Coordinated Telehealth Care Program for Rural Elders with Congestive Heart Failur

描述（由申请人提供）：国家的老龄化人口的经验，慢性病的发病率和死亡率高，伴随着高医疗费用。对患有慢性病的老年人的护理通常是分散的，并且随着时间的推移和跨环境缺乏连续性。无论是患有慢性病的老年人，还是他们的非正式家庭照顾者，通常都不具备管理这些疾病所需的知识或自我管理技能。慢性病管理不善对个人和社会都有重要影响，导致健康状况不佳，以及可避免的医疗保健费用。该第一阶段应用将确定独特的协调远程医疗保健计划的可行性、可接受性和短期有效性，该计划整合了家庭远程医疗/远程患者监测和农村老年充血性心力衰竭（CHF）患者的护理协调策略。关注CHF是因为它是医疗保险人群中最流行和最昂贵的慢性病之一。具体研究目标是：1）开发一个低成本、有效的远程患者监测系统，该系统使用低成本PC和Web 2.0技术来监测症状，并提高老年人及其护理者的自我管理技能; 2）开发并实施协调远程医疗保健计划，该计划将该低成本远程患者监测系统纳入阿肯色州农村老年人的CHF诊断; 3）使用RE-AIM概念模型在随机对照试点研究中评估该计划;以及，4）根据I期评估结果开发并提交II期申请。I期研究的结果，特别是治疗组和常规治疗组在终点（例如，再住院次数）将用于预测II期申请所需的样本量。环境与健康集团正在与雷诺兹研究所老龄化中心（RICOA）和阿肯色州医学院的雷诺兹老年医学系合作，这是该国最大的学术老年医学项目之一，并与Medullan Inc.合作，一家位于马萨诸塞州剑桥的健康软件开发公司。来自RICOA的老年临床研究人员就该提案进行了合作，确保家庭远程医疗/远程患者监测和护理协调计划解决了老年CHF患者特有的问题。RICOA的调查人员将在阿肯色州的农村老年人中实施该计划，而梅杜兰将开发所需的软件。第二阶段SBIR的目标是在一项强有力的随机试验中开发、实施和评估一项针对农村地区诊断为CHF的老年人的家庭远程医疗/远程患者监测护理协调计划。随后的第二阶段应用将为CHF老年患者以及患有多种合并症和老年综合征的老年人提供创新的服务提供模式，并有可能在全国农村地区复制和销售。 公共卫生相关性：随着美国人口的迅速老龄化，慢性病的管理是一个巨大的公共卫生挑战。在农村地区，心脏病和糖尿病等慢性病的管理存在特殊问题，因为保健提供者短缺，他们缺乏老年病方面的培训，而且病人必须长途跋涉才能获得保健。拟议的项目将开发和评估一种创新的方法，在农村充血性心力衰竭患者的护理协调和远程保健。拟议的项目旨在通过使用创新的低成本技术来改善患者健康并降低成本，以促进更好的护理协调。

DESCRIPTION (provided by applicant): The nation's aging population experiences high rates of chronic disease that are associated with excess morbidity and mortality, and concomitant high medical costs. Care for older adults with chronic disease is typically fragmented, and lacking continuity over time and across settings. Neither older adults with chronic disease, nor their informal family caregivers, typically have the knowledge or self-management skills necessary to manage these conditions. The mismanagement of chronic disease has important implications for both the individual and society, resulting in poor health outcomes, as well as avoidable health care costs. This Phase I application will establish the feasibility, acceptability, and short-term effectiveness of a unique Coordinated Telehealth Care Program that integrates strategies for home telehealth/remote patient monitoring and care coordination for rural, older patients with a diagnosis of congestive heart failure (CHF). The focus on CHF is because it is one of the most prevalent and costly chronic diseases in the Medicare population. Specific study aims are to: 1) develop a low cost, effective remote patient monitoring system that uses low cost PCs and web 2.0 technology to monitor symptoms and enhance self-management skills of the older adult and his/her caregiver; 2) develop and implement the Coordinated Telehealth Care Program that incorporates this low cost remote patient monitoring system for older, rural Arkansans with a diagnosis of CHF; 3) evaluate the program in a randomized controlled pilot study using the RE-AIM conceptual model; and, 4) develop and submit a Phase II application, based on Phase I evaluation results. The results from the Phase I study, specifically, the differences in outcomes between treatment and usual care groups in the endpoints (e.g., number of re- hospitalizations) will be used to predict sample size needed for the Phase II application. Environment and Health Group is collaborating with the Reynolds Institute Center on Aging (RICOA) and the Reynolds Department of Geriatrics at the University of Arkansas Medical School, one the largest academic geriatric medicine programs in the country, and with Medullan Inc., a Cambridge, MA-based health software development company. Geriatric clinical investigators from the RICOA have collaborated on this proposal, ensuring that the home telehealth/remote patient monitoring and care coordination program addresses issues unique to the geriatric patient with CHF. RICOA investigators will implement the program among rural, older Arkansans, while Medullan will develop the needed software. The goal of the Phase II SBIR will be to develop, implement, and evaluate, in a robust randomized trial, a home telehealth/remote patient monitoring care coordination program for older persons with a diagnosis of CHF in rural areas. The subsequent Phase II application, will lead to an innovative service delivery model not only for older patients with CHF, but for older adults with multiple co-morbidities and geriatric syndromes, with the potential to be replicated and marketed in rural areas across the country. PUBLIC HEALTH RELEVANCE: The management of chronic disease is an enormous public health challenge with the rapid aging of the United States population. The management of chronic diseases such as heart disease and diabetes presents special problems in rural areas because of the shortage of health care providers, their lack of training in geriatrics, and the long distances patients have to travel to access care. The proposed project will develop and evaluate an innovative approach to care coordination and telehealth in rural patients with congestive heart failure. The proposed project is designed to improve patient health and reduce costs by using innovative low cost technology to promote better care coordination.