patient-facing population health management · impact of mobile prompting on dementia patients in...

Summary of Research Evidence

Personal Health Coaching

• Diabetes

• Cardiovascular Disease

• Cancer

• Mental Health

• Wellness

Patient-facing Care Plans

Patient-facing Population Health ManagementPatient Engagement for Chronic Disease Management

TM

May 12, 2016

2 © 2016 NexJ Health Inc.

1. Transforming Healthcare into a Sustainable, Person-centered Model ......................... 4

Alignment with the Patient-centered Medical Home Model .............................................. 5

2. Empowering Patients to Better Manage their Chronic Conditions ................................ 7

3. Patient-facing Digital Platform for Population Health Management ............................. 8

4. Sustainable eHealth Innovation Chain ............................................................................ 10

5. NexJ Connected Wellness is Based on Research, Proven at Trial .............................. 12

Repeatable Funding Model .............................................................................................. 13

6. Connected Health and Wellness Project ......................................................................... 14

7. Research Trials Demonstrating the Effectiveness of Personal Health Coaching ...... 16

Personal Health Coaching for Diabetes ........................................................................... 17

Health Coaching Reduces HbA1c in Type 2 Diabetic Patients From a Lower-Socioeconomic Status Community: A Randomized Controlled Trial ..................... 17

Data Mining of a Remote Behavioral Tracking System for Type 2 Diabetes Patients: A Prospective Cohort Study .................................................... 18

Participant Experiences in a Smartphone-based Health Coaching Intervention for Type 2 Diabetes: A Qualitative Inquiry ...................................... 18

Smartphone-Enabled Health Coach Intervention for People with Diabetes from a Modest Socioeconomic Strata Community: Single-Arm Longitudinal Feasibility Study .................................................... 19

Personal Health Coaching for Cardiovascular Disease ................................................... 20

Investigating Improved Self-Management in Uncontrolled Systolic Hypertension ............................................................................ 20

Table of Contents

3© 2016 NexJ Health Inc.

Personal Health Coaching for Cancer ............................................................................. 21

A Phase II RCT and Economic Analysis of Three Exercise Delivery Methods in Men with Prostate Cancer on ADT, Prostate Cancer Canada-Movember Competition ........................................................... 21

Effectiveness of Personal Health Coaching on Long Term Exercise Adoption and Adherence ................................................................................. 21

An RCT and Economic Analysis of Three Delivery Methods in Men With Prostate Cancer on ADT ............................................................................. 21

Personal Health Coaching for Mental Health ................................................................... 22

Impact of Mobile Prompting on Dementia Patients in Long Term Care Setting ................................................................................................ 22

Perfectionism Anxiety and Depressive Distress: Evidence for the Mediating Role of Negative Automatic Thoughts and Anxiety Sensitivity. ......................................... 22

Cognitive Behavioral Therapy-related Increases in Cortical Inhibition in Problematic Perfectionists .......................................................................... 23

Evaluating a Web-based Cognitive-behavioral Therapy for Maladaptive Perfectionism in University Students ...................................................... 23

Personal Health Coaching for Wellness ........................................................................... 24

Impact of Personal Health Coaching on Employee Wellness in a Corporate Setting ..................................................................................... 24

8. Research Trials Demonstrating the Effectiveness of Patient-facing Care Plans ....... 25

Improving Doctor-patient Communication in the Outpatient Setting Using a Facilitation Tool: A Preliminary Study ...................................................... 26

Impact of Personal Care Plans on Health System Costs and Patient Activation in Ambulatory Care...................................................................... 26

Digital Platform for Cloud-based Population Health Management


Transforming Healthcare into a Sustainable, Person-centered Model

Person-centered health is about making each and every individual be as well as they can be, by connecting people with their health information and their care team. Doing so encourages collabora-tive care, enables patient advocacy, and drives system efficiencies. Furthermore, ongoing communication between the care provider and the patient can build a strong and trusting relationship, which can then be used to influence healthy behaviors.

Technologies that empower individuals and their families to achieve healthier lifestyles, and to become true partners with their profes-sional care teams hold the greatest promise for people to live lon-ger healthier lives without perpetuating unsustainable spending patterns.

NexJ Health’s vision is to drive the transformation of healthcare into a sustainable, person-centered model, where individuals are informed and educated regarding their condition, their treatment options and are motivated to take responsibility for their own well-ness.

