An innovative capstone health care informatics clinical residency: Interprofessional team collaboration.

Integrated information systems and wireless technology have been increasingly incorporated into health care organizations with the premise that information technology will promote safe, high-quality, cost-effective patient care. With the advancement of technology, the level of expertise necessary to assume health care information technology roles has escalated. The purpose of this article is to describe a clinical residency project whereby students in a graduate degree health care informatics program successfully fulfilled program competencies through a faculty-lead research project focused on the use of home telehealth with a group of heart failure patients. Through the use of Donabedian's framework of structure, process, and outcomes, the health care informatics students completed essential learning activities deemed essential for transition into the role of an informatics specialist. Health care informatics educational leaders are encouraged to adapt this template of applied learning into their practices.

Home telehealth and hospital readmissions: a retrospective OASIS-C data analysis.

Technology holds potential to improve the quality of healthcare delivery. The use of remote patient monitoring, or telehealth (TH), has been widely adopted by many home care agencies to facilitate early identification of disease exacerbation, particularly for patients with chronic diseases such as heart failure. TH has been successfully used to improve symptom detection and potentially reduce rehospitalization rates. Quantifying program effectiveness through data analysis is a critical step for program improvement, resource allocation, and future strategic planning. Using the Outcome and Assessment Information Set-C database, a retrospective analysis was conducted examining 22 months of heart failure patient data from one home care agency in southern California. Seventy patients receiving TH were compared to patients who received usual home care nursing services. No major differences in baseline socio-demographics were found between the 2 groups. While receiving home healthcare services, the non-TH patients had a 21% all-cause hospital readmission rate, compared to the home TH patients with a 10% all-cause readmission rate. Statistical differences were found between groups on the variables of fall risk, vision, smoking, shortness of breath, the ability to bathe and take oral meds, along with having been discharged from a skilled nursing facility in the last 2 weeks. These results indicate that aggregate data analysis is useful in providing insight into program effectiveness. This study suggests TH programs have the potential to reduce the burden associated with rehospitalizations in the heart failure population.

Interest in information about urinary incontinence among diabetic and nondiabetic heart failure patients.

PURPOSE: Diabetes mellitus (DM) and urinary incontinence (UI) are often prevalent in heart failure (HF) patients, rendering nursing management even more complex. The purpose of this study was to determine if differences existed between diabetic and nondiabetic HF patients regarding their interest in information about UI. DESIGN: Secondary analyses were conducted on survey and medical record data from 182 (97 hospitalized and 85 clinic) HF patients. All had reported UI at least once monthly. SUBJECTS AND SETTING: One hundred eighty-two patients with HF participated in the study; 97 were recruited while in hospital and 85 were recruited from a clinic setting. There were an equal number of participants with DM when compared to subjects without DM (n=91). The majority of subjects were white (64%), female (56%), and most perceived their health as fair to poor (74%). RESULTS: Eighty-three percent (N=151) had not asked for more UI information, while 64% indicated interest in learning more about UI. Using the transtheoretical model, participants with DM were more likely to be in the contemplation stage for behavioral change than those who did not have DM (79% vs 59%, P=.004). CONCLUSION: Few HF patients with UI (17%) had previously asked for more information about incontinence, but more than two-thirds (69%) indicated interest in learning more about UI. HF patients with DM were more likely to be in the contemplation stage for behavioral change related to UI than those without DM.

Improving glycemic control in older adults using a videophone motivational diabetes self-management intervention.

Older adults experience the greatest burden of diabetes. Resources must be available and accessible to empower older adults to perform diabetes self-care. The purpose of this study was to evaluate a videophone motivational interviewing (MI) diabetes self-management education (DSME) intervention to improve glycemic control of rural older adults. Sixty-six participants (mean age = 64.9 years, range 60-81) with uncontrolled diabetes were enrolled in a 6-month videophone intervention. Experimental group participants (n = 34) received weekly, then monthly, videophone MI DSME calls, whereas control participants (n = 32) received monthly videophone healthy-lifestyle education calls. Although both groups experienced a decreased HbA1c, there was a statistically significant difference in experimental group mean values (p = .015), but not the control group (p = .086). The experimental group demonstrated statistically significant increases in diabetes knowledge (p = .023) and diabetes self-efficacy (p = .002). Experimental group participants with high self-efficacy in contrast to low self-efficacy had a statistically significant decrease in HbA1c (p = .043).