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OP 4 Learning to evaluate and manage antenatal blood pressure at home (LEANBH): Results from the pilot study of a novel connected health solution
Abstract
Introduction
LEANBH (Learning to Evaluate and manage ANtenatal Blood pressure at Home) is a prospective, observational, non-interventional cohort, pilot study of a novel connected health solution aimed at empowering women to self-manage blood pressure (BP) monitoring in pregnancy. Hypertension in pregnancy affects around 5–8% of all pregnancies and misdiagnosis or poorly managed BP in pregnancy negatively affects maternal and neonatal outcomes.
Objectives
The primary objective of this study was to assess the feasibility and acceptability of home blood pressure monitoring (HBPM) and to compare these BP readings taken at home using the LEANBH architecture to those taken in healthcare settings (hospital and general practice).
Patients, materials and methods
Healthy primigravida with low risk singleton pregnancies were recruited from Cork University Maternity Hospital, Ireland. Women were equipped with a Microlife WatchBP Home Monitor, an Urisys 1100® Urine Analyzer and the mobile app developed for use throughout pregnancy as part of the Leanbh project. Participants were encouraged to submit BP and urine readings from home as frequently as possible and especially prior to an antenatal visit. All women attended their planned healthcare visits as usual. Mean arterial pressure (MAP) was calculated from the BP readings uploaded to a LEANBH platform throughout pregnancy and analysed using SPSS version 2.0 Mann–Whitney test.
Results
51 women volunteered with 46 of them completing the study. 27 women were equipped with the devices with 5 subsequently withdrawing from this group while 24 women were recruited into the control group.
A total of 1381 home BP readings and 983 healthcare setting BP readings were recorded with 972 paired (home vs healthcare setting) MAP available for analysis. The Mann–Whitney test performed showed statistical significance between the home vs healthcare setting MAP with a P value <0.05.
A user error rate of 3.8% was noted among the HBPM group.
Conclusion
BP taken at home was significantly lower than that taken in a health care setting, suggesting that the incidence of white coat hypertension in this cohort is under reported. The low error rate suggests that HPBM is easy to use. A large randomized control trial is planned to fully evaluate the utility of this technology solution.
... Collected data from connected devices can be continuously analyzed and shared to provide actors with key insights that allow them to take effective action. For instance, feedback can be derived from an analysis of a patient's home-based blood pressure readings or blood glucose levels taken from wearable body sensors or connected devices that record patients' vitals [31,32]. In addition, rule-based systems can be employed to act as early warning systems whereby health care professionals are notified when a patient's vitals pass certain thresholds, as detailed in the relevant clinical guidelines [33]. ...
Background
Health information technology (HIT) and associated data analytics offer significant opportunities for tackling some of the more complex challenges currently facing the health care sector. However, to deliver robust health care service improvements, it is essential that HIT solutions be designed by parallelly considering the 3 core pillars of health care quality: clinical effectiveness, patient safety, and patient experience. This requires multidisciplinary teams to design interventions that both adhere to medical protocols and achieve the tripartite goals of effectiveness, safety, and experience.
Objective
In this paper, we present a design tool called Integrated Patient Journey Mapping (IPJM) that was developed to assist multidisciplinary teams in designing effective HIT solutions to address the 3 core pillars of health care quality. IPJM is intended to support the analysis of requirements as well as to promote empathy and the emergence of shared commitment and understanding among multidisciplinary teams.
MethodsA 6-month, in-depth case study was conducted to derive findings on the use of IPJM during Learning to Evaluate Blood Pressure at Home (LEANBH), a connected health project that developed an HIT solution for the perinatal health context. Data were collected from over 700 hours of participant observations and 10 semistructured interviews.
ResultsThe findings indicate that IPJM offered a constructive tool for multidisciplinary teams to work together in designing an HIT solution, through mapping the physical and emotional journey of patients for both the current service and the proposed connected health service. This allowed team members to consider the goals, tasks, constraints, and actors involved in the delivery of this journey and to capture requirements for the digital touchpoints of the connected health service.
Conclusions
Overall, IPJM facilitates the design and implementation of complex HITs that require multidisciplinary participation.
... Collected data from connected devices can be continuously analyzed and shared to provide actors with key insights that allow them to take effective action. For instance, feedback can be derived from an analysis of a patient's home-based blood pressure readings or blood glucose levels taken from wearable body sensors or connected devices that record patients' vitals [31,32]. In addition, rule-based systems can be employed to act as early warning systems whereby health care professionals are notified when a patient's vitals pass certain thresholds, as detailed in the relevant clinical guidelines [33]. ...
