Development of Health-RESPECT: An Integrated Service Model for Older Long-Term Care Hospital/Nursing Home Patients Using Information and Communication Technology.

BACKGROUND: Korea, as one of the fastest-aging countries worldwide, requires an improved healthcare service model for older adults. We evaluated the current healthcare system and developed a service model based on information and communication technologies (ICT) for use in older patients in long-term care facilities (LTCF). METHODS: We conducted a qualitative literature review, focus group interviews (FGIs), and structured survey to identify the current technology use and status of healthcare systems. We then developed a web-based platform with necessary, high-priority, and usable content for the care of older patients in LTCF. RESULTS: We reviewed 60 (23 hypertension, 18 diabetes, and 19 heart failure) articles on information and communication technologies (ICT)-based disease management for clinical effectiveness and improved patient satisfaction. FGIs and structured surveys were used to evaluate the inconvenience in patient and medical information transfer between hospitals and cost and time required for its process. Accordingly, we confirmed the unmet need for an ICT-based service model for management, monitoring, and consultation among older patients and developed the Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT), a service platform for older patients residing in LTCF. The medical information exchange system was used to transfer medical information. Health-RESPECT includes an established algorithm for evidence-based comprehensive geriatric assessment and customized management; chronic disease management; management of potentially inappropriate medications; rehabilitation; and consultation and videoconferencing. CONCLUSION: This study identified the current status and unmet needs of healthcare systems for older adults. We developed an ICT-based system to manage older institutionalized patients. However, the Health-RESPECT service model requires further validation.

Factors Influencing Acceptance of Personal Health Record Apps for Workplace Health Promotion: Cross-Sectional Questionnaire Study.

BACKGROUND: Health care technologies can help improve workers' health and productivity by supporting workplace health promotion. A personal health record app is used to manage medical data such as results from medical checkups, which facilitates decision making for medical personnel. However, an analysis of users' technology acceptance is required to provide appropriate services based on personal health record apps. OBJECTIVE: The purpose of this study was to analyze the factors influencing the behavioral intention of health experts and workers to use an app in workers' health centers and to examine differences in their perception of the main variables. METHODS: The study involved health experts and workers who visited 21 workers' health centers in Korea to verify a research model in which perceived risk was added to the unified theory of acceptance and use of technology, a representative theory of information technology acceptance. After receiving ethical approval from the Korea National Institute for Bioethics Policy, 1050 questionnaires were distributed over 7 weeks with cooperation of the Korea Occupational Safety and Health Agency. A multiple linear regression analysis and multigroup path analysis were performed to verify the hypotheses, and independent samples t tests were performed to analyze differences between workers' and health experts' perception of the main variables. RESULTS: The analysis included data from 866 respondents (687 workers and 179 health experts). Effort expectancy (beta=.08, P=.03), social influence (beta=.43, P<.001), performance expectancy (beta=.07, P=.008), and facilitating conditions (beta=.13, P<.001) exerted significant positive effects on behavioral intention, whereas perceived risk (beta=-.29, P<.001) exerted a significant negative effect on behavioral intention. Performance expectancy had a significant effect on path differences depending on gender (critical ratio=-3.38) and age (critical ratio=1.97). Workers' mean scores for the main variables were higher relative to those of health experts for all remaining variables except perceived risk, and significant differences were observed for all remaining variables except facilitating condition. CONCLUSIONS: Social influence exerted the strongest effect on behavioral intention to use the personal health record app. Consequently, it is necessary to coordinate health promotion activities in the workplace as well as the operational direction of community institutions such as in workers' health centers to allow workers to manage their own health via continuous use of the app. In addition, the app should be developed based on a requirement analysis of the balance between both interest groups in consideration of differences in perspective between consumers and service providers.

Association between Hand Grip Strength and Self-Rated Health in Middle- and Old-Aged Korean Citizens.

