通过服务设计在 COVID-19 大流行期间塑造数字和远程糖尿病护理的工作流程：前瞻性、纵向、开放标签可行性试验。

Shaping Workflows in Digital and Remote Diabetes Care During the COVID-19 Pandemic via Service Design: Prospective, Longitudinal, Open-label Feasibility Trial.

机构信息

Charité - Universitätsmedizin Berlin, Department of Paediatric Endocrinology and Diabetes, Berlin, Germany.

Berlin Institute of Health, Berlin, Germany.

出版信息

JMIR Mhealth Uhealth. 2021 Apr 5;9(4):e24374. doi: 10.2196/24374.

DOI:10.2196/24374

PMID:33571104

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8023381/

Abstract

BACKGROUND

The COVID-19 pandemic poses new challenges to health care providers and the delivery of continuous care. Although many diabetes technologies, such as insulin pumps and continuous glucose monitors, have been established, the data from these devices are rarely assessed. Furthermore, telemedicine has not been sufficiently integrated into clinical workflows.

OBJECTIVE

We sought to remotely support children with type 1 diabetes and their caregivers, enhance the clinical outcomes and quality of life of children with diabetes, increase multiple stakeholders' engagement with digital care via a participatory approach, evaluate the feasibility of using an interoperable open-source platform in a university hospital setting, and analyze the success factors and barriers of transitioning from conventional care to digital care.

METHODS

Service design methods were used to adapt clinical workflows. Remote consultations were performed on a monthly and on-demand basis. Diabetes device data were uploaded from patients' homes to an open-source platform. Clinical and patient-reported outcomes were assessed before, during, and after the COVID-19 lockdown period in Germany.

RESULTS

A total of 28 children with type 1 diabetes and their caregivers enrolled in this study and completed 6 months of remote visits. Of these 28 participants, 16 (57%) also opted to attend at least one of their regular visits remotely. After 3 months of remote visits, participants' time in range (P=.001) and time in hyperglycemia (P=.004) significantly improved, and their time in hypoglycemia did not increase. These improvements were maintained during the COVID-19 lockdown period (ie, between months 3 and 6 of this study). Participants' psychosocial health improved after 6 months.

CONCLUSIONS

Remote consultations and commonly shared data access can improve the clinical outcomes and quality of life of children with type 1 diabetes, even during challenging circumstances. A service design approach helped with the delivery of comprehensive and holistic solutions that accounted for the needs of multiple stakeholders. Our findings can inform the future integration of digital tools into clinical care during and beyond the pandemic.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00016170; https://tinyurl.com/skz4wdk5.

摘要

背景

COVID-19 大流行给医疗保健提供者和持续护理的提供带来了新的挑战。尽管已经建立了许多糖尿病技术，如胰岛素泵和连续血糖监测器，但这些设备的数据很少得到评估。此外，远程医疗尚未充分融入临床工作流程。

目的

我们旨在远程支持 1 型糖尿病患儿及其照顾者，提高糖尿病患儿的临床结局和生活质量，通过参与式方法增加多个利益相关者对数字护理的参与，评估在大学医院环境中使用可互操作开源平台的可行性，并分析从常规护理向数字护理过渡的成功因素和障碍。

方法

使用服务设计方法来调整临床工作流程。每月和按需进行远程咨询。将患者家中的糖尿病设备数据上传到开源平台。在德国 COVID-19 封锁期间之前、期间和之后评估临床和患者报告的结果。

结果

共有 28 名 1 型糖尿病患儿及其照顾者参加了本研究，并完成了 6 个月的远程访问。在这 28 名参与者中，有 16 名（57%）还选择至少远程参加一次常规就诊。远程访问 3 个月后，参与者的血糖达标时间（P=.001）和高血糖时间（P=.004）显著改善，而低血糖时间没有增加。这些改善在 COVID-19 封锁期间（即本研究的第 3 至 6 个月）得以维持。6 个月后，参与者的心理健康得到改善。