Discharge Planning and Telehealth for Post CABG Elders

描述（由申请人提供： 越来越多的老年患者正在接受冠状动脉旁路移植术（CABG）手术;这是最常进行的大手术，也是冠心病最昂贵的单一治疗方法之一。预防并发症，包括再入院是重要的，但不需要昂贵的家访，以改善老年人的结果后，冠状动脉旁路移植术的干预措施在很大程度上是未经测试的。 目的：检查老年心脏病患者出院/干预（DICE）的有效性。DICE包括1）出院计划的重点强化，2）家庭远程健康生命体征和体重监测，3）老年心脏手术患者出院后的电话随访。 老年心脏病患者出院/干预（DICE）目的：使用3组（随机分配至两组之一） 干预和对照）设计，确定（1）DICE对住院后 功能状态、健康状态、卫生保健利用（初级保健医生和诊所就诊、急性护理就诊、急诊室就诊和再住院）以及出院后1个月、2个月和3个月老年心脏手术患者对护理的满意度的结果;（2）DICE的成本效益。 受试者：来自3家医院研究中心的330例年龄大于65岁的患者。 设计：4年随机对照试验。 干预措施：DICE包括1）出院计划的强化，2）基于家庭的远程健康监测，3）出院后第1天、第3天和每周一次的电话随访，持续4周。改良DICE包括1）强化出院计划，2）出院后第1天、第3天和每周一次电话随访，持续4周。 含义：拟议的研究代表了主要研究者研究老年患者结局的逻辑延伸，以及共同研究者研究远程医疗干预措施影响的重点。该研究旨在扩展研究团队的工作，探索干预措施对高风险老年冠状动脉旁路移植术患者的影响。本研究将进一步了解护理干预对老年心脏手术高危患者术后并发症的影响，并探讨DICE干预对改善老年人CABG术后预后的作用。

DESCRIPTION (provided by the applicant: A growing number of elderly patients are receiving coronary artery bypass graft (CABG) surgery; the most frequently performed major surgery and one of the most costly single treatments for coronary heart disease. Prevention of complications, including hospital readmissions are important, yet interventions that do not require costly home visiting to improve elders' outcomes after CABG are largely untested. Purpose: to examine the effectiveness of a Discharge /intervention for Cardiac Elderly (DICE). DICE consists of 1) focused reinforcement of the discharge plan, 2) home telehealth vital sign and weight monitoring, and 3) post-discharge telephone follow up of elderly cardiac surgery patients. Discharge/Intervention for Cardiac Elderly (DICE) Aims: using a 3 group (randomized to one of two interventions and control) design, determine (1) the effectiveness of DICE on the post hospitalization outcomes of functional status, health status, health care utilization (in terms of primary care physician and clinic visits, acute care visits, emergency room visits, and rehospitalizations), and satisfaction with care for elderly cardiac surgery patients at 1, 2, and 3 months after hospital discharge, (2) the cost effectiveness of DICE. Subjects: 330 patients age greater than 65 from 3 hospital sites. Design: 4 year randomized control trial. Intervention: DICE consists of 1) reinforcement of the discharge plan, 2) home based telehealth monitoring, and 3) post-discharge telephone follow up at 1 day, 3 days, and weekly for 4 weeks. Modified DICE consists of 1) reinforcement of the discharge plan, and 2) post-discharge telephone follow up at 1 day, 3 days, and weekly for 4 weeks. Implications: The proposed research represents a logical extension of the principal investigators research focus in studying outcomes for elderly patients, and the Co-Investigator's focus on studying the impact of telehealth interventions. The study serves to extend the research team's work to explore the effect of an intervention for high-risk elderly CABG surgery patients. The study will advance understanding of the outcomes of nursing interventions for elderly cardiac surgery patients at high risk for developing postoperative complications and explore the effect of the DICE intervention on improving elders' outcomes post CABG.