Determining the acceptability and feasibility of mobile-health approaches to gather clinical information from patients at home following hospital discharge

摘要 越来越多的患者更早地离开医院，并且历史上只有 在医院和他们的家中进行。最早的这种疗法之一是家庭 静脉注射抗生素，称为门诊胃肠外抗菌药物 治疗（OPAT）。许多OPAT出院的患者需要计划外的再次住院 并在出院后的前30天内到急诊室就诊。因为这 人口经常遭受广泛的医疗和外科问题，它提出了一个 这是一个独特的机会，可以有效地研究弱势群体的一系列健康结果。 无处不在的个人计算设备的出现提供了新的机会， 传统临床环境之外的健康相关数据。收藏的承诺 如果调查问题能够与"客观"信息配对，则有意义的数据会增加 从能够收集健康相关数据的传感器收集。到目前为止，我们的CTSA中心在 爱荷华州大学设计、测试并部署了定制的移动医疗软件， 使用短信、基于网络的工具和移动的应用程序获取受试者的信息。我们还 直接来自传感器的集成信息（步计数器，血压袖带，秤， 温度计）到我们的定制软件，以便我们可以远程收集客观的健康相关的 来自研究对象的数据。在这个提案中，我们将使用我们的移动健康平台来改变健康- 相关的测量和数据收集以前只能在医院进入研究 受试者的家此外，我们将使用我们的方法来衡量健康相关的结果 在OPAT出院的患者中。 我们研究的首要目标是开发易于使用的信息学工具， 疾病特异性有了这些工具，我们希望能够有效地收集重要的临床信息。 来自传统研究和临床环境之外的患者的数据。首先，我们将评估 使用我们的移动医疗方法收集患者临床数据的可行性 在OPAT上出院后回家。其次，我们将确定主题， 研究人员对我们方法的效用的看法。第三，我们将估计样本 确定远程收集的患者报告的效用的研究所需的样本量 用于预测OPAT出院患者再入院的数据。 这些目标的完成将使我们能够确定在一个 真实世界的设置，不仅收集患者报告的结果，而且收集来自传感器的数据， 帮助回答广泛的临床研究问题。

Abstract Patients are increasingly leaving the hospital sooner and continuing therapies historically only administered in hospitals in their homes. One of the first of such therapies was the home administration of intravenous antibiotics, referred to as outpatient parenteral antimicrobial therapy (OPAT). Many patients discharged on OPAT require unplanned hospital readmissions and visits to the emergency department within the first 30 days of discharge. Because this population routinely suffers from a wide range of medical and surgical problems, it presents a unique opportunity to efficiently study a range of health outcomes in a vulnerable population. The emerging ubiquity of personal computing devices provides new opportunities to collect health-related data outside traditional clinical environments. The promise of collecting meaningful data increases if survey questions can be paired with “objective” information collected from sensors capable of collecting health-related data. To date, our CTSA hub at The University of Iowa has designed, tested and deployed custom m-health software to aggregate information from subjects using SMS, web-based tools, and mobile apps. We have also integrated information directly from sensors (step counters, blood pressure cuffs, scales, thermometers) into our custom software so that we can remotely collect objective health-related data from research subjects. In this proposal we will use our m-health platform to shift health- related measurements and data collection previously only available in hospitals into research subjects' homes. In addition, we will use our approach to measure health-related outcomes among patients discharged on OPAT. The overarching goal of our research is to develop easy-to-use informatics tools that are not disease specific. With these tools, we hope to enable the efficient collection of important clinical data from patients outside traditional research and clinical settings. First, we will assess the feasibility of using our mobile-health approach to gather clinical data from patients in their homes following discharge from the hospital on OPAT. Second, we will determine subject and researcher perspectives regarding the utility of our approach. Third, we will estimate the sample size necessary to power a study to determine the utility of remotely-collected patient-reported data for predicting hospital readmissions among patients discharged on OPAT. Completion of these aims will allow us to determine the potential for using m-health tools in a real-world setting to gather not only patient-reported outcomes, but also data from sensors to help answer a wide range of clinical research questions.