Engagement with automated patient monitoring and self-management support calls: experience with a thousand chronically ill patients.
Engagement with automated patient monitoring and self-management support calls: experience with a thousand chronically ill patients.
复制标题
DOI：
10.1097/mlr.0b013e318277ebf8
复制
发表时间：
2013-03
期刊：
影响因子：
3
通讯作者：
Silveira MJ
中科院分区：
文献类型：
--
作者：
Piette JD;Rosland AM;Marinec NS;Striplin D;Bernstein SJ;Silveira MJ
通过交互式语音应答（IVR）提供的患者自我护理支持可以改善疾病管理。然而，人们对影响项目参与度的因素知之甚少。我们收集了1,173名患有心力衰竭、抑郁症、糖尿病和癌症的患者的IVR项目参与数据，这些患者接受了28,962人周的随访。参与糖尿病或抑郁症项目的患者（N=727）可以选择沿着一名非正式护理人员，该护理人员根据患者的IVR评估接受电子反馈。分析集中在与完成每周IVR呼叫相关的因素。患者平均年龄为61岁，37%的人最多受过高中教育，48%的人报告收入<30，000美元。在选择与非正式护理人员一起参与的患者中，65%的人选择这样做。患者完成了83%的尝试IVR评估，心力衰竭（90%）和癌症项目（90%）的比率高于糖尿病（81%）或抑郁症项目（71%）（p<0.001）。在糖尿病或抑郁症患者中，那些选择向非正式护理人员提供反馈的患者更有可能完成评估（调整后的比值比：1.36; 95% CI：1.06，1.75）。年龄较大的患者有较高的呼叫完成率，即使在> 75岁的患者中也是如此。错过诊所预约，先前住院，抑郁症计划的参与，以及较差的心理健康与较低的完成率相关。患有各种慢性疾病的患者将定期完成IVR自我护理支持电话。错过IVR呼叫的风险因素与错过预约的风险因素重叠。非正式照顾者的参与可能会大大增加参与。
Patient self-care support via Interactive Voice Response (IVR) can improve disease management. However little is known about the factors affecting program engagement. We compiled data on IVR program engagement for 1,173 patients with: heart failure, depression, diabetes, and cancer who were followed for 28,962 person-weeks. Patients in programs for diabetes or depression (N=727) had the option of participating along with an informal caregiver who received electronic feedback based on the patient’s IVR assessments. Analyses focused on factors associated with completing weekly IVR calls. Patients were on average 61 years old, 37% had at most a high school education, and 48% reported incomes < $30,000. Among patients given the option of participating with an informal caregiver, 65% chose to do so. Patients completed 83% of attempted IVR assessments, with rates higher for heart failure (90%) and cancer programs (90%) than for the diabetes (81%) or depression programs (71%) (p<0.001). Among patients in diabetes or depression programs, those opting to have feedback provided to an informal caregiver were more likely to complete assessments (adjusted odds ratio: 1.36; 95% CI: 1.06, 1.75). Older patients had higher call completion rates, even among patients > 75 years of age. Missed clinic appointments, prior hospitalizations, depression program participation, and poorer mental health were associated with lower completion rates. Patients with a variety of chronic conditions will complete IVR self-care support calls regularly. Risk factors for missed IVR calls overlap with those for missed appointments. Involvement of informal caregivers may significantly increase engagement.