several similariti...

Introduction Procurement is one tool for the public sector to acquire need-based, innovative and effective solutions. To succeed in purchasing services that succeed in improving patients’ outcomes and optimize cost of care, the process must be accompanied with tools for early decisional support. Documenting the effects of healthcare innovation is t...

Table 2, 'Stoddart [19]' row: The cell entry in the 'Mean cost per control patient (SE)' column.

Many countries have considered telemedicine and home monitoring of patients as a solution to the demographic challenges that health-care systems face. However, reviews of economic evaluations of telemedicine have identified methodological problems in many studies as they do not comply with guidelines. The aim of this study was to examine economic e...

The evaluation of telemedicine can be achieved using different evaluation models or theoretical frameworks. This paper presents a scoping review of published studies which have applied the Model for Assessment of Telemedicine (MAST). MAST includes pre-implementation assessment (e.g. by use of participatory design), followed by multidisciplinary ass...

This chapter describes how different types of telemedicine can be used to increase self-management of individuals with chronic health conditions. Based on a number of systematic literature reviews, the potential benefits of telemedicine for individuals with diabetes, COPD, and heart failure are presented. Because telemedicine in many countries are...

Introduction: Hospitals increasingly make decisions regarding the early development of and investment in technologies, but a formal evaluation model for assisting hospitals early on in assessing the potential of innovative medical technologies is lacking. This article provides an overview of models for early assessment in different health organisa...

Internet of Things (IoT) based solutions and services may be used to support and extend the independent living of older adults in their living environments by responding to real needs of caregivers, service providers and public authorities. Telemedicine and telehealth platforms are among the various types of IoT services that could support the prov...

ABSTRACT: Health Technology Assessment (HTA) has been increasingly used in decision-making processes at national, regional, and international levels over the past 40 years. However, a large number of good-value innovative Health Technologies (HTs) never reaches clinical practice while, in many instances, others with no significant added value actua...

Introduction In 2009, the Model for Assessment of Telemedicine (MAST) was developed within the MethoTelemed project as a framework for description of the effectiveness of telemedicine applications. The goal was for the assessments to be used as basis for decision-making in healthcare systems. Since then, MAST has been used in many European telemedi...

Purpose: To assess the perception of health care professionals of the organisational prerequisites for implementation of telehealth interventions in search of a generally applicable model for future use of telehealth. Context: United4Health, a European telehealth project comprising three multicentre studies of telehealth services for patients with...

Introduction: TMon for COPD has been associated with a reduced mortality, but was not deemed cost-effective (1). RCTs may not be the optimal trial design. Methods: The United4Health project in 6 sites across 4 EU countries, compared a TMon intervention with historical comparators discharged from hospital 1 year prior (ratio 1:2). Although devices d...

As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that can lead to scalable and sustainable telehealth programs. This paper has two aims: (1) to describe the challenges of promoting telehealth implementation to a...

Objectives: Health technology assessment (HTA) carried out for policy decision making has well-established principles unlike hospital-based HTA (HB-HTA), which differs from the former in the context characteristics and ways of operation. This study proposes principles for good practices in HB-HTA units. Methods: A framework for good practice crite...

Objectives: There is growing interest in implementing hospital-based health technology assessment (HB-HTA) as a tool to facilitate decision making based on a systematic and multidisciplinary assessment of evidence. However, the decision-making process, including the informational needs of hospital decision makers, is not well described. The objecti...

In their article "Assessment of MAST in European Patient-Centered Telemedicine Pilots" published in this journal (1), Anne Granstrøm Ekeland and Astrid Grøttland describe the results from a questionnaire study of how MAST (Model for Assessment of Telemedicine) (2) was used and perceived by the project managers in twenty-one studies of telemedicine...

The main users of HB-HTA are the clinical and administrative managers at the hospitals who need a basis for decisions on whether to invest in new treatments at the hospital. As it is described in this book – Sampietro-Colom et al. [1] – a number of hospitals around the world have started using HB-HTA, and many hospitals have demonstrated positive i...

Health-care system: Publicly funded and publicly owned hospitals.

Background: Cardiac rehabilitation can reduce mortality of patients with cardiovascular disease, but a frequently low participation rate in rehabilitation programs has been found globally. The objective of the Teledialog study was to assess the cost-utility (CU) of a cardiac telerehabilitation (CTR) program. The aim of the intervention was to incr...

Available from: http://www.adhophta.eu/adhophta-toolkit Guidance and tools facilitating pragmatic application of guiding principles for good practices in HB-HTA units. This toolkit is based on the HANDBOOK for HB-HTA developed by the AdHopHTA project. This toolkit is one of the final results of the research project AdHopHTA (Adopting hospital-base...

An essential element in the treatment of patients with chronic obstructive pulmonary disease (COPD) is rehabilitation, of which supervised training is an important part. However, not all individuals with severe COPD can participate in the rehabilitation provided by hospitals and municipal training centres due to distance to the training venues and...

Introduction: The European Telemedicine Conference 2015 (ETC15) serves as an interdisciplinary forum for healthcare professionals, directors, managers, and researchers and brings together governmental leaders, healthcare delivery organizations, and academic researchers. The research track of ETC15 focuses on research and operational evidence from i...

Introduction and aim: There is a rising need for decision support in the process with development of innovative health technologies. Further, sound approaches for early assessments of the expected value on innovations, coping with the uncertainty and flexibility inherent in innovations, are lacking. Along with the challenging economic conditions fo...

Assessments of new health technologies in Europe are often made at the hospital level. However, the guidelines for health technology assessment (HTA), e.g. the EUnetHTA Core Model, are produced by national HTA organizations and focus on decision-making at the national level. This paper describes the results of an interview study with European hospi...

The implementation of telemedicine often introduces major organizational changes in the affected healthcare sector. The objective of this study was to examine the organizational changes through the perception of the healthcare professionals regarding the implementation of a telemedical intervention. We posed the following research question: What ar...

The Whole Systems Demonstrator (WSD), a cluster randomized trial of effects of telehealth, was initiated in 2008 including 3.230 patients from 179 general practices. The objective of this review is to summarize the results from WSD based on publications made so far. Results from five publications show that telehealth reduces mortality (odds ratio 0...