心功能门诊实施心衰远程监测项目作为标准护理的结果:卡塔尔世界杯8强波胆分析Pretest-Posttest务实研究%一个器皿,帕特里克%罗斯,希瑟·J % Cafazzo,约瑟夫% Boodoo,克里斯% Munnery, Mikayla %濑户,艾米丽% +全球电子健康创新中心Techna研究所大学健康网络,TGH / RFE建筑物,4日,多伦多,伊丽莎白街190 Fl, M5G 2 c4,加拿大,1 647 227 6015,patrick.ware@uhn.ca % K遥控% K远程医疗% K虚拟保健% K mHealth % K心力衰竭% D原始论文7 6.2.2020 % 9 2020% % J J互联网Res % G英语% X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。 Clinical outcomes included bloodwork (B-type natriuretic peptide [BNP], creatinine, and sodium), left ventricular ejection fraction, and predicted survival score using the Seattle Heart Failure Model. 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. %R 10.2196/16538 %U //www.mybigtv.com/2020/2/e16538 %U https://doi.org/10.2196/16538