Browsing by Author "Shea, Steven"
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- ItemAmbulatory pulse pressure and progression of urinary albumin excretion in older patients with type 2 diabetes mellitus.(2006-07-21) Palmas, Walter; Moran, Andrew; Pickering, Thomas; Eimicke, Joseph P; Teresi, Jeanne; Schwartz, Joseph E; Field, Lesley; Weinstock, Ruth S; Shea, StevenWe studied whether ambulatory blood pressure monitoring added to office blood pressure in predicting progression of urine albumin excretion over 2 years of follow up in a multiethnic cohort of older people with type 2 diabetes mellitus Participants in the Informatics for Diabetes Education and Telemedicine study underwent a baseline evaluation that included office and 24 hour ambulatory blood pressure measurement and a spot urine measurement of albumin to creatinine ratio ACR Measurements of albumin to creatinine ratio were repeated 1 and 2 years later In bivariate analyses ambulatory 24 hour pulse pressure was the blood pressure variable most strongly associated with follow up ACR Repeated measures mixed linear models n 1040 were built adjusting for baseline ACR ratio clustered randomization time to follow up and multiple covariates When both were entered into the model ambulatory 24 hour pulse pressure and office pulse pressure were independently associated with follow up ACR beta SE 0 010 0 002 P Under 0 001 and 0 004 0 001 P 0 002 respectively Cox proportional hazards models examined associations with progression of albuminuria in 954 participants without macroalbuminuria at baseline adjusting for all of the covariates independently associated with follow up ACR in mixed linear models Ambulatory 24 hour pulse pressure but not office pulse pressure was independently associated with progression of albuminuria P 0 015 and 0 052 respectively The adjusted hazards ratio 95 CI per each 10 mm Hg increment in ambulatory pulse pressure was 1 23 1 04 to 1 42 In conclusion ambulatory pulse pressure may provide additional information to predict progression of albuminuria in elderly diabetic subjects above and beyond office blood pressure
- ItemArchitecture for remote training of home telemedicine patients.(2006-06-16) Lai, Albert M; Starren, Justin B; Shea, Steven; ,In spite of efforts to develop easy to use devices patients may require multiple training sessions to achieve mastery of advanced telehealth devices especially those incorporating web access In geographically distributed projects such repeat training can be costly A software architecture for simultaneous voice conferencing and remote device control over a single telephone line is presented Evaluation of the pilot implementation is favorable
- ItemA cognitive framework for understanding barriers to the productive use of a diabetes home telemedicine system.(2004-01-19) Kaufman, David R; Starren, Justin; Patel, Vimla L; Morin, Philip C; Hilliman, Charlyn; Pevzner, Jenia; Weinstock, Ruth S; Goland, Robin; Shea, StevenTelemedicine has the potential to transcend geographic and socio cultural barriers to the delivery of high quality health care to the medically underserved populations However there are significant cognitive and usability barriers This paper presents a multifaceted cognitive evaluation of the IDEATel diabetes education and telemedicine program The evaluation included a cognitive walkthrough analysis to characterize task complexity and identify potential problems as well as field usability testing in patients homes The study revealed dimensions of the interface that impeded optimal access to system resources In addition we found significant obstacles corresponding to perceptual motoric skills mental models of the system and health literacy The objective of this work is to contribute to a design framework so that participants with a wide range of skills can better manage their chronic illnesses
- ItemColumbia University's Informatics for Diabetes Education and Telemedicine (IDEATel) Project: rationale and design.