Association of Comorbidities With Home Care Service Utilization of Patients With Heart Failure While Receiving Telehealth
Association of Comorbidities With Home Care Service Utilization of Patients With Heart Failure While Receiving Telehealth
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DOI：
10.1097/jcn.0b013e3182512331
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发表时间：
2013-05-01
影响因子：
2
通讯作者：
Bowles, Kathryn H.
中科院分区：
文献类型：
--
作者：
Radhakrishnan, Kavita;Jacelon, Cynthia S.;Bowles, Kathryn H.
背景：合并症对心力衰竭（HF）结果有不利影响。远程医疗可以帮助医疗保健提供者，特别是护士，指导他们的病人遵循心衰治疗方案。然而，包括合并症模式在内的因素，与远程医疗相结合，以减少家庭护理的利用仍不清楚。目的：这篇文章的目的是研究在远程家庭护理期间，心衰患者的合并症特征与护理利用以及退出远程医疗服务的关系。方法：采用回顾性图表回顾的描述性相关研究设计。样本包括新英格兰家庭护理机构收治的诊断为心衰并在2008年至2010年期间使用远程医疗的医疗保险患者。以家庭护理机构的电子文档为数据源，其中包括心衰患者的结局和评估信息集数据。采用Logistic和多元回归分析对数据进行分析。结果：样本包括403名参与者，其中70%年龄在75岁以上，55%为女性，94%为白人。合并症平均为5.19 (SD, 1.92)，范围从1到11，近40%的参与者有5种或更多合并症。样本护理接触者平均（SD）为9.9（4.7）人，范围为1 ~ 26，有52例（12.7%）患者退出远程医疗服务。对于接受远程医疗的心衰患者，贫血、焦虑、肌肉骨骼和抑郁的合并症特征与护理利用模式显著相关，肾功能衰竭、癌症和抑郁合并症与退出远程医疗服务显著相关。临床意义：了解合并症特征与远程医疗心衰患者家庭护理服务利用模式的关联，可以帮助家庭保健护士制定量身定制的护理计划，以获得最佳的患者结果。了解这些关联还可以集中家庭护理资源，避免在这个医疗资源紧张的时代资源利用的冗余。
Background: Comorbidities adversely impact heart failure (HF) outcomes. Telehealth can assist healthcare providers, especially nurses, in guiding their patients to follow the HF regimen. However, factors, including comorbidity patterns, that act in combination with telehealth to reduce home care nursing utilization are still unclear. Purpose: The purpose of this article was to examine the association of the comorbidity characteristics of HF patients with nursing utilization along with withdrawal from telehealth service during an episode of tele-home care. Methodology: A descriptive, correlational study design using retrospective chart review was used. The sample comprised Medicare patients admitted to a New England home care agency who had HF as a diagnosis and had used telehealth from 2008 to 2010. The electronic documentation at the home care agency served as the data source, which included Outcome and Assessment Information Set data of patients with HF. Logistic and multiple regression analyses were used to analyze data. Results: The sample consisted of 403 participants, of whom 70% were older than 75 years, 55% were female, and 94% were white. Comorbidities averaged 5.19 (SD, 1.92), ranging from 1 to 11, and nearly 40% of the participants had 5 or more comorbidities. The mean (SD) nursing contacts in the sample was 9.9 (4.7), ranging from 1 to 26, and 52 (12.7%) patients withdrew from telehealth service. For patients with HF on telehealth, comorbidity characteristics of anemia, anxiety, musculoskeletal, and depression were significantly associated with nursing utilization patterns, and renal failure, cancer, and depression comorbidities were significantly associated with withdrawal from telehealth service. Clinical Implications: Knowledge of the association of comorbidity characteristics with the home care service utilization patterns of patients with HF on telehealth can assist the home health nurse to develop a tailored care plan that attains optimal patient outcomes. Knowledge of such associations would also focus home care resources, avoiding redundancy of resource utilization in this era of strained healthcare resources.