A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus: 5 Year Results of the IDEATel Study
A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus: 5 Year Results of the IDEATel Study
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DOI：
10.1197/jamia.m3157
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发表时间：
2009-07-01
影响因子：
6.4
通讯作者：
Eimicke, Joseph P.
中科院分区：
文献类型：
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作者：
Shea, Steven;Weinstock, Ruth S.;Eimicke, Joseph P.
内容：远程医疗是一种很有前途的，但在很大程度上未经证实的技术，为慢性病患者提供病例管理服务和较低的获得护理。Objectives：为了研究远程医疗干预的有效性，以实现老年人，种族多样化，医疗服务不足的糖尿病患者的临床管理目标。设计，设置和患者：进行了一项随机对照试验，在1,665名55岁的糖尿病医疗保险接受者中，将远程医疗病例管理与常规护理进行了比较，并进行了盲法结局评价，居住在纽约州联邦指定的医疗服务不足的地区。干预措施：家庭远程医疗单位与护士病例管理与常规护理。主要结果测量：5年随访期间评估的主要终点为血红蛋白A1 c（HgbA 1c）、低密度脂蛋白（LDL）胆固醇、结果：意向治疗混合模型显示，远程医疗在五年的随访中实现了主要终点的净总体降低（HbA 1c，p = 0.001; LDL，p < 0.001;收缩压和舒张压，p = 0.024; p < 0.001）。第5年HgbA 1c的估计差异（95%CI）为0.29（0.12，0.46）%，LDL胆固醇为3.84（-0.08，7.77）mg/dL，收缩压为4.32（1.93，6.72）mmHg，舒张压为2.64（1.53，3，74）mmHg。干预组有176例死亡，常规护理组有169例死亡（风险比1.01 [0.82，1.24]）。结论：远程医疗病例管理导致医疗服务不足的医疗保险受益人在5年内HbA 1c，LDL胆固醇和血压水平的净改善。死亡率在两组之间没有差异，尽管功效有限。
Context: Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions and lower access to care.Objectives: To examine the effectiveness of a telemedicine intervention to achieve clinical management goals in older, ethnically diverse, medically underserved patients with diabetes.Design, Setting, and Patients: A randomized controlled trial was conducted, comparing telemedicine case management to usual care, with blinded outcome evaluation, in 1,665 Medicare recipients with diabetes, aged 55 years, residing in federally designated medically underserved areas of New York State.Interventions: Home telemedicine unit with nurse case management versus usual care.Main Outcome Measures: The primary endpoints assessed over 5 years of follow-up were hemoglobin A1c (HgbA1c), low density lipoprotein (LDL) cholesterol, and blood pressure levels.Results: Intention-to-treat mixed models showed that telemedicine achieved net overall reductions over five years of follow-up in the primary endpoints (HgbA1c, p = 0.001; LDL, p < 0.001; systolic and diastolic blood pressure, p = 0.024; p < 0.001). Estimated differences (95% CI) in year 5 were 0.29 (0.12, 0.46)% for HgbA1c, 3.84 (-0.08, 7.77) mg/dL for LDL cholesterol, and 4.32 (1.93, 6.72) mm Hg for systolic and 2.64 (1.53, 3,74) mm Hg for diastolic blood pressure. There were 176 deaths in the intervention group and 169 in the usual care group (hazard ratio 1.01 [0.82, 1.24]).Conclusions: Telemedicine case management resulted in net improvements in HgbA1c, LDL-cholesterol and blood pressure levels over 5 years in medically underserved Medicare beneficiaries. Mortality was not different between the groups, although power was limited.