EFFICACY OF A HEART FAILURE MANAGEMENT SYSTEM

心力衰竭管理系统的功效

• 批准号: 2857894
• 负责人: ROBERT Frank DEBUSK
• 金额: $ 65.9万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-01-15 至 2000-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2857894
• 关键词: clinical research; computer assisted patient care; health care service evaluation; health services research tag; heart failure; human subject; nursing intervention; patient care management

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.

描述 拟议的研究将测试综合病例管理的有效性 心力衰竭系统。 拟议的系统建立了一个管理 利用护士案例管理器和计算机化数据库的基础设施 有心脏病专家的支持来监测并提供个性化的治疗 给患者治疗。 研究人员建议建立一个有效的系统 预期护理可以降低再住院率、发病率、 与为大多数心脏提供的常规事后护理相比，死亡率和死亡率 失败患者。 调查人员认为，事后管理 治疗实践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 缺陷（即没有做应该做的事情）和组织缺陷 （即，在需要看病人时不看病人，而在需要看病人时看病人 当他们不需要被看到时）。 调查人员认为，他们的 综合案件管理系统（MULTIFIT）可以减少这些缺陷 并改善患者护理的结果。 检查了 MULTIFIT 程序 在 138 天内对 51 名患者的小样本进行了研究，其使用结果 功能状态的显着改善。 初步数据来自 这项不受控制的试点研究为以下假设提供了支持 在提议的项目中进行了测试。 该项目将 646 名因心力衰竭入院的患者随机分为两组 Kaiser Permanente 医疗中心仅提供常规护理或常规护理加 MULTIFIT 案件管理系统。 随机化的单位是患者。 病例管理由经过专门培训的护士病例经理进行，他们 通过电话联系和监控收集有关患者的基本数据 患者的医疗状况和进展并开始治疗 管理指南。 计算机化数据库有助于获取 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 随访时间超过12个月。