June 24, 2013
By Toni Cardarella
|Carol Smith (r), with team members Brad O’Bryhim and Noreen Thompson|
Patients who suffer from severe digestive disorders can receive life-sustaining nutrition directly into their bloodstream at home, with an intravenous blood infusion therapy called home parenteral nutrition (HPN). However, the treatment can have complications, including blood stream infections. About one-third of the patients who get infections die.
A new telemedicine study led by University of Kansas School of Nursing researcher Carol Smith is investigating how iPad technology can be used to reduce intravenous blood stream infections and help improve the lives for these patients as well as the family members who care for them at home.
With an iPad in each study household, patients who receive HPN and their caregivers will have more real-time access to health care and expertise. The project, funded through a $1.3 million grant from the National Institutes of Health (NIH), will use mobile technology to engage and empower patients and their families by connecting them to web-based healthcare clinics, peer support and a range of internet nursing educational and counseling resources.
Millions of dollars are spent annually on poor health associated with complex home-caregiving, and Smith says the NIH identified IV blood stream sepsis infections as one of the most costly but preventable diagnoses in home health care.
"We'll use the iPad, with its wireless internet and photo capabilities, to troubleshoot health care issues related to home parenteral nutrition," says Smith, RN, Ph.D., FAAN. "For example, visual snapshots of the patients' IV catheter insertion sites have already provided early detection of skin and bloodstream infections, and other serious complications can also be monitored."
The mobile technology will mean patients and family members participating in the study can easily access website information about managing procedures and equipment of the complex technology at home as well as signs and symptoms of deteriorating conditions. Through the iPads, patients will have access to internet-based step-by-step home-caregiving procedures and videos illustrating home-care IV procedures.
"These patients and their families are dealing every day with the physical, emotional and financial issues that come with the complex home management of life-long daily IV infusions," says Smith, whose extensive research career has focused on home health patients with chronic illnesses. "We want to see if this technology can help in other ways as well."
The project will examine how mobile technology can assist with quality of life issues associated with HPN patients and their families, such as depression, fatigue and financial distress.
The iPads will connect family and patients with peer support, which has been shown to improve patients' and caregivers' sense of social support, in part by reducing the isolation caused by managing HPN. The study will use KU Medical Center's bridge technology for simultaneous visual interactions among patients, family members, peers and multiple professionals, via the iPad.
In between the web-based clinic visits, patients and family members will have online access to nursing guidance specific to this study, and to professionals and other participants in the study.
About 80 patients who are receiving HPN are part of the study, with the first group of 20 households receiving their iPads this summer. Each group will keep the iPads for eight months, then the smart device will be returned to Smith and her team, reconfigured and repackaged for the next 20 or so households participating in the research.
The project team includes Ryan Spaulding, Ph.D., co-investigator on the study and director of the Center of Telemedicine & Telehealth at KU Medical Center.
According to Spaulding, the iPad study marks an exciting emerging area for telemedicine research.
"Mobile health, or mHealth, is the fastest growing area of health technology," he says. "It's when mobile communications devices, such as mobile phones or tablet computers, are used to support the practice of medicine and public health. But this study is a first for us and definitely among the first in the country, to use a smart device in clinical outcomes research."
Typically, the focus of telemedicine research is on the method of delivering health care through electronic communications, not individual patient outcomes and a specific population.
"In telemedicine, it's hard to put a clinical outcomes study together," Spaulding says. "Carol Smith is already in front with her past telemedicine research, and now she's jumped ahead on the use of emerging technology."
The study was supported by the National Institutes of Health grant R01 EB015911. Trail Blazer award #UL1TR000001 from Frontiers: The Heartland Institute for Clinical and Translational Research helped fund the purchase of iPads for the study.