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，其特征是临床失代偿期反复发作，经常导致再次住院。定期的、通常不频繁的门诊就诊是提供者检测和治疗心力衰竭失代偿早期症状的唯一常规机会-这构成了当前医疗模式的主要差距。此外，患者在管理自己的病情方面发挥积极作用的机会很少。远程监护利用电子和通信技术在医生和患者之间架起桥梁，有望缩小心力衰竭护理的差距。然而，很少对远程监护的有效性进行严格的评估。我们将研究一种远程监护策略，以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。这一战略使用了Health Buddy（r）系统，该系统连接到传统的电话线，不需要上网。虽然许多供应商都有实施本研究的潜在工具，但我们选择使用Health Buddy（r）系统，因为它是目前可用的远程监护设备的代表，并且初步数据表明患者和供应商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个月是否能降低前30天内因心力衰竭住院的患者的全因再入院率。我们提出了一个多中心，随机对照试验，招募1,640例患者从社区为基础的心脏病实践在美国各地渴望参与。来自当地实践场所的提供者将审查来自远程监护设备的信息并对其采取行动。如果干预是有效的，我们将实施一个经济上有吸引力的疾病管理策略，可以标准化，整合到当前的护理系统中，并广泛部署，有可能显着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.