RCT of automated hovering for congestive heart failure management

 描述（由申请人提供）：拟议项目的目标是进行一项实用的随机对照试验，测试一种结合无线监测设备和行为经济参与激励的慢性病管理新方法，以降低最近在宾夕法尼亚大学卫生系统（UPHS）住院的充血性心力衰竭（CHF）患者的再住院率。我们将招募在过去12个月内至少有一次CHF主要诊断的UPHS医院住院的患者，并将他们随机分配到：[1]无额外干预的家庭护理; [2]提供无线药物依从性设备和量表，每日抽奖激励，以鼓励每日依从性。具体目标是：目标1：利用UPHS CHF诊所、EPIC资源（用于识别符合条件的患者）和Way to Health平台的访问权限，启动并招募一项实用的临床试验，以检测医院 使用远程监测设备自动悬停CHF管理的再入院率目的2：评价远程监测药物和体重沿着参与激励在降低高危CHF患者再住院率方面的有效性。目的3：评估这种干预相对于常规护理的成本效益。我们将利用NIH资助的Way to Health平台，该平台用于使用无线设备测试行为经济干预措施，以及Penn数据存储和电子病历（EPIC），该数据存储和电子病历为识别适当的患者提供了完善的工具，并允许与Way to Health平台进行双向通信，以促进临床医生了解患者的进展。我们将有最低限度的排除标准，以最大限度地提高普遍性。我们的团队将包括UPHS CHF服务的医疗总监，以及一个经验丰富的调查人员团队，包括行为经济学家，内科医生，成本效益专家和统计学家，并得到UPHS首席执行官的支持。

 DESCRIPTION (provided by applicant): The goal of the proposed project is to conduct a pragmatic randomized controlled trial testing a new approach to chronic disease management combining wireless monitoring devices and behavioral economic engagement incentives to reduce rehospitalization rates among patients with Congestive Heart Failure (CHF) recently hospitalized at the University of Pennsylvania Health System (UPHS). We will enroll patients who have been admitted to a UPHS hospital with a principal diagnosis of CHF at least once in the past 12 months and randomize them to either: [1] Usual care with no additional intervention; [2] the provision of wireless medication adherence devices and scales with daily lottery incentives to encourage daily adherence. Specific Aims are: Aim 1: To leverage access to the UPHS CHF clinic, EPIC resources for identifying eligible patients, and the Way to Health platform to launch and enroll a practical clinical trial powered to detect differences in hospital readmission rates using remote monitoring devices for automated hovering for CHF management Aim 2: To evaluate the effectiveness of remote monitoring of medication and weight along with engagement incentives in reducing rehospitalization rates among high-risk CHF patients. Aim 3: To assess the cost-effectiveness of this intervention relative to usual care. We will utilize the NIH-funded Way to Health platform, constructed for testing behavioral economic interventions using wireless devices, as well as the Penn data store and electronic medical record (EPIC), which provide well developed tools for identifying appropriate patients and allow for bidirectional communication with the Way to Health platform to facilitate clinician awareness of patient progress. We will have minimal exclusion criteria to maximize generalizability. Our team will include the medical director of the CHF service for UPHS, and a team of experienced investigators including behavioral economists, internists, a cost effectiveness expert, and a statistician, with support for this initiative from the CEO of UPHS.