Background: Health information technology (HIT) and associated data analytics offer significant opportunities for tackling some of the more complex challenges currently facing the healthcare sector. However, in order to deliver robust healthcare service improvements, it is essential that the design of these solutions considers in parallel the three core pillars of healthcare quality - clinical effectiveness, patient safety, and patient experience. This requires multidisciplinary teams to explore performance goals, medical protocols alongside the various touchpoints which affect clinicians’ interventions and patient experiences.
Objective: In this paper, we present a design tool called the ‘Integrated Patient Journey Map’ (IPJM) which has been developed to assist multidisciplinary teams in designing effective health IT solutions to address these three core pillars of healthcare quality. IPJM is intended to support the analysis of requirements, as well as promote empathy and the emergence of shared commitment and shared understanding amongst teams.
Methods: A six-month in-depth case study was undertaken to derive findings on the use of this tool from ‘LEANBH’, a connected health project which developed HIT solutions for the perinatal health context. Data was collected through over 700 hours of participant observations and 10 semi-structured interviews.
Results: Findings indicate that the Integrated Patient Journey Map offers a constructive tool for multi-disciplinary teams to explore the physical and emotional journey of patients, as well as their touchpoints with health IT solutions. In addition, it allows team members to consider the goals, tasks, constraints, and actors involved in delivery of this journey, and derive precise and complete sets of requirements for health IT applications.
Conclusions: Overall, the IPJM facilitates the implementation of balanced leadership for these type of complex Health Information Systems projects where multiple viewpoints must be considered.
Background:
Health information technology (HIT) and associated data analytics offer significant opportunities for tackling some of the more complex challenges currently facing the health care sector. However, to deliver robust health care service improvements, it is essential that HIT solutions be designed by parallelly considering the 3 core pillars of health care quality: clinical effectiveness, patient safety, and patient experience. This requires multidisciplinary teams to design interventions that both adhere to medical protocols and achieve the tripartite goals of effectiveness, safety, and experience.
Objective:
In this paper, we present a design tool called Integrated Patient Journey Mapping (IPJM) that was developed to assist multidisciplinary teams in designing effective HIT solutions to address the 3 core pillars of health care quality. IPJM is intended to support the analysis of requirements as well as to promote empathy and the emergence of shared commitment and understanding among multidisciplinary teams.
Methods:
A 6-month, in-depth case study was conducted to derive findings on the use of IPJM during Learning to Evaluate Blood Pressure at Home (LEANBH), a connected health project that developed an HIT solution for the perinatal health context. Data were collected from over 700 hours of participant observations and 10 semistructured interviews.
Results:
The findings indicate that IPJM offered a constructive tool for multidisciplinary teams to work together in designing an HIT solution, through mapping the physical and emotional journey of patients for both the current service and the proposed connected health service. This allowed team members to consider the goals, tasks, constraints, and actors involved in the delivery of this journey and to capture requirements for the digital touchpoints of the connected health service.
Conclusions:
Overall, IPJM facilitates the design and implementation of complex HITs that require multidisciplinary participation.
Background:
This paper examines the development of the Connected Health research landscape with a view on providing a historical perspective on existing Connected Health research. Connected Health has become a rapidly growing research field as our healthcare system is facing pressured to become more proactive and patient centred.
Objective:
We aimed to identify the extent and coverage of the current body of knowledge in Connected Health. With this, we want to identify which topics have drawn the attention of Connected health researchers, and if there are gaps or interdisciplinary opportunities for further research.
Methods:
We used a systematic mapping study that combines scientific contributions from research on medicine, business, computer science and engineering. We analyse the papers with seven classification criteria, publication source, publication year, research types, empirical types, contribution types research topic and the condition studied in the paper.
Results:
Altogether, our search resulted in 208 papers which were analysed by a multidisciplinary group of researchers. Our results indicate a slow start for Connected Health research but a more recent steady upswing since 2013. The majority of papers proposed healthcare solutions (37%) or evaluated Connected Health approaches (23%). Case studies (28%) and experiments (26%) were the most popular forms of scientific validation employed. Diabetes, cancer, multiple sclerosis, and heart conditions are among the most prevalent conditions studied.
Conclusions:
We conclude that Connected Health research seems to be an established field of research, which has been growing strongly during the last five years. There seems to be more focus on technology driven research with a strong contribution from medicine, but business aspects of Connected health are not as much studied.
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