On-offline Total Service of Community-based Healthcare Smart Home

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INTERNATIONALSYMPOSIUM

HEALTHCARESMART HOME

ISHSH 2013

BUILDABLE, SUSTAINABLE, AND DISTRIBUTABLE HEALTHCARE SMART HOME

On-offline Total Service ofCommunity-based

Healthcare Smart Home

Jeongeun Kim RN, INS, PhD

International Symposium on Healthcare Smart Home (ISHSH) 2013

September 3rd, 2013Seoul National University Hospital Biomedical Research Institute

This research was supported by a grant (10 High-tech Urban B02) from High-tech Urban Development Program funded by Ministry of Land, Transport and Maritime A!airs of Korean government.

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ISHSH 2013


Healthcare Available Whenever and Wherever

Healthcare Smart Home Service

• To Support Chronic Disease Self-management• To Improve Daily Habits and Quality of Life

Tailored Health Counseling and Education

Regular Health Monitoring

Early Detection of Health Problems{objectiv

es

vision

Image by Roberto Mangosi

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ISHSH 2013


Service Components

Image by Lego

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ISHSH 2013


Spaces

Network InfrastructureImage by SEOUL Magazine

Residential SpacesCommunity Spaces

Intensive Care Spaces

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ISHSH 2013


Service Delivery Framework

O!ine Service DeliveryOnline Service Delivery

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ISHSH 2013


Participant Management System

Health Education

Health Counseling

Health Programs

Demographics

Health Information

Counseling Records }

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ISHSH 2013


Clinical Decision Support System (CDSS)

CDSS

ImprovedSelf-management

Vital Signs Monitored in a Residential Space

Personal Health Characteristics

}High-risk Group

Intermediate-risk Group

Low-risk Group[ ]

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ISHSH 2013


Service Delivery Process

Vital Signs Monitored in a Residential Space

Collecting Information from the System in a Residential Space

Remote Health Monitoring by u-Health Nurses

Analysis with CDSS

High-risk Group

Intermediate-risk Group

Low-risk Group

Analysis Results

Health Programs developed by Health Professionals

- Video Consultation- Health Games- Health Recreation

Nurses

Quali"ed Personal Trainers- Physical Exercise

[

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ISHSH 2013


On/Offline Services for a Residential Space

Online Services in a Residential Space O#ine Services in a Residential Space

• u-Health Nurses Visiting Residential Spaces- Health Counseling- Health Education- Education on Equipment Use

• Self-monitoring Vital Signs

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ISHSH 2013


On/Offline Services for a Community Space

• Participants Visiting Community Spaces- Health Counseling- Health Education- Education on Equipment Use

• u-Health Nursing Center- Remote Health Monitoring- Video Consultation

Online Services in a Community Space O#ine Services in a Community Space

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ISHSH 2013


On/Offline Services for an Intensive Care Space

• u-Health Nurses’ Close Monitoring of Vital Signs- Early Detection of Participants in the High-risk Group

• Tailored Health Counseling- Referring Them to a Hospital

• CDSS Alerting the Participant to Abnormal Vital Signs

Online Services in an Intensive Care Space O#ine Services in an Intensive Care Space

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ISHSH 2013


Health Programs (1/2)• Disease Prevention and Health Promotion• Community-based Healthcare• Special Health Programs for the Elderly

Video Consultation – Video Health Counseling and Education Tailored to the Participant’s Health Status

Health Games – Video Games for the Elderly to Exercise

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ISHSH 2013


Game Designed for Walking Effects

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ISHSH 2013


Health Programs (2/2)• Disease Prevention and Health Promotion• Community-based Healthcare• Special Health Programs for the Elderly

Health Recreation – Recreation Programs for the Elderly to Reduce Stress, Anxiety, and Depression

Physical Exercise – Physical Exercise for the Elderly

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ISHSH 2013


Service Results

Image by Alexander Maslennikov

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ISHSH 2013


Research• Subjects:

