Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
J Clin Sleep Med. 2022 Dec 1;18(12):2785-2792. doi: 10.5664/jcsm.10218.
To describe the development and feasibility of a cognitive behavioral therapy for insomnia (CBT-I) program delivered via personal digital devices and fully integrated with the electronic health record (EHR).
A multidisciplinary team of clinicians and members of our Center for Digital Health collaborated to develop a Chronic Insomnia Interactive Care Plan (ChI-ICP), an application that provides personalized and just in time education and promotes self-management using CBT-I concepts, and is activated from and fully integrated into the EHR. Following development, we evaluated patient engagement and workflows, assessed changes to provider workload, and examined outcomes on measures of insomnia during a pilot deployment of the application.
A total of 222 patients were enrolled and 179 engaged with the plan during the 3-month pilot program. Enrolled patients generated an average of 3.9 ± 2.3 In Basket messages, most being automated notifications related to noncompletion of assigned tasks, while only a few were related to patients requesting additional training or help with insomnia. Sleep efficiency improved from baseline until the completion of the program from 74.5% ± 16.7% to 87.6% ± 10.8% ( = .001), and the Insomnia Severity Index improved from 14.9 ± 5.22 to 11.6 ± 4.80 ( = .006).
In this pilot implementation of an integrated ChI-ICP, patient engagement was favorable, workflows and workload were not significantly burdensome for the care teams, and initial evaluation of efficacy was favorable. This provides evidence for an application that is a scalable method to assist patients with chronic insomnia and future work should assess its efficacy in controlled trials.
Morgenthaler TI, Kolla BP, Anderson SE, et al. Development and acceptability of a mobile health application integrated with the electronic heath record for treatment of chronic insomnia disorder. . 2022;18(12):2785-2792.
描述通过个人数字设备提供并与电子健康记录（EHR）完全集成的失眠认知行为疗法（CBT-I）计划的开发和可行性。
由临床医生和我们的数字健康中心成员组成的多学科团队合作开发了一种慢性失眠互动护理计划（ChI-ICP），这是一种应用程序，它提供个性化和即时教育，并使用 CBT-I 概念促进自我管理，并且从 EHR 激活并完全集成到 EHR 中。在开发之后，我们评估了患者的参与度和工作流程，评估了提供者工作量的变化，并在该应用程序的试点部署期间检查了失眠措施的结果。
共有 222 名患者入组，在为期 3 个月的试点项目中，有 179 名患者参与了该计划。入组患者平均生成 3.9 ± 2.3 个 In Basket 消息，大多数是与未完成分配任务相关的自动通知，而只有少数是与患者请求额外的培训或帮助治疗失眠有关。睡眠效率从基线开始一直到计划完成时都有所提高，从 74.5% ± 16.7%提高到 87.6% ± 10.8%（ =.001），失眠严重程度指数从 14.9 ± 5.22 提高到 11.6 ± 4.80（ =.006）。
在这种集成的 ChI-ICP 的试点实施中，患者的参与度是有利的，工作流程和工作量对护理团队来说并不繁重，并且对疗效的初步评估是有利的。这为一种应用程序提供了证据，该应用程序是一种可扩展的方法，可以帮助患有慢性失眠的患者，未来的工作应该在对照试验中评估其疗效。
Morgenthaler TI、Kolla BP、Anderson SE 等人。一种与电子健康记录集成的移动健康应用程序的开发和可接受性，用于治疗慢性失眠障碍。睡眠。2022；18(12):2785-2792。