(2001-12-25) Shea, Steven; Starren, Justin; Weinstock, Ruth S; Knudson, Paul E; Teresi, Jeanne; Holmes, Douglas; Palmas, Walter; Field, Lesley; Goland, Robin; Tuck, Catherine; Hripcsak, George; Capps, Linnea; Liss, DavidThe Columbia University Informatics for Diabetes Education and Telemedicine IDEATel Project is a four year demonstration project funded by the Centers for Medicare and Medicaid Services with the overall goals of evaluating the feasibility acceptability effectiveness and cost effectiveness of telemedicine in the management of older patients with diabetes The study is designed as a randomized controlled trial and is being conducted by a state wide consortium in New York Eligibility requires that participants have diabetes are Medicare beneficiaries and reside in federally designated medically underserved areas A total of 1 500 participants will be randomized half in New York City and half in other areas of the state Intervention participants receive a home telemedicine unit that provides synchronous videoconferencing with a project based nurse electronic transmission of home fingerstick glucose and blood pressure data and Web access to a project Web site End points include glycosylated hemoglobin blood pressure and lipid levels patient satisfaction health care service utilization and costs The project is intended to provide data to help inform regulatory and reimbursement policies for electronically delivered health care services
- ItemColumbia University's Informatics for Diabetes Education and Telemedicine (IDEATel) project: technical implementation.(2001-12-25) Starren, Justin; Hripcsak, George; Sengupta, Soumitra; Abbruscato, C R; Knudson, Paul E; Weinstock, Ruth S; Shea, StevenThe Columbia University Informatics for Diabetes Education and Telemedicine IDEATel project is a four year demonstration project funded by the Centers for Medicare and Medicaid Services with the overall goal of evaluating the feasibility acceptability effectiveness and cost effectiveness of telemedicine The focal point of the intervention is the home telemedicine unit HTU which provides four functions synchronous videoconferencing over standard telephone lines electronic transmission for fingerstick glucose and blood pressure readings secure Web based messaging and clinical data review and access to Web based educational materials The HTU must be usable by elderly patients with no prior computer experience Providing these functions through the HTU requires tight integration of six components the HTU itself case management software a clinical information system Web based educational material data security and networking and telecommunications These six components were integrated through a variety of interfaces providing a system that works well for patients and providers With more than 400 HTUs installed IDEATel has demonstrated the feasibility of large scale home telemedicine
- ItemDepression and glycemic control in elderly ethnically diverse patients with diabetes: the IDEATel project.(2006-03-28) Trief, Paula M; Morin, Philip C; Izquierdo, Roberto; Teresi, Jeanne; Eimicke, Joseph P; Goland, Robin; Starren, Justin; Shea, Steven; Weinstock, Ruth SThe purpose of the study was to investigate the effect of comorbid depression on glycemic control and on response to a telemedicine case management intervention for elderly ethnically diverse diabetic patients
- ItemDetection and remediation of medically urgent situations using telemedicine case management for older patients with diabetes mellitus.(2008-05-19) Izquierdo, Roberto; Meyer, Suzanne; Starren, Justin; Goland, Robin; Teresi, Jeanne; Shea, Steven; Weinstock, Ruth SDetection and response to medically urgent situations in patients with diabetes mellitus can improve the process and outcomes of care and potentially decrease morbidity and mortality We examined the detection and remediation of medically urgent situations among older patients receiving telemedicine case management for diabetes
- ItemDeveloping computer skills and competencies in seniors.(2006-06-16) Pevzner, Jenia; Kaufmann, David R; Hilliman, Charlyn; Shea, Steven; Weinstock, Ruth S; Starren, JustinWe developed a training protocol for elderly participants of a home telemedicine study grounded in prior usability research The training aimed to reduce barriers in developing system mastery Our findings are indicative of both the promises and challenges involved in bridging the digital divide Sixteen participants of a diabetes study were trained to use the computer applications
- ItemDevelopment, validation, and use of English and Spanish versions of the telemedicine satisfaction and usefulness questionnaire.(2006-11-20) Bakken, Suzanne; Grullon-Figueroa, Lorena; Izquierdo, Roberto; Lee, Nam-Ju; Morin, Philip; Palmas, Walter; Teresi, Jeanne; Weinstock, Ruth S; Shea, Steven; Starren, Justin; ,To describe the development and validation of low literacy English and Spanish versions of the 26 item Telemedicine Satisfaction and Usefulness Questionnaire TSUQ report telemedicine satisfaction and usefulness ratings of urban and rural participants in the Informatics for Diabetes Education and Telemedicine IDEATel project and explore relationships between utilization and perceptions of satisfaction and usefulness
