Delivering heart failure disease management in 3 tertiary care centers: Key clinical components and venues of care
Delivering heart failure disease management in 3 tertiary care centers: Key clinical components and venues of care
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DOI：
10.1016/j.ahj.2007.12.026
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发表时间：
2008-04-01
影响因子：
4.8
通讯作者：
Stevenson, Lynne W.
中科院分区：
文献类型：
--
作者：
Shah, Monica R.;Whellan, David J.;Stevenson, Lynne W.
背景几乎没有数据来帮助那些组织和管理心力衰竭(HF)疾病管理(DM)计划的人。我们的目的是描述门诊心衰护理(门诊就诊和电话)以及医疗和非药物干预在门诊环境中的强度。方法这是一项前瞻性的子研究，在3个中心登记了130名参加HFDMStarbrite计划的患者。随访发生在出院后10、30、60、90和120天。前瞻性追踪心力衰竭专家、执业护士和护士的就诊次数和来电次数。结果共有581次来电，每例患者4(2，6)次；467次门诊，每例患者3(2，5)次。每位患者每次来电的时间为8.9(6，10.6)分钟，每次就诊的时间为23.8(20，28.3)分钟。护士和执业护士在电话中提供护理的时间为113小时，医生和执业护士在诊所的时间为187.6小时。在电话中解决的问题包括心力衰竭教育(341次[52.6%])和液体超载(87次[41.8%])。医疗干预包括调整环状利尿剂(电话101次，临床156次)；β-受体阻滞剂(电话18次，临床126次)；血管舒张剂(电话8次，临床55次)。结论临床医生三分之一以上的时间用于电话，其中50%的患者接触和接受心衰教育，39%的利尿剂调整发生在电话上。管理人员以及公共和私人保险公司需要认识到通过电话提供的医疗护理的数额，并应考虑对这些活动进行补偿。
Background Little data exist to assist to help those organizing and managing heart failure (HF) disease management (DM) programs. We aimed to describe the intensity of outpatient HF care (clinic visits and telephone calls) and medical and nonpharmacological interventions in the outpatient setting.Methods This was a prospective substudy of 130 patients enrolled in STARBRITE in HFDM programs at 3 centers. Followup occurred 10, 30, 60, 90, and 120 days after discharge. The number of clinic visits and calls made by HF cardiologists, nurse practitioners, and nurses were prospectively tracked. The results were reported as medians and interquartile ranges.Results There were a total of 581 calls with 4 (2, 6) per patient and 467 clinic visits with 3 (2, 5) per patient. Time spent per patient was 8.9 (6, 10.6) minutes per call and 23.8 (20, 28.3) minutes per clinic visit. Nurses and nurse practitioners spent 113 hours delivering care on the phone, and physicians and nurse practitioners spent 187.6 hours in clinic. Issues addressed during calls included HF education (341 times [52.6%]) and fluid overload (87 times [41.8%]). Medical interventions included adjustments to loop diuretics (calls 10 1 times, clinic 156 times); beta-blockers (calls 18 times, clinic 126 times); vasoclilators (calls 8 times, clinic 55 times).Conclusions More than a third of clinician time was spent on calls, during which >50% of patient contacts and HF education and >39% of diuretic adjustments occurred. Administrators and public and private insurers need to recognize the amount of medical care delivered over the telephone and should consider reimbursement for these activities.