Putting the patient at the center of their own health and wellness.



Alignment with the Patient-Centered Medical HomeThe Patient-Centered Medical Home (PCMH) is a model of enhanced primary-care that provides comprehensive and timely care that is accessible, continuous, comprehensive, coordinated and delivered in the context of family and community. The PCMH is accountable for meeting the patient’s physical and mental health care needs, in-cluding prevention and wellness, acute care, and chronic care. It facilitates partnerships between patients, their family, their personal physicians, other healthcare professionals.

The success of the PCMH is foundational to an Accountable Care Organization’s (ACO) ability to demonstrate that cost-effective, accessible, more equitable, higher-quality healthcare is possible. NexJ Connected Wellness is essential to an ACO. The solution improves care coordination and delivery in the manner that best suits a patient’s needs, improving an ACO's ability to be accountable to patients and third-party payers for the quality, appropri-ateness and efficiency of the health care provided.

The patient’s personal Circle of Care includes all of the patient's informal and formal care providers across the continuum of care

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Patient-centered A partnership among practitioners, patients, and their families ensures that decisions respect patients’ wants, needs, and preferences, and that patients have the information and support they need to make decisions and participate in their own care.

Comprehensive A team of care providers is wholly accountable for a patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care.

Coordinated Care is organized across all elements of the broader health care system, including specialty care, hospitals, home health care, community services and supports.

Accessible Patients are able to access services with shorter waiting times, “after hours” care, 24/7 electronic or telephone access, and strong communication through health IT innovations.

Committed to quality and safety Clinicians and staff are committed to quality and quality improvement by ongoing engagement in activities to guide shared decision-making with patients and families.

*Adapted from the Agency for Healthcare Research and Quality (AHRQ) definition.

How NexJ Connected Wellness Delivers the Patient-Centered Medical Home

Functions and Attributes of the Patient-Centered Medical Home*

Enables a people-centered model where every individual can be

• Informed about their health condition

• Educated on available treatment options

• Responsible for the decisions they make about their own health and wellness.

Personal Circle of Care includes the patient, family, friends, and all of their healthcare professionals

Health Library provides trusted content that is relevant to the patient's condition and/or treatment

Patient-facing Care Plans improve shared decision-making between patients and their circle of care

Referrals connects patients to other HCPs quickly and efficiently

Scheduling appointments with all of the patient's providers

24/7 multi-channel access using mobile, web, secure chat

Community Forums for communicating with peers and receiving support

Population Dashboard shows who is on track and who needs extra support

"What If's" provide guidance in case of adverse or expected events

Assessments allow HCPs to apply clinical best practices, identify potential problems and take corrective action

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Chronic Disease is Healthcare's Greatest Challenge

Chronic disease has become a global epidemic. It is a major contributor to reduced quality of life, loss of produc-tivity, increased hospitalization and health care costs, and premature death.

Approximately half of all North Americans have at least one chronic disease, and more than three-quarters of healthcare spending in North America is on chronic disease management. Aging populations and rising rates of chronic disease are only increasing these pressures.

Patient Engagement: A Patient's Knowledge, Skills and Confidence to Manage their own Health and Wellness

At NexJ Health, we believe that the most efficient and cost-effective way to offset the rise in chronic disease is to empower patients, with the support of their families, friends, and healthcare professionals, to actively participate in managing their own chronic conditions.

NexJ Health defines patient engagement as empowering patients with the knowledge, skills, and confidence to manage one’s own health and wellness. There is compelling evidence correlating these attributes with improve-ments in population health and patient experience and lower per capita costs.

Patient engagement delivers high value for all stakeholders: Patients achieve their health goals. Payers lower costs. Providers improve care. And pharmaceutical manufacturers and pharmacies improve medication adher-ence.

Empowering Patients to Better Manage their Chronic Conditions



Patient-facing Digital Platform for Population Health Management

NexJ Connected Wellness is a patient-facing solution for population health management that engages and activates patients to improve their ability to participate in self-management of their chronic conditions. We focus on the world’s most prevalent chronic conditions - diabetes, cancer, cardiovascular and respiratory diseases, mental illness, as well as musculoskeletal and gastrointestinal disorders.