- ItemGlycemic control and health disparities in older ethnically diverse underserved adults with diabetes: five-year results from the Informatics for Diabetes Education and Telemedicine (IDEATel) study.(2011-01-28) Weinstock, Ruth S; Teresi, Jeanne A; Goland, Robin; Izquierdo, Roberto; Palmas, Walter; Eimicke, Joseph P; Ebner, Susana; Shea, Steven; ,The Informatics for Diabetes Education and Telemedicine IDEATel project randomized ethnically diverse underserved older adults with diabetes to a telemedicine intervention or usual care Intervention participants had lower A1C levels over 5 years New analyses were performed to help better understand this difference
- ItemHealth care utilization and self-care behaviors of Medicare beneficiaries with diabetes: comparison of national and ethnically diverse underserved populations.(2011-02-15) Remler, Dahlia K; Teresi, Jeanne A; Weinstock, Ruth S; Ramirez, Mildred; Eimicke, Joseph P; Silver, Stephanie; Shea, StevenCaring for persons with diabetes is expensive and this burden is increasing Little is known about service use behaviors and self care of older individuals with diabetes who live in underserved communities Information about self care informal care and service utilization in urban largely Latino n 695 and rural mostly white n 819 Medicare beneficiaries with diabetes living in federally designated medically underserved areas was collected using computer aided telephone interviews as part of the baseline assessment in the Informatics and Diabetes Education and Telemedicine IDEATel Project Where items were comparable service use was compared with that of a nationally representative group of Medicare beneficiaries with diabetes using data from the Medical Expenditure Panel Survey Compared to nationally representative groups the underserved groups reported worse general health but similar health care service use with the exception of home care However compared to the underserved rural group the underserved largely minority urban group reported worse general health P Under 0 0001 more inpatient nights P 0 003 emergency room visits P Under 0 001 and home health care P Under 0 001 spent more time on self care and had more difficulty with housework meal preparation and personal care Differences in service use between urban and rural groups within the underserved group substantially exceeded differences between the underserved and nationally representative groups These findings address a gap in knowledge about older ethnically diverse individuals with diabetes living in medically underserved areas This profile of disparate service use and health care practices among urban minority and rural majority underserved adults with diabetes can assist in the planning of future interventions
- ItemHealth delivery system changes required when integrating telemedicine into existing treatment flows of information and patients.(2006-09-22) Shea, StevenBusiness model and financial recovery issues dominate discussions about using telemedicine to improve chronic disease management The technical issues are numerous daunting and complex but many can be addressed using the resources and infrastructure available in large well integrated clinical information systems The cost benefit balance will change when it becomes possible to use devices that are owned by patients for everyday use rather than installing special purpose devices for telemedicine Technology and communications capabilities are driven mainly by market factors other than uses for health care Provider side telemedicine capabilities specifically for upload storage and display of home medical data will improve as technology develops How health care providers will process the larger amount of data made available by telemedicine is a clinical issue but it is likely that software will emerge to assist in this task The alignment of financial incentives for health care providers is a decisive factor in understanding why telemedicine has had substantial deployment within the US Veterans Hospital Administration system and to some extent within prison health systems and the Kaiser Permanente Health Plan but much less widely in other settings
