TY -非盟的器皿,帕特里克AU -罗斯,希瑟·J AU - Cafazzo,约瑟夫•AU - Boodoo克里斯盟——Munnery Mikayla盟——濑户,艾米丽PY - 2020 DA - 2020/2/6 TI -结果心力衰竭远程控制程序的实现为标准的心脏功能的保健门诊诊所:Pretest-Posttest务实研究乔- J地中海互联网Res SP - e16538六世- 22 - 2 KW -遥控KW -远程医疗KW -虚拟保健KW - mHealth KW -心脏衰竭AB -背景:远程监护(TM)可以通过促进患者的自我护理和临床决策来改善心力衰竭(HF)的结果。Medly程序使患者能够使用手机记录每日HF读数，并接收由临床验证算法生成的个性化自我保健信息。TM系统还会发出警报，病人现有的护理团队会立即采取行动。这个项目作为加拿大多伦多一家门诊心功能诊所的护理标准的一部分已经运行了3年。目的:本研究旨在评估该TM计划在6个月内对医疗服务利用、临床结果、生活质量(QoL)和患者自我护理的影响。方法:这项实用的质量改进研究采用前测后测设计来比较6个月的结果测量与项目入组时的结果测量。主要结局是与hf相关的住院次数。次要结局包括全因住院、急诊科就诊(心衰相关和全因)、住院时间(心衰相关和全因)和门诊就诊。临床结果包括血检(b型利钠肽、肌酐和钠)、左心室射血分数和使用西雅图心力衰竭模型预测的生存评分。 QoL was measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the 5-level EuroQol 5-dimensional questionnaire. Self-care was measured using the Self-Care of Heart Failure Index (SCHFI). The difference in outcome scores was analyzed using negative binomial distribution and Poisson regressions for the health service utilization outcomes and linear regressions for all other outcomes to control for key demographic and clinical variables. Results: Available data for 315 patients enrolled in the TM program between August 2016 and January 2019 were analyzed. A 50% decrease in HF-related hospitalizations (incidence rate ratio [IRR]=0.50; P<.001) and a 24% decrease in the number of all-cause hospitalizations (IRR=0.76; P=.02) were found when comparing the number of events 6 months after program enrollment with the number of events 6 months before enrollment. With regard to clinical outcomes at 6 months, a 59% decrease in BNP values was found after adjusting for control variables. Moreover, 6-month MLHFQ total scores were 9.8 points lower than baseline scores (P<.001), representing a clinically meaningful improvement in HF-related QoL. Similarly, the MLHFQ physical and emotional subscales showed a decrease of 5.4 points (P<.001) and 1.5 points (P=.04), respectively. Finally, patient self-care after 6 months improved as demonstrated by a 7.8-point (P<.001) and 8.5-point (P=.01) increase in the SCHFI maintenance and management scores, respectively. No significant changes were observed in the remaining secondary outcomes. Conclusions: This study suggests that an HF TM program, which provides patients with self-care support and active monitoring by their existing care team, can reduce health service utilization and improve clinical, QoL, and patient self-care outcomes. SN - 1438-8871 UR - //www.mybigtv.com/2020/2/e16538 UR - https://doi.org/10.2196/16538 DO - 10.2196/16538 ID - info:doi/10.2196/16538 ER -