Jori E Fleisher1, Serena P Hess2, Ellen C Klostermann3, Jeanette Lee4, Erica Myrick5, Daniela Mitchem6, Claire Niemet7, Katheryn Woo8, Brianna J Sennott9, Maya Sanghvi10, Natalie Witek11, James C Beck12, Jayne R Wilkinson13, Bichun Ouyang14, Deborah A Hall15, Joshua Chodosh16. 1. Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA; Rush Graduate College, Rush University Medical Center, 600 South Paulina Street, Suite 438, Chicago, IL, 60612, USA. Electronic address: Jori_Fleisher@rush.edu. 2. Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA. Electronic address: serenahess773@gmail.com. 3. Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA. Electronic address: eckwallace@gmail.com. 4. Department of Social Work and Community Health, Rush University Medical Center, 701 South Paulina Street, Chicago, IL, 60612, USA. Electronic address: jparked@gmail.com. 5. Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA. Electronic address: emyrick@umich.edu. 6. Department of Social Work and Community Health, Rush University Medical Center, 701 South Paulina Street, Chicago, IL, 60612, USA. Electronic address: Daniela_mitchem@rush.edu. 7. Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA. Electronic address: claire.j.niemet@gmail.com. 8. Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA; Loyola University Chicago College of Arts and Sciences, 1032 West Sheridan Road, Chicago, IL, 60660, USA. Electronic address: Katheryn_woo@rush.edu. 9. Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA; Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 1118, Chicago, IL, 60612, USA. Electronic address: Brianna_j_sennott@rush.edu. 10. Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA. Electronic address: maya.sanghvi@yale.edu. 11. Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA. Electronic address: Natalie_p_witek@rush.edu. 12. Parkinson's Foundation, 1359 Broadway, Suite 1509, New York, NY, 10018, USA. Electronic address: jbeck@parkinson.org. 13. Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA; Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA. Electronic address: jayne.wilkinson@va.gov. 14. Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 1118, Chicago, IL, 60612, USA. Electronic address: Bichun_ouyang@rush.edu. 15. Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA. 16. Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University Grossman School of Medicine, 227 E. 30th Street, TRB 839, New York, NY, 10016, USA; VA New York Harbor Healthcare System, Medicine Service, 423 E. 23rd Street, New York, NY, 10010, USA. Electronic address: Joshua.chodosh@nyulangone.org.
Abstract
INTRODUCTION: Homebound individuals with advanced Parkinson's disease (PD) are underrepresented in research and care. We tested the impact of interdisciplinary, telehealth-enhanced home visits (IN-HOME-PD) on patient quality of life (QoL) compared with usual care. METHODS: Nonrandomized controlled trial of quarterly, structured, telehealth-enhanced interdisciplinary home visits focused on symptom management, home safety, medication reconciliation, and psychosocial needs (ClinicalTrials.gov NCT03189459). We enrolled homebound participants with advanced PD (Hoehn & Yahr (HY) stage ≥3). Usual care participants had ≥2 visits in the Parkinson's Outcomes Project (POP) registry. We compared within- and between-group one-year change in QoL using the Parkinson's Disease Questionnaire. RESULTS: Sixty-five individuals enrolled in IN-HOME-PD (32.3% women; mean age 78.9 (SD 7.6) years; 74.6% white; 78.5% HY ≥ 4) compared with 319 POP controls, with differences in age, race, and PD severity (37.9% women; mean age 70.1 (7.8) years; 96.2% white; 15.1% HY ≥ 4). Longitudinally, the intervention group's QoL remained unchanged (within-group p = 0.74, Cohen's d = 0.05) while QoL decreased over time in POP controls (p < 0.001, Cohen's d = 0.27). The difference favored the intervention (between-group p = 0.04). POP participants declined in 7/8 dimensions while IN-HOME-PD participants' bodily discomfort improved and hospice use and death at home-markers of goal-concordant care-far exceeded national data. CONCLUSIONS: Telehealth-enhanced home visits can stabilize and may improve the predicted QoL decline in advanced PD via continuity of care and facilitating goal-concordant care, particularly among diverse populations. Extrapolating features of this model may improve continuity of care and outcomes in advanced PD.
INTRODUCTION: Homebound individuals with advanced Parkinson's disease (PD) are underrepresented in research and care. We tested the impact of interdisciplinary, telehealth-enhanced home visits (IN-HOME-PD) on patient quality of life (QoL) compared with usual care. METHODS: Nonrandomized controlled trial of quarterly, structured, telehealth-enhanced interdisciplinary home visits focused on symptom management, home safety, medication reconciliation, and psychosocial needs (ClinicalTrials.gov NCT03189459). We enrolled homebound participants with advanced PD (Hoehn & Yahr (HY) stage ≥3). Usual care participants had ≥2 visits in the Parkinson's Outcomes Project (POP) registry. We compared within- and between-group one-year change in QoL using the Parkinson's Disease Questionnaire. RESULTS: Sixty-five individuals enrolled in IN-HOME-PD (32.3% women; mean age 78.9 (SD 7.6) years; 74.6% white; 78.5% HY ≥ 4) compared with 319 POP controls, with differences in age, race, and PD severity (37.9% women; mean age 70.1 (7.8) years; 96.2% white; 15.1% HY ≥ 4). Longitudinally, the intervention group's QoL remained unchanged (within-group p = 0.74, Cohen's d = 0.05) while QoL decreased over time in POP controls (p < 0.001, Cohen's d = 0.27). The difference favored the intervention (between-group p = 0.04). POP participants declined in 7/8 dimensions while IN-HOME-PD participants' bodily discomfort improved and hospice use and death at home-markers of goal-concordant care-far exceeded national data. CONCLUSIONS: Telehealth-enhanced home visits can stabilize and may improve the predicted QoL decline in advanced PD via continuity of care and facilitating goal-concordant care, particularly among diverse populations. Extrapolating features of this model may improve continuity of care and outcomes in advanced PD.
Authors: Allison W Willis; Mario Schootman; Nathan Kung; Xiao-Yu Wang; Joel S Perlmutter; Brad A Racette Journal: Neurology Date: 2013-12-11 Impact factor: 9.910
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Authors: Jori Fleisher; William Barbosa; Meghan M Sweeney; Sarah E Oyler; Amy C Lemen; Arash Fazl; Mia Ko; Talia Meisel; Naomi Friede; Geraldine Dacpano; Rebecca M Gilbert; Alessandro Di Rocco; Joshua Chodosh Journal: J Am Geriatr Soc Date: 2018-04-02 Impact factor: 5.562
Authors: Katrien Moens; Dirk Houttekier; Lieve Van den Block; Richard Harding; Lucas Morin; Stefano Marchetti; Agnes Csikos; Martin Loucka; Wayne A Naylor; Donna M Wilson; Joan Teno; Marylou Cardenas-Turanzas; YongJoo Rhee; Francisco Javier Garcia-Leon; Luc Deliens; Joachim Cohen Journal: BMC Palliat Care Date: 2015-05-20 Impact factor: 3.234