Identifying Disparities in Care of Rural Patients with Cardiac Implantable Electronic Devices

确定使用心脏植入电子设备的农村患者的护理差异

• 批准号: 10555010
• 负责人: Emily Zeitler
• 金额: $ 20.51万
• 依托单位: DARTMOUTH-HITCHCOCK CLINIC
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10555010
• 关键词: Academic Medical Centers; Achievement; Address; Age; American; Area; Arrhythmia; Cardiovascular system; Caring; Case Study; Cellular Phone; Characteristics; Client satisfaction; Clinical; Community Outreach; Consensus; Country; Data; Defibrillators; Devices; Disease Progression; Disparity; Early Intervention; Economics; Elderly; Electronics; Eligibility Determination; Equilibrium; Evaluation; Face; Geographic Distribution; Geography; Guidelines; Health Insurance; Health Technology; Health care facility; Healthcare; Home; Hospital Referrals; Hospitals; Implant; Implantable Defibrillators; Informatics; Infrastructure; Inpatients; Institution; Internet; Intervention; Interview; Lead; Longevity; Manufacturer; Measures; Medical; Medicare; Medicare claim; Methods; Monitor; Outcome; Pacemakers; Pathway Analysis; Patient Monitoring; Patients; Pattern; Performance; Periodicals; Persons; Physicians; Policy Maker; Population; Positioning Attribute; Prevalence; Primary Care Physician; Provider; Qualitative Methods; Qualitative Research; Recommendation; Reporting; Research; Research Methodology; Research Personnel; Resources; Rural; Rural Health Centers; Science; Services; Site; Speed; Structure; Surveys; System; Travel; Uninsured; Variant; Work; cardiac implant; care delivery; care outcomes; community engagement; cost; digital; digital health; ethnic minority population; experience; geographic difference; geographic disparity; health care delivery; health care disparity; implantable device; improved; improved outcome; medical specialties; monitoring device; mortality; older patient; population based; preference; racial minority population; remote monitoring; remote patient monitoring; rural area; rural patients; rural setting; rurality; statistics; uptake; wireless

PROJECT SUMMARY/ABSTRACT Project 2 (Zeitler): Identifying Disparities in Care of Rural Patients with Cardiac Implantable Electronic Devices Patients in rural settings have significantly worse outcomes from cardiovascular conditions compared with patients in non-rural settings, including treatment of arrhythmias with a cardiac implantable electronic device (CIED), like a pacemaker or defibrillator. These ubiquitous implantable devices store copious amounts of medical information related to device function and disease progression, among other items. These data are available to treating physicians and other clinicians through remote monitoring (RM), which relies on wireless connectivity between patients, a remote server, health care facilities, and treating physicians. Monitoring of patients with a CIED through this RM paradigm as an adjunct to periodic in-person evaluations has been associated with a variety of improved outcomes over in-person evaluations alone, ranging from improvements in patient satisfaction to decreased mortality. Thus, RM is unequivocally recommended in combination with in- person evaluations. While known disparities in RM exist among the uninsured and elderly, the geographic distribution of RM remains unstudied. A number of factors suggest that RM of CIEDs may be particularly vulnerable to geographic disparities. For one, patients in rural areas face greater barriers to connectivity, including less access to high-speed internet and less-consistent cell phone coverage. These barriers couple with the challenge of greater geographic distances that must be traveled to access in-person subspecialty services, a necessary aspect of CIED care. With the guidance of a community engagement studio, the proposed work incorporates mixed methods to: 1) better understand barriers and facilitators of RM in rural areas; 2) identify geographic disparities in CIED care; and 3) exploit variation in RM referral networks to understand characteristics associated with optimal CIED care in rural areas. These efforts will be informed and supported by expert input from the Statistics, Informatics, and Qualitative Methods Core to evaluate variation in health care delivery and outcomes, as well as the deep experience in community engagement and qualitative research methods represented by the Community Engagement and Outreach Core. Findings from this research will constitute meaningful progress towards addressing geographic disparities in arrhythmia care while, enabling achievement of investigator independence.

项目总结/摘要 项目2（Zeitler）：确定农村心脏植入式电子设备患者的护理差异 农村地区的患者心血管疾病的预后明显较差， 非农村环境中的患者，包括使用心脏植入式电子器械治疗心律失常 （CIED），就像起搏器或除颤器。这些无处不在的可植入设备储存了大量的 与器械功能和疾病进展相关的医疗信息等。这些数据 通过远程监控（RM）提供给治疗医生和其他临床医生， 患者、远程服务器、医疗保健设施和治疗医生之间的连接。监测 通过这种RM模式作为定期亲自评估的辅助手段， 与单独的亲自评价相比， 患者满意度降低死亡率。因此，RM明确建议与IN结合使用- 人的评价。虽然在没有保险的人和老年人中存在着已知的RM差异， RM的分布尚未研究。 一些因素表明，革新和发展中国家的记录管理可能特别容易受到地域差异的影响。为 第一，农村地区的患者面临更大的连接障碍，包括更少的高速互联网接入 手机信号覆盖也不稳定这些障碍加上更大的地理挑战， 距离必须前往访问亲自专科服务，CIED护理的一个必要方面。 在社区参与工作室的指导下，拟议的工作采用了混合方法：1） 更好地了解农村地区RM的障碍和促进因素; 2）确定CIED护理的地理差异; 以及3）利用RM转介网络中的变化来理解与最佳CIED相关联的特征 农村地区的护理。这些努力将得到统计局专家投入的指导和支持， 信息学和定性方法核心，以评估医疗保健服务和结果的变化，以及 作为社区参与和定性研究方法的深厚经验， 社区参与和外展核心。这项研究的结果将构成有意义的进展 解决心律失常护理的地理差异，同时使研究者能够 独立