title: Electronic physiologic and subjective data acquisition in home-dwelling heart failure patients: An assessment of patient use and perception of usability.
abstract: The current approach to the outpatient management of heart failure involves patients recollecting what has happened to them since their last clinic visit. But patients' recollection of their symptoms may not be sufficiently accurate to optimally manage their disease. Most of what is known about heart failure is related to patients' diurnal symptoms and activities. Some mobile electronic technologies can operate continuously to collect data from the time patients go to bed until they get up in the morning. We were therefore interested to evaluate if patients would use a system of selected patient-facing devices to collect physiologic and subjective state data in and around the patients' period of sleep, and if there were differences in device use and perceptions of usability at the device level
  
  
  
  This descriptive observational study of home-dwelling patients with heart failure, between 21 and 90 years of age, enrolled in an outpatient heart failure clinic was conducted between December 2014 and June 2015. Patients received five devices, namely, body weight scale, blood pressure device, an iPad-based subjective states assessment, pulse oximeter, and actigraph, to collect their physiologic (body weight, blood pressure, heart rate, blood oxygen saturation, and physical activity) and subjective state data (symptoms and subjective states) at home for the next six consecutive nights. Use was defined as the ratio of observed use over expected use, where 1.0 is observed equals expected. Usability was determined by the overall System Usability Scale score.
  
  
  
  Participants were 39 clinical heart failure patients, mean age 68.1 (SD, 12.3), 72% male, 62% African American. The ratio of observed over expected use for the body weight scale, blood pressure device, iPad application, pulse oximeter and actigraph was 0.8, 1.0, 1.1, 0.9, and 1.9, respectively. The mean overall System Usability Scale score for each device were 84.5, 89.7, 85.7, 87.6, and 85.2, respectively.
  
  
  
  Patients were able to use all of the devices and they rated the usability of all the devices higher than expected. Our study provides support for at-home patient-collected physiologic and subjective state data. To our knowledge, this is the first study to assess the use and usability of electronic objective and subjective data collection devices in heart failure patients' homes overnight.
authors.affiliation: Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, United States. Electronic address: cubby.gardner.1@us.af.mil.
authors.forename: Cubby L
authors.initials: CL
authors.lastname: Gardner
authors.affiliation: Cardiology Clinic, Walter Reed National Military Medical Center, Bethesda, MD, United States.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Flanagan
authors.affiliation: Cardiology Clinic, Walter Reed National Military Medical Center, Bethesda, MD, United States.
authors.forename: Cathy
authors.initials: C
authors.lastname: Franklin
authors.affiliation: Cardiology Clinic, Walter Reed National Military Medical Center, Bethesda, MD, United States.
authors.forename: Cherly
authors.initials: C
authors.lastname: John-Swayers
authors.affiliation: Cardiology Clinic, Walter Reed National Military Medical Center, Bethesda, MD, United States.
authors.forename: Stacy
authors.initials: S
authors.lastname: Walsh-Pouch
authors.affiliation: Cardiology Clinic, Walter Reed National Military Medical Center, Bethesda, MD, United States.
authors.forename: F Joyce
authors.initials: FJ
authors.lastname: Bryant
authors.affiliation: Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Romano
authors.affiliation: Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
authors.forename: Susanne
authors.initials: S
authors.lastname: Gibbons
authors.affiliation: Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
authors.forename: Marla
authors.initials: M
authors.lastname: De Jong
authors.affiliation: F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
authors.forename: Albert
authors.initials: A
authors.lastname: Hoang
authors.affiliation: F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Becher
authors.affiliation: F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
authors.forename: Harry B
authors.initials: HB
authors.lastname: Burke
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D034201:Computers, Handheld / Q000706:statistics & numerical data*; D003936:Diagnosis, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D059026:Diagnostic Self Evaluation; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods; D010358:Patient Participation; D010465:Perception; D017216:Telemedicine / Q000295:instrumentation* / Q000379:methods; D014584:User-Computer Interface
keywords: Electronic monitoring devices; Heart failure; Human factors; Morbidity