BackgroundSoaring health care costs and a rapidly aging population, with multiple comorbidities, necessitates the development of innovative strategies to deliver high-quality, value-based care.ObjectiveThe goal of this study is to evaluate the impact of a risk assessment system (CareSage) and targeted interventions on health care utilization.MethodsThis is a two-arm randomized controlled trial recruiting 370 participants from a pool of high-risk patients receiving care at a home health agency. CareSage is a risk assessment system that utilizes both real-time data collected via a Personal Emergency Response Service and historical patient data collected from the electronic medical records. All patients will first be observed for 3 months (observation period) to allow the CareSage algorithm to calibrate based on patient data. During the next 6 months (intervention period), CareSage will use a predictive algorithm to classify patients in the intervention group as “high” or “low” risk for emergency transport every 30 days. All patients flagged as “high risk” by CareSage will receive nurse triage calls to assess their needs and personalized interventions including patient education, home visits, and tele-monitoring. The primary outcome is the number of 180-day emergency department visits. Secondary outcomes include the number of 90-day emergency department visits, total medical expenses, 180-day mortality rates, time to first readmission, total number of readmissions and avoidable readmissions, 30-, 90-, and 180-day readmission rates, as well as cost of intervention per patient. The two study groups will be compared using the Student t test (two-tailed) for normally distributed and Mann Whitney U test for skewed continuous variables, respectively. The chi-square test will be used for categorical variables. Time to event (readmission) and 180-day mortality between the two study groups will be compared by using the Kaplan-Meier survival plots and the log-rank test. Cox proportional hazard regression will be used to compute hazard ratio and compare outcomes between the two groups.ResultsWe are actively enrolling participants and the study is expected to be completed by end of 2018; results are expected to be published in early 2019.ConclusionsInnovative solutions for identifying high-risk patients and personalizing interventions based on individual risk and needs may help facilitate the delivery of value-based care, improve long-term patient health outcomes and decrease health care costs.Trial RegistrationClinicalTrials.gov NCT03126565; https://clinicaltrials.gov/ct2/show/NCT03126565 (Archived by WebCite at http://www.webcitation.org/6ymDuAwQA).

Background: Overactive bladder (OAB), defined by urinary urgency with or without urge urinary incontinence (UI), usually with frequency and nocturia, can significantly impact patient's quality of life. Tracking symptoms is an important part of OAB management and has been shown to assist in enhancing patient interaction with health care providers (HCP) when discussing solutions for symptom management. Objective:The primary goal of this study was to assess the usability and acceptability of an Android smartphone mobile app designed to help participants learn about OAB symptom management through tracking and self-management. Secondarily, we also assessed engagement with the app over the three-month study period.

Background and Objective: Portable and readily accessible wellness devices can aid vital sign measuring for those interested in tracking their health. In this diagnostic accuracy study, we evaluated the performance of the VitalWellness device (VW), a wireless, compact, noninvasive device that measures four vital signs (VS) - blood pressure (BP), heart rate (HR), respiratory rate (RR), and body temperature (BT) - using the index finger and forehead. Methods: Adult volunteers with VS that fell both within and outside of the normal physiological range were enrolled to provide BP, HR, RR, and BT measurements using both the VW and Food and Drug Administration-approved reference devices. A subgroup of participants underwent an additional test to analyze the VW’s performance on HR and RR outside of normal physiological ranges. Statistical measurements were plotted on scatter and Bland-Altman plots. Sensitivity analyses to evaluate the VW’s performance by gender, skin color, finger size, and auxiliary activities were performed. Results: A total of 263 participants completed the study. On an average, systolic BP measured using the VW was 10 mmHg lower than that of the reference device (correlation coefficient r = 0.7), whereas diastolic BP was 3 mmHg lower (r = 0.6), and RR was 2 bpm lower (r = 0.7). VW HR and BT measurements were, on average, 1 bpm and 0.3°F higher than the corresponding reference measurements (r = 0.9 and r = 0.3), respectively. Conclusion: The VW device is well-suited for home-based, nonmedical monitoring of HR, RR, and BP. Further improvement in measurement accuracy is required to enable applications for medical use.