1 Medical Service, VA Boston Healthcare, USA.
2 Department of Medicine, Boston University School of Medicine, USA.
J Telemed Telecare. 2019 Aug;25(7):425-430. doi: 10.1177/1357633X18775852. Epub 2018 May 24.
Telehealth is a promising intervention to reduce readmissions and healthcare-associated costs in patients with heart failure.
We performed a retrospective analysis of the impact of telehealth on 197 heart failure patients who had successfully completed one year of home telehealth monitoring following a heart failure admission as part of a clinically mandated programme at a Veterans Affairs Medical Center. Outcomes were compared both within the group (one year before and one year after home telehealth monitoring), and to a contemporary control cohort of 870 heart failure patients who were admitted but not enrolled in home telehealth. The following outcomes were analysed: admissions for any cause, heart failure admissions, total hospital days per patient, average length of stay per admission, urgent care and emergency room visits, and primary care visits.
Both the home telehealth and control cohorts consisted of older male patients. Total hospital days per patient was significantly reduced by home telehealth monitoring in the home telehealth group (2.4 ± 3.5) in comparison to the previous year without monitoring (4.1 ± 4.6, < 0.0001) and to the control group (3.8 ± 5.3, < 0.001). A significantly lower admission rate (1.1 ± 1.6) and length of stay (5.7 ± 11.3 days) were observed during home telehealth monitoring within the home telehealth group compared to the prior year (1.6 ± 1.7, < 0.05 and 9.5 ± 14 days, < 0.01 respectively) but not in comparison with the control group (1.4 ± 2.0, < 0.07). The home telehealth group also had a significantly lower length of stay when compared to the control group (5.7 ± 11.3 vs 9.0 ± 14.9, < 0.01). The number of urgent care and emergency room visits, or primary care visits, was not significantly different during home telehealth monitoring as compared to the prior year.
Personalised and patient-centred home telehealth monitoring in heart failure patients was successful in reducing outcomes without an increase in outpatient and urgent care visits.
远程医疗是一种很有前途的干预手段，可以降低心力衰竭患者的再入院率和与医疗相关的成本。
我们对退伍军人事务医疗中心一项临床要求的计划中，197 名心力衰竭患者在成功完成一年家庭远程健康监测后（这是该计划的一部分）的影响进行了回顾性分析。结果与组内（家庭远程健康监测前一年和后一年）以及 870 名未接受家庭远程健康监测但住院的同期对照组心力衰竭患者进行了比较。分析了以下结果：任何原因的入院、心力衰竭入院、每位患者的总住院天数、每次入院的平均住院时间、急诊和急诊室就诊次数以及初级保健就诊次数。
家庭远程健康组和对照组均由老年男性患者组成。与无监测前一年（4.1±4.6， <0.0001）和对照组（3.8±5.3， <0.001）相比，家庭远程健康监测显著减少了每位患者的总住院天数（2.4±3.5）。家庭远程健康组在家庭远程健康监测期间观察到的入院率（1.1±1.6）和住院时间（5.7±11.3 天）显著低于前一年（1.6±1.7， <0.05 和 9.5±14 天， <0.01 分别），但与对照组无差异（1.4±2.0， <0.07）。与对照组相比（5.7±11.3 vs 9.0±14.9， <0.01），家庭远程健康组的住院时间也明显更短。家庭远程健康监测期间，急诊和急诊室就诊次数或初级保健就诊次数与前一年相比无显著差异。
个性化和以患者为中心的心力衰竭患者家庭远程健康监测在降低结局方面取得了成功，同时并未增加门诊和急诊就诊次数。
