An E-health Based Integrated Management Program Advancing Community Treatment Of Atrial Fibrillation (IMPACT-AF)

Atrial fibrillation (AF) is the most common abnormality of cardiac rhythm. There is growing evidence advocating an integrated multi-disciplinary approach to delivery of AF care facilitates which has led to improved care and outcomes and reductions in hospitalizations. In this research program, we have implemented a patient-centered and community-focused AF management program—termed as IMPACT-AF—to provide specialized AF care at the primary care level. Our approach is to exploit state-of-the-art e-Health technologies to: (a) computerize Canadian clinical practice guidelines as a web-based clinical decision support accessible to primary care providers to deliver evidence-informed AF diagnostic and therapeutic interventions at the primary care level; (b) monitor the patient in a home-based setting and proactively generate alerts and reminders to family physicians in response to adverse trends in the patient condition; and (c) engage patients through m-Health (mobile health) tools to self-manage their condition and undergo behaviour modification. Two research themes have been pursued in the development of the IMPACT-AF program: (1) Translation of AF Clinical Guidelines to Achieve Evidence-Informed AF Management: This theme involved three main tasks: (i) Computerization of the AF guidelines using ontology based knowledge models; (ii) Localization of the computerized AF guidelines to implement the local clinical pathways; and (iii) Operationalization of the computerized AF guidelines into practice through a computerized decision support system to provide evidence-informed patient care at the point-of-care. (2) Patient Engagement to Achieve Home-Based AF Management: This theme focused on the implementation of innovative AF self-management and behaviour modification interventions delivered to patients using mobile devices. We computerized theoretical behaviour modification model—i.e. Social Cognition Theory (SCT)—to generate personalized and mobile patient care plans. Using an AF (mobile) patient diary patients record their vitals and other AF related symptoms, and in turn receive educational messages, alerts, reminders and behaviour modification plans. The primary outcome of the IMPACT-AF project is reduction in AF related CV hospitalization. The secondary outcome is at two levels: (i) Process of Care: Reduction in specialist consultation, echo, catheter ablations; and, (ii) Economic: Reduction in health care costs and utilization for AF services. The clinical decision support systems developed by the IMPACT-AF project is deployed across the province of Nova Sctioa, engaging 200 primary care providers to deliver evidence informed AF management at the primary care level. We are gearing for a cluster randomized study involving 4000 patients across the province--the study will permit measurement and comparison of the clinical decision support system pre- and post-intervention, and across cases. The overall result will be cost-efficient improvement of care and outcomes for AF patients. In summary, the IMPACT-AF solution offers an innovative strategy to address two critical knowledge gaps —i.e. primary care physicians are often ill-equipped to provide evidence-based care for chronic conditions, and likewise patients are underprepared to apply the 'right' self-management and behaviour modification strategies to achieve meaningful outcomes in response to a longitudinal care plan. IMPACT-AF exploits state-of-the-art e-health technologies to develop an integrated and mobile clinical decision support systems to provide evidence-based AF care.

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