A Personalized and Interactive Web-Based Advance Care Planning Intervention for Older Adults (Koda Health): Pilot Feasibility Study.

Background: Advance care planning (ACP) is a process that involves patients expressing their personal goals, values, and future medical care preferences. Digital applications may help facilitate this process, though their use in older adults has not been adequately studied. Objective: This pilot study aimed to evaluate the reach, adoption, and usability of Koda Health, a web-based patient-facing ACP platform, among older adults. Methods: Older adults (aged 50 years and older) who had an active Epic MyChart account at an academic health care system in North Carolina were recruited to participate. A total of 2850 electronic invitations were sent through MyChart accounts with an embedded hyperlink to the Koda platform. Participants who agreed to participate were asked to complete pre- and posttest surveys before and after navigating through the Koda Health platform. Primary outcomes were reach, adoption, and System Usability Scale (SUS) scores. Exploratory outcomes included ACP knowledge and readiness. Results: A total of 161 participants enrolled in the study and created an account on the platform (age: mean 63, SD 9.3 years), with 80% (129/161) of these participants going on to complete all steps of the intervention, thereby generating an advance directive. Participants reported minimal difficulty in using the Koda platform, with an overall SUS score of 76.2. Additionally, knowledge of ACP (eg, mean increase from 3.2 to 4.2 on 5-point scale; P<.001) and readiness (eg, mean increase from 2.6 to 3.2 on readiness to discuss ACP with health care provider; P<.001) significantly increased from before to after the intervention. Conclusions: This study demonstrated that the Koda Health platform is feasible, had above-average usability, and improved ACP documentation of preferences in older adults. Our findings indicate that web-based health tools like Koda may help older individuals learn about and feel more comfortable with ACP while potentially facilitating greater engagement in care planning.

Feasibility, Acceptability, and Performance of a Continuous Temperature Monitor in Older Adults and Staff in Congregate-Living Facilities.

OBJECTIVES: Residents of congregate-living facilities are susceptible to disability and mortality from infection given the presence of advanced age, multimorbidity, and frailty-as demonstrated in the recent COVID pandemic. This study assessed the feasibility, acceptability, and applicability of a continuous temperature monitoring device in a congregate-living facility with residents of independent living, assisted living, and their care-providing staff. We hypothesized that a wearable device compared with daily manual temperature assessment would be well tolerated and more effective at detecting temperature variances than current standard of care body temperature assessment. DESIGN: Feasibility study. SETTING AND PARTICIPANTS: Residents of assisted and independent living and staff of a retirement community. METHODS: Thirty-five participants, including residents in assisted- and independent-living facilities (25) and staff (10) were enrolled in a 90-day feasibility study and wore a continuous temperature sensor from March to July 2021. Primary outcomes included study completion, ability to reapply the sensor, temperature data acquisition, and data availability from the sensors. A secondary analysis of the temperature data involved comparing the method of obtaining temperature using the continuous monitoring device against standard of care using traditional manual thermometers. RESULTS: Overall, 91.3% of residents, who were in the study during the first reapplication, were able to apply the device without assistance (21 of 23), and 80% of resident participants completed the study (20 of 25). For staff participants, completion rates and reapplication rates were 100%. Data acquisition rates from the continuous temperature devices were much higher than manual temperatures. Four episodes of fever were detected by the devices; manual temperature checks did not identify these events. CONCLUSIONS AND IMPLICATIONS: Continuous temperature monitoring in an older adult population and the staff in congregate-living facilities is feasible and acceptable. This approach identified fever undetected by current standard of care indicating the capability of this device for earlier detection of fevers.