- ItemThe Informatics for Diabetes and Education Telemedicine (IDEATel) project.(2008-06-05) Shea, Steven; ,Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions who experience barriers to access to care or a high burden of illness We conducted a randomized controlled trial comparing telemedicine case management to usual care with blinding of those obtaining outcome data in 1 665 Medicare recipients with diabetes aged 55 years or greater and living in federally designated medically underserved areas of New York State In New York City 98 of participants were black or Hispanic 69 were Medicaid eligible and 93 reported annual household income Under or 20 000 In upstate New York 91 were white 14 Medicaid eligible and 50 reported annual household income Under or 20 000 A baseline survey found that 95 of participants in New York City and 67 in upstate New York reported that they did not know how to use a computer The primary endpoints were HgbA1c blood pressure and low density lipoprotein LDL cholesterol levels In the intervention group N 844 mean HgbA1c improved over 1 year from 7 35 to 6 97 and from 8 35 to 7 42 in the subgroup with baseline HgbA1c or 7 N 353 In the usual care group N 821 mean HgbA1c improved over 1 year from 7 42 to 7 17 Adjusted net reductions 1 year minus baseline mean values in each group compared between groups favoring the intervention were as follows HgbA1c 0 18 p 0 006 systolic and diastolic blood pressure 3 4 p 0 001 and 1 9 mmHg p Under 0 001 and LDL cholesterol 9 5 mg dl p Under 0 001 In the subgroup with baseline HgbA1c or 7 net adjusted reduction in HgbA1c favoring the intervention group was 0 32 p 0 002 Mean LDL cholesterol level in the intervention group at one year was 95 7 mg dl The intervention effects were similar in magnitude in the subgroups living in New York City and upstate New York A satisfaction survey of intervention group participants N 346 respondents showed high levels of satisfaction with major intervention components A satisfaction survey of participating primary care physicians N 116 respondents showed positive perceptions for acceptability impact on patients and communication Telemedicine case management improved glycemic control blood pressure levels and total and LDL cholesterol levels at 1 year of follow up Telemedicine is an effective method for translating modern approaches to disease management into effective care for underserved populations
- ItemMild cognitive dysfunction does not affect diabetes mellitus control in minority elderly adults.(2014-12-17) Palta, Priya; Golden, Sherita H; Teresi, Jeanne; Palmas, Walter; Weinstock, Ruth S; Shea, Steven; Manly, Jennifer J; Luchsinger, Jose ATo determine whether older adults with type 2 diabetes mellitus and cognitive dysfunction have poorer metabolic control of glycosylated hemoglobin systolic blood pressure and low density lipoprotein cholesterol than those without cognitive dysfunction
- ItemOffice and ambulatory blood pressure are independently associated with albuminuria in older subjects with type 2 diabetes.(2006-04-21) Moran, Andrew; Palmas, Walter; Pickering, Thomas G; Schwartz, Joseph E; Field, Lesley; Weinstock, Ruth S; Shea, StevenBlood pressure strongly predicts microalbuminuria and later progression to renal failure in people with diabetes Ambulatory blood pressure monitoring seems to be superior to office blood pressure in predicting progression to microalbuminuria in type 1 diabetes The associations of ambulatory blood pressure with office blood pressure and microalbuminuria in type 2 diabetes remain unclear We studied the association of office blood pressure taken with an automated device and ambulatory blood pressure with spot urine albumin creatinine ratio in 1180 older people with type 2 diabetes participating in the Informatics for Diabetes Education and Telemedicine Study Office and awake systolic blood pressure were independently associated with albuminuria PUnder0 001 for both in a multivariate linear regression analysis that adjusted for age gender duration of diabetes hemoglobin A1c number of antihypertensive medications and use of an angiotensin converting enzyme inhibitor or angiotensin receptor blocker Twelve percent of participants had well controlled office blood pressure but not ambulatory blood pressure whereas 14 had well controlled ambulatory but not office blood pressure The prevalence of microalbuminuria and macroalbuminuria in these subgroups was intermediate between those with well controlled or uncontrolled blood pressure by both methods We found in a multiethnic group of older subjects with type 2 diabetes that office systolic blood pressure and awake systolic ambulatory blood pressure exhibited independent associations with degree of albuminuria
- ItemPrimary care providers' perceptions of home diabetes telemedicine care in the IDEATel project.(2007-02-15) Tudiver, Fred; Wolff, L Thomas; Morin, Philip C; Teresi, Jeanne; Palmas, Walter; Starren, Justin; Shea, Steven; Weinstock, Ruth SFew telemedicine projects have systematically examined provider satisfaction and attitudes
