Reduced Chronic Obstructive Pulmonary Disease–Related Utilization of Health Care Services and Increased Social Activities by Patients Offered a 24/7 Accessible Telehealth Service Based on the Epital Care Model: Pragmatic Modified Stepped Wedge Randomized Controlled Trial (Preprint)
Bibliographic record
Abstract
BACKGROUND An escalating prevalence of older adults living longer with chronic conditions challenges the health care workforce. Innovative web-based services, such as those based on the Epital Care Model (ECM), may help address these challenges, though their effects remain undocumented. OBJECTIVE The objectives of this study are to investigate whether telehealth services provided by an ECM response and coordination center, complementary to usual care provided by general practitioners (GPs), affect the participants’ mental well-being and use of health care services as primary outcomes, and social activities and mobility as a secondary outcome. METHODS Using a pragmatic, modified, stepped wedged, nonblinded design, 184 people living with chronic obstructive pulmonary disease, diagnosed in accordance with the GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines, were, for logistic and resource reasons, randomized over a period of 10 months, within blocks of up to ten participants and at four geographically distinct locations, into either an ECM-based complementary telehealth service (ECTHS), manned by certified nonprofessional staff, or usual care provided by GPs and other health care services. All baseline parameters were collected in person, whereas all follow-up data were based on data from the participants’ health records and telephone interviews at 8 months (T1) and 12 months (T2). Mental well-being was assessed by the World Health Organization-5 Well-Being Index (WHO-5), using an independent 2-sample t test for comparison between groups and a dependent 2-sample t test for comparison between T0 and T1 and T2, respectively, within the two groups. Health care service usage and participants’ social activity and mobility were assessed and compared using Poisson regression. RESULTS In an intention-to-treat analysis, there were no differences in WHO-5 score within or between groups, whereas a difference was found at T2 in a per protocol analysis (mean 68.68, SD 17.40 in ECTHS vs 59.70, SD 19.51 in usual care; P=.01). Estimates of the Poisson regression were for chronic obstructive pulmonary disease related contacts to health care services at T2 for hospital admissions (0.51; P=.04), out-of-office services (0.49; P=.09), outpatient clinics (0.49; P=.02), and visits at GP (0.25; P<.001), demonstrating a reduction in usage between 49% and 75% after adjustment for age, GOLD risk score, risk time and comorbidities. In addition, at both T1 and T2, there was an increase in participation in cultural events and travel activities abroad, with T2 estimates of 1.73 (P<.001) and 2.50 (P=.002), respectively, demonstrating an increase of 73% and 150%, respectively. CONCLUSIONS These results contribute to a new perspective on how health care services can be organized to reduce health care usage and increase social activity and mobility based on an ECTHS manned with nonprofessional certified staff. CLINICALTRIAL ClinicalTrials.gov NCT06988566, https://clinicaltrials.gov/study/NCT06988566 (retrospectively registered)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.004 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".