Reducing heart failure re-admissions by enhancing sleep apnea treatment adherence

通过提高睡眠呼吸暂停治疗依从性来减少心力衰竭再次入院

• 批准号: 8976905
• 负责人: Eric Heil
• 金额: $ 12.59万
• 依托单位: RIGHTCARE SOLUTIONS, INC.
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2015-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8976905
• 关键词: Reducing; heart; failure; re; admissions

DESCRIPTION (provided by applicant): Hospital re-admission can be devastating for patients and carries significant financial burdens for health care systems. In 2013, the recently implemented Medicare Hospital Readmissions Reduction Program imposed $227 million in penalties on 2,225 hospitals. Medicare has focused on heart failure diagnoses because it is one of the most common causes of admission and has the highest re-admission rate of any medical diagnosis. A growing body of research suggests that sleep apnea is a major predictor of heart failure re-admission; it is present in 50-80 percent of heart failure patients. Furthermore, preliminary research gathered by the University of Pennsylvania Sleep Center suggests that positive airway pressure (PAP) treatment of sleep apnea is associated with significantly reduced re-admission rates. However, adherence to sleep apnea treatment with PAP is poor, with only 30-40 percent of patients having adequate hours of use. This finding has led the study investigators to conclude that patients with heart failure recently discharged from the hospital are at increased risk of re-admission due to non-adherence with PAP. A potential solution for this major problem facing hospitals can be found in the AirCareLabs system. It offers an integrated care approach that includes telemedicine with video conferencing features delivered via tablet based communication that is initiated promptly in the peri-discharge period and continued at home. The study team proposes modifying this system for targeted care of sleep apnea patients through wireless real-time monitoring of pulse oximetry and PAP adherence, along with additional educational content, in order to significantly reduce readmission rates during the first month post discharge for patients with heart failure that are starting PAP therapy Key innovations include the ability for patients to receive at-home, night-time assistance with their PAP (remarkably, this is currently unavailable to patients), and a financial model in which costs for the application are covered by the health system as it seeks to avoid Medicare penalties, thus bypassing the limited fee-for-service approach that has curtailed innovation in the sleep apnea field. The proposed project includes a Phase I component that consists of modifying the AirCareLab system to integrate wireless pulse oximetry data, structured interviews to identify the optimal treatment approach to resolve patient care concerns, development of educational material for patients to access at home via the AirCareLab system, and a pilot clinical study in 20 study participants. The Phase II component includes further refining the oximetry data and integrating with PAP device data to create interpretive risk classification algorithms, and a large randomized controlled trial of 240 subjects to confirm efficacy. If successful, this project will create a new scalable model which can substantially reduce hospital readmission rates for heart failure.

描述（由申请人提供）：再次入院对患者来说可能是毁灭性的，并为医疗保健系统带来重大的经济负担。2013年，最近实施的医疗保险医院再入院减少计划对2,225家医院征收了2.27亿美元的罚款。医疗保险专注于心力衰竭诊断，因为它是入院的最常见原因之一，并且在任何医疗诊断中具有最高的再入院率。越来越多的研究表明，睡眠呼吸暂停是心力衰竭再次入院的主要预测因素;它存在于50- 80%的心力衰竭患者中。此外，宾夕法尼亚大学睡眠中心收集的初步研究表明，气道正压通气（PAP）治疗睡眠呼吸暂停与显着降低再入院率有关。然而，PAP治疗睡眠呼吸暂停的依从性很差，只有30- 40%的患者有足够的使用时间。这一发现使研究人员得出结论，最近出院的心力衰竭患者由于不依从PAP而再次入院的风险增加。医院面临的这一主要问题的潜在解决方案可以在AirCareLabs系统中找到。它提供了一种综合护理方法，包括通过基于平板电脑的通信提供的具有视频会议功能的远程医疗，该通信在出院期间迅速启动并在家中继续。研究小组建议修改该系统，通过无线实时监测脉搏血氧饱和度和PAP依从性，沿着额外的教育内容，对睡眠呼吸暂停患者进行有针对性的护理，以显著降低开始PAP治疗的心力衰竭患者出院后第一个月的再入院率。关键创新包括患者能够在家接受，夜间辅助PAP（值得注意的是，这是目前患者无法获得的），以及一种财务模式，其中应用程序的成本由卫生系统支付，因为它试图避免医疗保险处罚，从而绕过有限的服务收费方法，该方法限制了睡眠呼吸暂停领域的创新。拟议的项目包括第一阶段的组成部分，包括修改AirCareLab系统，以整合无线脉搏血氧饱和度数据，结构化访谈，以确定最佳的治疗方法，以解决患者的护理问题，开发教育材料，供患者通过AirCareLab系统在家中访问，并在20名研究参与者中进行试点临床研究。II期部分包括进一步完善血氧测定数据并与PAP器械数据整合以创建解释性风险分类算法，以及一项240例受试者的大型随机对照试验以确认疗效。如果成功，该项目将创建一个新的可扩展模型，可以大大降低心力衰竭的再入院率。