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Biomedical subjects

Sandra Potthoff

Publications and source records attributed to Sandra Potthoff.

6 recordsLinked to original sources
PubMed2006

Home telehealth improves clinical outcomes at lower cost for home healthcare.

Patient outcomes and cost were compared when home healthcare was delivered by telemedicine or by traditional means for patients receiving skilled nursing care at home. A randomized controlled trial was established using three groups. The first group, control group C, received traditional skilled nursing care at home. The second group, video intervention group V, received traditional skilled nursing care at home and virtual visits using videoconferencing technology. The third group, monitoring intervention group M, received traditional skilled nursing care at home, virtual visits using videoconferencing technology, and physiologic monitoring for their underlying chronic condition. Discharge to a higher level of care (hospital, nursing home) within 6 months of study participation was 42% for C subjects, 21% for V subjects, and 15% for M subjects. There was no difference in mortality between the groups. Morbidity, as evaluated by changes in the knowledge, behavior and status scales of the Omaha Assessment Tool, showed no differences between groups except for increased scores for activities of daily living at study discharge in the V and M groups. The average visit costs were $48.27 for face-to-face home visits, $22.11 for average virtual visits (video group), and $32.06 and $38.62 for average monitoring group visits for congestive heart failure and chronic obstructive pulmonary disease subjects, respectively. This study has demonstrated that virtual visits between a skilled home healthcare nurse and chronically ill patients at home can improve patient outcome at lower cost than traditional skilled face-to-face home healthcare visits.

Community Health Nursing↗
PubMed2004

Telehomecare: quality, perception, satisfaction.

The aim of this study was to demonstrate that telehomecare linking homebound patients with their home health-care nurses over the plain old telephone system (POTS) provides high-quality, clinically useful, and patient satisfactory interactions. Congestive heart failure, chronic obstructive pulmonary disease, and chronic wound-care patients receiving skilled home nursing care were randomized into control (standard home health care, HHC) and two intervention (standard care plus video conferencing/Internet access; the above plus physiological monitoring) groups. Virtual visits (VVs), consisting of two-way audio and video interactions between the central site HHC nurse and the subject at home, were compared for technical quality and clinical usefulness by the HHC nurses who performed the VVs. Subject perception of telehomecare and satisfaction with their HHC were assessed over the course of the project. There were a total of 567 virtual and 1,057 actual visits conducted for the 53 subjects completing the study. The technical quality of VVs were rated at 94.7%. They were considered to be as useful as actual visits in 90.7% of cases. Subject telehomecare perception increased after experiencing the process. All subjects were satisfied with their HHC; satisfaction increased with an increasing level of telehomecare intervention. Subjects receiving physiological monitoring and video conferencing/Internet access in addition to standard care were most satisfied with their care. VVs can be conducted over POTS. Patients can use telehomecare with moderate levels of training. These programs can provide timely and quality home health nursing care with VVs augmenting traditional home visits.

Aged↗
PubMed2004

The effect of alcoholism treatment on medical care use.

OBJECTIVE: The objective of this study was to assess changes in outpatient and inpatient medical care utilization associated with outpatient and inpatient treatment of alcohol abuse by comparing alcoholics who engaged in treatment to alcoholics who presented for, but did not engage in, treatment. RESEARCH DESIGN: Claims and encounter data of 29,122 adults receiving benefits from both a behavioral managed care company and its parent medical care insurance company who had a diagnosis of alcoholism were analyzed. The nontreated alcoholics in this sample (n = 13,133) were used for comparison and to control for historical time trend in medical utilization across the study years 1993-1999. A longitudinal over-dispersed Poisson regression model was fit by the generalized estimating equation method to compare differences in medical utilization before and after outpatient and inpatient alcoholism treatment. RESULTS: The pattern of medical utilization before and after alcoholism treatment appears basically symmetric. There is a gradual increase, which accelerates in the year before treatment and then falls off rapidly for the first year after treatment and then falls more gradually. Such a pattern does not suggest any net savings over time. The area under the curve before treatment is basically equivalent to that after treatment. Slopes of medical utilization for both treatment groups before 1 year before treatment were statistically similar to the control groups, but during 1 year before treatment, both treatment groups' outpatient utilization increased 1.25% and inpatient utilization increased 1.8% relative to the nontreated group. The slopes posttreatment showed differential effects over time of inpatient versus outpatient alcoholism treatment on inpatient and outpatient medical utilization. CONCLUSIONS: Although a clear increase in medical utilization before treatment and a decrease in utilization after treatment was found, it is not clear if the change is linked to changes in the status of the individuals as they prepare to enter alcoholism treatment or if there is a real causal effect of the alcoholism treatment.

Adult↗
PubMed2004

Isolating the effect of alcoholism treatment on medical care use.

OBJECTIVE: This study seeks to refine the analysis of the effects of alcoholism treatment on subsequent use of medical care by examining components of the latter. METHOD: Claims and encounter data of 29,122 adults (mean age 40, 35% female) receiving benefits from both a mental health managed care program and its parent medical care insurance company who had a diagnosis of alcoholism were analyzed using a longitudinal Poisson regression model fit by the generalized estimating equation method to compare differences between the groups in medical utilization before and after alcoholism treatment. The diagnoses associated with medical care were assigned to one of four groups: alcohol specific, alcohol acute, alcohol chronic and nonalcohol related. All persons applying for alcoholism treatment benefits were included; those who had fewer than four visits for alcoholism treatment served as controls. RESULTS: The largest effect of alcoholism treatment is seen for medical encounters associated with diagnoses that reflect the acute effects of intoxication. The frequency of encounters related to conditions associated with chronic alcohol misuse were the only type that did not significantly decline 1 year past treatment in the outpatient treatment group. CONCLUSIONS: This study provides support for the belief that treatment for alcoholism is directly associated with a change in medical care use. However, the findings suggest that the impact on utilization varies with the type of medical care. The most pronounced effects appear to be for acute problems that may be most directly attributed to the effects of active drinking. Changes in medical utilization in this area, therefore, may be responsible for the cost-offset of alcoholism treatment that has been observed in prior research.

Adult↗
PubMedDate not supplied

Performance metrics for advanced access.

Advanced access is an outpatient scheduling technique that aims to provide sameday appointment access. It is designed to reduce the time patients must wait for a scheduled appointment and to improve continuity of care by matching daily appointment supply and demand. Factors that make it difficult to sustain initial success in achieving supply-demand balance include different practice styles of doctors, differences in panel compositions and patient preferences, and time-varying demand patterns. This article proposes several performance measures that can help clinic directors monitor and evaluate their advanced access implementation. We also discuss strategies for sustaining advanced access in the long run.

Adolescent↗