TY - JOUR AU - Kaiser, Paulina AU - Pipitone, Olivia AU - Franklin, Anthony AU - Jackson, Dixie R AU - Moore, Elizabeth A AU - Dubuque, Christopher R AU - Peralta, Carmen A AU - De Mory, Anthony C PY - 2020 DA - 2020/2/12 TI -晚期慢性肾脏疾病管理的虚拟多学科护理方案:配对队列研究JO - J Med Internet Res SP - e17194 VL - 22 IS - 2kw -慢性肾病KW -终末期肾病KW -在线社交网络KW -患者教育KW -肾透析AB -背景:对于晚期慢性肾脏疾病(CKD)患者的虚拟多学科护理计划是否可以提高他们对疾病的认识，增加他们对家庭透析治疗的兴趣，并导致更多计划的门诊(相对于住院)透析开始，目前还没有很好的确定。目的:我们旨在评估社区肾病实践中晚期CKD患者参与项目与疾病知识、家庭透析方式偏好和门诊透析起始的可行性和初步关联。方法:在一个匹配的前瞻性队列中，我们招募了年龄在18至85岁之间，至少有两种肾小球滤过率(eGFR)估计小于30 mL/min/1.73 m2的成年人进入蟋蟀健康计划，并将他们与在同一诊所接受治疗的对照组进行比较，年龄、性别、eGFR、心力衰竭和糖尿病的存在相匹配。干预包括在线教育材料、虚拟多学科团队(护士、药剂师、社会工作者、营养师)和患者导师。预先指定的随访时间为9个月，并延长随访时间，以便有足够的时间确定透析开始时间。CKD知识和透析方式的选择在干预参与者的前后调查中进行评估。结果:37名参与者按年龄(平均67.2,SD 10.4对平均68.8,SD 9.5)、糖尿病患病率(54%，20/37对57%，35/61)、充血性心力衰竭(22%，8/37对25%，15/61)和基线eGFR(平均19,SD 6对平均21,SD 5 mL/min/1.73 m2)分别与61名对照组匹配。随访9个月时，两组均有5例患者开始透析(P= 0.62)。 Among program participants, 80% (4/5) started dialysis as an outpatient compared with 20% (1/5) of controls (OR 6.28, 95% CI 0.69-57.22). In extended follow-up (median 15.7, range 11.7 to 18.1 months), 19 of 98 patients started dialysis; 80% (8/10) of the intervention group patients started dialysis in the outpatient setting versus 22% (2/9) of control patients (hazard ratio 6.89, 95% CI 1.46-32.66). Compared to before participation, patients who completed the program had higher disease knowledge levels (mean 52%, SD 29% versus mean 94%, SD 14% of questions correct on knowledge-based survey, P<.001) and were more likely to choose a home modality as their first dialysis choice (36%, 7/22 versus 68%, 15/22, P=.047) after program completion. Conclusions: The Cricket Health program can improve patient knowledge about CKD and increase interest in home dialysis modalities, and may increase the proportion of dialysis starts in the outpatient setting. SN - 1438-8871 UR - //www.mybigtv.com/2020/2/e17194/ UR - https://doi.org/10.2196/17194 UR - http://www.ncbi.nlm.nih.gov/pubmed/32049061 DO - 10.2196/17194 ID - info:doi/10.2196/17194 ER -