160 Low-income Elderly Residents in Permanent Rental Houses in Town "G", City "S", who had Used the u-Health Services from August, 2012 to June, 2013

• Design:One Group Pretest-Posttest Design

• Tools:Purpose Tool Description

E!ectiveness Analysis

Korean Questionnaire for Health-related Habits and Lifestyle

Survey of 11 Health-related Habits and Lifestyle Factors including Smoking, Drinking, and Sleeping Habits


EQ-5D (EuroQol 5 Dimensions)Subjective Evaluation of Health-related

Quality of Life (HRQoL) and Health StatusE!ectiveness Analysis

Transtheoretical Model (TTM)Model to Conceptualize the Process of

Intentional Behavior Change and Maintenance


Korea Form of Geriatric Depression Scale (KFGD)

Standardized Korean Version of Geriatric Depression Scale (GDS)

Satisfaction Analysis

Technology Acceptance Model (TAM) Information Systems Theory that Models How Users Come to Accept and Use a Technology

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ISHSH 2013


General, Health, and Service Characteristics

Variable Classi!cation n %

GenderMale 52 32.5

GenderFemale 108 67.5

Age

65-70 46 28.8

Age

71-75 44 27.5

Age 76-80 34 21.3Age

81-85 27 16.9

Age

86+ 9 5.6

Education

Uneducated 42 26.3

Education

Elementary School 57 35.6

Education Middle School 26 16.3Education

High School 21 13.1

Education

Some College+ 7 4.4

Household Type

Solitary 85 53.1Household

Type Couple Alone 36 22.5Household Type

Couple with Child 38 23.8

Duration of Residence

Less than 5 yrs. 15 9.4Duration of Residence 5-10 yrs. 20 12.5Duration of Residence

10-20+ yrs. 123 76.9


Monthly Household

Income

Less than $300 104 65.0Monthly

Household Income

$300-500 35 21.9Monthly Household

Income $500-1,000 13 8.1

Monthly Household

Income$1,000-2,000+ 7 4.4

OccupationUnoccupied 149 93.1

OccupationOccupied 9 5.6

Duration of Smoking

Never Smoked 112 70.0

Duration of Smoking

Former Smoker 21 13.1

Duration of Smoking

1-10 yrs. 5 3.1Duration of Smoking 11-20 yrs. 2 1.3

Duration of Smoking

21-30 yrs. 1 0.6

Duration of Smoking

30+ yrs. 19 11.9

Frequency of Drinking

Never Drunk 113 70.6


Less than Once a Month 24 15.0Frequency of

Drinking 2-4 Times a Month 8 5.0Frequency of

Drinking2-4 Times a Week 7 4.4


Daily 4 2.5

Duration of Service Use

Less than 6 months 41 25.6Duration of Service Use More than or Equal to 6 months 119 74.4


Frequency of Exercise

Never Exercise 60 37.5


Less than Once a Week 16 10.0Frequency of

Exercise Twice a Week 15 9.4Frequency of

Exercise3-4 Times a Week 25 15.6


Daily 43 26.9

Health Examination within a Year

Yes 101 63.1Health Examination within a Year No 56 35.0

ComplexNo. 7 104 65.0

ComplexNo. 5 56 35.0

SpaceResidential Space 127 79.4

SpaceCommunity Space 33 20.6

Disease Group

Hypertension 97 60.6

Disease Group

Diabetes 41 25.6Disease Group Heart & Blood Vessel Diseases 12 7.5

Disease Group

Chronic Pulmonary Disease 10 6.3

Frequency of Service Use

Very Good 65 40.6


Good 28 17.5Frequency of Service Use Bad 25 15.6


Very Bad 42 26.3

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ISHSH 2013


Effectiveness Analysis

nMean±SDMean±SD

t (p)nPretest Posttest

t (p)

