Dataset Information

Use of a Medical-Alert Accessory in CKD: A Pilot Study.

ABSTRACT: BACKGROUND AND OBJECTIVES:Poor disease recognition may jeopardize the safety of CKD care. We examined safety events and outcomes in patients with CKD piloting a medical-alert accessory intended to improve disease recognition and an observational subcohort from the same population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:We recruited 350 patients with stage 2-5 predialysis CKD. The first (pilot) 108 participants were given a medical-alert accessory (bracelet or necklace) indicating the diagnosis of CKD and displaying a website with safe CKD practices. The subsequent (observation) subcohort (n=242) received usual care. All participants underwent annual visits with ascertainment of patient-reported events (class 1) and actionable safety findings (class 2). Secondary outcomes included 50% GFR reduction, ESKD, and death. Cox proportional hazards assessed the association of the medical-alert accessory with outcomes. RESULTS:Median follow-up of pilot and observation subcohorts were 52 (interquartile range, 44-63) and 37 (interquartile range, 27-47) months, respectively. The frequency of class 1 and class 2 safety events reported at annual visits was not different in the pilot versus observation group, with 108.7 and 100.6 events per 100 patient-visits (P=0.13), and 38.3 events and 41.2 events per 100 patient visits (P=0.23), respectively. The medical-alert accessory was associated with lower crude and adjusted rate of ESKD versus the observation group (hazard ratio, 0.42; 95% confidence interval, 0.20 to 0.89; and hazard ratio, 0.38; 95% confidence interval, 0.16 to 0.94, respectively). The association of the medical-alert accessory with the composite endpoint of ESKD or 50% reduction GFR was variable over time but appeared to have an early benefit (up to 23 months) with its use. There was no significant difference in incidence of hospitalization, death, or a composite of all outcomes between medical-alert accessory users and the observational group. CONCLUSIONS:The medical-alert accessory was not associated with incidence of safety events but was associated with a lower rate of ESKD relative to usual care.

SUBMITTER: Farhy E

PROVIDER: S-EPMC6625620 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Use of a Medical-Alert Accessory in CKD: A Pilot Study.

Farhy Eli E Diamantidis Clarissa Jonas CJ Doerfler Rebecca M RM Fink Wanda J WJ Zhan Min M Fink Jeffrey C JC

Clinical journal of the American Society of Nephrology : CJASN 20190606 7

<h4>Background and objectives</h4>Poor disease recognition may jeopardize the safety of CKD care. We examined safety events and outcomes in patients with CKD piloting a medical-alert accessory intended to improve disease recognition and an observational subcohort from the same population.<h4>Design, setting, participants, & measurements</h4>We recruited 350 patients with stage 2-5 predialysis CKD. The first (pilot) 108 participants were given a medical-alert accessory (bracelet or necklace) indi ...[more]

PMID: 31171589

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Project description:BackgroundPrior literature suggests that alert dismissal could be linked to physicians' habits and automaticity. The evidence for this perspective has been mainly observational data. This study uses log data from an electronic medical records system to empirically validate this perspective.ObjectiveWe seek to quantify the association between habit and alert dismissal in physicians.MethodsWe conducted a retrospective analysis using the log data comprising 66,049 alerts generated from hospitalized patients in a hospital from March 2017 to December 2018. We analyzed 1152 physicians exposed to a specific clinical support alert triggered in a hospital's electronic medical record system to estimate the extent to which the physicians' habit strength, which had been developed from habitual learning, impacted their propensity toward alert dismissal. We further examined the association between a physician's habit strength and their subsequent incidences of alert dismissal. Additionally, we recorded the time taken by the physician to respond to the alert and collected data on other clinical and environmental factors related to the alerts as covariates for the analysis.ResultsWe found that a physician's prior dismissal of alerts leads to their increased habit strength to dismiss alerts. Furthermore, a physician's habit strength to dismiss alerts was found to be positively associated with incidences of subsequent alert dismissals after their initial alert dismissal. Alert dismissal due to habitual learning was also found to be pervasive across all physician ranks, from junior interns to senior attending specialists. Further, the dismissal of alerts had been observed to typically occur after a very short processing time. Our study found that 72.5% of alerts were dismissed in under 3 seconds after the alert appeared, and 13.2% of all alerts were dismissed in under 1 second after the alert appeared. We found empirical support that habitual dismissal is one of the key factors associated with alert dismissal. We also found that habitual dismissal of alerts is self-reinforcing, which suggests significant challenges in disrupting or changing alert dismissal habits once they are formed.ConclusionsHabitual tendencies are associated with the dismissal of alerts. This relationship is pervasive across all levels of physician rank and experience, and the effect is self-reinforcing.

Project description:BackgroundWearable technology for fall alerts among older adult care recipients is one of the more frequently studied areas of technology, given the concerning consequences of falls among this population. Falls are quite prevalent in later life. While there is a growing amount of literature on older adults' acceptance of technology, less is known about how caregivers' attitudes toward technology can impact care recipients' use of such technology.ObjectiveThe objective of our study was to examine associations between caregivers' attitudes toward technology for caregiving and care recipients' use of fall alert wearables.MethodsThis study examined data collected with an online survey from 626 caregivers for adults 50 years and older. Adapted from the technology acceptance model, a structural equation model tested the following prespecified hypotheses: (1) higher perceived usefulness of technologies for caregiving would predict higher perceived value of and greater interest in technologies for caregiving; (2) higher perceived value of technologies for caregiving would predict greater interest in technologies for caregiving; and (3) greater interest in technologies for caregiving would predict greater use of fall alert wearables among care recipients. Additionally, we included demographic factors (eg, caregivers' and care recipients' ages) and caregiving context (eg, caregiver type and caregiving situation) as important predictors of care recipients' use of fall alert wearables.ResultsOf 626 total respondents, 548 (87.5%) with all valid responses were included in this study. Among care recipients, 28% used fall alert wearables. The final model had a good to fair model fit: a confirmatory factor index of 0.93, a standardized root mean square residual of 0.049, and root mean square error of approximation of 0.066. Caregivers' perceived usefulness of technology was positively associated with their attitudes toward using technology in caregiving (b=.70, P<.001) and interest in using technology for caregiving (b=.22, P=.003). Greater perceived value of using technology in caregiving predicted greater interest in using technology for caregiving (b=.65, P<.001). Greater interest in using technology for caregiving was associated with greater likelihood of care recipients using fall alert wearables (b=.27, P<.001). The caregiver type had the strongest inverse relationship with care recipients' use of fall alert wearables (unpaid vs paid caregiver) (b=-.33, P<.001).ConclusionsThis study underscores the importance of caregivers' attitudes in care recipients' technology use for falls management. Raising awareness and improving perception about technologies for caregiving may help caregivers and care recipients adopt and better utilize technologies that can promote independence and enhance safety.

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Dataset Information

Use of a Medical-Alert Accessory in CKD: A Pilot Study.

Publications

Use of a Medical-Alert Accessory in CKD: A Pilot Study.

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