Pennsylvania's Community Coordination Strategy to Reduce Opioid Overdose Deaths.

OBJECTIVE: The Pennsylvania Opioid Overdose Reduction Technical Assistance Center (ORTAC) was developed to provide community-level support across Pennsylvania with the goal of reducing the opioid-related overdose death (ODD) rate via coalition building/coordination and tailored technical assistance. This study evaluates the initial effects of ORTAC engagement on county-level opioid ODD reductions. METHOD: Using quasi-experimental difference-in-difference models, we compared ODD per 100,000 population per quarter between 2016 and 2019 in the 29 ORTAC-implementing counties against the 19 nonengaged counties while controlling for county-level time-varying confounders (e.g., naloxone administration by law enforcement). RESULTS: Before ORTAC implementation, the average ODD/100,000 was 8.92 per 100,000 (SD = 3.62) in ORTAC counties and 5.62 per 100,000 (SD = 2.17) for the 19 comparison counties. Relative to the pre-study rate, there was an estimated 30% decrease in the ODD/100,000 within implementing counties after the first two quarters of ORTAC implementation. In the second year after ORTAC implementation, the estimated difference between ORTAC and non-ORTAC counties reached a high of 3.80 fewer deaths per 100,000. Overall, analyses indicated that ORTAC's service was associated with avoiding 1,818 opioid ODD in the 29 implementing counties in the 2 years following implementation. CONCLUSIONS: Findings reinforce the impact of coordinating communities around addressing the ODD crisis. Future policy efforts should provide a suite of overdose reduction strategies and intuitive data structures that can be tailored to individual communities' needs.

An mHealth Platform for Supporting Clinical Data Integration into Augmentative and Alternative Communication Service Delivery: User-Centered Design and Usability Evaluation.

BACKGROUND: The recent trend of increasing health care costs in the United States is likely not sustainable. To make health care more economically sustainable, attention must be directed toward improving the quality while simultaneously reducing the cost of health care. One of the recommended approaches to provide better care at a lower cost is to develop high-quality data collection and reporting systems, which support health care professionals in making optimal clinical decisions based on solid, extensive evidence. OBJECTIVE: The objective of this project was to develop an integrated mobile health Augmentative and Alternative Communication (AAC) platform consisting of an AAC mobile app and a Web-based clinician portal for supporting evidence-based clinical service delivery. METHODS: A questionnaire and interviews were used to collect clinicians' ideas regarding what constitutes their desired "clinically relevant" data. In response, a Web-based portal was designed by combining mobile and Web technologies with an AAC intervention to create an integrated platform for supporting data collection, integration, and reporting. Finally, a usability study was conducted with health care professionals. RESULTS: A Web-based portal was created and integrated with a tablet-based AAC mobile app and data analysis procedures. In the usability study, all participants agreed that the integrated platform provided the ability to collect comprehensive clinical evidence, automatically analyze collected data in real time, and generate clinically relevant performance measures through an easily accessible Web-based portal. CONCLUSIONS: The integrated platform offers a better approach for clinical data reporting and analytics. Additionally, the platform streamlines the workflow of AAC clinical service delivery.

Development and evaluation of a mobile AAC: a virtual therapist and speech assistant for people with communication disabilities.

PURPOSE: The currently existing Augmentative and Alternative Communication (AAC) technologies have limitations to produce the best communication rehabilitation outcomes and therefore a better solution is needed. METHOD: In this work, a mobile AAC app was developed based on results from research studies. Sophisticated AAC language programming, embedded training materials, and real-time communication performance reporting were integrated into the app. Two groups of study participants were recruited to participate a usability study and a preliminary feasibility study for the purpose of evaluating this mobile AAC app, respectively. RESULTS: A tablet-based AAC app was developed to support communication rehabilitation. User studies of the app were conducted and included able-bodied individuals and people with verbal communication disabilities. All study participants agreed that the app establishes a usable alternative treatment protocol for communication rehabilitation. CONCLUSIONS: The app's integrated features have great potential to maximize users' communication effectiveness, enhance language skills, and ultimately improve users' quality of life. Implications for rehabilitation We have developed and evaluated an integrated mobile AAC language-based app. This tablet-based app integrated AAC with embedded trainings and real-time performance report.

Teleophthalmology assessment of diabetic retinopathy fundus images: smartphone versus standard office computer workstation.

PURPOSE: To evaluate the diagnostic capability of a smartphone handset compared with a standard office computer workstation for teleophthalmology fundus photo assessments of diabetic retinopathy. METHODS: Eligible, consenting participants' fundus images were acquired using a non-mydriatic camera. These images along with other medical data were transmitted 20 miles away through the Internet (gold standard) and also through an iPhone(®) (Apple, Cupertino, CA) to two ophthalmologists, who independently compared the images. RESULTS: The κ coefficient between the gold standard workstation display and iPhone images to detect retinopathy-related changes for both readers was more than 0.9. The image quality of the iPhone was scored high by the ophthalmologists. CONCLUSIONS: Ophthalmic images transmitted through both smartphone and Internet techniques match well with each other. Despite current limitations, smartphones could represent as a tool for fundus photo assessments of diabetic retinopathy. Further studies are needed to investigate the economic and clinical feasibility of smartphones in ophthalmology.