The solution is founded on respected healthcare industry research and has been proven in trials to effectively engage patients with chronic disease to better manage their own health and wellness, contributing to improving patient outcomes and lower costs. Through research, we have identified three core areas where information tech-nology will have the greatest impact on engaging patients with the support of their families, friends, and healthcare professionals:

Deliver interactive, infographic patient education that improves understanding and retention. Include an audio-visual record of the discus-sion and decisions that patients can share with family and friends.

Enable shared decision-making between patients, their family, and healthcare professionals to foster a strong and trusting relationship and improved care delivery.

Create a personalized wellness plan and deliver personal health coaching to provide patients with the support they need to achieve adopt and sustain healthier behaviors.

Educate Collaborate Motivate


Patient-facing Digital Platform for Population Health Management

NexJ Health Pro is an iPad app used by healthcare professionals (HCPs) to efficiently educate their patients about their condition and treatment, improving patient understanding and retention. At the point of care, the HCP takes the patient through a presentation, captures audio of the conversation and adds notes, annotations, images, test results, etc. The outcome is a personalized Patient Visit Record (PVR), an exact copy (in video form and as a PDF) of the teaching presentation that patients can access through NexJ Connected Wellness. The patient can watch the video as often as they wish and share it with their family, friends.

Using NexJ Connected Wellness HCPs can create lay language, patient-facing care plans that are used to communicate to patients and their family as to the patient's condition, next steps, treatment history and 'what if's'. Patients can share their information and securely communicate with anyone in their personal circle of care. They can also request appointments, complete assessments and workbooks, and access trusted content through the health library. Population and participant dashboards enable all stakeholders to better manage chronic disease.

Personal health coaching delivered using NexJ Health Coach enables HCPs to provide ongoing support to individuals so they can better manage their chronic disease. Using the app, patients capture their behaviors and biometrics and receive timely feedback and encouragement from their health coach. Patients develop a better understanding of the relationship between their behaviors, biometrics, and how they feel, driving sustainable be-havior change.

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Sustainable eHealth Innovation Chain

The Sustainable eHealth Innovation Chain is a proven process that takes funded input research, applying it to a market need to create a product that can be then commercialized. This is a repeatable process that NexJ Health has used to successfully identify core areas where information technology will have the greatest impact on engaging patients.

As part of the process, NexJ Health donates software and services to get matching research funds. The project is done in a living lab, where academic researchers use NexJ Connected Wellness on patients with support from healthcare providers. The published research includes measurable results which are then used as a ref-erence to help commercialize the solution.

A proven approach to bring innovative

healthcare IT research to market.


Sustainable eHealth Innovation Chain 4

Research Trials Resulting from this Process

• Health Coaching Reduces HbA1c in Type 2 Diabetic Patients From a Lower-Socioeconomic Status Community: A Randomized Controlled Trial

• Data Mining of a Remote Behavioral Tracking System for Type 2 Diabetes Patients: A Prospective Cohort Study

• Participant Experiences in a Smartphone-based Health Coaching Intervention for Type 2 Diabetes: A Qualitative Inquiry

• Smartphone-Enabled Health Coach Intervention for People with Diabetes from a Modest Socioeconomic Strata Community: Single-Arm Longitudinal Feasibility Study

• Investigating Improved Self-Management in Uncontrolled Systolic Hypertension

• A Phase II RCT and Economic Analysis of Three Exercise Delivery Methods in Men with Prostate Cancer on ADT, Prostate Cancer Canada-Movember Competition

• Effectiveness of Personal Health Coaching on Long Term Exercise Adoption and Adherence

• An RCT and Economic Analysis of Three Delivery Methods in Men With Prostate Cancer on ADT

• Impact of Mobile Prompting on Dementia Patients in Long Term Care Setting

• Perfectionism Anxiety and Depressive Distress: Evidence for the Mediating Role of Negative Automatic Thoughts and Anxiety Sensitivity.

• Cognitive Behavioral Therapy-related Increases in Cortical Inhibition in Problematic Perfectionists Evaluating a Web-based Cognitive-behavioral Therapy for Maladaptive Perfectionism in University Students

• Impact of Personal Health Coaching on Employee Wellness in a Corporate Setting

• Improving Doctor-patient Communication in the Outpatient Setting Using a Facilitation Tool: A Preliminary Study

• Impact of Personal Care Plans on Health System Costs and Patient Activation in Ambulatory Care



NexJ Connected Wellness Based on Research, Proven at Trial

NexJ Connected Wellness is based on research, proven at trial, and purpose-built for the objective of engaging chronic disease patients. Seventeen research trials and 8 deployment evaluations of NexJ Connected Wellness have currently been completed or are in progress. This research has involved over 4,000 participants.