Health-related Habits and

Lifestyle

Total 160 0.63±.15 0.63±.150.00

(1.000)Health-related

Habits and Lifestyle

Health-related Habits

160 0.67±.18 0.63±.17 2.60(0.010)*

Health-related Habits and

LifestyleHealth-related

Lifestyle 160 0.58±.22 0.63±.22-2.48

(0.014)*

Quality of LifeEQ-5D VAS 122 52.58±21.15 56.93±21.86

-1.94(0.055)

Quality of LifeEQ-5D (y) 160 0.80±.16 0.72±.22

5.18(<0.001)*

Depression 155 7.50±3.95 7.77±3.81-0.83

(0.408)

StagePretestPretest PosttestPosttest

Stagen % n %

Exercise

Precontemplation 62 39.0 53 33.3

Exercise

Contemplation 6 3.8 11 6.9

Exercise Preparation 28 17.6 14 8.8Exercise

Action 8 5.0 9 5.7

Exercise

Maintenance 55 34.6 72 45.3

Diet


Diet

Contemplation 7 4.4 14 8.8

Diet Preparation 52 32.5 28 17.6Diet

Action 7 4.4 7 4.4

Diet


Changes in Health

Management


Changes in Health

Management

Contemplation 8 5.0 13 8.2Changes in Health

ManagementPreparation 94 58.8 25 15.7

Changes in Health

Management Action 5 3.1 17 10.7

Changes in Health

Management


Transtheoretical AnalysisQuestionnaire Scores

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ISHSH 2013


Satisfaction Analysis Tool based on TAM

Variable Measurement

Perceived Usefulness

The Degree to which Using the u-Health Platform Service has Its Advantages

Perceived UsefulnessThe Degree of Usefulness of the u-Health Platform Service

Perceived UsefulnessThe Degree to which Using the u-Health Platform Service Improves a Person's Daily Life

Perceived Usefulness

The Degree to which the Time and Cost are Reduced by Using the u-Health Platform Service

Perceived Ease of Use

The Degree to which Learning How to Use the u-Health Platform Service is Free from E!ort

Perceived Ease of UseThe Degree to which a Person Understands How to Use the u-Health Platform Service

Perceived Ease of UseThe Degree of E!orts to be Pro"cient in Using the u-Health Platform Service


The Degree to which a Person Thinks that the u-Health Platform Service is Easy to Use

Attitude toward Using

The Degree to which a Person Likes to Use the u-Health Platform Service

Attitude toward Using The Degree of Bene"t from Using the u-Health Platform ServiceAttitude toward Using

The Degree to which Use of the u-Health Platform Service Helps with a Person's Health Management

Behavioral Intention to Use

The Intention to Use the u-Health Platform Service

Behavioral Intention to Use The Intention to Manage Health by Using the u-Health Platform ServiceBehavioral Intention to Use

The Intention to Use the u-Health Platform Service Frequently

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ISHSH 2013


Satisfaction Analysis (1/3)

VariableMean±SDMean±SD

t pVariablePretest Posttest

t p

Perceived Usefulness 2.93±.56 2.96±.85 -.488 .627

Perceived Ease of Use 2.71±.51 2.82±2.61 -1.77 .078

Attitude toward Using 2.98±.42 3.12±.82 -1.95 .053

Behavioral Intention to Use 2.66±.48 2.83±2.78 -2.47 .014*

Variabler(p)r(p)r(p)r(p)

VariablePerceived Usefulness Perceived Ease of Use Attitude toward Using Behavioral Intention to Use

Perceived Ease of Use.407

(<.001)* - - -

Attitude toward Using.803

(<.001)*.429

(<.001)* - -

Behavioral Intention to Use .623(<.001)*

.229(<.001)*

.764(<.001)* -

Pretest-Posttest Comparison

Correlation between Variables

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ISHSH 2013


Satisfaction Analysis (2/3)Statistically Signi!cant Di"erences According to the General Characteristics:

Pretest

Posttest

-0.08±.75

MaleFemale


+0.21±.83

Posttest

Pretest

Duration of Residence


Less than 5 yrs.

