Department of Pediatrics, University of Utah, Salt Lake City, Utah
Department of Pediatrics, University of Utah, Salt Lake City, Utah.
Hosp Pediatr. 2021 May;11(5):492-502. doi: 10.1542/hpeds.2020-002097. Epub 2021 Apr 7.
Mobile apps are suggested for supporting home monitoring and reducing emergency department (ED) visits and hospitalizations for children with medical complexity (CMC). None have been implemented. We sought to assess the MyChildCMC app (1) feasibility for CMC home monitoring, (2) ability to detect early deteriorations before ED and hospital admissions, and (3) preliminary impact.
Parents of CMC (aged 1-21 years) admitted to a children's hospital were randomly assigned to MyChildCMC or usual care. MyChildCMC subjects recorded their child's vital signs and symptoms daily for 3 months postdischarge and received real-time feedback. Feasibility measures included parent's enrollment, retention, and engagement. The preliminary impact was determined by using quality of life, parent satisfaction with care, and subsequent ED and hospital admissions and hospital days.
A total of 62 parents and CMC were invited to participate: 50 enrolled (80.6% enrollment rate) and were randomly assigned to MyChildCMC ( = 24) or usual care ( = 26). Retention at 1 and 3 months was 80% and 74%, and engagement was 68.3% and 62.6%. Run-chart shifts in vital signs were common findings preceding admissions. The satisfaction score was 26.9 in the MyChildCMC group and 24.1 in the control group ( = .035). No quality of life or subsequent admission differences occurred between groups. The 3-month hospital days (pre-post enrollment) decreased from 9.25 to 4.54 days (rate ratio = 0.49; 95% confidence interval = 0.39-0.62; < .001) in the MyChildCMC group and increased from 1.08 to 2.46 days (rate ratio = 2.29; 95% confidence interval = 1.47-3.56; < .001) in the control group.
MyChildCMC was feasible and appears effective, with the potential to detect early deteriorations in health for timely interventions that might avoid ED and hospitalizations. A larger and definitive study of MyChildCMC's impact and sustainability is needed.
移动应用程序被建议用于支持儿童医疗复杂性（CMC）患者的家庭监测，以减少他们前往急诊部（ED）就诊和住院的次数。目前尚未有此类应用程序被实际应用。我们旨在评估 MyChildCMC 应用程序（1）用于 CMC 家庭监测的可行性，（2）在 ED 和住院之前检测早期恶化的能力，以及（3）初步影响。
随机将住院儿童医院收治的 CMC（年龄为 1-21 岁）的父母分为 MyChildCMC 组或常规护理组。MyChildCMC 组的受试者在出院后 3 个月内每天记录其孩子的生命体征和症状，并获得实时反馈。可行性措施包括家长的参与、保留和参与度。初步影响通过生活质量、家长对护理的满意度以及随后的 ED 和住院就诊次数和住院天数来确定。
共邀请了 62 位家长和 CMC 参与：50 位（80.6%的入组率）参与并被随机分配到 MyChildCMC（n=24）或常规护理组（n=26）。1 个月和 3 个月的保留率分别为 80%和 74%，参与率分别为 68.3%和 62.6%。在就诊前，生命体征的变化趋势图是常见的发现。MyChildCMC 组的满意度评分为 26.9，对照组为 24.1（P=0.035）。两组之间在生活质量或随后的入院率方面没有差异。MyChildCMC 组的 3 个月住院天数（入组前后）从 9.25 天减少到 4.54 天（比率比=0.49；95%置信区间=0.39-0.62；P＜0.001），对照组从 1.08 天增加到 2.46 天（比率比=2.29；95%置信区间=1.47-3.56；P＜0.001）。
MyChildCMC 是可行的，并且似乎有效，有可能检测到健康状况的早期恶化，以便及时进行干预，从而避免 ED 和住院。需要进一步开展关于 MyChildCMC 影响和可持续性的更大规模和更明确的研究。
