EVALUATION OF HOME ASTHMA TELEMONITORING (HAT) IN ADULTS

哮喘患者的自我护理计划，包括定期的家庭高峰 呼气流量(PEF)监测、预防性用药和患者 行动计划，已经成为哮喘的标准护理，由 国家哮喘教育和预防计划。然而，这一点的价值 方法受到质疑，因为患者不遵守自我护理 计划是很常见的。基于互联网的家庭哮喘远程监测(HAT)系统 旨在为哮喘患者提供持续的个性化帮助 他们的自我护理计划，并在临床上通知他们的医疗保健提供者 重大事件时有发生。这项研究的目标是评估是否使用 HAT可改善临床结果和患者对HAT的依从性 自我护理计划。本申请建议：(1)将HAT修改为完全 实施NAEPP指南，以及(2)在 随机对照研究。使用HAT的患者在他们的家中将有一个 电子流量计和掌上电脑，通过电话连接到基于Web的 哮喘信息系统。患者将被指示每天使用该系统 首先使用流量计获得最大PEF测量值，然后通过 在掌上电脑上回答有关他们哮喘状况和信息的问题 旨在提高他们对自我护理计划的遵从性。一例哮喘护士案例 如果患者不遵循自己的自我护理，HAT也会通知经理 计划，如果出现临床上重要的情况。这将使 护士及时与患者联系，加强自我管理 处理病情恶化的技巧，如有必要，使患者的 医生。一项随机临床试验将在240个市中心进行 成人哮喘患者，在BMC健康诊所网络得到护理。这项研究将 比较分配给HAT的患者和未分配HAT的患者。所有受试者将收到最新的 哮喘护理标准，由NEAPP推荐。每门课程都将紧随其后 已经12个月了。临床结果将是：紧急护理服务的利用， 包括急诊科使用和住院治疗。患者的依从性 自我护理计划将根据PEF监护仪的使用情况、药物使用情况进行评估 坚持不懈，有能力遵循个人行动计划。最后，我们将评估 HAT对哮喘自我护理的行为和认知成分的影响， 包括哮喘自我调节阶段、哮喘自我效能感和知识水平。

Asthma patient self-care plans, consisting of regular home peak expiratory flow (PEF) monitoring, use of prophylactic medications and patient action plans, have become the standard of care in asthma, indorsed by the National Asthma Education and Prevention Program. However, the value of this approach has been questioned because patient non-compliance with self-care plans is common. The internet-based Home Asthma Telemonitoring (HAT) system was designed to provide continuous individualized help to asthma patients following their self-care plans, and to notify their health care providers if clinically significant events occur. The goal of the study is to evaluate whether use of HAT leads to improved clinical outcomes and better patient compliance with self-care plans. This application proposes to: (1) modify HAT to fully implement the NAEPP guidelines, and (2) evaluate the modified HAT system in a randomized controlled study. Patients using HAT will have in their home, an electronic flow meter and palmtop computer linked, by telephone, to a Web-based asthma information system. Patients will be instructed to use the system daily by first obtaining a maximum PEF measurement using the flow meter and by answering questions on the palmtop about their asthma status and messages designed to improve their compliance with self-care plans. An asthma nurse case manager will also be notified by HAT if patients do not follow their self-care plans and if clinically significant conditions occur. This will enable the nurse to contact those patients in a timely manner to reinforce self-management skills dealing with an exacerbation, and if necessary, to involve the patients' physician. A randomized clinical trial will be conducted with 240 inner-city adult asthma patients, cared for at BMC Health Clinics Network. The study will compare patients assigned to HAT or not. All subjects will receive the current standard of asthma care, recommended by NEAPP. Each subject will be followed for 12 months. Clinical outcomes will be: utilization of urgent care services, including emergency department use and hospitalization. The patient compliance with self-care plans will be assessed in terms of PEF monitor use, medication adherence, and ability to follow personal action plan. Lastly, we will evaluate the HAT impact on behavioral and cognitive components of asthma self-care, including phase of asthma self-regulation, asthma self-efficacy and knowledge.