Aetna, Inc, Princeton, NJ 08540, USA.
Am J Manag Care. 2011 Mar 1;17(3):e71-9.
To assess the impact of supplementing nurse case management with Internet-connected telemonitoring on clinical outcomes in an elderly heart failure (HF) population.
Randomized clinical trial allocating high-risk HF subjects to the telehealth system with case management (THCM) versus case management (CM) alone.
Medicare Advantage members with HF and recent hospitalization were randomized to THCM or CM. Consenting participants received THCM for 6 months or the health plan's usual Medicare specialized CM as long as deemed necessary. The primary outcome measure was a composite of all-cause hospitalization, ED visit, or death. Because only a subset of those who were randomized consented and participated, the strategies were evaluated as-treated rather than by intention-to-treat, with multivariate adjustment in logistic regression models for confounding introduced by postrandomization exclusions.
The treated sample size was 164 subjects in THCM and 152 in CM. Treatment arms did not differ significantly for the primary composite outcome (45% for THCM vs 40% for CM, relative risk 1.18; P = .22). Telehealth alerts prompted frequent telephonic contact, increasing THCM case managers' workload. The participant population overall had 42% fewer inpatient days during the intervention period compared with the previous year.
Despite effective implementation of an Internet-based telehealth intervention in an elderly HF population, there was no discernible impact on overall morbidity or mortality. Notably, limited postrandomization participation decreased power to detect a difference. The reduction in days hospitalized for trial participants overall underscores the benefit of CM for such HF patients.
评估在老年心力衰竭（HF）人群中，将护士病例管理与互联网连接的远程监测相结合对临床结局的影响。
将高危 HF 患者随机分配到远程健康系统联合病例管理（THCM）组或单独病例管理（CM）组的随机临床试验。
医疗保险优势计划中有 HF 和近期住院史的成员被随机分配到 THCM 或 CM。同意参与的患者接受 THCM 治疗 6 个月，或根据健康计划的需要接受 Medicare 专门的 CM 治疗。主要结局指标是全因住院、急诊就诊或死亡的复合指标。由于仅对随机分组并同意参与的患者进行了亚组分析，因此该策略是按实际治疗而非意向治疗进行评估的，在多变量逻辑回归模型中对随机分组后排除的混杂因素进行了调整。
THCM 组和 CM 组的治疗样本量分别为 164 例和 152 例。治疗组在主要复合结局方面无显著差异（THCM 组为 45%，CM 组为 40%，相对风险 1.18；P =.22）。远程健康警报提示频繁进行电话联系，增加了 THCM 病例经理的工作量。与前一年相比，整个参与者人群在干预期间的住院天数减少了 42%。
尽管在老年 HF 人群中成功实施了基于互联网的远程健康干预措施，但对整体发病率或死亡率没有明显影响。值得注意的是，随机分组后参与度有限降低了检测差异的能力。试验参与者的整体住院天数减少，突出了 CM 对这些 HF 患者的益处。