BACKGROUND: To investigate the relationship between hand grip strength (HGS) and self-rated health in middleand old-aged Korean subjects. METHODS: The data used for this study were derived from the Korean Longitudinal Study of Aging. A total of 9,132 participants were enrolled using the year 2006 as the baseline, with additional data collected throughout the followup period until 2016. Chi-square test and generalized estimating equation regression models were used for data analysis. HGS was measured in a sitting position with the elbow fixed at 90° on both sides using a dynamometer, and calculated using the values measured from both sides. Relative HGS was measured by dividing HGS by the subject's body mass index. Self-rated health was assessed with the question "How would you rate your current health in general?" and answers were categorized as "excellent," "moderate," or "poor." RESULTS: HGS was shown to be inversely associated with self-rated health (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.93-0.94; P<0.0001). Patients aged 65 years or older with lower scores were more likely to report poor self-rated health. Similar results were obtained with relative HGS (OR, 0.40; 95% CI, 0.36-0.45; P<0.0001), but standard HGS had better model fitting (quasi-likelihood under independence model criteria=33,890). CONCLUSION: HGS may be considered an index for the diagnosis of sarcopenia and may also affect self-rated health, which is a multidimensional indicator of an individual's health status and can identify patients who may require special attention.

Effect of relative handgrip strength on cardiovascular disease among Korean adults aged 45 years and older: Results from the Korean Longitudinal Study of Aging (2006-2016).

BACKGROUND: Aging causes both structural and functional changes in the skeletal muscle, and is associated with changes in body composition form, which results in an increased incidence of cardiovascular death. Handgrip strength (HGS) is a simple, fast, reliable, and cost-effective tool for measuring muscle strength. OBJECTIVE: We aimed to investigate which index was most suitable for predicting cardiovascular disease (CVD), and suggested the optimal cut-off points based on the handgrip strength index. In addition, we aimed to identify the effects of weak HGS, as determined by applying the optimal cut point on the occurrence of CVD. METHOD: A total of 8494 older men and women aged over 45 years from the Korean Longitudinal Study of Aging (KLoSA) were included in this study at baseline. We performed general estimating equations (GEE) with independent correlation structure to assess whether handgrip strength is longitudinally related to occurrence of CVDs such as heart disease or stroke reported from 1 st to 6th wave of KLoSA. RESULTS: The relative HGS was strongly associated with CVD in both sexes, and the best fit model was in that in comparison to dominant HGS and absolute HGS. In addition, we calculated the optimal cut point for CVD based on the relative HGS in this study (men: 2.52 and women: 1.55, respectively), and demonstrated that low HGS, as determined by applying relative HGS cut points, was associated with a higher OR for CVD compared to normal HGS; the associations observed were consistent between the sexes. CONCLUSIONS: Our findings suggest that HGS has the potential to be a valuable screening tool for cardiovascular risk in clinical settings; this is advantageous in situations where blood sampling is not possible since HGS is easily measured and highly reproducible. It is necessary to pay attention to weak grip strength against body size in the elderly population.

Developing a mobile epilepsy management application integrated with an electronic health record for effective seizure management.

INTRODUCTION: Epilepsy is a chronic neurological disorder characterized by recurrent spontaneous seizures. Over 70% epilepsy patients can live normally if their seizures can be controlled. For this, many factors should be tracked and managed, but doing so is hard because of individual differences. There are mobile applications to help track these factors; however, no application covers crucial factors comprehensively, and they are complicated to use. Therefore, this study aimed to develop a mobile epilepsy management application covering crucial factors comprehensively in a user-friendly way. We evaluated the pilot version with a usability and satisfaction survey and an interview. METHODS: We established a task force comprising professionals from various fields who participated in all processes of this research. Existing service analysis and professional interviews were conducted to draw a function list. User interface and graphic user interface were designed under the supervision of the task force. After developing the application's pilot version, usability and satisfaction of the application were evaluated with eight patients and caregivers through scenario-based usability test, satisfaction survey, and interview. RESULTS: All existing mobile epilepsy management applications provide seizure and medication diary functions. We decided to provide six main functions: seizure diary, medication reminder, appointments, outpatient survey, education materials, and personal dashboard (My epilepsy). We also integrated the application with the hospital's electronic health record system. To simplify usability, frequently used and relatively important functions are located in the main page as "seizure recording" and "medication diary." Additionally, when designing graphics, art therapy was used to enhance psychological stability. For evaluation, eight participants were recruited. In scenario-based tasks, among 10 tasks, all participants completed six tasks. However, only 37.5% participants could record seizures in detail. System Usability Scale score was 84.5 points, indicating that the system was satisfactory. CONCLUSION: This study confirmed that patients' satisfaction of this application were high. Additionally, it helped them record their seizures accurately, which is very useful for seizure trend analysis, discovering seizure trigger factors, and ensuring efficient management of epilepsy. Through integration with the electronic health record, patient medical information could be utilized to guide physicians' decision-making for setting future medical treatment plan and could contribute greatly to the overall management of epilepsy.