PILOT: Home Telemonitoring for Self Management Education of Patients with Lung Ca

描述(由申请者提供)：该申请是医院后家庭远程监护干预的试点，帮助肺癌(CA)患者在需要紧急护理之前识别他们病情的变化并联系临床医生。WV肺CA发病率和死亡率超过美国平均水平。有限的知识和获得护理的机会造成了WV肺CA患者的显著健康差距，特别是在农村地区。迫切需要低成本、高质量的干预措施，以在患者出院后的头两周内帮助他们安排后续的临床医生访问。通过电话传输的远程监护数据将用于提醒护士解释体征/症状的变化，并指导患者何时以及如何联系临床医生。远程监护将提供与疾病相关的变化的早期证据，然后患者可以识别这些变化，并在病情恶化之前传达给他们的临床医生。到目前为止，还没有关于远程监护数据用于成人肺部CA教育的研究。有效性的衡量标准将是患者与护士/医生的接触、出院后2个月内治疗的变化、卫生保健资源的使用和成本，以及患者的生活质量(QOL)和功能状态。研究的具体目标是：(1)描述远程监护组出院后14天内远程监护的生理测量和主观症状的变化；(2)检验有无基于家庭远程监护的自我管理教育在功能状态、生活质量和患者/家庭满意度方面的差异；以及(3)分析有无家庭远程监护自我管理教育在护士/医生接触、治疗变化和医疗资源利用方面的差异。这项研究很重要，因为知识渊博的患者自我管理的改善可能会影响长期结果。与紧急护理或再次住院相比，患者直接接触临床医生进行治疗和自我管理的成本更低。这项研究的成功完成还将有助于填补有关肺部CA患者在出院和通常的两周后出院后就诊之间生命体征和症状变化的知识空白。与NIH和NCI建立知识库以减轻疾病和残疾负担并为癌症患者提供持续护理的使命一致，我们的R15赠款申请支持基于体征/症状识别的患者自我管理，以便在问题恶化之前进行适当的临床医生联系，改善患有肺部CA的成人患者的生活质量，并检查有限(14天)远程监护员使用的患者和家庭的满意度。护理知识将用于解读远程监护数据，并在住院后在家对癌症患者进行教育。基于远程监护的短期患者教育为发展患者自我管理知识和技能提供了一个很有前途的选择。 公共卫生相关性：肺癌患者的高护理费用与频繁住院和紧急护理就诊有关。迫切需要确定干预措施，帮助肺癌患者认识到病情的变化，并在需要紧急护理之前联系临床医生。建议的研究使用自我管理模式来测试家庭的使用情况 在阿巴拉契亚地区因肺癌和合并症住院的成年人样本中，远程监控者作为出院后的风险指标。通过电话传输的远程监护信息将帮助护士解释体征/症状的变化，并指导患者何时以及如何联系临床医生。通过以成本效益的方式降低再次住院/紧急护理的风险并提高生活质量来解决成年肺癌患者的健康差距，这对“2010年健康人”至关重要。

DESCRIPTION (provided by applicant): The application is a pilot for a post-hospital home telemonitoring intervention to help people with lung cancer (CA) recognize changes in their condition and contact a clinician before emergent care is needed. WV lung CA illness and death rates exceed US averages. Limited knowledge and access to care have contributed to significant health disparities for WV lung CA patients, especially in rural areas. There is a critical need for low cost, high quality interventions to assist patients during the first two weeks following hospital discharge before they have scheduled follow-up clinician visits. Phone-transmitted telemonitor data will be used to alert nurses to explain changes in signs/symptoms and coach patients on when and how to contact a clinician. Telemonitors will provide early evidence of disease-related changes which can then be recognized by patients and relayed to their clinician before they exacerbate. To date, there have been no studies of telemonitor data used for education of adults with lung CA. Measures of effectiveness will be patient contacts to nurses/physicians, changes in treatment, use and cost of health care resources for 2 months following hospital discharge, as well as patient quality of life (QOL), and functional status. Study specific aims are: (1) Describe changes in telemonitored physiological measurements and subjective symptoms over 14-days following discharge in the telemonitor group; (2) Examine the differences in functional status, QOL, and patient/family satisfaction with and without home telemonitor-based education for self-management; and (3) Analyze differences in nurse/physician contact, treatment changes, and healthcare resource utilization with and without home telemonitor surveillance education for self-management. This study is important because improved knowledgeable patient self-management could impact long term outcomes. Patient direct contacts to clinicians for treatment and self-management would be less costly compared to emergency care or rehospitalization. Successful completion of the study would also help to fill the gap in knowledge about changes in lung CA patients' vital signs and symptoms between hospital discharge and the usual 2 week post-hospital visit. Consistent with the missions of NIH and NCI to build a knowledge base to alleviate the burdens of illness and disability and provide continuing care of cancer patients, our R15 grant application supports patient self-management based on signs/ symptom identification for appropriate clinician contact before problems exacerbate, improving QOL for adults with lung CA, and examining the satisfaction of patients and families with limited (14 day) telemonitor use. Nursing knowledge will be used to interpret telemonitor data and educate cancer patients at home after hospitalization. Short term remote telemonitoring-based patient education offers a promising option to develop patient self-management knowledge and skills. PUBLIC HEALTH RELEVANCE: High costs of care for patients with lung cancer have been related to frequent hospitalizations and emergency care visits. There is a critical need to identify interventions to help people with lung cancer recognize changes in their condition and contact a clinician before emergent care is needed. The proposed study uses a self-management model to test the use of home telemonitors as risk indicators after discharge in a sample of Appalachian adults hospitalized with lung cancer and comorbidities. Phone-transmitted telemonitor information will assist nurses to explain changes in signs/symptoms and coach patients on when and how to contact a clinician. Addressing health disparities for adults with lung cancer by cost-effectively reducing risks for rehospitalization/emergent care and improving life quality is critical to "Healthy People 2010".