OB Nest: Reimagining Low-Risk Prenatal Care.

Using a human-centered design method, our team sought to envision a new model of care for women experiencing low-risk pregnancy. This model, called OB Nest, aimed to demedicalize the experience of pregnancy by providing a supportive and empowering experience that fits within patients' daily lives. To explore this topic, we invited women to use self-monitoring tools, a text-based smartphone application to communicate with their care team, and moderated online communities to connect with other pregnant women. Through observations of tool use and patient- and care team-provided feedback, we found that self-measurement and access to a fetal heart monitor provided women with confidence and joy in the progress of their pregnancies while shifting their position to being an active participant in their care. The smartphone application gave women direct access to their care team, provided continuity, and removed hurdles in establishing communication. The online community platform was a space where women in the same obstetric clinic could share nonmedical questions and advice with one another. This created a sense of community, leveraged the knowledge of women, and provided a venue beyond the clinic visit for information exchange. These findings were integrated into the design of the Mayo Clinic OB Nest model. This model redistributes care based on the individual needs of patients by providing self-measurement tools and continuous flexible access to their care team. By enabling women to meaningfully participate in their care, there is potential for cost savings and improved patient satisfaction.

A Survey of Perceptions and Acceptance of Wearable Technology for Health Monitoring in a Urological Patient Population.

INTRODUCTION: Through real-time monitoring of biophysical parameters, physical activity monitors may represent a medium by which urologists can actively engage patients and improve treatment outcomes. We examined patient reported acceptance of physical activity monitor technology in an ambulatory urology setting. METHODS: Patients treated at a single urology department during a 6-month period were identified. A web based survey was conducted evaluating patient characteristics and acceptance of physical activity monitors. RESULTS: A total of 1,043 (19%) patients completed the survey, of whom 210 (20%) reported using physical activity monitors for health and wellness. Overall 854 (82%) respondents were willing to use these devices for urological care. Compared to patients who disagreed, those willing to use physical activity monitors for medical care reported greater perceived medical benefit (86% vs 14%), improved communication (85% vs 26%), confidentiality (89% vs 45%), less interference with daily activity (4% vs 55%) and improved health (81% vs 13%, all p <0.0001). Benefits and usefulness among accepting patients included health monitoring convenience (82%), goal related feedback (82%), ease of communication (57%) and monitoring of post-procedure recovery (56%). After controlling for associated patient characteristics, the degree of perceived burden, medical benefit, health improvement and enhancement in communication were modifiable, and independently associated with physical activity monitor acceptance. CONCLUSIONS: There is a high level of acceptance for wearable technology among urology patients. This may have significant implications for improving patient engagement, perioperative care pathways and surgical outcomes. Finally, these findings may assist urologists in directing future efforts to clinically integrate physical activity monitors to enhance patient acceptance and potential outcomes.

Efficiency, satisfaction, and costs for remote video visits following radical prostatectomy: a randomized controlled trial.

BACKGROUND: Telemedicine in an ambulatory surgical population remains incompletely evaluated. OBJECTIVE: To investigate patient encounters in the outpatient setting using video visit (VV) technology compared to traditional office visits (OVs). DESIGN, SETTING, AND PARTICIPANTS: From June 2013 to March 2014, 55 prescreened men with a history of prostate cancer were prospectively randomized. VVs, with the patient at home or at work, were included in the outpatient clinic calendar of urologists. INTERVENTION: Remote VV versus traditional OV. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: An equivalence analysis was used to assess the primary outcome, visit efficiency as measured by time studies. Secondary outcomes were patient/provider satisfaction and costs. RESULTS AND LIMITATIONS: There were 28 VVs and 27 OVs. VVs were equivalent in efficiency to relative to OVs, as measured by patient-provider face time (mean 14.5 vs 14.3min; p=0.96), patient wait time (18.4 vs 13.0min; p=0.20), and total time devoted to care (17.9 vs 17.8min; p=0.97). There were no significant differences in patient perception of visit confidentiality, efficiency, education quality, or overall satisfaction. VVs incurred lower costs, including distance traveled (median 0 vs 95 miles), travel time (0 vs 95min), missed work (0 vs 1 d), and money spent on travel ($0 vs $48; all p<0.0001). There was a high level of urologist satisfaction for both VVs (88%) and OVs (90%). The major limitation was sample size. CONCLUSIONS: VV in the ambulatory postprostatectomy setting may have a future role in health care delivery models. We found equivalent efficiency, similar satisfaction, but significantly reduced patient costs for VV compared to OV. Further prospective analyses are warranted. PATIENT SUMMARY: Among men with surgically treated prostate cancer, we evaluated the utility of remote video visits compared to office visits for outpatient consultation with a urologist. Video visits were associated with equivalent efficiency, similar satisfaction, and significantly lower patient costs when compared to office visits. We conclude that video visits may have a future role in health care delivery models.

Are Patients Willing to Engage in Telemedicine for Their Care: A Survey of Preuse Perceptions and Acceptance of Remote Video Visits in a Urological Patient Population.

OBJECTIVE: To examine patient preuse acceptance and perceptions of video visit (VV) technology within an ambulatory urology setting. METHODS: Patients treated by a single urology department from January to June 2013 were identified. A Web-based survey was conducted evaluating patient demographics, preuse perceptions, and acceptance of VV. RESULTS: In total, 1378 patients (25%) completed the survey; of which 868 (63%) were willing to participate in VV for their urologic care. Compared with patients "unlikely," those "likely" to participate in VV were younger (62 vs 65 years), had a college education (77% vs 65%), had previous exposure to videoconference technology (57% vs 38%), were more comfortable discussing new symptoms (56% vs 30%) and sensitive information (48% vs 27%), and played an active role in their healthcare (65% vs 54%). Moreover, patients willing to participate in VV traveled larger distances (>90 minutes; 69% vs 58%), missed more work (>1 day; 39% vs 29%), and incurred greater expenses for their care (>$250; 52% vs 25%) relative to those who were unlikely. After controlling for associated patient characteristics, a high level of agreement among urology-specific questions remained independently associated with greater likelihood of VV acceptance among both male and female patients. CONCLUSION: A large proportion of patients are willing to participate in VV for their urologic care. This may have significant implications by reducing costs and increasing access to, and quality of, health care services. These findings may assist urologists in strategically directing future efforts to reach diverse patient populations via VV technology.

Perceptions of video-based appointments from the patient's home: a patient survey.

BACKGROUND: We examined patient interest in a telehealth model in which the patient supplies the hardware and Internet connectivity to meet with a healthcare provider from his or her home via video call (video appointment). We hoped to understand prospectively the desirability, feasibility, and viability from the patient perspective. MATERIALS AND METHODS: A phone survey was conducted of a random sample of patients who had been seen in the outpatient setting at a single institution. The sample was stratified by proximity to the local institution with oversampling for patients living outside a 120-mile radius. RESULTS: Out of 500 total patients, 301 patients responded, and 263 met the inclusion criteria. Of those 263 respondents, 38% indicated "very likely" to accept an invitation to see their provider via video, 28.1% "somewhat likely," and 33.8% "not at all likely." Of respondents, 75% have broadband, although only 36% reported having a Web camera. The primary factors affecting willingness to participate in a video appointment include comfort in setting up a video call, age, and distance participants would have traveled for an in-clinic appointment. CONCLUSIONS: Patient survey data indicate that most patients are likely to be accepting of telehealth care to the home using video call and that most have the required technology. Nevertheless, there are still significant hurdles to effectively implement this adaptation of telehealth care as part of mainstream practice.