- ItemPsychosocial outcomes of telemedicine case management for elderly patients with diabetes: the randomized IDEATel trial.(2007-04-30) Trief, Paula M; Teresi, Jeanne A; Izquierdo, Roberto; Morin, Philip C; Goland, Robin; Field, Leslie; Eimicke, Joseph P; Brittain, Rebecca; Starren, Justin; Shea, Steven; Weinstock, Ruth S
- ItemA randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus.(2006-01-02) Shea, Steven; Weinstock, Ruth S; Starren, Justin; Teresi, Jeanne; Palmas, Walter; Field, Lesley; Morin, Philip; Goland, Robin; Izquierdo, Roberto E; Wolff, L Thomas; Ashraf, Mohammed; Hilliman, Charlyn; Silver, Stephanie; Meyer, Suzanne; Holmes, Douglas; Petkova, Eva; Capps, Linnea; Lantigua, Rafael ATelemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions who experience barriers to access to care or a high burden of illness
- ItemRecruitment and enrollment of rural and urban medically underserved elderly into a randomized trial of telemedicine case management for diabetes care.(2006-10-17) Palmas, Walter; Teresi, Jeanne; Morin, Philip; Wolff, L Thomas; Field, Lesley; Eimicke, Joseph P; Capps, Linnea; Prigollini, Alejandro; Orbe, Irma; Weinstock, Ruth S; Shea, StevenOur goal was to identify reasons for enrollment or refusal to participate in a randomized trial of telemedicine case management of diabetes We performed a prospective survey of participants and non participants during recruitment for the Informatics for Diabetes Education and Telemedicine IDEATel study a randomized trial of telemedicine case management of diabetes mellitus in medically underserved elderly There were two recruitment areas urban New York City and rural upstate New York A Participant Questionnaire PQ was administered at the baseline IDEATel visit and a Non Participant Questionnaire NPQ was administered during the recruitment telephone call Both questionnaires listed possible responses subjects could choose more than one response or give their own Of 1 660 IDEATel participants 99 7 completed the PQ Most frequent reason for participation was the belief that the technology could help them 52 and 42 of urban and rural respondents respectively Of the 2 231 subjects refusing participation 28 answered the NPQ 90 of respondents were from rural area Most frequent reasons not to participate in the rural area were being too busy 23 and discomfort with the technology 22 and in the urban area the belief that the technology could not help them 71 discomfort with it 52 and not liking to participate in studies 52 In multivariate analysis rural respondents only knowing how to use a computer was an independent predictor of participation p Under 0 001 In conclusion perceptions and beliefs regarding technology including the expectation to benefit from it played an important role in the decision to participate
- ItemThe REmote Patient Education in a Telemedicine Environment Architecture (REPETE).(2008-06-23) Lai, Albert M; Starren, Justin B; Kaufman, David R; Mendonca, Eneida A; Palmas, Walter; Nieh, Jason; Shea, StevenThe objective of the study was to develop and implement an architecture for remote training that can be used in the narrowband home telemedicine environment A remote training architecture the REmote Patient Education in a Telemedicine Environment REPETE architecture using a remote control protocol RCP was developed A set of design criteria was specified The developed architecture was integrated into the IDEATel home telemedicine unit HTU and evaluated against these design criteria using a combination of technical and expert evaluations Technical evaluation of the architecture demonstrated that remote cursor movements and positioning displayed on the HTU were smooth and effectively real time The trainers were able to observe within approximately 2 seconds lag what the patient sees on their HTU screen Evaluation of the architecture by experts was favorable Responses to a Likert scale questionnaire regarding audio quality and remote control performance indicated that the expert evaluators thought that the audio quality and remote control performance were adequate for remote training All evaluators strongly agreed that the system would be useful for training patients The REPETE architecture supports basic training needs over a narrowband dial up connection We were able to maintain an audio chat simultaneously with performing a remote training session while maintaining both acceptable audio quality and remote control performance The RCP provides a mechanism to provide training without requiring a trainer to go to the patient s home and effectively supports deictic referencing to on screen objects