TY -的盟Indraratna Praveen AU - Biswas Uzzal AU -麦克维,詹姆斯盟——乳房,Andrew AU - Magdy约瑟夫AU -维氏,多米尼克AU -沃特金斯,伊莱恩盟——Ziegl Andreas盟——刘Hueiming AU - Cholerton,尼古拉斯·李盟——琼AU -霍尔盖特,凯蒂AU -菲尔德斯,詹妮弗AU -加拉格尔,Robyn盟——渡轮,凯特AU - 1月,斯蒂芬。非盟-布里格斯,南希盟——Schreier京特·AU -雷蒙德,Stephen J AU - Loh,尤金AU - Yu,詹妮弗AU -洛弗尔,奈杰尔·H AU - Ooisz - yuan PY - 2022 DA - 2022/2/28 TI -基于智能手机的护理模式，以支持心脏病患者从医院过渡到社区(远程临床护理):试点随机对照试验JO - JMIR Mhealth Uhealth SP - e32554 VL - 10 IS - 2 KW -数字健康KW -远程医疗KW - Mhealth KW -心力衰竭KW -缺血性心脏病KW -手机AB -背景:急性冠状动脉综合征(ACS)或心力衰竭(HF)住院患者经常再次入院。这是第一个针对ACS或HF住院患者结合远程监测和教育以防止再入院的移动健康干预的随机对照试验。目的:本研究旨在探讨基于智能手机应用程序的护理模式(TeleClinical care [TCC])在ACS或HF入院后出院患者中的可行性、有效性和成本效益。方法:在这项试验中，2中心随机对照试验，TCC在出院时与常规护理一起应用于干预组参与者。对照组参与者只接受常规护理。纳入标准为目前患有ACS或HF入院，拥有兼容的智能手机，年龄≥18岁，并提供知情同意。主要终点是计划外30天再入院的发生率。次要终点包括全因再入院、心脏再入院、心脏康复完成、药物依从性、成本效益和用户满意度。 Intervention arm participants received the app and Bluetooth-enabled devices for measuring weight, blood pressure, and physical activity daily plus usual care. The devices automatically transmitted recordings to the patients’ smartphones and a central server. Thresholds for blood pressure, heart rate, and weight were determined by the treating cardiologists. Readings outside these thresholds were flagged to a monitoring team, who discussed salient abnormalities with the patients’ usual care providers (cardiologists, general practitioners, or HF outreach nurses), who were responsible for further management. The app also provided educational push notifications. Participants were followed up after 6 months. Results: Overall, 164 inpatients were randomized (TCC: 81/164, 49.4%; control: 83/164, 50.6%; mean age 61.5, SD 12.3 years; 130/164, 79.3% men; 128/164, 78% admitted with ACS). There were 11 unplanned 30-day readmissions in both groups (P=.97). Over a mean follow-up of 193 days, the intervention was associated with a significant reduction in unplanned hospital readmissions (21 in TCC vs 41 in the control arm; P=.02), including cardiac readmissions (11 in TCC vs 25 in the control arm; P=.03), and higher rates of cardiac rehabilitation completion (20/51, 39% vs 9/49, 18%; P=.03) and medication adherence (57/76, 75% vs 37/74, 50%; P=.002). The average usability rating for the app was 4.5/5. The intervention cost Aus $6028 (US $4342.26) per cardiac readmission saved. When modeled in a mainstream clinical setting, enrollment of 237 patients was projected to have the same expenditure compared with usual care, and enrollment of 500 patients was projected to save approximately Aus $100,000 (approximately US $70,000) annually. Conclusions: TCC was feasible and safe for inpatients with either ACS or HF. The incidence of 30-day readmissions was similar; however, long-term benefits were demonstrated, including fewer readmissions over 6 months, improved medication adherence, and improved cardiac rehabilitation completion. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001547235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375945 SN - 2291-5222 UR - https://mhealth.www.mybigtv.com/2022/2/e32554 UR - https://doi.org/10.2196/32554 UR - http://www.ncbi.nlm.nih.gov/pubmed/35225819 DO - 10.2196/32554 ID - info:doi/10.2196/32554 ER -