Industrial Research to generate evidence for submission to NICE using a novel, real-world trial design for a technology-enabled, blended service for Cardiac Rehabilitation.

**出了什么问题？**尽管心脏康复降低了死亡和未来心脏病发作的风险，并提高了患者的生活质量，但只有大约一半的受邀者参加了新冠肺炎疫情之前提供的以小组为基础的项目。在大流行期间，许多心脏康复服务被转移到网上或远程实时交付，患者的接受率有所增加。现在面对面的NHS服务重新启动，医疗保健内部的压力增加：等待的人积压，医院的健身房设施被增选为其他服务，或者工作人员仍从重新部署中返回(背景是610万患者等待NHS护理，而工作人员短缺11万人)。患者和临床工作人员之间的每一次面对面接触都是非常有价值(和成本)的。通过使用数字交付的服务，尤其是当在患者家中提供服务时，这些服务可以更有效地发挥作用，从而节省时间、金钱和减少碳排放。NHS长期计划的目标是85%的符合条件的患者在心脏“事件”后加入心脏康复。我们相信，提供从面对面交付开始的心脏康复混合计划，并支持患者转移到远程服务(如果适合他们)，将使更多的人能够获得康复服务。提高接受率，减轻劳动力压力。**研究的目的是什么？**这个研究项目旨在探索新的方法，在没有传统临床试验的成本和较长时间的情况下，在患者中测试数字提供的医疗保健。**我们建议做什么？**我们将引入数字技术，使NHS工作人员能够在三个康复中心提供混合计划并安全地监控患者。与患者和康复工作人员组成的焦点小组将了解他们提供康复服务的新方式的经验。我们将使用向国家心脏康复审计(NACR)报告的匿名数据来了解是否有更多的患者接受混合康复，以及与大流行前仅提供面对面分娩的服务相比，是否看到预期的生活质量改善。**涉及患者**公众讨论了这一建议并提出了建议。有心脏疾病的人提供了关于数字系统的反馈，导致了改进。通过新的研究方法，我们将表明，技术支持的混合服务交付不仅改善了结果和降低了成本，而且被患者视为更好的服务。

**WHAT IS THE PROBLEM?**Whilst cardiac rehabilitation reduces the risk of death and future heart attacks and improves the quality of life for patients, only about half of those invited attended the group-based programmes that were provided prior to the COVID-19 pandemic. During the pandemic, many cardiac rehabilitation services were moved online or to remote real-time delivery and saw an increase in uptake by their patients.Now that in-person NHS services have restarted, there are increased pressures within healthcare: backlogs of people waiting, hospital gym facilities co-opted for other services, or staff still returning from redeployment (against a backdrop of 6.1 million patients waiting for NHS care and a shortage of 110,000 staff). Every in-person encounter between the patient and clinical staff is of great value (and cost). These can be made more impactful through the use of digitally-delivered services, especially when provided in the patient's home, saving time, money and reducing carbon emissions.The NHS Long Term Plan has a goal of 85% of eligible patients joining cardiac rehabilitation after a heart "event."We believe that delivering a blended programme of cardiac rehabilitation starting with face-to-face delivery and supporting patients to move to a remote service (if it suits them), will enable more people to access rehabilitation, increase rates of uptake and reduce pressure on the workforce.**WHAT IS THE AIM OF THE RESEARCH?**This research project aims to explore new ways in which digitally-delivered healthcare is tested with patients without the costs and long timelines associated with traditional clinical trials.**WHAT ARE WE PROPOSING TO DO?**We will introduce a digital technology to enable NHS staff to deliver the blended programme and monitor patients safely in three rehabilitation centres. Focus groups with patients and rehabilitation staff will understand their experience of the new way of delivering rehabilitation. We will use anonymised data reported to the National Audit of Cardiac Rehabilitation (NACR) to find out whether more patients take-up blended rehabilitation and whether the expected improvements in quality of life are seen, compared with pre-pandemic services which previously only offered face-to-face delivery.**INVOLVING PATIENTS**Members of the public have discussed this proposal and made suggestions. People with heart conditions have provided feedback on the digital system, leading to improvements. With new research methods, we will show that a technology-enabled blended service delivery not only improves outcomes and reduces costs, but is seen as a better service by patients.