Characterization of Telecare Conversations on Lifestyle Management and Their Relation to Health Care Utilization for Patients with Heart Failure: Mixed Methods Study

Telehealth interventions where providers offer support and coaching to patients with chronic conditions such as heart failure (HF) and type 2 diabetes mellitus (T2DM) are effective in improving health outcomes. However, the understanding of the content and structure of these interactions and how the...

Full description

Saved in:

Bibliographic Details
Published in:	Journal of medical Internet research Vol. 26; no. 17; p. e46983
Main Authors:	Erdt, Mojisola, Yusof, Sakinah Binte, Chai, Liquan, Md Salleh, Siti Umairah, Liu, Zhengyuan, Sarim, Halimah Binte, Lim, Geok Choo, Lim, Hazel, Suhaimi, Nur Farah Ain, Yulong, Lin, Guo, Yang, Ng, Angela, Ong, Sharon, Choo, Bryan Peide, Lee, Sheldon, Weiliang, Huang, Oh, Hong Choon, Wolters, Maria Klara, Chen, Nancy F, Krishnaswamy, Pavitra
Format:	Journal Article
Language:	English
Published:	Canada Journal of Medical Internet Research 30-10-2024 JMIR Publications
Subjects:	Aged Analysis Behavior modification Cardiac patients Care and treatment Communication Computational linguistics Diabetes Mellitus, Type 2 - therapy Female Health aspects Heart failure Heart Failure - therapy Humans Language processing Life Style Male Medical care Medical law Medical research Medicine, Experimental Methods Middle Aged Natural language interfaces Nurses Original Paper Patient Acceptance of Health Care - statistics & numerical data Patient compliance Self-care, Health Telemedicine Telemedicine - statistics & numerical data Type 2 diabetes Utilization Singapore lifestyle management health care utilization heart failure medical informatics chronic disease telehealth dialogue behavior self-management telecare conversation
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Telehealth interventions where providers offer support and coaching to patients with chronic conditions such as heart failure (HF) and type 2 diabetes mellitus (T2DM) are effective in improving health outcomes. However, the understanding of the content and structure of these interactions and how they relate to health care utilization remains incomplete. This study aimed to characterize the content and structure of telecare conversations on lifestyle management for patients with HF and investigate how these conversations relate to health care utilization. We leveraged real-world data from 50 patients with HF enrolled in a postdischarge telehealth program, with the primary intervention comprising a series of telephone calls from nurse telecarers over a 12-month period. For the full cohort, we transcribed 729 English-language calls and annotated conversation topics. For a subcohort (25 patients with both HF and T2DM), we annotated lifestyle management content with fine-grained dialogue acts describing typical conversational structures. For each patient, we identified calls with unusually high ratios of utterances on lifestyle management as lifestyle-focused calls. We further extracted structured data for inpatient admissions from 6 months before to 6 months after the intervention period. First, to understand conversational structures and content of lifestyle-focused calls, we compared the number of utterances, dialogue acts, and symptom attributes in lifestyle-focused calls to those in calls containing but not focused on lifestyle management. Second, to understand the perspectives of nurse telecarers on these calls, we conducted an expert evaluation where 2 nurse telecarers judged levels of concern and follow-up actions for lifestyle-focused and other calls (not focused on lifestyle management content). Finally, we assessed how the number of lifestyle-focused calls relates to the number of admissions, and to the average length of stay per admission. In comparative analyses, lifestyle-focused calls had significantly fewer utterances (P=.01) and more dialogue acts (P =.005) than calls containing but not focused on lifestyle management. Lifestyle-focused calls did not contain deeper discussions on clinical symptoms. These findings indicate that lifestyle-focused calls entail short, intense discussions with greater emphasis on understanding patient experience and coaching than on clinical content. In the expert evaluation, nurse telecarers identified 24.2% (29/120) of calls assessed as concerning enough for follow-up. For these 29 calls, nurse telecarers were more attuned to concerns about symptoms and vitals (19/29, 65.5%) than lifestyle management concerns (4/29, 13.8%). The number of lifestyle-focused calls a patient had was modestly (but not significantly) associated with a lower average length of stay for inpatient admissions (Spearman ρ=-0.30; P =.06), but not with the number of admissions (Spearman ρ=-0.03; P =.84). Our approach and findings offer novel perspectives on the content, structure, and clinical associations of telehealth conversations on lifestyle management for patients with HF. Hence, our study could inform ways to enhance telehealth programs for self-care management in chronic conditions.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1438-8871 1439-4456 1438-8871
DOI:	10.2196/46983