Medical Technology

Advances in drugs, devices, and biological products that change the way health care is delivered. LDI Senior Fellows study the adoption and diffusion of medical technologies and assesses their impact on costs and quality of care.

Implementation of a Calculator To Predict Cesarean During Labor Induction: A Qualitative Evaluation of the Clinician Perspective

Jan. 22, 2021

Rebecca F. Hamm, Lisa D. Levine, Maria N. Nelson, Rinad Beidas

Abstract [from journal]

Background: We previously conducted a prospective cohort study (n=1610) demonstrating that implementation of a validated calculator to predict likelihood of cesarean delivery during labor induction was associated with reduced maternal morbidity, reduced cesarean delivery rate, and improved birth satisfaction.

Objective: To optimize future implementation, we used qualitative interviews to understand the clinician perspective on: (1) the cesarean risk calculator implementation, and (2) the


Clarifying the Role of the Modern General Surgeon: The Effect of Specialization on Inpatient Practice Patterns in General Surgery

Jan. 13, 2021

Catherine L. Mavroudis, Christopher Wirtalla, Jason Tong, Ezra S. Brooks, Cary B. Aarons, Rachel R. Kelz

Abstract [from journal]

Objective: The growing concentration of fellowship-trained and integrated residency-trained subspecialty surgeons has encroached on the breadth and volume of a so-called "true" general surgery practice, leaving the role of new general surgeons in flux. We aimed to describe the surgical practice of new general surgeons with and without subspecialty fellowship training.

Design: In this retrospective cohort study, state discharge data was linked to American Medical Association Masterfile and


Lessons Learned From the Implementation of a Video Health Coaching Technology Intervention to Improve Self-Care of Family Caregivers of Adults With Heart Failure

Dec. 20, 2020

Karen B. Hirschman, Kathryn H. Bowles, Lydia Garcia-Gonzalez, Brooke Shepard, Tracie J. Walser, Gladys L. Thomas, Michael A. StawnychyBarbara Riegel

Abstract [from journal]

Individuals with heart failure (HF) typically live in the community and are cared for at home by family caregivers. These caregivers often lack supportive services and the time to access those services when available. Technology can play a role in conveniently bringing needed support to these caregivers. The purpose of this article is to describe the implementation of a virtual health coaching intervention with caregivers of HF patients ("Virtual Caregiver Coach for You"-ViCCY). A randomized controlled trial is currently in progress


Mobile Health (mHealth) Technology: Assessment of Availability, Acceptability, and Use in CKD

Dec. 3, 2020

Sarah J. Schrauben, Lawrence Appel, Eleanor Rivera, Claudia M. Lora, James P. Lash, Jing Chen, L. Lee Hamm, Jeffrey C. Fink, Alan S. Go, Raymond R. Townsend, Rajat Deo, Laura M. Dember, Harold I. Feldman, Clarissa J. Diamantidis, CRIC Study...

Abstract [from journal]

Rationale & objective: Digital and mobile health (mHealth) technologies improve patient-provider communication and increase information accessibility. We assessed technology use, attitudes toward using mHealth technologies, and the proficiency in using mHealth technologies among individuals with chronic kidney disease (CKD).

Study design: Cross-sectional survey with open text responses SETTING & PARTICIPANTS: Chronic Renal Insufficiency Cohort Study participants who completed current


Surgical Delay and Pathological Outcomes for Clinically Localized High-Risk Prostate Cancer

Dec. 1, 2020

Leilei Xia, Ruchika Talwar, Raju R. Chelluri, Thomas J. Guzzo, Daniel J. Lee

Abstract [from journal]

Importance: There is a lack of data evaluating the association of surgical delay time (SDT) with outcomes in patients with localized, high-risk prostate cancer.

Objective: To investigate the association of SDT of radical prostatectomy and final pathological and survival outcomes.

Design, setting, and participants: This cohort study used data from the US National Cancer Database (NCDB) and identified all patients with clinically localized (cT1-2cN0cM0) high-risk prostate


Group-Randomized Trial of Tailored Brief Shared Decision-Making to Improve Asthma Control in Urban Black Adults

Karen Glanz
Nov. 29, 2020

Maureen George, Jean-Marie Bruzzese, Marilyn Lynn S. Sommers, Michael V. Pantalon, Haomiao Jia, Joseph Rhodes, Allison A. Norful, Annie Chung, Jesse Chittams, Danielle Coleman, Karen Glanz

Abstract [from journal]

Aims: To assess the intervention effects of BREATHE (BRief intervention to Evaluate Asthma THErapy), a novel brief shared decision-making intervention and evaluate feasibility and acceptability of intervention procedures.

Design: Group-randomized longitudinal pilot study.

