EFFICACY OF A HEART FAILURE MANAGEMENT SYSTEM

心力衰竭管理系统的功效

• 批准号: 6139207
• 负责人: ROBERT Frank DEBUSK
• 金额: $ 49.68万
• 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 2003-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6139207
• 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 拟议的研究将测试一个全面的个案管理的功效， 心力衰竭的治疗方法 拟议的系统建立了一个管理 利用护士病例管理员和计算机化数据库的基础设施 与项目心脏病专家的支持，以监测和提供个性化的 对患者的治疗。 研究人员认为，一个有效的系统 可以降低再住院率，发病率， 和死亡率相比， 失败的病人 调查人员认为， 治疗实践的三个方面的缺陷，包括 认知缺陷（即，不知道该做什么），执行 缺陷（即，不做应该做的事）和组织缺陷 (i.e.,当病人需要被看的时候， 当他们不需要看到）。 调查人员认为， 综合病例管理系统（MULTIFIT）可以减少这些缺陷 并改善病人护理的效果。 检查了MULTIFIT程序 在一个小样本的51名患者在138天的时间内，它的使用导致 功能状态的显著改善。 述初步数据 这一非对照的初步研究为以下假设提供了支持： 在拟议的项目中进行测试。 该项目将646名心力衰竭患者随机分为两组 Kaiser Permanente医疗中心将常规护理单独或常规护理加 MULTIFIT案例管理系统。 随机化单位为患者。 病例管理由经过专门培训的护士病例管理人员进行， 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，并在以下情况下开始治疗 管理方针。 计算机化的数据库便于获取 数据并为医生生成进度报告。 程序备份 心脏病专家可提供护士发起的咨询。 治疗和 随访时间超过12个月。