Using Smart Devices to Implement an Evidence-based eHealth System for Older Adults (Wisconsin)

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Enhancing an evidence-based electronic health intervention, Elder Tree, with voice-controlled technology can broaden its use, leading to improved overall health and reduced hospital readmission for older adults with multiple chronic conditions.

Project Details - Ongoing


Multiple chronic conditions (MCCs) are a significant issue among older adults, posing a costly and time-consuming burden on the U.S. healthcare system. For example, 65 percent of Medicare beneficiaries have three or more chronic conditions, accounting for 90 percent of Medicare spending. Healthcare management is crucial for those with MCCs, though adherence can often be complex and overwhelming for patients. While MCCs are usually addressed with a patient’s primary care provider, time constraints during visits may prevent dissemination of self-management tools and resources for patients to gain proper management skills. Technological interventions for the delivery of motivation and support have proven to help older adult patients manage their health.

The evidence-based electronic health intervention Elder Tree (ET) is a laptop application that provides coping tools, motivation, and social support to help patients with MCCs to manage their health. Previous AHRQ-funded research found the application to be successful among users; however, there is the barrier of technology literacy among the older adult population. This research will investigate whether voice-controlled technology can broaden and sustain the use of ET more effectively than the laptop platform. In addition to audio-activation software, the enhanced ET system includes a smart display to add a visual component so a voice command response can be heard and read. The goal of the system enhancement is to increase the impact for older adults with MCCs.

The specific aims of the project are as follows:

  • Develop, with user-centered design, the smart system platform to deliver the evidence-based ET. 
  • Conduct a randomized clinical trial to test patient outcomes such as medication adherence, depression symptoms, quality of life, and compare improvements among men versus women. 

The research team will conduct a two-arm randomized clinical trial comparing the laptop platform of ET to the enhanced “smart system” version of it using a smart device. This enhanced version includes a smart screen display as a visual component, which is integrated with a speaker for volume to extend to a large area of the home. The trial will involve 220 participants over the age of 65 with four or more MCCs recruited from primary care clinics in Madison, Wisconsin.

The overall goal of this research is to deliver healthcare self-management tools for skill development to older adults with MCCs in a way that is accessible and encouraging to the patient. The expectation of this study will be to show smart devices can enhance the sustainability of programs such as ET, and in turn will significantly increase the impact of it among older adults. This advancement aims to increase quality of life, improve overall health, and reduce hospital readmission among older patients with MCCs.