急性心肌梗死后二级预防自我管理的科里健康数字平台。
Corrie Health Digital Platform for Self-Management in Secondary Prevention After Acute Myocardial Infarction.
作者信息
Spaulding Erin M, Marvel Francoise A, Lee Matthias A, Yang William E, Demo Ryan, Wang Jane, Xun Helen, Shah Lochan, Weng Daniel, Fashanu Oluwaseun E, Carter Jocelyn, Sheidy Julie, McLin Renee, Flowers Jennifer, Majmudar Maulik, Elgin Eric, Vilarino Valerie, Lumelsky David, Bhardwaj Vinayak, Padula William, Allen Jerilyn K, Martin Seth S
机构信息
Johns Hopkins University School of Nursing, Baltimore, MD (E.M.S., J.K.A.).
Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (F.A.M., O.E.F., S.S.M.).
出版信息
Circ Cardiovasc Qual Outcomes. 2019 May;12(5):e005509. doi: 10.1161/CIRCOUTCOMES.119.005509.
BACKGROUND
Unplanned readmissions after hospitalization for acute myocardial infarction are among the leading causes of preventable morbidity, mortality, and healthcare costs. Digital health interventions could be an effective tool in promoting self-management, adherence to guideline-directed therapy, and cardiovascular risk reduction. A digital health intervention developed at Johns Hopkins-the Corrie Health Digital Platform (Corrie)-includes the first cardiology Apple CareKit smartphone application, which is paired with an Apple Watch and iHealth Bluetooth-enabled blood pressure cuff. Corrie targets: (1) self-management of cardiac medications, (2) self-tracking of vital signs, (3) education about cardiovascular disease through articles and animated videos, and (4) care coordination that includes outpatient follow-up appointments.
METHODS AND RESULTS
The 3 phases of the MiCORE study (Myocardial infarction, Combined-device, Recovery Enhancement) include (1) the development of Corrie, (2) a pilot study to assess the usability and feasibility of Corrie, and (3) a prospective research study to primarily compare time to first readmission within 30 days postdischarge among patients with Corrie to patients in the historical standard of care comparison group. In Phase 2, the feasibility of deploying Corrie in an acute care setting was established among a sample of 60 patients with acute myocardial infarction. Phase 3 is ongoing and patients from 4 hospitals are being enrolled as early as possible during their hospital stay if they are 18 years or older, admitted with acute myocardial infarction (ST-segment-elevation myocardial infarction or type I non-ST-segment-elevation myocardial infarction), and own a smartphone. Patients are either being enrolled with their own personal devices or they are provided an iPhone and/or Apple Watch for the duration of the study. Phase 3 started in October 2017 and we aim to recruit 140 participants.
CONCLUSIONS
This article will provide an in-depth understanding of the feasibility associated with implementing a digital health intervention in an acute care setting and the potential of Corrie as a self-management tool for acute myocardial infarction recovery.
背景
急性心肌梗死后住院期间的非计划再入院是可预防的发病、死亡及医疗费用的主要原因之一。数字健康干预可能是促进自我管理、坚持指南指导治疗以及降低心血管风险的有效工具。约翰·霍普金斯大学开发的一种数字健康干预措施——科里健康数字平台（Corrie）——包括首款心脏病学领域的苹果CareKit智能手机应用程序，该程序与苹果手表及支持iHealth蓝牙的血压袖带配对使用。Corrie的目标包括：（1）心脏药物的自我管理；（2）生命体征的自我监测；（3）通过文章和动画视频进行心血管疾病教育；（4）包括门诊随访预约在内的护理协调。
方法与结果
MiCORE研究（心肌梗死、联合设备、康复强化）的三个阶段包括：（1）Corrie的开发；（2）一项试点研究，以评估Corrie的可用性和可行性；（3）一项前瞻性研究，主要比较使用Corrie的患者与历史标准护理比较组患者出院后30天内首次再入院的时间。在第二阶段，在60例急性心肌梗死患者的样本中确定了在急性护理环境中部署Corrie的可行性。第三阶段正在进行中，4家医院的患者如果年龄在18岁及以上、因急性心肌梗死（ST段抬高型心肌梗死或I型非ST段抬高型心肌梗死）入院且拥有智能手机，将在住院期间尽早入组。患者要么使用自己的个人设备入组，要么在研究期间获得一部iPhone和/或苹果手表。第三阶段于2017年10月开始，我们的目标是招募140名参与者。
结论
本文将深入探讨在急性护理环境中实施数字健康干预的可行性，以及Corrie作为急性心肌梗死康复自我管理工具的潜力。
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