RAND-University of Pittsburgh Health Institute

Feasibility of a Telehealth Kiosk Intervention for Community-Dwelling Older Adults

Karen L. Courtney, RN, PhD, University of Pittsburgh
Jennifer H. Lingler, PhD, FNP, University of Pittsburgh
Andrew Dick, PhD, RAND

Background: Although mounting evidence suggests that telehealth technologies are user-friendly and beneficial when used in private homes among patients with specific, well-characterized chronic illnesses, little was known about how acceptable and effective telehealth interventions would be in congregate settings such as retirement communities or residential care facilities.

Specific Aims: The specific aims of this pilot investigation were to: 1. Determine the feasibility, acceptability and usability of a telehealth kiosk for older adults residing in Naturally Occurring Retirement Communities (NORC); 2. Identify the critical elements for sustaining a telehealth kiosk intervention in an urban NORC; and 3. Identify potential barriers to and facilitators of communal telehealth kiosk utilization and sustainability in an urban NORC.

Methods: This descriptive qualitative project used a combination of individual interviews and focus groups with program staff and residents. Thirteen of the forty-three building residents (30.2%) and three case managers (100%) were recruited. The sample of resident participants purposefully included kiosk non-users to ensure that a diverse range of perspectives on the technology was captured. Transcribed data from focus group and interview sessions were coded using constant comparative techniques. Discussions among the coders continued until consensus was reached. Credibility of interpretations of the qualitative data analysis was performed by using member checks in which participants were asked to review the findings and interpretations and to validate whether or not these interpretations reflected their own experiences.

Findings: Preliminary data from our RUPHI-CTSI pilot study suggest that implementing telehealth hubs in senior congregate housing is feasible and that these hubs have the potential to support self-monitoring of chronic health conditions. Study subjects were interested in further utilizing the telehealth kiosks to support healthy behaviors as well as self-monitoring of blood pressure and weight. Furthermore, subjects indicated that the involvement of their primary care providers as partners in this process is critical to the long term success and their use of these telehealth devices. Data analysis is still ongoing.

Conclusions: Feasibility data from this project will directly inform a future multi-site proposal to evaluate the sustainability and long-term clinical and cost-effectiveness of telehealth kiosks for community-dwelling older adults.

Resulting Publications & Presentations:

  1. Courtney, K. L., Lingler, J. H., Iyengar, S., Schulz, R., & Olshansky, E. (2008). User-Centered Telehealth Designs for Community-Based Projects. Paper presented at the 2008 American Telemedicine Association Annual Conference, Seattle, WA.
  2. Courtney, K. L., Lingler, J. H., Olshansky, E., & Garlock, L. A. (November 2008). Community-Based Telehealth Kiosks: First Impressions Poster to be presented at the AMIA 2008 Fall Symposium, Washington, DC.

Manuscripts in preparation:

  1. Courtney, K. L., Lingler, J. H., Person Mecca, L., Garlock, L. A., Dick, A., Schulz, R. & Olshansky, E. (Preparation). The First Impressions of Community-Dwelling Older Adults and Case Managers Regarding Community-Based Telehealth Kiosks.
  2. Courtney, K. L., Lingler, J. H., Dick, A., Olshansky, E., & Schulz, R. (Preparation). Telehealth Services to Older Adults in the Community: A Literature Review.
  3. Courtney, K. L., Lingler, J. H., Olshansky, E., Dick, A., Person Mecca, L., Garlock, L. A., Iyengar, S., & Schulz, R. (Preparation). Feasibility of a Telehealth Kiosk Intervention for Community-Dwelling Older Adults.

Future Work: Senior congregate housing communities, which are often inhabited by poor older adults with low health literacy and multiple co-morbid conditions, typically provide little on-site access to health information and clinical care. Given the limited resources available to many of these individuals, there is a pressing need for the exploration of novel mechanisms for increasing residents’ capacity to access to healthcare and co-manage their complex, chronic health conditions. Telehealth devices are interactive, multi-function devices that can provide tailored health messages to users, monitor vital signs and other health behaviors, and facilitate virtual visits between users and their health care providers. Evidence suggests that telehealth devices are user-friendly and beneficial when used in individual homes among older adult patients; however, individual placement in the home may be financially unrealistic for low income older adults and/or the long term management that is needed for chronic health conditions.

At present, multi-user devices exist in the form of telehealth kiosks or “hubs”, but there is little research regarding their use. Preliminary data from our RUPHI-CTSI pilot study suggest that implementing telehealth hubs in senior congregate housing is feasible and that these hubs have the potential to support self-monitoring. Study subjects were interested in further utilizing the telehealth kiosks to support healthy behaviors as well as self-monitoring of blood pressure and weight. Furthermore, subjects indicated that the involvement of their primary care providers (PCPs) as partners in this process is critical to the long term success and their use of these telehealth devices.

We have been funded by the School of Nursing’s Center for Research in Chronic Disorders (CRCD) for a second year of the pilot study (2008-2009). This phase of the study will explore the use of the telehealth kiosk to promote individualized health behaviors among older adult residents of a HUD-subsidized apartment building. We will also investigate ways for PCPs to incorporate telehealth data into their routine clinical workflow.

A forthcoming R01 proposal to the National Institutes of Health (NIH) will expand upon our previous RUPHI-CTSI work and the new CRCD study. The objective of the R01 will be to assess the effectiveness of a telehealth hub to support the co-management of the complex health care needs of community dwelling older adults. In addition to placing telehealth kiosks within senior congregate housing facilities, this proposed study will also test placement in community senior centers.

Specific aims are:

Aim 1: Examine the effectiveness of a multi-user, telehealth hub to increase adherence to individually-tailored health promotion behaviors among community dwelling older adults compared to usual care
Aim 2: Explore the effect of telehealth data visualization tools (such as longitudinal graphs and trend lines comparing individual performance to personal and population norms) to increase PCP use of telehealth health data in their co-management of complex health care needs with community dwelling older adults
Aim 3: Examine the effect of the telehealth technology on patterns of care utilization, medical expenditures, and health outcomes

Potential Funding NIH Mechanisms:

PAR-08-080: NLM Express Research Grants in Biomedical Informatics (R01)
PA-07-295: Information Technologies and the Internet in Health Services and Intervention Delivery (R01)

Participants:
University of Pittsburgh (Karen Courtney, Jennifer Lingler, Judy Matthews), RAND Corporation (Andy Dick), University of California (Ellen Olshansky), & Northeastern University (Mary Benham-Hutchins, consultant)