5-10 yrs.

10-20+ yrs.

Statistically Signi!cant Di"erences According to the Health Characteristics:

No (0.33±.87)

Yes (0.01±.92)

Health Examination within a Year


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ISHSH 2013


Satisfaction Analysis (3/3)Statistically Signi!cant Di"erences According to the Service Characteristics:

Duration of Service Use

Less than 6 Months

More than or Equal to 6 Months

Perc

eive

d Us

eful

ness

Perc

eive

d Ea

se o

f Use

Attit

ude

tow

ard

Usin

g

Frequency of Service UseChronic Pulmonary Disease

HypertensionHeart & Blood Vessel Diseases

Diabetes

Perceived Ease of UseBehavioral Intention to Use

No. 5 (0.33±1.05)

No. 7 (0.00±.63)

Complex


Disease GroupPerc

eive

d Us

eful

ness

Diabetes

Heart & Blood Vessel Diseases

Chronic Pulmonary Disease

Hypertension


Behavioral Intension to Use

Diabetes

Chronic Pulmonary Disease

Hypertension

Heart & Blood Vessel Diseases

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ISHSH 2013


Cost-benefit Analysis

Residential Spaces

$753 average medical cost for each person per year

7 days spent in hospital or visits to hospitals or clinics8 the number of medication days

Community Spaces



For Each Elderly Person Per Year



the Project in 2013

Cost: $201,243when Considering the Depreciation of the Material Costs

Bene"t: $343,290$132,339 by reducing a doctor’s bill$210,951 by reducing days spent in hospital

and the number of medication days

Net Pro"t: $142,047BCR: 1.71

(Bene"t-cost Ratio)

Economically Valid

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ISHSH 2013


Conclusion

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ISHSH 2013


Directions

• The Model of Smart Home with Healthcare TechnologiesOperational Guideline

• Guideline for Space Design, Healthcare Programs, and Operational Strategies, which could be Applied to Housing for the Elderly such as Bogeumjari Housing or Silver Housing

, which could be Applied to Long-term Public Rental Housing as the First Step

Economic E!ciency• Continued Support from the Government and the Related Public Organizations

to Make the Project Expandable and Sustainable

• Adjusted Distribution of the Resources between Community and Residential Spacesto Improve the Economic E!ciency

• Reduced Unemployment Rate as a Side-e!ectby Promoting Health of the Nation Including the Disadvantaged

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ISHSH 2013


Directions

• The Model of Smart Home with Healthcare TechnologiesOperational Guideline

• Guideline for Space Design, Healthcare Programs, and Operational Strategies, which could be Applied to Housing for the Elderly such as Bogeumjari Housing or Silver Housing

, which could be Applied to Long-term Public Rental Housing as the First Step

Economic E#ciency• Continued Support from the Government and the Related Public Organizations

to Make the Project Expandable and Sustainable

• Adjusted Distribution of the Resources between Community and Residential Spacesto Improve the Economic E#ciency

• Reduced Unemployment Rate as a Side-e"ectby Promoting Health of the Nation Including the Disadvantaged

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ISHSH 2013


Suggestions

• Promoting the Value of the ServiceThe Value of the Service

to Reduce the Service Dropout Rate

26%: No NeedsVisit Hospitals or Clinics Often

22%: No Enough Spaces for the EquipmentsRefuse to Install an Internet Connection or the Equipments at Home

Utilization of Community Spaces• E$ective Utilization of Community Spaces

for the Low-cost and High-e#ciency Healthcare Smart Home Service

• Community-centered Healthcare Servicessince Elderly People A$ect Each Other and Stay at the Community Center for Long Time

• Developing Infrastructures and Social Memesto Provide Healthcare Services to the Elderly

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ISHSH 2013


Thank You.

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Category:	Health & Medicine
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On-offline Total Service of Community-based Healthcare Smart Home

Health & Medicine