Rosenfeld Aaron, Ball Jillian, Rattanasithy Sara, Tsilas Christine, Miller Rachel, Berardi Joanne, Pupulin Alaina, Carvalho Carolina, Segal Samantha, Kruger Shaul, Bajaj Ravi, Alter David
My Heart Fitness Canada.
Faculty of Medicine, University of Ottawa Ottawa, ON, Canada.
Am J Cardiovasc Dis. 2023 Apr 15;13(2):87-100. eCollection 2023.
While value-based learning health systems may address challenges associated with the integrative delivery of therapeutic lifestyle management in usual care, the extent to which they have been evaluated in real-world settings have remained limited.
To explore the feasibility and user-experiences, associated with the first-year implementation of a preventative Learning Health System (LHS), consecutive patients were evaluated following referral from primary and/or specialty care providers from the Halton and Greater Toronto Area in Ontario, Canada, between December 2020 and December 2021. The integration of a LHS into medical care was facilitated using a digital e-learning platform, and consisted of exercise, lifestyle, and disease-management counselling. The dynamic monitoring of user-data allowed patients and providers to modify goals, treatment plans, and care-delivery in real-time in accordance with patient engagement, weekly exercise, and risk-factor targets. All program costs were covered by the public-payer health care system using a physician fee-for-service payment model. Descriptive statistics evaluated attendance to prescheduled visits, drop-out rates, changes in self-reported weekly Metabolic Expenditure Task-Minutes (MET-MINUTES), perceived changes in health knowledge, lifestyle behaviours, health status, satisfaction with care, and programmatic costs.
378 of 437 patients (86.5%) enrolled in the 6-month program; The average age of patients was 61.2 ± 12.2, 156 (41.3%) of which were female and 140 (37.0%) with established coronary disease. After 1 year, 15.6% dropped out of the program. On average, weekly MET-MINUTES rose by 191.1 throughout the program (95% CI [331.82, 57.96], P=0.007), with increases most prominent among sedentary populations. Participants reported significant improvements in perceived health status and health knowledge, at a total health-care delivery cost of $517.70 per patient for a completed program.
The implementation of an integrative preventative learning health system was feasible, with high patient engagement and favourable user-experiences. Further research is required to compare health outcomes against usual care.
虽然基于价值的学习型健康系统可能解决常规护理中与治疗性生活方式管理综合提供相关的挑战，但它们在现实环境中的评估程度仍然有限。
为了探索与预防性学习健康系统（LHS）第一年实施相关的可行性和用户体验，在2020年12月至2021年12月期间，对来自加拿大安大略省哈尔顿和大多伦多地区的初级和/或专科护理提供者转诊的连续患者进行了评估。使用数字电子学习平台促进LHS融入医疗护理，包括运动、生活方式和疾病管理咨询。对用户数据的动态监测使患者和提供者能够根据患者参与度、每周运动量和风险因素目标实时修改目标、治疗计划和护理提供方式。所有项目费用由公共支付方医疗保健系统使用医生按服务收费支付模式支付。描述性统计评估预定就诊的出勤率、退出率、自我报告的每周代谢支出任务分钟数（MET-分钟）的变化、健康知识、生活方式行为、健康状况、护理满意度和项目成本的感知变化。
437名患者中有378名（86.5%）参加了为期6个月的项目；患者的平均年龄为61.2±12.2岁，其中156名（41.3%）为女性，140名（37.0%）患有冠心病。1年后，15.6%的人退出了该项目。在整个项目中，每周MET-分钟平均增加了191.1（95%CI[331.82,57.96]，P=0.007），在久坐人群中增加最为显著。参与者报告健康状况和健康知识有显著改善，完成项目的每位患者的总医疗保健提供成本为517.70美元。
实施综合预防性学习健康系统是可行的，患者参与度高，用户体验良好。需要进一步研究将健康结果与常规护理进行比较。
