Dang Stuti, Ma Fangchao, Nedd Nicole, Aguilar Enrique J, Roos Bernard A
Geriatric Research, Education, and Clinical Center (GRECC) and Research Service, Veterans Affairs Medical Center, Miami, Florida 33125, USA.
Telemed J E Health. 2006 Feb;12(1):14-23. doi: 10.1089/tmj.2006.12.14.
Our objective was to evaluate in a demonstration project whether our T-Care Program, telecare management via an Internet-based home-messaging device, reduces resource utilization by patients with congestive heart failure (CHF), diabetes mellitus (DM), and chronic obstructive pulmonary disease (COPD). Study participants were drawn from a group of high resource-utilizing veterans over age 60 and included 19 patients with CHF, 23 with DM, and 17 with COPD. Data were gathered on hospital admissions, bed days of care (BDOC), outpatient admissions, and emergency department visits 6 months before and 6 months after enrollment in the telecare program. Nonparametric tests examined pre- and postintervention effects. For patients with CHF, significant decreases were found with T-Care in total emergency department visits (30 to 10, p = 0.03) and hospital admissions (20 to 8, p = 0.03). The decrease in BDOC (179 to 53) was not significant (p = 0.07). Outpatient visits were unchanged (71 to 83, p = 0.38). There were no significant changes for patients with COPD: the apparent BDOC decrease (115 to 46) was not significant (p = 0.24). The outpatient visits by patients with DM decreased significantly (199 to 143, p = 0.03), but no significance was found for changes in their emergency department visits, hospital admissions, and BDOC. The apparent BDOC increase (38 to 198, p = 0.23) was related to two patients with extended stays for an amputation and mitral valve surgery. We found that telecare models may reduce resource utilization in elderly patients with chronic diseases, especially in patients with CHF. Because of the small sample size and lack of controls, larger and more carefully designed follow-up trials are needed to determine cost efficiency for different chronic diseases, and the relative value of the interpersonal contact versus the technological components of this care coordination model.
我们的目标是在一个示范项目中评估我们的T-Care项目，即通过基于互联网的家庭信息设备进行远程护理管理，是否能降低充血性心力衰竭（CHF）、糖尿病（DM）和慢性阻塞性肺疾病（COPD）患者的资源利用率。研究参与者来自一组60岁以上高资源利用率的退伍军人，包括19名CHF患者、23名DM患者和17名COPD患者。收集了患者在参加远程护理项目前6个月和后6个月的住院次数、护理床日（BDOC）、门诊就诊次数和急诊就诊次数的数据。采用非参数检验来检查干预前后的效果。对于CHF患者，T-Care项目使急诊就诊总次数显著减少（从30次降至10次，p = 0.03），住院次数也显著减少（从20次降至8次，p = 0.03）。BDOC的减少（从179天降至53天）不显著（p = 0.07）。门诊就诊次数没有变化（从71次增至83次，p = 0.38）。COPD患者没有显著变化：BDOC的明显减少（从115天降至46天）不显著（p = 0.24）。DM患者的门诊就诊次数显著减少（从199次降至143次，p = 0.03），但其急诊就诊次数、住院次数和BDOC的变化没有显著性。BDOC的明显增加（从38天增至198天，p = 0.23）与两名因截肢和二尖瓣手术而延长住院时间的患者有关。我们发现，远程护理模式可能会降低老年慢性病患者的资源利用率，尤其是CHF患者。由于样本量小且缺乏对照，需要进行更大规模、设计更严谨的后续试验，以确定不同慢性病的成本效益，以及这种护理协调模式中人际接触与技术成分的相对价值。
