Clinical outcome and cost-effectiveness of a synchronous telehealth service for seniors and nonseniors with cardiovascular diseases: quasi-experimental study.
Clinical outcome and cost-effectiveness of a synchronous telehealth service for seniors and nonseniors with cardiovascular diseases: quasi-experimental study.
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DOI：
10.2196/jmir.2091
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发表时间：
2013-04-24
影响因子：
7.4
通讯作者：
Chen MF
中科院分区：
文献类型：
--
作者：
Chen YH;Lin YH;Hung CS;Huang CC;Yeih DF;Chuang PY;Ho YL;Chen MF
基于先进信息技术的远程保健是一种管理慢性病的新兴保健战略。然而，同步远程医疗服务在老年心血管疾病患者中的成本效益和临床效果尚未得到研究。自2009年以来，台大医院远程医疗中心为心血管疾病患者提供一系列远程医疗服务（由心脏病专家领导，由心血管护理专家组成），包括(1)即时传递血压、脉搏、心电图、血氧仪和血糖仪进行分析，(2)相互电话沟通和健康促进，以及(3)持续分析和决策支持。评估同步远程医疗服务对老年心血管疾病患者的影响。在2009年11月至2010年4月期间，招募了在国立台湾大学医院接受远程医疗服务的心血管疾病患者。为了评估远程医疗服务对心血管患者的临床影响和成本效益，我们收集了远程医疗中心开业前和开业后6个月期间的医院就诊和医疗支出数据。共招募141例连续心血管疾病患者，其中年龄≥65岁组93例，年龄<65岁组48例，非老年组。远程医疗干预显著降低了非老年组每月人均全因入院率（远程前：中位数0.09,IQR 0-0.14；远程后：中位数0，IQR 0-0； P= 0.002）和全因住院时间（每人每月天数）（远程前：中位数0.70,IQR 0-1.96；远程后：中位数0，IQR 0-0； P< 0.001），每月人均全因门诊次数增加(远程前：中位数0.77,IQR 0.20-1.64；远程医疗后：平均1.60,IQR 1.06-2.57；P = .002)。在老年组中，远程医疗干预还显著降低了每人每月全因入院率（远程前：中位数0.10,IQR 0-0.18；远程后：中位数0，IQR 0-0； P< 0.001）和全因住院时间（每人每月天数）（远程前：中位数0.59,IQR 0-2.24；远程后：中位数0，IQR 0-0； P< 0.001），增加了每人每月全因门诊次数(远程前：中位数1.40,IQR 0.52-2.63；远程医疗后：中位数1.76,IQR 1.12-2.75；P = .02点)。此外，远程医疗干预将非老年组的住院费用从814.93美元（SD 1000.40）降低到217.39美元（SD 771.01， P= 0.001），每月总费用从954.78美元（SD 998.70）降低到485.06美元（SD 952.47， P< 0.001）。在老年组，每月住院费用从768.27美元（SD 1148.20）降至301.14美元（SD 926.92， P< 0.001），每月总费用从928.20美元（SD 1194.11）降至494.87美元（SD 1047.08， P< 0.001）。同步远程医疗干预可以降低成本，降低全因住院率，缩短心血管疾病患者的全因住院时间，无论年龄大小。
Telehealth based on advanced information technology is an emerging health care strategy for managing chronic diseases. However, the cost-effectiveness and clinical effect of synchronous telehealth services in older patients with cardiovascular diseases has not yet been studied. Since 2009, the Telehealth Center at the National Taiwan University Hospital has provided a range of telehealth services (led by a cardiologist and staffed by cardiovascular nursing specialists) for cardiovascular disease patients including (1) instant transmission of blood pressure, pulse rate, electrocardiography, oximetry, and glucometry for analysis, (2) mutual telephone communication and health promotion, and (3) continuous analytical and decision-making support. To evaluate the impact of a synchronous telehealth service on older patients with cardiovascular diseases. Between November 2009 and April 2010, patients with cardiovascular disease who received telehealth services at the National Taiwan University Hospital were recruited. We collected data on hospital visits and health expenditures for the 6-month period before and the 6-month period after the opening of the Telehealth Center to assess the clinical impact and cost-effectiveness of telehealth services on cardiovascular patients. A total of 141 consecutive cardiovascular disease patients were recruited, including 93 aged ≥65 years (senior group) and 48 aged <65 years (nonsenior group). The telehealth intervention significantly reduced the all-cause admission rate per month per person in the nonsenior group (pretelehealth: median 0.09, IQR 0-0.14; posttelehealth: median 0, IQR 0-0; P=.002) and the duration (days per month per person) of all-cause hospital stay (pretelehealth: median 0.70, IQR 0-1.96; posttelehealth: median 0, IQR 0-0; P<.001) with increased all-cause outpatient visits per month per person (pretelehealth: median 0.77, IQR 0.20-1.64; posttelehealth: mean 1.60, IQR 1.06-2.57; P=.002). In the senior group, the telehealth intervention also significantly reduced the all-cause admission rate per month per person (pretelehealth: median 0.10, IQR 0-0.18; posttelehealth: median 0, IQR 0-0; P<.001) and the duration (days per month per person) of all-cause hospital stay (pretelehealth: median 0.59, IQR 0-2.24; posttelehealth: median 0, IQR 0-0; P<.001) with increased all-cause outpatient visits per month per person (pretelehealth: median 1.40, IQR 0.52-2.63; posttelehealth: median 1.76, IQR 1.12-2.75; P=.02). In addition, telehealth intervention reduced the inpatient cost in the nonsenior group from $814.93 (SD 1000.40) to US $217.39 (SD 771.01, P=.001) and the total cost per month from US $954.78 (SD 998.70) to US $485.06 (SD 952.47, P<.001). In the senior group, the inpatient cost per month was reduced from US $768.27 (SD 1148.20) to US $301.14 (SD 926.92, P<.001) and the total cost per month from US $928.20 (SD 1194.11) to US $494.87 (SD 1047.08, P<.001). Synchronous telehealth intervention may reduce costs, decrease all-cause admission rates, and decrease durations of all-cause hospital stays in cardiovascular disease patients, regardless of age.
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影响因子：
--
作者：
Bugeja, G;Kumar, A;Banerjee, AK
通讯作者：
Banerjee, AK
DOI：
10.1056/nejmoa1010029
发表时间：
2010-12-09
期刊：
The New England journal of medicine
影响因子：
--
作者：
Chaudhry SI;Mattera JA;Curtis JP;Spertus JA;Herrin J;Lin Z;Phillips CO;Hodshon BV;Cooper LS;Krumholz HM
通讯作者：
Krumholz HM
影响因子：
24
作者：
Maron, David J.;Boden, William E.;Teo, Koon K.
通讯作者：
Teo, Koon K.
影响因子：
18.2
作者：
de Lusignan, S;Wells, S;Leatham, E
通讯作者：
Leatham, E
DOI：
10.1016/j.jstrokecerebrovasdis.2011.09.013
发表时间：
2013-05-01
影响因子：
2.5
作者：
Anderson, Eric R.;Smith, Bryan;Frankel, Michael
通讯作者：
Frankel, Michael