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DEVELOPMENT OF A HEALTHY EATING
KIOSK-BASED FEASIBILITY STUDY
IN A PUBLIC HEALTH
PRIMARY CARE CLINIC
140th American Public Health Association
2012 Annual Meeting
Health Informatics Information Technology
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WSU RESEARCH TEAM
Julie Gleason-Comstock, PhD, MCHES, PI and Assistant Professor
Department of Family Medicine & Public Health Sciences (DFMPHS) Wayne
State University (WSU)
Nancy T. Artinian, PhD, RN, FAHA, FPCNA, FAAN, Co-PI, Professor
Associate Dean for Research, Director of Center for Health Research
College of Nursing, WSU
Catherine Jen, PhD, Co-PI, Professor
Chair, Department of Nutrition and Food Science, WSU
Alicia Streater, PhD, Co-PI, Research Associate
Center for Urban Studies, WSU
Presenters Disclosures
“No relationships to disclose.”
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RESEARCH MENTORED STUDENTS
Suzanne Baker, PhD, DFMPHS, MPH Candidate
Bosede Joshua, MBBS, MPH, DFMPHS
Kristin Oneail, RN, MSN, Nursing PhD Candidate
Deborah Slago, RN, MSN, Nursing PhD Candidate
Jessica Timmins, Honors Nutrition & Biology
Andy Paranjpe, MD/MPH 2011-2016
www.cvri.med.wayne.edu_trainees
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RESEARCH PARTNERS
PRIMARY CARE
City of Detroit Department of Health & Wellness Promotion
Herman Kiefer Adult Primary Care Clinic
TELEHEALTH
American TeleCare and LifeView
www.americantelecare.com
www.LifeviewTransform.com
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LEARNING OBJECTIVES
• Describe the development of a telehealth
education study
• Assess the feasibility of integration into a
primary care clinic
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CARDIOVASCULAR DISEASE PREVENTION
AND HEART HEALTH
Heart disease & stroke are 1st & 3rd leading causes
death for men & women men (33.6% all U.S.
deaths), yet among the most preventable
• 2010 cost of CVD in U.S. estimated @ $444
billion; about $1 of every $6 spent on healthcare
http://www.cdc.gov/chronicdisease (2012)
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CVD DEATH RATES
• Age-adjusted death rates for CVD are 37%
higher among African-Americans than Whites
• Risk of having a stroke is nearly 2x higher for
African-Americans than Whites
http://www.cdc.gov/chronicdisease (2012)
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CVD PREVENTION SAVES LIVES
• Healthy lifestyle, including healthy food choices,
and a healthy weight reduce risk of developing
heart disease/stroke
• Preventing and controlling blood pressure also
play a significant role in CVH
http://www.cdc.gov/chronicdisease (2012)
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CVD - USA CHALLENGE
• Nearly 68 million adults have high blood
pressure & about half do not have this condition
under control
• Estimated 71 million adults have high
cholesterol & nearly 2/3 do not have this
condition under control
http://www.cdc.gov/chronicdisease (2012)
CDC 2012. Vital signs awareness and treatment of uncontrolled hypertension among
adults 2003-2010. MMWR 61(35) 703-709. Accessed Sept 7, 2012.
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NATIONAL PREVENTION STRATEGY 2011 PLAN
Clinical and Community Services Recommendations
• Support National Quality Strategy’s focus on improving
cardiovascular health.
• Expand use of interoperable health information technology to
improve preventive services, quality of care & reduce health care costs.
• Support implementation of community-based preventive services &
clinical linkages .
• Reduce barriers to access clinical & community preventive services.
• Enhance coordination & integration clinical & behavioral health,
including telemedicine.
National Prevention Council (June 2011). Clinical and Community Preventive Services.
National Prevention Strategy. http://www.healthcare.gov/center/councils/nphpphc
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RELEVANCE OF HEALTH REFORM TO
HEALTH INFORMATION TECHNOLOGY
Improvement of quality of healthcare by
increasing quality data collection, creating new
programs, and payment to existing entities for
improvement. 1
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Patient Protection & Affordable Care Act (PPACA, H.R. 3590): Summary of Key Health
Information Technology Provisions, June 1, 2010 www.himss.org. Accessed January
26, 2012.
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HEALTH REFORM AND
TELEMEDICINE STRATEGY
Response from American Telemedicine National Health
Reform Timeline and Telemedicine Public Policy Papers
(2011)
▫ Telemedicine should be one component of any national
strategy to increase access, improve quality and lower the
costs of healthcare. http://www.americantelemed.org
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TELEMEDICINE AND TELEHEALTH
• Telehealth is within the family of telemedicine
electronic communication & information
technology
• It encompasses broader application, such as
distance education & consumer outreach to
support healthcare services. 1
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American Telemedicine Association. (2006) Telemedicine, Telehealth and
Health Information Technology: An ATA Issue Paper.
http://www.americantelemed.org
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TELEHEALTH TECHNOLOGY
• Kiosks are one example of telehealth technology.
