School of Nursing, University of Pennsylvania, Philadelphia 19104, USA.
J Cardiovasc Nurs. 2013 May-Jun;28(3):216-27. doi: 10.1097/JCN.0b013e3182512331.
Comorbidities adversely impact heart failure (HF) outcomes. Telehealth can assist healthcare providers, especially nurses, in guiding their patients to follow the HF regimen. However, factors, including comorbidity patterns, that act in combination with telehealth to reduce home care nursing utilization are still unclear.
The purpose of this article was to examine the association of the comorbidity characteristics of HF patients with nursing utilization along with withdrawal from telehealth service during an episode of tele-home care.
A descriptive, correlational study design using retrospective chart review was used. The sample comprised Medicare patients admitted to a New England home care agency who had HF as a diagnosis and had used telehealth from 2008 to 2010. The electronic documentation at the home care agency served as the data source, which included Outcome and Assessment Information Set data of patients with HF. Logistic and multiple regression analyses were used to analyze data.
The sample consisted of 403 participants, of whom 70% were older than 75 years, 55% were female, and 94% were white. Comorbidities averaged 5.19 (SD, 1.92), ranging from 1 to 11, and nearly 40% of the participants had 5 or more comorbidities. The mean (SD) nursing contacts in the sample was 9.9 (4.7), ranging from 1 to 26, and 52 (12.7%) patients withdrew from telehealth service. For patients with HF on telehealth, comorbidity characteristics of anemia, anxiety, musculoskeletal, and depression were significantly associated with nursing utilization patterns, and renal failure, cancer, and depression comorbidities were significantly associated with withdrawal from telehealth service.
Knowledge of the association of comorbidity characteristics with the home care service utilization patterns of patients with HF on telehealth can assist the home health nurse to develop a tailored care plan that attains optimal patient outcomes. Knowledge of such associations would also focus home care resources, avoiding redundancy of resource utilization in this era of strained healthcare resources.
合并症会对心力衰竭（HF）的结局产生不利影响。远程医疗可以帮助医疗保健提供者，尤其是护士，指导患者遵循 HF 治疗方案。然而，与远程医疗相结合，可降低家庭护理护理利用率的合并症模式等因素仍不清楚。
本文旨在探讨 HF 患者的合并症特征与远程家庭护理期间护理利用情况以及退出远程医疗服务之间的关联。
使用回顾性图表审查描述性相关性研究设计。该样本包括 2008 年至 2010 年在新英格兰家庭护理机构住院且 HF 为诊断并使用远程医疗的医疗保险患者。家庭护理机构的电子文档作为数据源，其中包括 HF 患者的结局和评估信息集数据。使用逻辑回归和多元回归分析来分析数据。
该样本包括 403 名参与者，其中 70%的年龄大于 75 岁，55%为女性，94%为白人。合并症平均为 5.19（SD，1.92），范围为 1 至 11，近 40%的参与者有 5 种或更多种合并症。样本中护理接触的平均值（SD）为 9.9（4.7），范围为 1 至 26，有 52 名（12.7%）患者退出远程医疗服务。对于接受远程医疗的 HF 患者，贫血、焦虑、肌肉骨骼和抑郁的合并症特征与护理利用模式显著相关，而肾衰竭、癌症和抑郁合并症与退出远程医疗服务显著相关。
了解 HF 患者远程医疗护理利用模式与合并症特征的关系，可以帮助家庭保健护士制定量身定制的护理计划，实现最佳的患者结局。了解这些关联也将集中家庭护理资源，避免在医疗资源紧张的时代重复利用资源。
