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.

有什么问题吗？**虽然心脏康复降低了死亡和未来心脏病发作的风险，并改善了患者的生活质量，但只有约一半的受邀者参加了在2019冠状病毒病大流行之前提供的以团体为基础的规划。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提供，患者的接受程度有所增加。现在，NHS的上门服务已经重启，医疗保健行业的压力也在增加：等待的人数积压，医院的健身设施被其他服务占用，或者重新部署的员工仍在返回（在610万患者等待NHS护理的背景下，员工短缺11万）。患者和临床工作人员之间的每一次面对面的接触都具有巨大的价值（和成本）。通过使用数字化提供的服务，特别是在患者家中提供的服务，可以节省时间、金钱并减少碳排放，从而使这些服务更有影响力。NHS长期计划的目标是85%的符合条件的患者在心脏事件后参加心脏康复。“我们相信，提供一个混合的心脏康复计划，从面对面的交付开始，并支持患者转移到远程服务（如果适合他们），将使更多的人获得康复，提高吸收率并减少劳动力压力。”这项研究的目的是什么？**该研究项目旨在探索新的方法，在患者身上测试数字提供的医疗保健，而不需要传统临床试验相关的成本和长时间。我们打算做什么？**我们将引入一种数字技术，使NHS工作人员能够提供混合方案，并在三个康复中心安全地监测患者。病人和康复人员的焦点小组将了解他们对提供康复新方法的体验。我们将使用报告给国家心脏康复审计（NACR）的匿名数据，以查明是否有更多的患者接受混合康复，以及与以前只提供面对面交付的大流行前的服务相比，是否看到了预期的生活质量改善。**涉及病人**市民已讨论此建议并提出建议。患有心脏病的人在数字系统上提供了反馈，导致了改进。通过新的研究方法，我们将证明技术支持的混合服务交付不仅可以改善结果并降低成本，而且可以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.