NexJ Health has invested $28 million in research and development. We have also helped to direct $27 million of government funding to academic partners conducting research supporting the devel-opment and trialing of the NexJ Connected Wellness platform and its mobile apps.

17 research trials

8 deploymentevaluations

More than 4,000participants

$28 M investmentin R&D


NexJ Connected Wellness Based on Research, Proven at Trial

Repeatable Funding Model

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Connected Health and Wellness Project

In 2012, the Connected Health and Wellness Project (CHWP) was initiated as a collaboration of 18 public, private, and academic partners and affiliates who share a common vision for the future of healthcare. CHWP’s driving premise is that transforming Canada’s healthcare system means rapidly adopting a more person-centered approach to healthcare delivery: one that is focused on enhancing life-long wellness though improved access to trusted health infor-mation, health coaching and technology advancements that sus-tain wellness.

The Connected Health & Wellness Project had two goals:

• To create components of NexJ Connected Wellness: a cloud-based solution that enables patients, their family, friends and healthcare professionals to collaboratively manage health and wellness through the use of innovative applications and the delivery of healthcare services.

• To build an educational platform for healthcare professionals that will be foundational for the emergence of future standards and practice competencies in the health coach profession, which will integrate NexJ Connected Wellness into practice in health promotion, disease prevention, and chronic disease management.

The single largest healthcare project

and the largest project funded by

the Economic Development

Agency for Southern Ontario built around

a single vision.


Connected Health and Wellness Project

At $37M, the Connected Health and Wellness Project was the single largest healthcare project and the largest project funded by the Eco-nomic Development Agency for Southern Ontario built around a single vision.

It is testimony to the strength of this common belief that all partners (academic, industry, medical) have been able to work in a very com-pressed 2-year timeframe to deliver on this ambitious project. New technologies, innovative healthcare practices and creating self-knowl-edge about wellness, offer powerful tools for transforming healthcare into a people-centered and more effective system.

Outcomes of the project include:

• Evidence-based research into the effects of health coaching on Type 2 Diabetes and other chronic diseases using NexJ’s innova-tive health coaching software

• Improvements to NexJ's patient-facing care plans which were co-developed with Beth Israel Deaconess Medical Center and based on their proven Passport to TRUST program.

• An extensive suite of healthy recipes and meal plan videos were developed and accessible through NexJ Connected Wellness Health Library

• New Basic Certificate Health Coach Training Modules and Advanced HC Training Modules from York University’s Faculty of Health

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Computerworld Honors Laureate for Mobile Health for Chronic Disease NexJ won this award for the successful project at the Toronto’s Black Creek Community Health Centre. Type 2 diabetic patients used the NexJ Health Coach mobile app to track their food, exercise and stress levels as well as blood sugar and blood pressure. They received feedback, support and encouragement from personal health coaches who monitored activity andbiometric trackers for a roster of patients.



Research Trials Demonstrating the Effectiveness of Personal Health Coaching

“Health coaching” also referred to as wellness coaching, is a process that facilitates healthy, sustainable behavior change by motivating individual clients to cultivate positive health choices and transform their goals into action.

Personal health coaching draws on the principles of positive psychology and the practices of motivational inter-viewing and goal-setting. Sustained behavior change is imperative to ensure that individuals, particularly those with chronic disease, are able to adopt and maintain healthy lifestyles. Our research shows that personal health coaching, using NexJ Connected Wellness is the key to delivering the motivation and engagement that is essen-tial for people to make sustainable behavior change in their journey to become well.

The technology-enabled health coaching protocols developed under CHWP have offered an exciting new teach-ing frontier for York University and have provided a solid scientific foundation for NexJ Connected Wellness and the personal health coaching mobile app - NexJ Health Coach. Using York University’s Faculty of Health, clinical research trials were designed to create a solid empirical basis for both personal health coach training and new software development. Clinical trials tested the efficacy of personal health coaching in modifying behavior to create sustained and positive lifestyle changes. It is an “evidence-based” approach to personal health coaching that enables coaches and their patients to provide feedback about their experience with NexJ’s health coaching software. Ongoing trials provide a continuous feedback loop that informs each new generation of personal health coaching software.


