Discharge Planning and Telehealth for Post CABG Elders

描述(由申请人提供： 越来越多的老年患者正在接受冠状动脉旁路移植(CABG)手术；这是进行最频繁的大手术，也是冠心病最昂贵的单一治疗方法之一。预防并发症，包括再次住院是重要的，然而，不需要昂贵的家访来改善CABG术后老年人预后的干预措施基本上是未经检验的。 目的：探讨老年心脏出院/干预(DICE)的效果。DICE包括1)重点加强出院计划，2)家庭远程健康生命体征和体重监测，3)老年心脏手术患者出院后电话随访。 老年人心脏出院/干预(DICE)目标：使用3组(随机分为两组 干预和对照)设计，确定(1)DICE对住院后的有效性 老年心脏手术患者出院后1、2、3个月的功能状况、健康状况、卫生保健利用(初级保健医生和诊所就诊、急性护理就诊、急诊室就诊和再住院)和护理满意度的结果；(2)DICE的成本效益。 对象：来自3个医院站点的330名年龄大于65岁的患者。 设计：4年随机对照试验。 干预：DICE包括1)加强出院计划，2)家庭远程健康监测，3)出院后电话随访，1天，3天，每周4周。改良DICE包括1)强化出院计划，2)出院后电话随访，1天，3天，每周4周。 影响：拟议的研究代表了主要调查者研究老年患者结果的研究重点的合乎逻辑的扩展，以及联合调查者专注于研究远程保健干预的影响。这项研究旨在扩展研究团队的工作，以探索对高危老年CABG手术患者进行干预的效果。本研究将增进对老年心脏手术术后并发症高危患者护理干预效果的了解，并探讨DICE干预对改善老年CABG术后预后的作用。

DESCRIPTION (provided by the applicant: A growing number of elderly patients are receiving coronary artery bypass graft (CABG) surgery; the most frequently performed major surgery and one of the most costly single treatments for coronary heart disease. Prevention of complications, including hospital readmissions are important, yet interventions that do not require costly home visiting to improve elders' outcomes after CABG are largely untested. Purpose: to examine the effectiveness of a Discharge /intervention for Cardiac Elderly (DICE). DICE consists of 1) focused reinforcement of the discharge plan, 2) home telehealth vital sign and weight monitoring, and 3) post-discharge telephone follow up of elderly cardiac surgery patients. Discharge/Intervention for Cardiac Elderly (DICE) Aims: using a 3 group (randomized to one of two interventions and control) design, determine (1) the effectiveness of DICE on the post hospitalization outcomes of functional status, health status, health care utilization (in terms of primary care physician and clinic visits, acute care visits, emergency room visits, and rehospitalizations), and satisfaction with care for elderly cardiac surgery patients at 1, 2, and 3 months after hospital discharge, (2) the cost effectiveness of DICE. Subjects: 330 patients age greater than 65 from 3 hospital sites. Design: 4 year randomized control trial. Intervention: DICE consists of 1) reinforcement of the discharge plan, 2) home based telehealth monitoring, and 3) post-discharge telephone follow up at 1 day, 3 days, and weekly for 4 weeks. Modified DICE consists of 1) reinforcement of the discharge plan, and 2) post-discharge telephone follow up at 1 day, 3 days, and weekly for 4 weeks. Implications: The proposed research represents a logical extension of the principal investigators research focus in studying outcomes for elderly patients, and the Co-Investigator's focus on studying the impact of telehealth interventions. The study serves to extend the research team's work to explore the effect of an intervention for high-risk elderly CABG surgery patients. The study will advance understanding of the outcomes of nursing interventions for elderly cardiac surgery patients at high risk for developing postoperative complications and explore the effect of the DICE intervention on improving elders' outcomes post CABG.