EFFICACY OF A HEART FAILURE MANAGEMENT SYSTEM

描述 拟议的研究将测试综合病例管理的有效性。 治疗心力衰竭的系统。建议的系统建立了一种管理 利用护士病例管理器和计算机化数据库的基础设施 有计划心脏病专家的支持，以监测和提供个性化 对病人的治疗。调查人员建议，一个有效的系统 预见性护理可以降低再住院率、发病率、 和死亡率相比，通常提供给大多数心脏的术后护理 失败的病人。调查人员认为，后临时管理 治疗实践的三个领域的缺陷造成的结果，包括 认知缺陷(即不知道应该做什么)、执行力 赤字(即没有做应该做的事情)和组织赤字 (即，在需要看病的时候不看病人和看病人 当他们不需要被看到时)。调查人员认为，他们的 综合案例管理系统(MULTIFIT)可以减少这些缺陷 并改善患者护理的结果。审查了MULTIFIT计划 在138天内对51名患者进行了小样本试验，结果是 在功能状态方面的显著改善。来自中国的初步数据 这项不受控制的初步研究为假设提供了支持 在拟议的项目中进行了测试。 该项目将646名心力衰竭患者随机分成两组。 Kaiser Permanente医疗中心单独接受常规护理或常规护理加上 MULTIFIT案例管理系统随机分组的单位是患者。 病例管理由受过专门培训的护士病例经理执行 通过电话联系和监测收集有关患者的基本数据 患者的医疗状况和进展及后续治疗 管理指南。计算机化的数据库便于获取 数据，并为医生生成进度报告。从程序备份 心脏病专家可以接受护士发起的咨询。治疗和 随访期超过12个月。

DESCRIPTION The proposed study will test the efficacy of a comprehensive case management system for heart failure. The proposed system establishes a management infrastructure that utilizes nurse case managers and computerized databases with backup from program cardiologists to monitor and provide individualized treatment to patients. The investigators suggest that an effective system of anticipatory care can reduce the rates of rehospitalization, morbidity, and mortality compared to the usual post-hoc care provided to most heart failure patients. The investigators believe that post-hoc management results from deficits in three areas of treatment practice, including cognitive deficits (i.e., not knowing what should be done), executive deficits (i.e., not doing what should be done), and organizational deficits (i.e., not seeing patients when they need to be seen and seeing patients when they do not need to be seen). The investigators believe that their comprehensive case management system (MULTIFIT) can reduce these deficits and improve the outcome of patient care. The MULTIFIT program was examined in a small sample of 51 patients over a 138-day period, and its use resulted in significant improvements in functional status. The preliminary data from this uncontrolled pilot study provide support for the hypothesis to be tested in the proposed project. This project will randomize 646 patients admitted with heart failure in two Kaiser Permanente Medical Centers to usual care alone or usual care plus the MULTIFIT case management system. The unit of randomization is the patient. Case management is carried out by specially trained nurse case managers who gather essential data about patients through telephone contact and monitor patients' medical status and progress and initiate treatment following management guidelines. A computerized database facilitates acquisition of data and generates progress reports for physicians. Back-up from program cardiologists is available for nurse-initiated consultation. Treatment and follow-up extends over 12 months.