Managing Chronic Illness: Telemonitoring vs Telephone

远程医疗(使用电信设备监测患者的生命体征和病情)正在家庭护理行业取得巨大增长，成为密切监测患者的一种具有成本效益的手段。 家庭健康机构正在寻找替代护理的方法，以降低成本，提高效率，同时保持或提高患者护理的质量。然而，没有研究直接评估这种额外技术的价值，而不是更普遍地测试的电话疾病管理程序。 这项拟议的随机现场研究将解决这一知识差距，并试图展示初步诊断为心力衰竭、糖尿病或高血压的患者对使用远程监护和面对面家庭护理提供的基于证据的疾病管理方案的反应，而不是仅仅使用电话和面对面家庭护理。本研究的目的是：1)比较这两种疾病管理模式对患者主观健康状况评分、销售护理知识和行为、资源利用等健康结局的影响。2)研究在家庭活动期间通过远程监护与电话提供疾病管理方案的优缺点 关心。其中一组将通过远程监护单元接收协议，远程监护单元为生理监测提供外围设备。第二组将通过标准电话接收疾病管理方案。这两个群体都将参加传统的技能型家庭护理。研究结果将在进入研究时和出院时(通常是45-60天后)进行评估。来自四个参与的家庭健康机构的护士将接受使用疾病管理方案的培训。所有这些机构目前都对继承人进行远程监测，但没有进行疾病管理。患者的结果将包括：与饮食和药物、健康状况和健康护理相关的自我护理知识和行为 利用率。数据分析将包括连续变量的混合模型ANOVA，序数变量的非参数类似的ANOVA，离散终点的Fisher精确检验，以及首次再入院时间的生存分析。关于健康结果和两种干预措施的优缺点的研究结果将指导设计一项更大的临床试验，将远程监测与电话疾病管理进行比较。

Telehealth (the monitoring of a patient's vital signs and condition using telecommunications equipment) is seeing a great deal of growth in the homecare industry as a cost-effective means to closely monitor patients. Home health agencies are seeking alternatives to care that reduce their costs and make them more efficient while maintaining or improving the quality of patient care. However, no studies have directly evaluated the value of this additional technology over the more commonly tested telephone disease mangement programs. This proposed randomized field study will address this gap in knowledge and attempt to demonstrate how patients with a primary diagnosis of heart failure, diabetes or hypertension respond to evidence based disease management protocols provided using telemonitoring and in-person home care versus just telephone and in-person home care. The aims of this study are to, 1) compare the effects of these two disease management modalities on health outcomes such as patients' subjective health status rating, sell care knowledge and behavior, and resource utilization. 2) examine the advantages and disadvantages of delivering disease management protocols via telemonitoring versus telephone during an episode of home care. One group will receive the protocols via a telemonitoring unit that provides peripheral devices for physiological monitoring. A second group will receive the disease management protocols over a standard telephone. Both groups will be enrolled in traditional skilled home care. Study outcomes will be measured upon admission into the study and at discharge (typically 45-60 days later). Nurses from the four participating home health agencies will be trained in using the disease management protocols. All of the agencies currently conduct telemonitoring of heir patients but no disease management. Patient outcomes will include: self-care knowledge and behavior related to diet and medications, health status, and health care utilization. Data analysis will include mixed model ANOVA for continuous variables, non-parametric analogues of ANOVA for ordinal variables, Fisher's exact test for discrete endpoints, and survival analysis for time to first readmission. Findings regarding health outcomes and advantages and disadvantages of the two interventions will guide the design of a larger clinical trial to compare telemonitoring to telephone disease management.