Personal Health Coaching for Diabetes

Research Trials Demonstrating the Effectiveness of Personal Health Coaching

Health Coaching Reduces HbA1c in Type 2 Diabetic Patients From a Lower-Socioeconomic Status Community: A Randomized Controlled Trial

N. Wayne, D.F. Perez, D.M. Kaplan, P. Ritvo

This randomized controlled trial (RCT) compared health coaching delivered to Type 2 diabetic patients using NexJ Connected Wellness to a control group receiving health coaching without the software. The population was largely made up of individuals from a lower socioeconomic strata.

At 3 months the intervention group (health coaching + NexJ Connected Wellness) achieved clinically significant reductions in HbA1c (average blood glucose), when compared to the control group. Not only did the intervention group cut the amount of time required for the intervention in half, they also experienced significant decreases in weight and waist circumference, while the control group did not. Both groups reported improvements in mood, satisfaction with life, and quality of life. With this mix of patients, the effect size is one of the largest in current behavioral intervention research.

Journal of Medical Internet Research, 2015, Vol. 17, No 10, October 15 http://www.ncbi.nlm.nih.gov/pubmed/26441467

Trial shows that NexJ Health Coach

software significantly lowers HbA1c in

half the time.

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7 Research Trials Demonstrating the Effectiveness of Personal Health Coaching

Data Mining of a Remote Behavioral Tracking System for Type 2 Diabetes Patients: A Prospective Cohort Study

N. Wayne, N. Cercone, J. Li, A. Zohar, J. Katz, P. Brown, P. Ritvo

Mobile tracking technologies can help patients adopt and sustain self-man-agement behaviors and can help health professionals provide better moni-toring and support. However, there are challenges in determining the optimal design of self-tracking tools and their optimal use with respect to frequency and duration.

This study used data mining methods to better understand the self-monitor-ing patterns of type 2 diabetes patients, using smartphone tracking software. Use was evaluated in relation to improved HbA1c outcomes.

The findings indicate that it might be advisable for patients with type 2 dia-betes to focus on one or two trackers, one tracker assessing blood glucose levels and the other food or exercise. From a behavioral perspective, these data could influence health coaching recommendations for health behavior tracking.

Previous associations between counseling and outcomes were difficult to obtain and often based on retrospective self-reporting, whereas today, mobile devise monitoring offers ongoing records that precisely reflect the patient’s status, improvements, stability, and fluctuations. Altogether, with the increas-ing collection of wearable data, we may derive a quantifiable perspective on health changes that instructs the patient and health coach in improving chronic disease management.

Journal of Medical Internet Research - Diabetes, 2016;1(1):e1 http://diabetes.jmir.org/2016/1/e1/

Participant Experiences in a Smartphone-based Health Coaching Intervention for Type 2 Diabetes: A Qualitative Inquiry

P. Ritvo , N. Wayne , D. Kaplan, F. Ahmad, M. Coons

This study investigated and evaluated the experience of patients with poorly controlled type 2 diabetes using smartphones, and the effects on motivation for health behavior change. Participants found that using the NexJ Health Coach app on a smartphone, increased self-awareness of habitual behaviors, especially dietary choices. According to the interviews, the integration of the software + smartphone + health coach proved to be factors that positively encouraged the participants. Each piece fit together in bringing their blood sugars under better control.

Participants identified the real-time feedback as motivating, and ‘being heard’ by the health coach was perceived as a key factor in achieving personal goals. Comments from the participants included statements such as, “I think this study helped me emotionally a lot, more than physical…” and “It was a helpful reminder of keeping a check on my blood…what I eat…what I shouldn’t”.

All participants contributed their positive, healthy behavior change to the per-sonal health coach interventions using mobile phones and NexJ’s self-moni-toring software.

Journal of Telemedicine and Telecare, July 21, 2015 http://jtt.sagepub.com/content/early/2015/07/17/1357633X15595178.abstract

Monitoring of specific, quantifiable data

can aid the patient and health coach in improving chronic

disease management.

All participants contributed their positive, healthy

behavior change to the personal health coach interventions

using mobile phones and NexJ’s self-

monitoring software.


