Access to Mobile Health Interventions Among Patients Hospitalized With Heart Failure: Insights Into the Digital Divide From the CONNECT-HF mHealth Substudy.
Access to Mobile Health Interventions Among Patients Hospitalized With Heart Failure: Insights Into the Digital Divide From the CONNECT-HF mHealth Substudy.
复制标题
因心力衰竭住院的患者获得移动健康干预措施：从 CONNECT-HF mHealth 子研究中洞察数字鸿沟。
DOI：
10.1161/circheartfailure.123.011140
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
DeVore,Ada
中科院分区：
文献类型：
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作者：
Diamond,JamieE;Kaltenbach,LisaA;Granger,BradiB;Fonarow,GreggC;Al-Khalidi,HusseinR;Albert,NancyM;Butler,Javed;Allen,LarryA;Lanfear,DavidE;Thibodeau,JenniferT;Granger,ChristopherB;Hernandez,AdrianF;Ariely,Dan;DeVore,Ada
数字健康干预有可能在人口层面改善心血管疾病患者的护理和预后。实施数字健康干预措施，包括移动健康(MHealth)应用程序，需要从立法者到技术公司的多个利益攸关方的参与。利益攸关方面临的一个基本且悬而未决的挑战是改善患者获得数字医疗服务的途径。心力衰竭(HF)指南强调需要对数字健康进行更多研究，以此作为改善HF护理的战略。目前，从战略上改善心力衰竭患者的数字健康途径的数据有限。为了解决这个问题，我们分析了参加CONNECTHF(通过患者和医院参与的心力衰竭临床试验优化护理)的mHealth子研究的参与者的特征。CONNECT-HF是一项多中心、整群随机试验，旨在评估为期一年的出院后质量改善干预的效果。1，2名参与者的左心室射血分数≤为40%，在2017年3月至2020年5月期间因心力衰竭住院而出院。一项可选的、前瞻性的辅助性子研究评估了旨在改善心力衰竭护理的移动应用程序。3名参与者在全美72家医院接受了筛查，如果他们符合CONNECT-HF调查人员定义的以下筛查标准，则被视为拥有mHealth访问权限：(1)拥有智能手机，(2)拥有移动互联网接入，(3)拥有智能手机电子邮件接入，以及(4)能够在提示时在智能手机上下载天气应用程序。所有研究地点都获得了机构审查委员会的批准，所有参与者在收集任何研究数据之前都必须签署书面知情同意书。在合理的要求下，本研究的数据可从相应的作者处获得。使用标准统计方法总结了基线特征。使用多变量Logistic回归来确定与数字接入相关的因素，包括人口统计学、临床因素、医疗保健地点地区和社会经济状况因素。社会经济地位变量是通过将患者邮政编码与2018年人口普查局美国社区调查数据联系起来确定的，这些数据包括家庭收入中位数、大学毕业率和失业率。在接受评估的2044名参与者中，889人(43%)通过了4项筛选标准。在未接入mHealth的1155人中，589人(51%)没有智能手机，927人(80%)无法访问移动互联网，1053人(91%)无法访问智能手机电子邮件，1122人(97%)无法下载天气应用程序。报告了未经调整的分析结果(表)。与移动健康服务访问增加独立相关的因素包括年轻人
Digital health interventions have the potential to improve care and outcomes for patients with cardiovascular disease at a population level. Implementation of digital health interventions, including mobile health (mHealth) applications, requires engagement from multiple stakeholders, from legislators to technology companies. An essential and unresolved challenge across stakeholders is improving digital health access for patients. Heart failure (HF) guidelines highlight the need for more studies on digital health as a strategy to improve HF care. Currently, limited data exist to strategically improve digital health access among patients with HF. To address this, we analyzed the characteristics of participants enrolled in the mHealth substudy of CONNECTHF (Care Optimization Through Patient and Hospital Engagement Clinical Trial for Heart Failure). CONNECT-HF was a multicenter, cluster-randomized trial to evaluate the effect of a year-long, postdischarge, quality improvement intervention. 1, 2 Participants had a left ventricular ejection fraction≤ 40% and were discharged after an HF hospitalization from March 2017 to May 2020. An optional, prospective, ancillary substudy evaluated a mobile application intended to improve HF care. 3 Participants were screened at 72 hospitals across the United States and were considered to have mHealth access if they met the following screening criteria defined by the CONNECT-HF investigators:(1) owned a smartphone,(2) had mobile internet access,(3) had smartphone email access, and (4) were able to download a weather application on the smartphone when prompted. All sites obtained institutional review board approval, and all participants were required to sign written informed consent before the collection of any study data. Data for this study are available from the corresponding author upon reasonable request. Baseline characteristics were summarized using standard statistical methods. Multivariable logistic regression was used to determine factors associated with digital access and included demographics, clinical factors, health care site region, and socioeconomic status factors. Socioeconomic status variables were determined by linking the patient ZIP Code to the 2018 Census Bureau American Community Survey data median household income, college graduation rate, and unemployment rate. Of the 2044 participants evaluated, 889 (43%) passed the 4 screening criteria. Of 1155 without mHealth access, 589 (51%) had no smartphone, 927 (80%) could not access mobile internet, 1053 (91%) could not access smartphone email, and 1122 (97%) could not download a weather application. The results of unadjusted analyses are reported (Table). Factors independently associated with increased mHealth access included younger