TY  - JOUR
AU  - Erdt, Mojisola
AU  - Yusof, Sakinah Binte
AU  - Chai, Liquan
AU  - Md Salleh, Siti Umairah
AU  - Liu, Zhengyuan
AU  - Sarim, Halimah Binte
AU  - Lim, Geok Choo
AU  - Lim, Hazel
AU  - Suhaimi, Nur Farah Ain
AU  - Yulong, Lin
AU  - Guo, Yang
AU  - Ng, Angela
AU  - Ong, Sharon
AU  - Choo, Bryan Peide
AU  - Lee, Sheldon
AU  - Weiliang, Huang
AU  - Oh, Hong Choon
AU  - Wolters, Maria Klara
AU  - Chen, Nancy F
AU  - Krishnaswamy, Pavitra
PY  - 2024
DA  - 2024/10/30
TI  - Characterization of Telecare Conversations on Lifestyle Management and Their Relation to Health Care Utilization for Patients with Heart Failure: Mixed Methods Study
JO  - J Med Internet Res
SP  - e46983
VL  - 26
KW  - telehealth
KW  - telecare
KW  - heart failure
KW  - chronic disease
KW  - self-management
KW  - lifestyle management
KW  - behavior
KW  - health care utilization
KW  - conversation
KW  - dialogue
KW  - medical informatics
AB  - Background: Telehealth interventions where providers offer support and coaching to patients with chronic conditions such as heart failure (HF) and type 2 diabetes mellitus (T2DM) are effective in improving health outcomes. However, the understanding of the content and structure of these interactions and how they relate to health care utilization remains incomplete. Objective: This study aimed to characterize the content and structure of telecare conversations on lifestyle management for patients with HF and investigate how these conversations relate to health care utilization. Methods: We leveraged real-world data from 50 patients with HF enrolled in a postdischarge telehealth program, with the primary intervention comprising a series of telephone calls from nurse telecarers over a 12-month period. For the full cohort, we transcribed 729 English-language calls and annotated conversation topics. For a subcohort (25 patients with both HF and T2DM), we annotated lifestyle management content with fine-grained dialogue acts describing typical conversational structures. For each patient, we identified calls with unusually high ratios of utterances on lifestyle management as lifestyle-focused calls. We further extracted structured data for inpatient admissions from 6 months before to 6 months after the intervention period. First, to understand conversational structures and content of lifestyle-focused calls, we compared the number of utterances, dialogue acts, and symptom attributes in lifestyle-focused calls to those in calls containing but not focused on lifestyle management. Second, to understand the perspectives of nurse telecarers on these calls, we conducted an expert evaluation where 2 nurse telecarers judged levels of concern and follow-up actions for lifestyle-focused and other calls (not focused on lifestyle management content). Finally, we assessed how the number of lifestyle-focused calls relates to the number of admissions, and to the average length of stay per admission. Results: In comparative analyses, lifestyle-focused calls had significantly fewer utterances (P=.01) and more dialogue acts (Padj=.005) than calls containing but not focused on lifestyle management. Lifestyle-focused calls did not contain deeper discussions on clinical symptoms. These findings indicate that lifestyle-focused calls entail short, intense discussions with greater emphasis on understanding patient experience and coaching than on clinical content. In the expert evaluation, nurse telecarers identified 24.2% (29/120) of calls assessed as concerning enough for follow-up. For these 29 calls, nurse telecarers were more attuned to concerns about symptoms and vitals (19/29, 65.5%) than lifestyle management concerns (4/29, 13.8%). The number of lifestyle-focused calls a patient had was modestly (but not significantly) associated with a lower average length of stay for inpatient admissions (Spearman ρ=-0.30; Padj=.06), but not with the number of admissions (Spearman ρ=-0.03; Padj=.84). Conclusions: Our approach and findings offer novel perspectives on the content, structure, and clinical associations of telehealth conversations on lifestyle management for patients with HF. Hence, our study could inform ways to enhance telehealth programs for self-care management in chronic conditions. 
SN  - 1438-8871
UR  - https://www.jmir.org/2024/1/e46983
UR  - https://doi.org/10.2196/46983
DO  - 10.2196/46983
ID  - info:doi/10.2196/46983
ER  -