Smartphone-Enabled Health Coach Intervention for People with Diabetes from a Modest Socioeconomic Strata Community: Single-Arm Longitudinal Feasibility Study

N. Wayne, P. Ritvo

In this single-arm pilot study, NexJ Health Coach, a smartphone application, was used in conjunction with NexJ Connected Wellness to support communi-cation between health coaches, patients and their supportive family mem-bers. The Health Coach app was collaboratively designed by software devel-opers (NexJ Systems Inc.) and study investigators to support participants in electronically tracking health behaviors and self-monitoring health data.

Patients with poorly managed type 2 diabetes, were recruited from the Black Creek Community Health Centre in Toronto, Ontario, which represents an eth-nically diverse, lower socioeconomic strata of the city. Lower socioeconomic strata (SES) populations are known to have higher chronic disease risks. Low-er SES populations often have difficulty navigating and accessing the health care system to a degree where SES appears to be the best predictor of health status in Canada and the United States. The primary study outcome was gly-cosylated hemoglobin (HbA1c) assessed at baseline and 24 weeks. HbA1c is a clinical indicator of glucose regulation correlated with debilitating and costly diabetic complications.

This study demonstrated the effectiveness of a personalized, electronically assisted, health coaching intervention in an underserved population, with all participants showing a reduction in their HbA1c. This pilot study was intended to generate results guiding the design of a randomized controlled trial.

Journal of Medical Internet Research, 2014, Vol. 16, No 6, June 6 http://www.jmir.org/2014/6/e149/

Smartphone- based personal health coaching

is effective in reducing HbA1c (average blood

glucose) in patients with type 2 diabetes,

even in a lower SES population.

Research Trials Demonstrating the Effectiveness of Personal Health Coaching 7


Investigating Improved Self-Management in Uncontrolled Systolic Hypertension

P. Ritvo, L. Stefanyk, J. Irvine

This study investigated the effectiveness of smartphone-assisted health coaching for the control of hypertension. Smartphone-assisted health coach-ing with NexJ Connected Wellness will provide self-monitoring of exercise, diet and stress reduction; provision of timely reminders; photo-journaling of meals; secure text messaging.

Secondary outcomes will measure self-reported quality of life. 350 men and women between the ages of 25 and 70 with a mean daytime systolic BP >130 mm Hg will be evaluated at Southlake Regional Health Centre, Newmarket, Ontario.

Research trial complete. Pending publication. More information: https://clinicaltrials.gov/ct2/show/NCT02032719

Personal Health Coaching for Cardiovascular Disease



A Phase II RCT and Economic Analysis of Three Exercise Delivery Methods in Men with Prostate Cancer on ADT, Prostate Cancer Canada-Movember Competition

S. Alibhai, P. Ritvo, N. Culos-Reed, M. Krahn, H. Luuka, A. Matthew, C. Sabiston, D. Santa Mina, R. Segal, G. Tomlinson, P. Warde

Androgen deprivation therapy (ADT) is used to treat nearly 50% of men with prostate cancer (PC). Despite delaying disease progression and improving survival, ADT is associated with significant side effects, including declines in health-related quality of life (QOL), fatigue, loss of muscle mass and physi-cal function, bone loss, and metabolic changes. Multiple clinical trials have demonstrated that 8-24 weeks of exercise in men on ADT are associated with improvements in QOL, fatigue, muscle mass, and physical function.

This study, currently in progress, will compare three methods of health coach-ing for adherence to exercise, relative to cost. The use of the NexJ Health Coach mobile app will permit patients to remain in close contact with health professionals via remote health monitoring (e.g. blood pressure, physical activity) and provide instantaneous voice/text communication. This creates potential for unprecedented precision in assisting health-related change.

Effectiveness of Personal Health Coaching on Long Term Exercise Adoption and Adherence

P. Ritvo, J. Jones

The objective of this study is to assess motivational interviewing and smart-phone assisted personal health coaching on increasing exercise activity in breast cancer survivors. Assessing whether smart-phone assisted health coaching improves exercise adoption and adherence.

Published results expected in 2016.

An RCT and Economic Analysis of Three Delivery Methods in Men With Prostate Cancer on ADT

S. Alibhai, P. Ritvo, N. Culos-Reed, M. Krahn, H. Luuka, A. Matthew, C. Sabiston, D. Santa Mina, R. Segal, G. Tomlinson, P. Warde

Comparison of three methods of health coaching for adherence to exercise relative to cost. Assessing whether smart-phone assisted health coaching improves quality of life and physical fitness, especially in terms of long-term adherence and cost-effectiveness.

Research trial approved. To be completed in 2017.

