The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States.
Quantitative Biomedical Science Program, Geisel School of Medicine, Dartmouth, Lebanon, NH, United States.
JMIR Mhealth Uhealth. 2019 Mar 20;7(3):e11082. doi: 10.2196/11082.
Caring for individuals with chronic conditions is labor intensive, requiring ongoing appointments, treatments, and support. The growing number of individuals with chronic conditions makes this support model unsustainably burdensome on health care systems globally. Mobile health technologies are increasingly being used throughout health care to facilitate communication, track disease, and provide educational support to patients. Such technologies show promise, yet they are not being used to their full extent within US health care systems.
The purpose of this study was to examine the use of staff and costs of a remote monitoring care model in persons with and without a chronic condition.
At Dartmouth-Hitchcock Health, 2894 employees volunteered to monitor their health, transmit data for analysis, and communicate digitally with a care team. Volunteers received Bluetooth-connected consumer-grade devices that were paired to a mobile phone app that facilitated digital communication with nursing and health behavior change staff. Health data were collected and automatically analyzed, and behavioral support communications were generated based on those analyses. Care support staff were automatically alerted according to purpose-developed algorithms. In a subgroup of participants and matched controls, we used difference-in-difference techniques to examine changes in per capita expenditures.
Participants averaged 41 years of age; 72.70% (2104/2894) were female and 12.99% (376/2894) had at least one chronic condition. On average each month, participants submitted 23 vital sign measurements, engaged in 1.96 conversations, and received 0.25 automated messages. Persons with chronic conditions accounted for 39.74% (8587/21,607) of all staff conversations, with higher per capita conversation rates for all shifts compared to those without chronic conditions (P<.001). Additionally, persons with chronic conditions engaged nursing staff more than those without chronic conditions (1.40 and 0.19 per capita conversations, respectively, P<.001). When compared to the same period in the prior year, per capita health care expenditures for persons with chronic conditions dropped by 15% (P=.06) more than did those for matched controls.
The technology-based chronic condition management care model was frequently used and demonstrated potential for cost savings among participants with chronic conditions. While further studies are necessary, this model appears to be a promising solution to efficiently provide patients with personalized care, when and where they need it.
照顾患有慢性病的个体需要付出大量的劳动，需要进行持续的预约、治疗和支持。全球范围内，慢性病患者数量不断增加，这使得这种支持模式对医疗体系造成了难以承受的负担。移动医疗技术正越来越多地应用于整个医疗领域，以促进医患之间的沟通、跟踪疾病并为患者提供教育支持。这些技术显示出了一定的前景，但在美国医疗体系中尚未得到充分利用。
本研究旨在考察慢性病患者和非慢性病患者远程监测护理模式的人员配备和成本使用情况。
在达特茅斯-希契科克卫生保健系统中，2894 名员工自愿监测自己的健康状况，传输数据进行分析，并与护理团队进行数字通信。志愿者使用蓝牙连接的消费级设备，这些设备与移动电话应用程序配对，便于与护理和健康行为改变人员进行数字通信。收集健康数据并进行自动分析，并根据这些分析生成行为支持通信。根据专门开发的算法，护理支持人员会自动收到警报。在参与者和匹配对照组的一个子集中，我们使用差异法技术来检测人均支出的变化。
参与者的平均年龄为 41 岁；72.70%（2104/2894）为女性，12.99%（376/2894）患有至少一种慢性病。平均每个月，参与者提交 23 次生命体征测量值，进行 1.96 次对话，并收到 0.25 条自动消息。患有慢性病的人占所有员工谈话的 39.74%（8587/21607），与没有慢性病的人相比，所有班次的人均谈话率都更高（P<.001）。此外，患有慢性病的人比没有慢性病的人更频繁地与护理人员接触（人均谈话次数分别为 1.40 次和 0.19 次，P<.001）。与前一年同期相比，患有慢性病的人的人均医疗保健支出下降了 15%（P=.06），降幅超过了匹配对照组。
基于技术的慢性病管理护理模式得到了广泛应用，并显示出在慢性病患者中具有潜在的成本节约效果。虽然还需要进一步的研究，但这种模式似乎是一种有前途的解决方案，可以有效地为患者提供个性化的护理，无论他们何时何地需要。
