PILOT: Home Telemonitoring for Self Management Education of Patients with Lung Ca

描述（由申请人提供）：该应用程序是医院后家庭远程监护干预的试点，旨在帮助肺癌（CA）患者识别其病情变化，并在需要紧急护理之前联系临床医生。WV肺CA发病率和死亡率超过美国平均水平。有限的知识和获得护理的机会导致了WV肺CA患者的显著健康差异，特别是在农村地区。迫切需要低成本、高质量的干预措施，以在出院后的前两周内帮助患者，然后再安排临床医生进行随访。电话传输的远程监控数据将用于提醒护士解释体征/症状的变化，并指导患者何时以及如何联系临床医生。远程监测器将提供疾病相关变化的早期证据，然后患者可以识别这些证据，并在病情恶化之前将其传达给临床医生。到目前为止，还没有研究远程监护数据用于教育成人肺CA。有效性指标将包括患者与护士/医生的接触、治疗变化、出院后2个月内医疗保健资源的使用和成本以及患者生活质量（QOL）和功能状态。研究的具体目标是：（1）描述远程监护组出院后14天内远程监护生理测量和主观症状的变化;（2）检查功能状态、QOL和患者/家庭满意度的差异，以及是否有基于家庭远程监护的自我管理教育;和（3）分析护士/医生接触、治疗变化以及在有和没有家庭远程监护监视教育的情况下进行自我管理的医疗保健资源利用。这项研究是重要的，因为改善知识渊博的患者自我管理可能会影响长期结果。与急诊护理或再住院相比，患者直接接触临床医生进行治疗和自我管理的成本更低。研究的成功完成也将有助于填补关于出院和通常的2周出院后访视之间的肺CA患者生命体征和症状变化的知识的差距。与NIH和NCI建立知识库以减轻疾病和残疾负担并为癌症患者提供持续护理的使命相一致，我们的R15补助金申请支持基于体征/症状识别的患者自我管理，以便在问题恶化之前与适当的临床医生联系，改善肺CA成人的QOL，并检查患者和家属对有限（14天）远程监护仪使用的满意度。护理知识将用于解释远程监护数据和教育癌症患者住院后在家里。短期远程远程监护为基础的病人教育提供了一个有前途的选择，发展病人自我管理的知识和技能。 公共卫生相关性：肺癌患者的高护理成本与频繁的住院和急诊就诊有关。迫切需要确定干预措施，以帮助肺癌患者认识到他们的病情变化，并在需要紧急护理之前联系临床医生。这项研究采用自我管理模式来测试家庭的使用情况。 远程监护仪作为出院后的风险指标在阿巴拉契亚成年人肺癌和合并症住院样本。电话传输的远程监护信息将帮助护士解释体征/症状的变化，并指导患者何时以及如何联系临床医生。通过具有成本效益地降低再住院/急诊护理的风险和提高生活质量来解决成年肺癌患者的健康差异，对“健康人2010”至关重要。

DESCRIPTION (provided by applicant): The application is a pilot for a post-hospital home telemonitoring intervention to help people with lung cancer (CA) recognize changes in their condition and contact a clinician before emergent care is needed. WV lung CA illness and death rates exceed US averages. Limited knowledge and access to care have contributed to significant health disparities for WV lung CA patients, especially in rural areas. There is a critical need for low cost, high quality interventions to assist patients during the first two weeks following hospital discharge before they have scheduled follow-up clinician visits. Phone-transmitted telemonitor data will be used to alert nurses to explain changes in signs/symptoms and coach patients on when and how to contact a clinician. Telemonitors will provide early evidence of disease-related changes which can then be recognized by patients and relayed to their clinician before they exacerbate. To date, there have been no studies of telemonitor data used for education of adults with lung CA. Measures of effectiveness will be patient contacts to nurses/physicians, changes in treatment, use and cost of health care resources for 2 months following hospital discharge, as well as patient quality of life (QOL), and functional status. Study specific aims are: (1) Describe changes in telemonitored physiological measurements and subjective symptoms over 14-days following discharge in the telemonitor group; (2) Examine the differences in functional status, QOL, and patient/family satisfaction with and without home telemonitor-based education for self-management; and (3) Analyze differences in nurse/physician contact, treatment changes, and healthcare resource utilization with and without home telemonitor surveillance education for self-management. This study is important because improved knowledgeable patient self-management could impact long term outcomes. Patient direct contacts to clinicians for treatment and self-management would be less costly compared to emergency care or rehospitalization. Successful completion of the study would also help to fill the gap in knowledge about changes in lung CA patients' vital signs and symptoms between hospital discharge and the usual 2 week post-hospital visit. Consistent with the missions of NIH and NCI to build a knowledge base to alleviate the burdens of illness and disability and provide continuing care of cancer patients, our R15 grant application supports patient self-management based on signs/ symptom identification for appropriate clinician contact before problems exacerbate, improving QOL for adults with lung CA, and examining the satisfaction of patients and families with limited (14 day) telemonitor use. Nursing knowledge will be used to interpret telemonitor data and educate cancer patients at home after hospitalization. Short term remote telemonitoring-based patient education offers a promising option to develop patient self-management knowledge and skills. PUBLIC HEALTH RELEVANCE: High costs of care for patients with lung cancer have been related to frequent hospitalizations and emergency care visits. There is a critical need to identify interventions to help people with lung cancer recognize changes in their condition and contact a clinician before emergent care is needed. The proposed study uses a self-management model to test the use of home telemonitors as risk indicators after discharge in a sample of Appalachian adults hospitalized with lung cancer and comorbidities. Phone-transmitted telemonitor information will assist nurses to explain changes in signs/symptoms and coach patients on when and how to contact a clinician. Addressing health disparities for adults with lung cancer by cost-effectively reducing risks for rehospitalization/emergent care and improving life quality is critical to "Healthy People 2010".