Personal Health Coaching for Cancer

Data collected from this trial will be used for the

RCT and Economic Analysis of Men

with Prostate Cancer on ADT.

7Research Trials Demonstrating the Effectiveness of Personal Health Coaching


University students are an at-risk population for

depression and anxiety.

Personal Health Coaching for Mental Health

Impact of Mobile Prompting on Dementia Patients in Long Term Care Setting.

J. Tung, P. Poupart

Residents of the Schlegel Village Retirement Community were given mobile technology to be monitored and collect feedback. Efficacy of different mobile prompts is assessed for increasing activity within this patient group. The data collected will be used to develop software and prompting algorithms.

Research trial complete. Pending publication.

Perfectionism Anxiety and Depressive Distress: Evidence for the Mediating Role of Negative Automatic Thoughts and Anxiety Sensitivity.

M. Pirbaglou, R. Cribbie, J. Irvine, N. Radhu, K. Vora, P. Ritvo

Current research suggests perfectionistic thinking is a prevalent concern in academic settings. In those manifesting maladaptive perfectionism, the desire for high-level performance is coupled with distorted cognitions that negatively affect academic performance and add to mental health burdens. In light of this, there have been many efforts to reduce perfectionism-related distress in university students using cost-effective interventions.

This study assessed a mediational model in which negative automatic thoughts and anxiety sensitivity were hypothesized to mediate the relation-ship between perfectionism cognitions and depressive and anxiety symp-toms. Participants at a large Canadian university completed questionnaires that assessed perfectionism cognitions, negative automatic thinking, anxiety sensitivity, and anxiety and depressive symptoms.

The evidence suggests that university students are an at-risk population for depression and anxiety, finding that 33% experienced moderate to high levels of depression and anxiety symptoms.

This study further clarified the associations and mediating relationships among mood states associated with perfectionism. The evidence suggests that university students are an at-risk population for depression and anxiety.

J Am Coll Health. 2013;61(8):477-83. http://www.ncbi.nlm.nih.gov/pubmed/24152025



Cognitive Behavioral Therapy-related Increases in Cortical Inhibition in Problematic Perfectionists

N. Radhu, Z.J. Daskalakis, C.L. Guglietti, F. Farzan, M.S. Barr, C.A. Arpin-Cribbie, P.B. Fitzgerald, P. Ritvo

Cognitive behavioral therapy (CBT) is widely accepted as an effective treat-ment for depression and anxiety disorders. The therapeutic effects of CBT are related to neurophysiologic changes in the cortex and can be measured with the use of non-invasive, transcranial magnetic stimulation (TMS). This purpose of this study was to demonstrate the effectiveness of a 12-week CBT intervention compared with a wait list control group by measuring cortical inhibition in participants with pathologic perfectionism.

When compared with the control group the CBT group demonstrated a signif-icant increase in cortical inhibition, seen as the cortical silent period.

Brain Stimul. 2012 Jan;5(1):44-54. http://www.ncbi.nlm.nih.gov/pubmed/22037137

Evaluating a Web-based Cognitive-behavioral Therapy for Maladaptive Perfectionism in University Students.

N. Radhu, Z.J. Daskalakis, C.A. Arpin-Cribbie, J. Irvine, P. Ritvo

University students often set excessively high-level perfectionist standards for themselves. In a maladaptive form, perfectionism drives them to achieve unattainable ideals, while engaging in overly critical self-evaluations. This puts them at risk to develop anxiety, depression, obsessive compulsive disor-der, eating disorders and other mental health problems. Previous research estimates that maladaptive perfectionism adversely affects about 25% of the university undergraduate population. In other studies, cognitive-behavioral therapy (CBT), has been shown to be effective in modifying these dysfunc-tional cognitions and behaviors that cause psychological distress.

In this study 56, undergraduate students defined as maladaptive perfection-ists were randomly assigned to a 12-week cognitive-behavioral therapy, or a wait-list control group. The data were collected from July 2009 to August 2010. The study used a Web-based CBT, investigating perfectionism, anxiety, depression, negative automatic thoughts, and perceived stress.

At the post-intervention measure, the CBT group demonstrated significant decreases in anxiety sensitivity and negative automatic thoughts compared to the control group. Within the CBT group, changes in perfectionism scores were significantly correlated with positive changes in depression, anxiety, stress, and negative automatic thoughts.

