Riley Hospital for Children at Indiana University Health, Pediatric Cardiology, 705 Riley Hospital Drive, Indianapolis, USA.
Indiana University School of Medicine, Pediatric Cardiology, 705 Riley Hospital Drive, Indianapolis, Indiana, USA.
Cardiol Young. 2023 Jul;33(7):1124-1128. doi: 10.1017/S1047951122002232. Epub 2022 Jul 15.
Infants born with single ventricle physiology that require an aorto-pulmonary shunt are at high risk for sudden cardiac death, particularly during the interstage period between the first-stage palliation and the second-stage palliation. Home monitoring programs have decreased interstage mortality in the hypoplastic left heart syndrome population prompting programs to expand the home monitoring program to other high-risk populations. At our mid-sized program, we implemented the Locus Health home monitoring platform first in the hypoplastic left heart syndrome population, then expanding to the single ventricle shunt population. Interstage mortality for the hypoplastic left heart syndrome population after initiation of the home monitoring program went from 18% prior to 2009 to 7% as of the end of 2020 (n = 99), with 2.8% mortality from 2013 to 2020 and 0% mortality since initiation of the Locus program in 2017. Caregiver surveys done prior to discharge and then 3 weeks later were used to document caregiver experience using the digital home monitoring program. Caregivers reported overall positive experience with the digital application, with 91.8% stating that they felt confident taking care of their baby at home. Transitioning the home monitoring program from a traditional binder to an iPad with the Locus Health application allowed us to expand the program, utilize the electronic medical record, bill for the service, and demonstrate positive experiences for caregivers. Overall engagement and adherence with the program by caregivers were 50.94 and 45.45%, with a total of 112 patient episodes. Reimbursement from private insurance providers was 22% of the billed amount for 2020.
患有单心室生理结构且需要主动脉肺动脉分流术的婴儿发生心脏性猝死的风险很高，尤其是在第一阶段姑息治疗和第二阶段姑息治疗之间的过渡期。家庭监测计划降低了左心发育不全综合征患者的过渡期死亡率，促使该计划将家庭监测计划扩展到其他高危人群。在我们的中型项目中，我们首先在左心发育不全综合征患者中实施了 Locus Health 家庭监测平台，然后将其扩展到单心室分流患者中。在开始家庭监测计划后，左心发育不全综合征患者的过渡期死亡率从 2009 年之前的 18%下降到 2020 年底的 7%（n = 99），2013 年至 2020 年的死亡率为 2.8%，自 2017 年开始 Locus 计划以来死亡率为 0%。在出院前和 3 周后进行的护理人员调查用于记录护理人员使用数字家庭监测计划的经验。护理人员对数字应用程序的总体体验报告为正面，91.8%的护理人员表示他们在家照顾婴儿时感到有信心。将家庭监测计划从传统的活页夹转换为具有 Locus Health 应用程序的 iPad，使我们能够扩展该计划，利用电子病历，为该服务计费，并为护理人员展示积极的体验。护理人员对该计划的整体参与度和坚持度分别为 50.94%和 45.45%，共有 112 例患者的记录。2020 年，私人保险公司的报销比例为账单金额的 22%。
