Characterization of Telecare Conversations on Lifestyle Management and Their Relation to Health Care Utilization for Patients with Heart Failure: Mixed Methods Study

Characterization of Telecare Conversations on Lifestyle Management and Their Relation to Health Care Utilization for Patients with Heart Failure: Mixed Methods Study

Journal of Medical Internet Research

10.2196/46983

http://dx.doi.org/10.2196/46983

Mojisola Erdt, Sakinah Binte Yusof, Liquan Chai, Siti Umairah Md Salleh, Zhengyuan Liu, Halimah Binte Sarim, Geok Choo Lim, Hazel Lim, Nur Farah Ain Suhaimi, Lin Yulong, Yang Guo, Angela Ng, Sharon Ong, Bryan Peide Choo, Sheldon Lee, Huang Weiliang, Hong Choon Oh, Maria Klara Wolters, Nancy F Chen, Pavitra Krishnaswamy

data analysis, telehealth, heart failure, telecare, conversation, dialogue, healthy lifestyle

31 October 2024

Erdt, M., Yusof, S. B., Chai, L., Md Salleh, S. U., Liu, Z., Sarim, H. B., Lim, G. C., Lim, H., Suhaimi, N. F. A., Yulong, L., Guo, Y., Ng, A., Ong, S., Choo, B. P., Lee, S., Weiliang, H., Oh, H. C., Wolters, M. K., Chen, N. F., & Krishnaswamy, P. (2024). Characterization of Telecare Conversations on Lifestyle Management and Their Relation to Health Care Utilization for Patients with Heart Failure: Mixed Methods Study. Journal of Medical Internet Research, 26, e46983. https://doi.org/10.2196/46983

Background: Telehealth interventions where providers offer support and coaching to patients with chronic conditions such as heart failure (HF) and type 2 diabetes mellitus (T2DM) are effective in improving health outcomes. However, the understanding of the content and structure of these interactions and how they relate to health care utilization remains incomplete. Objective: This study aimed to characterize the content and structure of telecare conversations on lifestyle management for patients with HF and investigate how these conversations relate to health care utilization. Methods: We leveraged real-world data from 50 patients with HF enrolled in a postdischarge telehealth program, with the primary intervention comprising a series of telephone calls from nurse telecarers over a 12-month period. For the full cohort, we transcribed 729 English-language calls and annotated conversation topics. For a subcohort (25 patients with both HF and T2DM), we annotated lifestyle management content with fine-grained dialogue acts describing typical conversational structures. For each patient, we identified calls with unusually high ratios of utterances on lifestyle management as lifestyle-focused calls. We further extracted structured data for inpatient admissions from 6 months before to 6 months after the intervention period. First, to understand conversational structures and content of lifestyle-focused calls, we compared the number of utterances, dialogue acts, and symptom attributes in lifestyle-focused calls to those in calls containing but not focused on lifestyle management. Second, to understand the perspectives of nurse telecarers on these calls, we conducted an expert evaluation where 2 nurse telecarers judged levels of concern and follow-up actions for lifestyle-focused and other calls (not focused on lifestyle management content). Finally, we assessed how the number of lifestyle-focused calls relates to the number of admissions, and to the average length of stay per admission. Results: In comparative analyses, lifestyle-focused calls had significantly fewer utterances (P=.01) and more dialogue acts (Padj=.005) than calls containing but not focused on lifestyle management. Lifestyle-focused calls did not contain deeper discussions on clinical symptoms. These findings indicate that lifestyle-focused calls entail short, intense discussions with greater emphasis on understanding patient experience and coaching than on clinical content. In the expert evaluation, nurse telecarers identified 24.2% (29/120) of calls assessed as concerning enough for follow-up. For these 29 calls, nurse telecarers were more attuned to concerns about symptoms and vitals (19/29, 65.5%) than lifestyle management concerns (4/29, 13.8%). The number of lifestyle-focused calls a patient had was modestly (but not significantly) associated with a lower average length of stay for inpatient admissions (Spearman ρ=-0.30; Padj=.06), but not with the number of admissions (Spearman ρ=-0.03; Padj=.84). Conclusions: Our approach and findings offer novel perspectives on the content, structure, and clinical associations of telehealth conversations on lifestyle management for patients with HF. Hence, our study could inform ways to enhance telehealth programs for self-care management in chronic conditions.

Attribution 4.0 International (CC BY 4.0)

This research / project is supported by the A*STAR, Singapore - Diabetes Clinic of the Future
Grant Reference no. : IAF H19/01/a0/023

This research / project is supported by the A*STAR, Singapore - Digital Health
Grant Reference no. : SSF A1818g0044

This research / project is supported by the A*STAR, Singapore - Deep Learning 2.0
Grant Reference no. : SSF A1718g0045

This research / project is supported by the Economic Development Board (EDB), Singapore Living Lab Fund, and Philips Electronics Hospital to Home Pilot Project - N/A
Grant Reference no. : S14-1035-RF-LLF H and S14-1035-RF-LLF W

https://oar.a-star.edu.sg/communities-collections/articles/21273

1438-8871

Institute for Infocomm Research

https://www.jmir.org/2024/1/e46983