Challenges in implementing a pediatric cardiovascular home telehealth project.
Challenges in implementing a pediatric cardiovascular home telehealth project.
复制标题
实施儿科心血管家庭远程医疗项目面临的挑战。
DOI：
10.1089/tmj.2013.0343
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
B. Keller
中科院分区：
文献类型：
--
作者：
A. K. Black;Usha K Sadanala;C. Mascio;C. Hornung;B. Keller
目的
患有“单心室”先天性心脏病的婴儿在姑息手术治疗后猝死的风险很高。我们开发了一个试点远程医疗项目，以评估使用基于Web的临床数据的日常报告的可行性，以减少意外入院和猝死的目标。
受试者和方法
我们入组了9例在12个月内接受手术姑息治疗的受试者（入组受试者[ES]）。父母通过电子方式发送ES的每日体重和血氧饱和度，然后完成一份关于营养、活动和痛苦的自动化10点电话问卷。受试者入组持续至第二次姑息性手术（n=5）、猝死（n=2）或退出（n=2）。我们收集了过去18个月内所有ES和9个历史对照（HC）的临床数据，并分析了临床管理，包括门诊电话监测成功率、计划和计划外的办公室和急诊室访视、住院、手术和不良事件（包括死亡）。
结果
受试者招募比预期更困难。体重传输成功率很高，但远程医疗系统测量的血氧饱和度与商业监护仪之间的相关性很差。HC和ES的门诊临床电话监测成功率约为30%。经过技术调整后，所有ES的父母（100%）都能够传输问卷数据。ES有9次急诊室访视，HC有11次计划外急诊室访视。9例HC和9例ES中分别有1例和2例发生猝死。
结论
对高危先天性心脏病患者进行远程医疗监测是可行的，但具有挑战性，可能会减少计划外访视，但可能不会影响预防这一高危儿科人群猝死的主要终点。
OBJECTIVE
Infants with "single ventricle" congenital heart disease are at high risk for sudden death following palliative surgical management. We developed a pilot telemedicine project to evaluate the feasibility of using Web-based daily reporting of clinical data with the goal of reducing unexpected admissions and sudden death.
SUBJECTS AND METHODS
We enrolled 9 subjects (enrolled subjects [ES]) following surgical palliation over 12 months. Parents electronically transmitted ES daily weight and oxygen saturation and then completed an automated 10-point phone questionnaire on nutrition, activity, and distress. Subject enrollment continued until a second surgical palliative procedure (n=5), sudden death (n=2), or disenrollment (n=2). We collected clinical data on all ES and 9 historical controls (HC) from the preceding 18 months and analyzed clinical management, including outpatient telephone surveillance success, scheduled and unscheduled office and emergency department visits, hospitalizations, procedures, and adverse events, including death.
RESULTS
Subject recruitment was more difficult than expected. Weight transmission success was high, but there was poor correlation between telemedicine system-measured oxygen saturation and a commercial monitor. The outpatient clinical telephone surveillance success rate for HC and ES was approximately 30%. After technical adjustments, parents of all ES (100%) were able to transmit questionnaire data. There were 9 emergency room visits for ES versus 11 unscheduled emergency room visits for HC. Sudden death occurred in 1 of 9 HC and 2 of 9 ES.
CONCLUSIONS
Telemedicine monitoring for high-risk congenital heart disease patients is feasible but challenging, may reduce unscheduled visits, but may not impact the primary end point of preventing sudden death in this high-risk pediatric population.