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Improving Chronic Care Management: Post-stroke Management and Education Using the Smartphone

Improving Chronic Care Management: Post-stroke Management and Education Using the Smartphone. Presented by: Anthony Sterns, PhD Kent State University Co-authors: Greta Lax, Harvey L. Sterns, PhD The University of Akron Kyle Allen, DO, Sue Hazelett, RN, MS Summa Health System.

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Improving Chronic Care Management: Post-stroke Management and Education Using the Smartphone

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  1. Improving Chronic Care Management: Post-stroke Management and Education Using the Smartphone Presented by: Anthony Sterns, PhDKent State University Co-authors: Greta Lax, Harvey L. Sterns, PhD The University of Akron Kyle Allen, DO, Sue Hazelett, RN, MS Summa Health System

  2. Overview of the Technology • A complete SmartPhone-based data gathering system for • medication • physical • behavioral • and attitudinal data collection • The system consists of: • Web-based management • iPhone application • Pillbox Case • The system provides: • Surveying • Reminders • Activities • Tracking • Integration with EMR • Output for Analysis

  3. Overview • Environmental Press Model • User Centered Design • Theory of Empowerment • Application for Post-stroke • How we apply to stroke prevention program • Medication Adherence • Health Education • Monitoring • Design • Results • Questions

  4. User-centered design • Needs • Capabilities • Limitations • Environmental Press • (Lawton, 1991) Person Performance Place Mayhorn, C., & Sterns, A. (2006). Perfecting the Handheld Computer for Older Adults: From Cognitive Theory to Practical Application. Cognitive Technology, 12(1), 15-21.

  5. Bandura’s Theory of Empowerment Fear Does Not Change Behavior Efficacy Does or Belief in Ability to Control Behavior Lead to Behavior Change Behavior Change

  6. Medication Adherence • Poor adherence • Behavioral disease (Johnson and Bootman, 1995) • Correct adherence 26-59% (Malhotra et al., 2001) • 76% of patients errors in 3 months (Bedell et al., 2000) • ~50% of ER visits for 60+ year olds is non-adherence for CV meds (Chia, Schlenk, and Dunbar-Jacob, 2006) • Causes • 71% due to forgetfullness (Kidder, Park, Hertzog, and Morrell, 1997) • 33% fail to follow directions correctly • Scheduled appointments missed 20-50% (DiMetteo et al., 1993). Sterns, A. A. & Mayhorn, C. B. (2006). Persuasive pillboxes: Improving medication adherence with personal digital assistants. Y. de Kort and W. I. Jsselsteijn (Eds.), Persuasive Technologies, LNCS v. 3962, New York, NY: Springer Publishing

  7. Cognitive Prosthesis • Prospective memory support • Knowledge activation • Our previous research provides evidence of: • Improving medication adherence • Link between specialists • Feedback to better direct medication regimens. (Sterns, 2005; Sterns and Mayhorn, 2006)

  8. Why Stroke Recovery and Prevention • Primarily affects older adults • Stroke is challenging and expensive to treat • Is the leading cause of disability • Third leading cause of death in the U.S. (American Heart Assoc. [AMA], 2007; 2006)

  9. Post Stroke Management Care Model • Education – Understand risk factors • Maintenance of function • – ADLs, IADLs, exercise • Medication Appropriateness • Medication Adherence • Monitoring

  10. Post Stroke Management Care Model Education – Understand risk factors Maintenance of function – ADLs, IADLs, exercise Medication Appropriateness Medication Adherence Monitoring

  11. Experimental Design Post-test Use-Test Stroke Knowledge ADL/IADLs (@2-months) N=10 RandomAssignment Recruiting on Stroke Unit Pre-test Use-Test Stroke Knowledge Med Reconciliation ADL/IADLs N=10

  12. In Hospital Use Test • Talked through 18 Steps • Use all interface elements • Home button • Slide • Icon • + • Numbers • Screen slip • Cylinders • Letters Ranked: 3 – first try 2 – 2nd try 1 – with demo 0 – unable to do Sterns, A. A., Lax, G, Sterns, H., Allen, K, Hazelet, S., and Fosnight, S. (Nov., 2009). Improving Chronic Care Management: An iPhone Application for Post-Stroke Recovery. Part of a symposium on Technology presented at the 62nd annual meeting of the Gerontological Society of America, Atlanta, GA.

  13. Gain in Stroke Knowledge N=20

  14. Compliance • Education • 88% Compliance with 1-month curriculum • 94% Compliance if exclude outlier (100% nc) • 89% correct on education quizzes • Surveys • Mood (2x daily) – 61%, 72% excluding 2 outliers • Exercise (daily) – 54%, 63% excluding outlier • ADL/IADL (weekly) – 57%, 61% without outlier • Medication • 70% compliance with confirmation to alerts • 83% compliance if exclude outlier (100% nc)

  15. What’s Next • Multi-model Data • Behavioral • Motion (Exercise: Nike+) • Taking Medication (iRx Reminder) • Attitudinal • Mood Assessment (Anger, Depression, Happiness • Wellness (Stiffness, Pain) • Cognitive • Reaction Time Tests • Fluid Tests • Physical (Heart Rate, Skin Temperature) • Environmental (Location, Ambient Light, Temperature)

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