Impact of patient-centred home telehealth programme on outcomes in heart failure
Impact of patient-centred home telehealth programme on outcomes in heart failure
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DOI：
10.1177/1357633x18775852
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发表时间：
2019-08-01
影响因子：
4.7
通讯作者：
Joseph, Jacob
中科院分区：
文献类型：
--
作者：
Srivastava, Anshul;Do, Jacquelyn-My;Joseph, Jacob
远程医疗是一种有前途的干预措施，可以减少心力衰竭患者的再入院率和医疗保健相关费用。方法：我们对197名心力衰竭患者进行了远程医疗的影响进行了回顾性分析，这些患者在心力衰竭入院后成功完成了一年的家庭远程医疗监测，作为退伍军人事务医疗中心临床授权计划的一部分。结果在组内进行了比较（家庭远程医疗监测前一年和家庭远程医疗监测后一年），并与870名入院但未参加家庭远程医疗的心力衰竭患者的当代对照队列进行了比较。分析了以下结果：任何原因的入院，心力衰竭入院，每位患者的总住院日，每次入院的平均住院时间，紧急护理和急诊室就诊，以及初级保健就诊。结果家庭远程医疗和对照队列均由老年男性患者组成。与前一年没有监测（4.1 +/- 4.6，p < 0.0001）和对照组（3.8 +/- 5.3，p <0.001）相比，家庭远程健康监测组（2.4 +/- 3.5）中每位患者的总住院天数显著减少。录取率明显降低（1.1 +/- 1.6）和逗留时间与前一年相比，家庭远程医疗组在家庭远程医疗监测期间观察到的时间为5.7 +/- 11.3天（分别为1.6 +/-1.7，p < 0.05和9.5 +/-14天，p < 0.01），但与对照组（1.4 +/-2.0，p < 0.07）相比没有变化。与对照组相比，家庭远程医疗组的住院时间也显著较短（5.7 +/- 11.3 vs 9.0 +/- 14.9，p < 0.01）。与前一年相比，在家庭远程医疗监测期间，紧急护理和急诊室就诊或初级保健就诊的数量没有显著差异。结论：对心力衰竭患者进行个性化和以患者为中心的家庭远程健康监测，在不增加门诊和急诊就诊的情况下，成功地减少了结局。
Background Telehealth is a promising intervention to reduce readmissions and healthcare-associated costs in patients with heart failure. Methods We performed a retrospective analysis of the impact of telehealth on 197 heart failure patients who had successfully completed one year of home telehealth monitoring following a heart failure admission as part of a clinically mandated programme at a Veterans Affairs Medical Center. Outcomes were compared both within the group (one year before and one year after home telehealth monitoring), and to a contemporary control cohort of 870 heart failure patients who were admitted but not enrolled in home telehealth. The following outcomes were analysed: admissions for any cause, heart failure admissions, total hospital days per patient, average length of stay per admission, urgent care and emergency room visits, and primary care visits. Results Both the home telehealth and control cohorts consisted of older male patients. Total hospital days per patient was significantly reduced by home telehealth monitoring in the home telehealth group (2.4 +/- 3.5) in comparison to the previous year without monitoring (4.1 +/- 4.6, p < 0.0001) and to the control group (3.8 +/- 5.3, p < 0.001). A significantly lower admission rate (1.1 +/- 1.6) and length of stay (5.7 +/- 11.3 days) were observed during home telehealth monitoring within the home telehealth group compared to the prior year (1.6 +/- 1.7, p < 0.05 and 9.5 +/- 14 days, p < 0.01 respectively) but not in comparison with the control group (1.4 +/- 2.0, p < 0.07). The home telehealth group also had a significantly lower length of stay when compared to the control group (5.7 +/- 11.3 vs 9.0 +/- 14.9, p < 0.01). The number of urgent care and emergency room visits, or primary care visits, was not significantly different during home telehealth monitoring as compared to the prior year. Conclusions Personalised and patient-centred home telehealth monitoring in heart failure patients was successful in reducing outcomes without an increase in outpatient and urgent care visits.