• Computer-based systems designed to facilitate
information access & exchange, enhance decision
making , provide social and emotional support, & help
behavior changes that promote health and well-being. 1
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Or C, Karsh B-T (2009). A systematic review of patient acceptance of consumer health information
technology. J of the Amer Informatics Association 16 (4): 550-556. doi:10.1197/jamia.M2888
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UTILIZATION
• Potential for using consumer health technology to
improve health has been acknowledged, but
technologies are not always accepted by patients.
• Reasons can include device usability, computer
skills and low self-efficacy.
• Evidence shows substantial numbers of potential
users, including those underserved by the health
system, do not accept consumer health information
technology. 1
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Jimison H, Gorman P, Woods S, et a . Barriers and drivers of health information
technology use for the elderly , chronically ill, and underserved(2008) Evid
Rep/Technol Assess 175. AHRQ Publication No. 09-E004. Rockville, MD: AHRQ.
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RESEARCH POTENTIAL
Health information technology studies are needed that examine
variables predicting consumer acceptance, including identifying
factors which:
▫ Create acceptance for the technology
▫ Develop & evaluate the ability of applications to fulfill consumer
expectations
▫ Increase the likelihood of technology implementation success. 1
Literature review related specifically to health kiosks identified a role
for integrated kiosks as part of patient flow, e.g., physical
monitoring or planned education. 2
1
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Jamison et al, (2008), Barriers of HIT for elderly, chronically ill & underserved, AHRQ.
Jones R. (2009) The role of health kiosks in 2009: literature and informant review. Int J
Environ Res Public Health 6: 1818-1855. doi.10.3390/ijerph6061919
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Eating for Heart Health (E4H2):
A Kiosk-Based Public Health Education and
Primary Care Feasibility Study
Cardiovascular Research Institute Isis Award
Department Family Medicine & Public Health Sciences
School of Medicine, Wayne State University
2010 – 2011
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HEALTH INFORMATION TECHNOLOGY:
AMERICAN TELECARE, INC.
Telehealth company with affordable kiosk
technology, experience in evidence-based chronic
disease management & patient education.
▫ Web-based orientation & training for multi-user
station and peripherals
▫ Real-time operational support
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TECHNOLOGY
• Telehealth provider station with administrator
log-in to secure website.
• Kiosk multi-user station for multiple encounters
with:
▫
▫
▫
▫
Interactive touch screen including audio option
Password protected log-in
Self-monitoring for weight/blood pressure
Health education modules
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RESEARCH DESIGN
• Convenience sample 51 adults with BMI > 25
• Participant kiosk log-in over six weeks
• Randomized into two groups of six sessions
▫ Nutrition/Intervention (25 participants)
 Primarily diabetes education content
 Weight self-monitored via kiosk
▫ General Health /Attention Control (26
participants)
 Hypertension, physical activity, smoking & stress
education content
 Blood pressure self-monitored via kiosk
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IMPLEMENTATION
• Baseline and follow-up blood pressure & weight
assessments conducted by graduate nurses
• Demographic, healthy eating behaviors and
satisfaction surveys conducted by nutrition and
public health students
• Research faculty & students from public health,
nursing and nutrition faculty cross-trained in
cardiovascular health & telehealth technology
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RESEARCH PROTOCOL
APPROVAL
• The research protocol was approved by the
Wayne State University Institutional Review
Board (IRB) and the City of Detroit Health
Department Research Committee.
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PARTICIPANT SCREENING/BASELINE
Body Mass Index
25-29
(Overweight)
30-39
(Obese)
40-54
(Extreme
Obesity)
35%
18%
47%
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PARTICIPANTS
Average age about 50 years old, primarily AfricanAmerican and female.
About equally divided between education of high
school/less, or some trade school/college. About half
had annual household income of $10K or less; half
between $10K - $35K.
Around three-quarters had used the internet in the
past six months, and two-thirds of those at home.
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CLINIC VISITS
• Clinic Visit Frequency
▫
▫
▫
▫
Every 2-3 months (49%)
Monthly (18%)
New to clinic (14%)
Other (19%)
• Waiting Time
▫
▫
▫
▫
1-2 hours (41%)
<1 hour (33%)
3 or more hours (12%)
Other (12%)
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KIOSK FEASIBILITY STUDY
DEVELOPMENT
• Kiosk-based consumer health information
technology was feasible in a primary care
environment.
• Telehealth corporate - academic partnership
resulted in a health education pilot with an
underserved population.
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PRIMARY CARE CLINIC INTEGRATION
▫ Short, flexible kiosk sessions did not interrupt
patient visits
▫ Participants returned for multiple kiosk sessions
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FUTURE STUDY DIRECTIONS
• Expand from primary care clinic to health systems
environment
• Develop Community Health Worker/Peer Educator
CBPR training curriculum
• Integrate consumer health information technology into
multiple kiosk/interactive website/tablet/smart phone
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E4H² TeleHealth Feasibility Study
SCREENING
INTERVENTION
FOLLOW UP
OUTCOMES
6 Sessions
Nutrition
Modules
Weight
Blood
Pressure
Weight
What
Are You
Eating
Pre-Test
BMI>25
Kiosk
Sessions
General
Health
Modules
Blood
Pressure
3 MONTHS
Post Test (2 months)
Baseline
Survey
EATING
BEHAVIORS
What You Eat
Weight
MyPlate.gov
Blood Pressure