Kohn Martin Steven, Haggard Jeffrey, Kreindler Jack, Birkeland Kade, Kedan Ilan, Zimmer Raymond, Khandwalla Raj
Sentrian, San Juan Capistrano, CA, United States.
Cedars-Sinai Heart Institute, Beverly Hills, CA, United States.
JMIR Res Protoc. 2017 Mar 20;6(3):e46. doi: 10.2196/resprot.5744.
Improving the management of patients with complex chronic disease is a substantial undertaking with the simultaneous goals of improving patient outcomes and controlling costs. Reducing avoidable hospitalization for such patients is a step toward both objectives. Some of the deterioration experienced in chronic disease patients occurs outside the view of their clinicians, and before the patient becomes overtly symptomatic. Home monitoring has been used for more than 20 years to detect deterioration earlier so that the patients could be treated before they became ill enough to require hospitalization. Patient participation is an important requirement for successful home monitoring. There has been some concern that patients would be unwilling or unable to engage in a program that collected multiple measurements. The Cedars-Sinai Cardiology Center provides a high-touch, intense management program for patients with congestive heart failure (CHF). A group of their patients were chosen to join a complex, multidevice home monitoring system to see whether such patients would find value in the additional effort.
The objective of our study was to determine whether patients already actively engaged in a high-touch intensive management program for CHF would take on the additional burden of a complex home monitoring effort.
A total of 20 patients from the Cedars-Sinai group were enrolled in a monitoring program utilizing 5 different devices. Anonymous surveys were collected from the patients to assess their satisfaction with the program.
In total, 90% (18/20) completed the program, and 61% (11/20) submitted the survey. Among the 18 patients, overall compliance with the requested measurements was 70%. It was found that 73% (8/11) felt better about their health as a result of the program, whereas another 73% (8/11) believed that the care team now had a better picture of their health.
Substantial patient compliance and satisfaction can be achieved in a sophisticated home monitoring program.
改善复杂慢性病患者的管理是一项重大任务，其同时具有改善患者预后和控制成本的目标。减少此类患者可避免的住院是朝着这两个目标迈出的一步。慢性病患者出现的一些病情恶化发生在临床医生的视野之外，且在患者出现明显症状之前。家庭监测已使用20多年，用于更早地检测病情恶化，以便在患者病情严重到需要住院之前进行治疗。患者参与是家庭监测成功的一项重要要求。有人担心患者会不愿意或无法参与收集多项测量数据的项目。雪松西奈心脏中心为充血性心力衰竭（CHF）患者提供了一项密切关注、强化管理的项目。他们挑选了一组患者加入一个复杂的多设备家庭监测系统，以了解此类患者是否会从额外的努力中发现价值。
我们研究的目的是确定已经积极参与CHF密切关注强化管理项目的患者是否会承担复杂家庭监测工作的额外负担。
来自雪松西奈组的20名患者参加了一个使用5种不同设备的监测项目。从患者那里收集匿名调查问卷，以评估他们对该项目的满意度。
总共有90%（18/20）的患者完成了该项目，61%（11/20）的患者提交了调查问卷。在这18名患者中，对要求测量项目的总体依从率为70%。结果发现，73%（8/11）的患者因该项目对自己的健康感觉更好，而另外73%（8/11）的患者认为护理团队现在对他们的健康状况有了更清楚的了解。
在一个复杂的家庭监测项目中可以实现较高的患者依从率和满意度。