J Am Coll Health. 2012 60(5):357-66. http://www.ncbi.nlm.nih.gov/pubmed/22686358

Web-based CBT demonstrated a

significant decrease in depression, anxiety, stress, and negative automatic thoughts

amongst problematic perfectionists.

Cognitive behavioral therapy decreased anxiety

sensitivity and automatic thoughts

in problematic perfectionists.

7Research Trials Demonstrating the Effectiveness of Personal Health Coaching


Impact of Personal Health Coaching on Employee Wellness in a Corporate Setting

P. Ritvo, D. Perez

The objective of this study is to assess impact of personal health coaching on employees motivated to achieve weight, nutrition and exercise goals. Assess-ing whether smartphone-enabled personal health coaching reduces health risk. Employees will self-report results using the IPAC assessment (Interna-tional Physical Activity Questionnaire).


Personal Health Coaching for Wellness

Smartphone- enabled personal health coaching

showed a significant increase in exercise adoption and a reduction in

sitting minutes.



Research Trials Demonstrating the Effectiveness of Patient-facing Care Plans

Often patients do not fully understand medical information discussed during their office visits, which can result in a lack of adherence to recommended treatment plans and poorer health outcomes.

Based on the proven Passport to TRUST™ program devel-oped at Beth Israel Deaconess Medical Center, a Harvard Medical School affiliate, NexJ’s patient-friendly care plans support patients through transitions in care, such as when they are discharged from hospital or between doctor’s visits.

Patient-friendly care plans are written in easy to understand lay-language, and communicate to patients language the de-tails around their condition, what treatments have been per-formed to date, what treatments are next expected, and what to do in case of adverse or expected events.

Patient-friendly care plans provide

patients and their fam-ilies with

peace of mind post-discharge, and contribute

to reducing unnecessary hospital

re-admissions.


Research Trials demonstrating the Effectiveness of Patient-facing Care Plans8Improving Doctor-patient Communication in the Outpatient Setting Using a Facilitation Tool: A Preliminary Study

N. Neeman, T. Isaac, S. Leveille, C. Dimonda, J.Y. Shin, M.D. Aronson, S.D. Freedman

For this study, a program was developed and implemented at Beth Israel Deaconess Medical Center in Boston, to enhance physician–patient com-munication. A quality improvement intervention was implemented across the following five sub-specialties: gastroenterology, hematology/oncology, pulmonary, rheumatology and general medicine. These specialties were cho-sen to broadly cover the major areas of medicine as well as primary care and urgent visit care. All patients were either new to the physicians participating in this project or were presenting with a new problem. Prior to the program only 38% of patients felt their problems and questions were adequately addressed by other physicians, compared to 94% post-intervention. Sixty-nine percent of patients shared the program with their family members, which helped in-crease understanding and compliance with treatments and therapies.

By adding a patient-friendly care plan to their medical visits, patients reported a significant improvement in their overall satisfaction. Ninety-eight percent of patients were highly satisfied with the program. They felt their self-confidence in communicating with their doctors was significantly improved, as well as their understanding of their illness and treatment plan. By creating a formal-ized roadmap with their patients, physicians felt their patients were better informed and engaged, becoming active partners in their care.

Int J Qual Health Care 2012 Aug;24(4):357-64 http://intqhc.oxfordjournals.org/content/intqhc/24/4/357.full.pdf

Impact of Personal Care Plans on Health System Costs and Patient Activation in Ambulatory Care

S. Freedman, C. Martin

This study will assess whether personal care plans improve Patient Activation Measures (PAM) and lower health system costs by reducing tests.


96% of patients reported feeling

confident in understanding their medical condition.

69% of patients shared the program

with their family and/or friends.

94% of patients felt their problems and

questions were adequately addressed

versus 38% prior to visit.

TM

www.nexjhealth.com

About NexJ Health NexJ Health Inc. is a provider of cloud-based population health management solutions delivering patient engagement for chronic disease management. At NexJ Health, we believe that controlling the rise of chronic disease is possible when patients are engaged to actively participate in managing their chronic conditions. By engaging patients through NexJ Connected Wellness, patients are more likely to achieve their health goals, payers can lower costs, providers can improve care to patients, and pharmaceutical manufacturers and pharmacies can improve medication adherence. © 2016 NexJ Health Inc. All rights reserved. All trademarks are the property of their respective owners. 2016.05.10

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