Brown-Connolly Nancy E, Concha Jeannie B, English Jennifer
Project HOPE , HABITS for LIFE Program, Albuquerque, New Mexico .
Telemed J E Health. 2014 Jan;20(1):18-23. doi: 10.1089/tmj.2013.0080. Epub 2013 Nov 15.
HABITS for Life was a 3-year initiative to broadly deliver a statewide biometric and retinal screening program via a mobile unit throughout New Mexico at no charge to participants. The program goal-to identify health risk and improve population health status-was tested over a 3-year period. Value to participants and impact to the healthcare system were measured to quantify impact and value of investing in prevention at the community level.
We used the Mobile Health Map Return-on-Investment Calculator, a mobile screening unit, biometric screening, retinography, and community coordination. Our systems included satellite, DSL, and 3G connectivity, a Tanita® (Arlington Heights, IL) automated body mass index-measuring scale, the Cholestec® (Alere™, Waltham, MA) system for biomarkers and glycosylated hemoglobin, a Canon (Melville, NY) CR-1 Mark II camera, and the Picture Archiving Communication System.
In this report for the fiscal year 2011 time frame, 6,426 individuals received biometric screening, and 5,219 received retinal screening. A 15:1 return on investment was calculated; this excluded retinal screening for the under-65 year olds, estimated at $10 million in quality-adjusted life years saved. Statistically significant improvement in health status evidenced by sequential screening included a decrease in total cholesterol level (p=0.002) (n=308) and an increase in high-density lipoprotein level after the first and second screening (p=0.02 and p=0.01, respectively), but a decrease in mean random glucose level was not statistically significant (p=0.62). Retinal results indicate 28.4% (n=1,482) with a positive/abnormal finding, of which 1.79% (n=93) required immediate referral for sight-threatening retinopathy and 27% (n=1,389) required follow-up of from 3 months to 1 year.
Screening programs are cost-effective and provide value in preventive health efforts. Broad use of screening programs should be considered in healthcare redesign efforts. Community-based screening is an effective strategy to identify health risk, improve access, provide motivation to change health habits, and improve physical status while returning significant value.
“生活习惯”项目是一项为期三年的倡议，旨在通过移动设备在新墨西哥州全境广泛开展一项免费的全州生物识别和视网膜筛查项目。该项目的目标——识别健康风险并改善人群健康状况——在三年时间里得到了检验。对参与者的价值以及对医疗系统的影响进行了评估，以量化在社区层面投资预防措施的影响和价值。
我们使用了移动健康地图投资回报率计算器、一个移动筛查设备、生物识别筛查、视网膜成像以及社区协调。我们的系统包括卫星、数字用户线路和3G连接、一台Tanita®（伊利诺伊州阿灵顿高地）自动体重指数测量秤、用于生物标志物和糖化血红蛋白检测的Cholestec®（Alere™，马萨诸塞州沃尔瑟姆）系统、一台佳能（纽约州梅尔维尔）CR - 1 Mark II相机以及图像存档与通信系统。
在这份关于2011财年时间段的报告中，6426人接受了生物识别筛查，5219人接受了视网膜筛查。计算得出投资回报率为15:1；这其中不包括对65岁以下人群的视网膜筛查，据估计这部分筛查在质量调整生命年方面节省了1000万美元。连续筛查显示健康状况有统计学意义的改善，包括总胆固醇水平下降（p = 0.002）（n = 308）以及首次和第二次筛查后高密度脂蛋白水平升高（分别为p = 0.02和p = 0.01），但平均随机血糖水平下降没有统计学意义（p = 0.62）。视网膜检查结果显示，28.4%（n = 1482）的检查结果呈阳性/异常，其中1.79%（n = 93）的患者因威胁视力的视网膜病变需要立即转诊，27%（n = 1389）的患者需要在3个月至1年的时间内进行随访。
筛查项目具有成本效益，在预防保健工作中具有价值。在医疗保健重新设计工作中应考虑广泛使用筛查项目。基于社区的筛查是识别健康风险、改善医疗服务可及性、激发改变健康习惯动力以及改善身体状况并同时带来显著价值的有效策略。
