Chumbler Neale R, Mann William C, Wu Samuel, Schmid Arlene, Kobb Rita
Veterans Affairs Health Services Research & Development/Rehabilitation Research & Development, Rehabilitation Outcomes Research Center (RORC), North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA.
Telemed J E Health. 2004 Summer;10(2):129-37. doi: 10.1089/tmj.2004.10.129.
This study compared health-related outcomes, during a 1-year period, for two groups of frail elders-one that received care coordination via distance monitoring (home-telehealth) and one that received no intervention. A case-control design was employed. The home telehealth intervention group was made up of 111 male veterans who were enrolled in a Veterans Health Administration project. The control group consisted of 115 men who were referred from either senior service agencies or hospital rehabilitation programs, but did not receive home-telehealth. Subjects in both groups had primary diagnoses of hypertension, diabetes, respiratory disease, or heart disease. The two groups were similar in terms of age, race, marital status, and independence in instrumental activities of daily living (IADL) at baseline. A paired t-test was used to study the before-after (baseline to 12-month follow-up) improvements in the outcome measures within each group. Regression models were used to compare the outcome improvements between the two groups. Over 1 year, the intervention group improved 2.2 points more in IADL, 14.4 points more in FIM motor scores, and 2.7 points more in FIM cognitive scores than the control group (p < 0.0001). This evidence supports the use of a specific home-telehealth strategy for care coordination to improve functional independence in non-institutionalized veterans with chronic disease. A randomized controlled trial should be employed to confirm these findings.
本研究比较了两组体弱老年人在1年期间与健康相关的结果，一组通过远程监测（家庭远程医疗）接受护理协调，另一组未接受干预。采用病例对照设计。家庭远程医疗干预组由111名参加退伍军人健康管理局项目的男性退伍军人组成。对照组由115名从高级服务机构或医院康复项目转介而来但未接受家庭远程医疗的男性组成。两组受试者的主要诊断均为高血压、糖尿病、呼吸系统疾病或心脏病。两组在年龄、种族、婚姻状况以及基线时日常生活工具性活动（IADL）的独立性方面相似。采用配对t检验研究每组内结果测量指标在基线至12个月随访期间的前后改善情况。使用回归模型比较两组之间的结果改善情况。在1年多的时间里，干预组在IADL方面比对照组多改善2.2分，在FIM运动评分方面多改善14.4分，在FIM认知评分方面多改善2.7分（p < 0.0001）。这一证据支持使用特定的家庭远程医疗策略进行护理协调，以提高患有慢性病的非机构化退伍军人的功能独立性。应采用随机对照试验来证实这些发现。
