Telemonitoring to improve heart failure outcomes

描述（由申请人提供）：心力衰竭是一种常见的、昂贵的疾病，其特点是反复出现临床代偿失代偿，经常导致再次住院。定期（通常不频繁）的门诊就诊是提供者发现和治疗心力衰竭失代偿早期症状的唯一通常机会——这构成了当前医疗模式的一个主要缺口。此外，患者在管理自己病情方面发挥积极作用的情况很少。远程监护是一种利用电子和通信技术弥合医生和病人之间距离的技术，有望缩小心力衰竭护理的差距。然而，很少对远程监测的有效性进行严格的评估。我们将研究一种远程监测策略，促进患者和医疗保健提供者之间的沟通，并对患者进行有关管理其病情的一般教育。该策略使用Health Buddy(r)系统，该系统连接到传统电话线，不需要互联网接入。虽然许多供应商都有实现本研究的潜在工具，但我们选择使用Health Buddy(r)系统，因为它是目前可用的远程监控设备的代表，并且可以获得初步数据，表明患者和提供者对其使用的满意度很高。我们将确定在常规医疗护理的基础上使用该策略6个月是否能降低在过去30天内因心力衰竭住院的患者的全因再入院率。我们建议开展一项多中心、随机对照试验，招募1640名渴望参与的美国社区心脏病学实践的患者。来自当地诊所的医疗服务提供者将根据远程监控设备提供的信息进行审查并采取行动。如果干预有效，我们将实施一种经济上有吸引力的疾病管理策略，这种策略可以标准化，整合到当前的护理系统中，并广泛应用，有可能显著改善心力衰竭患者的预后。

DESCRIPTION (provided by applicant): Heart failure is a common, costly condition characterized by recurrent periods of clinical decompensation that often lead to rehospitalizations. Periodic, often infrequent, outpatient visits are the only usual opportunities for providers to detect and treat early signs of heart failure decompensation - this constitutes a major gap in the current medical model. Moreover, occasions for patients to take an active role in managing their own conditions are rare. Telemonitoring, which uses electronic and communication technology to bridge distances between physicians and patients, holds promise for closing the gap in heart failure care. However, little rigorous assessment of the effectiveness of telemonitoring has been conducted. We will examine a telemonitoring strategy that facilitates communication between patients and health care providers and the general education of patients about managing their conditions. This strategy uses the Health Buddy(r) system, which connects to conventional telephone lines and does not require Internet access. While many vendors have potential tools to implement this study, we have chosen to use the Health Buddy(r) system because it is representative of telemonitoring appliances currently available and preliminary data are available to suggest high patient and provider satisfaction with its use. We will determine whether use of this strategy for 6 months, added to usual medical care, reduces rates of all-cause readmission in patients who had been hospitalized for heart failure in the previous 30 days. We propose a multicenter, randomized controlled trial, recruiting 1,640 patients from community-based cardiology practices across the United States that are eager to participate. Providers from the local practice sites will review and act upon information from the telemonitoring appliances. If the intervention is effective, we will have implemented an economically attractive disease-management strategy that can be standardized, integrated into the current system of care, and deployed on a wide scale, with potential for dramatic improvements in outcomes of heart failure patients.