The Impact of a Designated Cardiology Team Involving Telemedicine Home Monitoring on the Care of Children with Single-Ventricle Physiology After Norwood Palliation
The Impact of a Designated Cardiology Team Involving Telemedicine Home Monitoring on the Care of Children with Single-Ventricle Physiology After Norwood Palliation
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DOI：
10.1007/s00246-016-1366-y
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发表时间：
2016-06-01
影响因子：
1.6
通讯作者：
Martin, Gerard R.
中科院分区：
文献类型：
--
作者：
Harahsheh, Ashraf S.;Hom, Lisa A.;Martin, Gerard R.
我们评估了跨学科单心室工作组（SVTF）的效果，该工作组利用家庭驱动的远程医疗家庭监测计划对II期入院的临床结果以及家长和心脏病专家的接受程度。研究人群分为两个队列，一个队列的诺伍德手术日期在SVTF之前（SVTF前），一个队列的干预性手术日期在SVTF后。SVTF后数据还包括对父母和心脏病专家关于SVTF疗效的调查。进行了比较和多变量统计检验。与SVTF前组相比，SVTF后组II期后并发症较低（18.4 vs. 34.1%，p = 0.02），II期年龄别体重z评分较高（-1.5 +/-A 0.97对比-1.58 +/-A 1.34，p = 0.02），II期年龄别体重z评分低于-2的可能性较小（26.5对比31.7%，p = 0.03）。多变量回归分析显示，在出院时向父母提供书面的红旗行动计划与II期较高的体重（β = 0.42，p = 0.04）和较高的年龄别体重z评分（β = 0.48，p = 0.02）独立相关。父母对SVTF的满意度（α = 0.97）为4.34 +/-A 0.62;（95% CI 4.01 - 4.67），心脏病专家的接受度（α = 0.93）为4.1 +/-A 0.7（95% CI 3.79 - 4.42）。SVTF的发展与II期后并发症的减少和II期体重状况的改善相关。在诺伍德出院时向父母提供的书面红旗行动计划与II期较高的体重状态相关。家长和心脏病专家对SVTF的实用性表示满意，并鼓励将其扩展到所有先天性心脏病儿童。
We evaluated the effect of an interdisciplinary single-ventricle task force (SVTF) that utilizes a family-driven, telemedicine home monitoring program on clinical outcomes of stage II admissions and its acceptance by parents and cardiologists. Study population was divided into two cohorts, one with Norwood surgery dates before the SVTF (pre-SVTF) and one interventional (post-SVTF). Post-SVTF data also included surveys of parents and cardiologists on the efficacy of the SVTF. Comparative and multivariate statistical testing was performed. Compared to the pre-SVTF group, the post-SVTF group had lower complications after stage II (18.4 vs. 34.1 %, p = 0.02), higher weight-for-age z scores at stage II (-1.5 +/- A 0.97 vs. -1.58 +/- A 1.34, p = 0.02) and were less likely to have a stage II weight-for-age z score below -2 (26.5 vs. 31.7 %, p = 0.03). A multivariate regression analysis showed providing a written red-flag action plan to parents at discharge was independently associated with higher weight at stage II (beta = 0.42, p = 0.04) and higher weight-for-age z score (beta = 0.48, p = 0.02). Parents' satisfaction with SVTF (alpha = 0.97) was 4.34 +/- A 0.62; (95 % CI 4.01-4.67) and cardiologists' acceptance (alpha = 0.93) was 4.1 +/- A 0.7 (95 % CI 3.79-4.42). Development of SVTF was associated with a reduction in complications post-stage II and improved weight status at stage II. A written red-flag action plan provided to parents at the time of Norwood discharge was associated with higher weight status at stage II. Parents and cardiologists expressed satisfaction with the utility of SVTF and encouraged expansion to cover all children with congenital heart disease.