Ammenwerth Elske, Modre-Osprian Robert, Fetz Bettina, Gstrein Susanne, Krestan Susanne, Dörler Jakob, Kastner Peter, Welte Stefan, Rissbacher Clemens, Pölzl Gerhard
Institute of Medical Informatics, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
Center for Health & Bioresources, AIT Austrian Institute of Technology, Graz, Austria.
JMIR Cardio. 2018 Apr 30;2(1):e11. doi: 10.2196/cardio.9936.
Heart failure is a major health problem associated with frequent hospital admissions. HerzMobil Tirol is a multidisciplinary postdischarge disease management program for heart failure patients to improve quality of life, prevent readmission, and reduce mortality and health care costs. It uses a telemonitoring system that is incorporated into a network of specialized heart failure nurses, physicians, and hospitals. Patients are equipped with a mobile phone, a weighing scale, and a blood pressure and heart rate monitor for daily acquisition and transmission of data on blood pressure, heart rate, weight, well-being, and drug intake. These data are transmitted daily and regularly reviewed by the network team. In addition, patients are scheduled for 3 visits with the network physician and 2 visits with the heart failure nurse within 3 months after hospitalization for acute heart failure.
The objectives of this study were to evaluate the feasibility of HerzMobil Tirol by analyzing changes in health status as well as patients' self-care behavior and satisfaction and to derive recommendations for implementing a telemonitoring-based interdisciplinary disease management program for heart failure in everyday clinical practice.
In this prospective, pilot, single-arm study including 35 elderly patients, the feasibility of HerzMobil Tirol was assessed by analyzing changes in health status (via Kansas City Cardiomyopathy Questionnaire, KCCQ), patients' self-care behavior (via European Heart Failure Self-Care Behavior Scale, revised into a 9-item scale, EHFScB-9), and user satisfaction (via Delone and McLean System Success Model).
A total of 43 patients joined the HerzMobil Tirol program, and of these, 35 patients completed it. The mean age of participants was 67 years (range: 43-86 years). Health status (KCCQ, range: 0-100) improved from 46.2 to 69.8 after 3 months. Self-care behavior (EHFScB-9, possible range: 9-22) after 3 months was 13.2. Patient satisfaction in all dimensions was 86% or higher. Lessons learned for the rollout of HerzMobil Tirol comprise a definite time schedule for interventions, solid network structures with clear process definition, a network coordinator, and specially trained heart failure nurses.
On the basis of the positive evaluation results, HerzMobil Tirol has been officially introduced in the province of Tyrol in July 2017. It is, therefore, the first regular financed telehealth care program in Austria.
心力衰竭是一个与频繁住院相关的主要健康问题。蒂罗尔心脏移动计划（HerzMobil Tirol）是一项针对心力衰竭患者的多学科出院后疾病管理计划，旨在提高生活质量、预防再次入院，并降低死亡率和医疗保健成本。该计划使用一种远程监测系统，该系统融入了由专业心力衰竭护士、医生和医院组成的网络。患者配备一部手机、一台体重秤以及一台血压和心率监测仪，用于每日采集和传输有关血压、心率、体重、健康状况和药物摄入的数据。这些数据每天传输，并由网络团队定期审查。此外，急性心力衰竭住院后的3个月内，患者安排与网络医生进行3次就诊，并与心力衰竭护士进行2次就诊。
本研究的目的是通过分析健康状况变化、患者自我护理行为和满意度来评估蒂罗尔心脏移动计划的可行性，并为在日常临床实践中实施基于远程监测的心力衰竭跨学科疾病管理计划得出建议。
在这项前瞻性、试点、单臂研究中，纳入了35名老年患者，通过分析健康状况变化（通过堪萨斯城心肌病问卷，KCCQ）、患者自我护理行为（通过欧洲心力衰竭自我护理行为量表，修订为9项量表，EHFScB - 9）和用户满意度（通过德隆和麦克林系统成功模型）来评估蒂罗尔心脏移动计划的可行性。
共有43名患者加入了蒂罗尔心脏移动计划，其中35名患者完成了该计划。参与者的平均年龄为67岁（范围：43 - 86岁）。3个月后，健康状况（KCCQ，范围：0 - 100）从46.2提高到69.8。3个月后的自我护理行为（EHFScB - 9，可能范围：9 - 22）为13.2。所有维度的患者满意度均达到8S%或更高。蒂罗尔心脏移动计划推广过程中的经验教训包括明确的干预时间表、具有清晰流程定义的稳固网络结构、一名网络协调员以及经过专门培训的心力衰竭护士。
基于积极的评估结果，蒂罗尔心脏移动计划于2017年7月在蒂罗尔州正式推出。因此，它是奥地利首个获得正规资助的远程医疗保健计划。
