A patient-centered mobile intervention to promote self-management and improve patient outcomes in chronic heart failure

 描述（由申请人提供）：在美国，心力衰竭（HF）是老年人最常见的出院诊断。约40%的患者在首次因HF入院后1年内再次入院，住院费用约占HF管理费用的70%。先前的研究表明，病例管理和电话支持在减少HF住院方面是有效的，但这些策略成本较高。因此，HF患者的管理正在从面对面随访访视的传统模式向在社区中帮助患者进行监测和自我管理的主动实时技术模式发展。虽然一些HF研究已经实施了技术驱动的疾病管理计划，但结果好坏参半。这些系统对于向医疗保健提供者提供监测数据和警报是有效的，但它们在提供和修改患者行为方面的有效性尚未经过测试。这代表了一个重大的知识差距，除非填补将扼杀自我管理科学的进步。因此，迫切需要开发这样的技术，其毫不费力地增加由患者执行的自我监测（主动监测）和由外部设备完成的监测（被动监测），识别HF恶化的临床前和临床测量，并提供促进自我管理的行为干预，其总体目标是减少HF住院。拟定项目将确定自我监测移动的应用程序对非卧床HF患者的自我管理、生活质量和入院的影响，确定被动临床前测量预测HF临床恶化症状的程度，并为移动的应用程序开发通知消息系统，以通过患者参与者反馈改善HF的自我管理。这些数据对于进一步完善我们的干预（移动的应用）至关重要，并作为未来研究的基础，该研究将在更大的随机临床试验中使用强大的推送通知系统测试移动的应用程序，以对抗常规护理。这种技术方法对改善自我管理和降低疾病发病率具有积极意义。它还将促进引进一种新的工具和技术，这种工具和技术有可能为常见的和使人衰弱的慢性健康状况的自我管理带来新的范例。

 DESCRIPTION (provided by applicant): In the United States, heart failure (HF) is the most common hospital discharge diagnosis among older adults. About 40 percent of patients are readmitted within 1-year following their first admission for HF and hospitalization accounts for approximately 70 percent of the costs of HF management. Previous research shows that case management and telephonic support are effective in reducing HF hospitalizations, but these strategies are costly. As a result, the management of HF patients is evolving from the traditional model of face-to-face follow-up visits toward a proactive real-time technological model of assisting patients with monitoring and self- management while in the community. While several HF studies have implemented technologically-driven disease management programs, results have been mixed. These systems are effective for delivering the monitoring data and alerts to healthcare providers, but they have not been tested for their effectiveness in delivering and modifying patient behavior. This represents a significant gap in knowledge that unless filled will stifle the advancement of self-management science. Therefore, there is a critical need for the development of technologies that effortlessly increase self-monitoring performed by the patient (active monitoring) and monitoring done by external devices (passive monitoring), identify pre-clinical and clinical measurements of worsening HF, and deliver behavioral interventions that promote self-management with an overall goal of reducing HF hospitalizations. The proposed project will determine the impact of a self-monitoring mobile application on self-management, quality of life and hospital admission in ambulatory HF patients, determine the extent to which passive pre- clinical measurements predict symptoms of clinical worsening in HF and develop a notification message system for the mobile application to improve self-management of HF via patient participant feedback. These data will be crucial in further refining our intervention (the mobile application) and serve as the basis for future research that will test the mobile applicatio with a robust push notification system against the usual care in a larger randomized clinical trial This technological approach has positive implications in improving self-management and reducing disease morbidity. It will also foster the introduction of a novel tool and technology tha has the potential to bring about a new paradigm for self-management of common and debilitating chronic health conditions.