Thomas Craig Kelly J, Fusco Nicole, Lindsley Kristina, Snowdon Jane L, Willis Van C, Arriaga Yull E, Dankwa-Mullan Irene
Center for AI, Research, and Evaluation, IBM Watson Health, Cambridge, Massachusetts.
Life Sciences, IBM Watson Health, Cambridge, Massachusetts.
Cardiovasc Digit Health J. 2020 Nov 6;1(3):139-148. doi: 10.1016/j.cvdhj.2020.11.001. eCollection 2020 Nov-Dec.
Disparities in cardiovascular disease (CVD) and associated health and healthcare delivery outcomes have been partially attributed to differential risk factors, and to prevention and treatment inequities within racial and ethnic (including language) minority groups and low socioeconomic status (SES) populations in urban and rural settings. Digital health interventions (DHIs) show promise in promoting equitable access to high-quality care, optimal utilization, and improved outcomes; however, their potential role and impact has not been fully explored. The role of DHIs to mitigate drivers of the health disparities listed above in populations disproportionately affected by atherosclerotic-related CVD was systematically reviewed using published literature (January 2008-July 2020) from multiple databases. Study design, type and description of the technology, health disparities information, type of CVD, outcomes, and notable barriers and innovations associated with the technology utilized were abstracted. Study quality was assessed using the Oxford Levels of Evidence. Included studies described digital health technologies in a disparity population with CVD and reported outcomes. DHIs significantly improved health (eg, clinical, intermediate, and patient-reported) and healthcare delivery (eg, access, quality, and utilization of care) outcomes in populations disproportionately affected by CVD in 24 of 38 included studies identified from 2104 citations. Hypertension control was the most frequently improved clinical outcome. Telemedicine, mobile health, and clinical decision support systems were the most common types of DHIs identified. DHIs improved CVD-related health and healthcare delivery outcomes in racial/ethnic groups and low SES populations in both rural and urban geographies globally.
心血管疾病(CVD)以及相关健康和医疗服务结果的差异,部分归因于不同的风险因素,以及城乡环境中种族和族裔(包括语言)少数群体和社会经济地位较低(SES)人群在预防和治疗方面的不平等。数字健康干预措施(DHIs)在促进公平获得高质量医疗、优化利用和改善结果方面显示出前景;然而,其潜在作用和影响尚未得到充分探索。我们使用多个数据库中已发表的文献(2008年1月至2020年7月),系统回顾了数字健康干预措施在受动脉粥样硬化相关心血管疾病影响尤为严重的人群中,对减轻上述健康差异驱动因素的作用。提取了研究设计、技术类型和描述、健康差异信息、心血管疾病类型、结果,以及与所使用技术相关的显著障碍和创新。使用牛津证据水平评估研究质量。纳入的研究描述了在患有心血管疾病的差异人群中的数字健康技术,并报告了结果。在从2104篇文献中筛选出的38项纳入研究中的24项中,数字健康干预措施显著改善了受心血管疾病影响尤为严重人群的健康(如临床、中间指标和患者报告的结果)和医疗服务(如医疗可及性、质量和利用)结果。高血压控制是最常得到改善的临床结果。远程医疗、移动健康和临床决策支持系统是最常见的数字健康干预措施类型。数字健康干预措施在全球城乡地区的种族/族裔群体和社会经济地位较低人群中,改善了与心血管疾病相关的健康和医疗服务结果。