Methods: In total, 80 adults with uncontrolled persistent asthma participated in a trial comparing BREATHE (N = 40) to a dose-matched attention control intervention (N = 40). BREATHE is a one-time


Utilization and Outcomes of Sentinel Lymph Node Biopsy in Patients With Early Stage Vulvar Cancer

Nov. 26, 2020

Catherine E. Hermann, Dimitrios Nasioudis, Spyridon A. Mastroyannis, Nawar A. Latif, Ashley F. Haggerty, Robert L. Giuntoli Ii, Lori Cory, Sarah H. Kim, Mark A. Morgan, Emily M. Ko

Abstract [from journal]

Objective: A retrospective cohort study comparing survival and perioperative outcomes of patients with early vulvar cancer who underwent sentinel lymph node biopsy versus standard lymphadenectomy METHODS: Patients diagnosed between January 2012 and December 2015 with vulvar squamous cell carcinoma of less than 4 cm in size, with invasion of at least 1 mm, who underwent sentinel lymph node biopsy, lymphadenectomy, or both were identified from the National Cancer Database. Overall survival was evaluated following


Using Informational Murals and Handwashing Stations to Increase Access to Sanitation Among People Experiencing Homelessness During the COVID-19 Pandemic

Nov. 19, 2020

Yoonhee P. Ha, Nicole McDonald, Shari Hersh, Stephanie R. Fenniri, Amy HillierCarolyn C. Cannuscio

Abstract [from journal]

The coronavirus disease 2019 (COVID-19) pandemic has upended every aspect of life in the United States and forced Americans to rethink their daily activities, including how they work, attend school, secure food, obtain health care, and maintain social connections. For vulnerable populations that were already facing significant barriers to health, such as people experiencing homelessness, the pandemic has only generated new hardships and exacerbated existing inequities. 

Use of an Internet-of-Things Smart Home System for Healthy Aging in Older Adults in Residential Settings: Pilot Feasibility Study

George Demiris, Penn Nursing School
Nov. 10, 2020

Yong K. Choi, Hilaire J. Thompson, George Demiris

Abstract [from journal]

Background: The Internet-of-Things (IoT) technologies can create smart residences that integrate technology within the home to enhance residents' safety as well as monitor their health and wellness. However, there has been little research on real-world testing of IoT smart home devices with older adults, and the feasibility and acceptance of such tools have not been systematically examined.

Objective: This study aims to conduct a pilot study to investigate the feasibility of using IoT smart


Vaccipack, A Mobile App to Promote Human Papillomavirus Vaccine Uptake Among Adolescents Aged 11 to 14 Years: Development and Usability Study

Kristen Feemster, MD, MPH, MSHP
Oct. 29, 2020

Anne M. TeitelmanEmily F. Gregory, Joshua Jayasinghe, Zara Wermers, Ja H. Koo, Jennifer F. Morone, Damien C. Leri, Annet Davis, Kristen A. Feemster

Abstract [from journal]

Background: More than 90% of human papillomavirus (HPV)-related cancers could be prevented by widespread uptake of the HPV vaccine, yet vaccine use in the United States falls short of public health goals.

Objective: The purpose of this study was to describe the development, acceptability, and intention to use the mobile app Vaccipack, which was designed to promote uptake and completion of the adolescent HPV vaccine series.

Methods: Development of the mobile health (mHealth) content was based...

Effect Of Integrating Machine Learning Mortality Estimates With Behavioral Nudges To Clinicians On Serious Illness Conversations Among Patients With Cancer: A Stepped-Wedge Cluster Randomized Clinical Trial

Oct. 15, 2020

Christopher R. Manz, Ravi B. Parikh, Dylan S. Small, Chalanda N. Evans, Corey Chivers, Susan H. Regli, C. William Hanson, Justin E Bekelman, Charles A. L. Rareshide, Nina O'Connor, Lynn M. Schuchter, Lawrence N. Shulman,...

Abstract [from journal]

Importance: Serious illness conversations (SICs) are structured conversations between clinicians and patients about prognosis, treatment goals, and end-of-life preferences. Interventions that increase the rate of SICs between oncology clinicians and patients may improve goal-concordant care and patient outcomes.

Objective: To determine the effect of a clinician-directed intervention integrating machine learning mortality predictions with behavioral nudges on motivating clinician-patient SICs


Direct-to-Consumer COVID-19 Testing

Oct. 14, 2020

In the midst of the pandemic, many companies have started marketing diagnostic and serological (antibody) COVID-19 tests directly to consumers. Such direct-to-consumer (DTC) tests can be initiated by consumers, typically through the company’s website. The sample can be collected at home or in a laboratory, with no or little direct involvement from a health care provider. About a dozen companies have received emergency use authorization (EUA) for diagnostic DTC COVID-19 tests and at least two for serological testing.

Association Of Discharge To Home Vs Institutional Postacute Care With Outcomes After Lower Extremity Joint Replacement

Amole Navathe19-head
Oct. 1, 2020

Robert E. Burke, Anne Canamucio, Elina Medvedeva, Eric L. HumeAmol S. Navathe

Abstract [from journal]

Importance: Changes in financial incentives have led to more patients being discharged home than to institutional forms of postacute care, such as skilled nursing facilities (SNFs), after elective lower extremity total joint replacement (LEJR).

Objective: To evaluate the association of this change with hospital readmissions, surgical complications, and mortality.

Design, setting, and participants: This cohort study used cross-temporal propensity-matching to identify 104


Improving Identification Of Patients At Low Risk For Major Cardiac Events After Noncardiac Surgery Using Intraoperative Data

Amole Navathe19-head
Oct. 1, 2020

Amol S. NavatheVictor J. LeiLee A. Fleisher, ThaiBinh Luong, Xinwei Chen, Edward Kennedy, Kevin G. VolppDaniel E. PolskyPeter W. Groeneveld, Mark Weiner, John H. Holmes...

Abstract [from journal]

Background/objective: Risk-stratification tools for cardiac complications after noncardiac surgery based on preoperative risk factors are used to inform postoperative management. However, there is limited evidence on whether risk stratification can be improved by incorporating data collected intraoperatively, particularly for low-risk patients.

Methods: We conducted a retrospective cohort study of adults who underwent noncardiac surgery between 2014 and 2018 at four