IN-HOME-PD: The effects of longitudinal telehealth-enhanced interdisciplinary home visits on care and quality of life for homebound individuals with Parkinson's disease.
IN-HOME-PD: The effects of longitudinal telehealth-enhanced interdisciplinary home visits on care and quality of life for homebound individuals with Parkinson's disease.
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DOI：
10.1016/j.parkreldis.2022.07.017
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发表时间：
2022-09
影响因子：
4.1
通讯作者：
Chodosh, Joshua
中科院分区：
文献类型：
--
作者：
Fleisher, Jori E.;Hess, Serena P.;Klostermann, Ellen C.;Lee, Jeanette;Myrick, Erica;Mitchem, Daniela;Niemet, Claire;Woo, Katheryn;Sennott, Brianna J.;Sanghvi, Maya;Witek, Natalie;Beck, James C.;Wilkinson, Jayne R.;Ouyang, Bichun;Hall, Deborah A.;Chodosh, Joshua
在家的晚期帕金森病患者在研究和护理中代表性不足。与常规护理相比，我们测试了跨学科、远程医疗增强家访（IN-HOME-PD）对患者生活质量（QoL）的影响。针对症状管理、家庭安全、药物和解和心理社会需求的季度、结构化、远程医疗增强的跨学科家访的非随机对照试验（ClinicalTrials.gov NCT03189459）。我们招募了晚期PD患者（Hoehn & Yahr (HY)≥3期）。常规护理参与者在帕金森预后项目（POP）登记中就诊≥2次。我们使用帕金森病问卷比较了组内和组间一年生活质量的变化。65例入组in - home - pd（32.3%为女性），平均年龄78.9岁（SD 7.6）；74.6%的白人;78.5% HY≥4)与319名POP对照组相比，在年龄、种族和PD严重程度上存在差异(37.9%为女性，平均年龄70.1（7.8）岁；96.2%的白人;15.1%≥4)。纵向上，干预组的生活质量保持不变（组内p = 0.74, Cohen’s d = 0.05），而POP对照组的生活质量随着时间的推移而下降（p < 0.001, Cohen’s d = 0.27）。差异有利于干预（组间p = 0.04）。POP参与者在7/8个维度上有所下降，而in - home - pd参与者的身体不适有所改善，临终关怀的使用和在家死亡——目标和谐护理的标志——远远超过全国数据。通过护理的连续性和促进目标一致性护理，特别是在不同人群中，远程医疗增强的家访可以稳定并可能改善晚期PD预测的生活质量下降。该模型的外推特征可以改善晚期PD患者护理的连续性和预后。
Homebound individuals with advanced Parkinson’s disease (PD) are underrepresented in research and care. We tested the impact of interdisciplinary, telehealth-enhanced home visits (IN-HOME-PD) on patient quality of life (QoL) compared with usual care. Nonrandomized controlled trial of quarterly, structured, telehealth-enhanced interdisciplinary home visits focused on symptom management, home safety, medication reconciliation, and psychosocial needs (ClinicalTrials.gov NCT03189459). We enrolled homebound participants with advanced PD (Hoehn & Yahr (HY) stage ≥3). Usual care participants had ≥2 visits in the Parkinson’s Outcomes Project (POP) registry. We compared within- and between-group one-year change in QoL using the Parkinson’s Disease Questionnaire. Sixty-five individuals enrolled in IN-HOME-PD (32.3% women; mean age 78.9 (SD 7.6) years; 74.6% white; 78.5% HY ≥ 4) compared with 319 POP controls, with differences in age, race, and PD severity (37.9% women; mean age 70.1 (7.8) years; 96.2% white; 15.1% HY ≥ 4). Longitudinally, the intervention group’s QoL remained unchanged (within-group p = 0.74, Cohen’s d = 0.05) while QoL decreased over time in POP controls (p < 0.001, Cohen’s d = 0.27). The difference favored the intervention (between-group p = 0.04). POP participants declined in 7/8 dimensions while IN-HOME-PD participants’ bodily discomfort improved and hospice use and death at home—markers of goal-concordant care—far exceeded national data. Telehealth-enhanced home visits can stabilize and may improve the predicted QoL decline in advanced PD via continuity of care and facilitating goal-concordant care, particularly among diverse populations. Extrapolating features of this model may improve continuity of care and outcomes in advanced PD.
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通讯作者：
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