新型冠状病毒肺炎的远程协助与远程会诊：一项配对病例对照研究（意大利伦巴第大区MIRATO项目）

COVID-19 teleassistance and teleconsultation: a matched case-control study (MIRATO project, Lombardy, Italy).

作者信息

Bernocchi Palmira, Crotti Giacomo, Beato Elvira, Bonometti Francesco, Giudici Vittorio, Bertolaia Patrizia, Perger Elisa, Remuzzi Andrea, Bachetti Tiziana, La Rovere Maria Teresa, Dalla Vecchia Laura Adelaide, Angeli Fabio, Parati Gianfranco, Borghi Gabriella, Vitacca Michele, Scalvini Simonetta

机构信息

Continuity Care and Telemedicine Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy.

Epidemiology Unit, Bergamo Health Protection Agency, Bergamo, Italy.

出版信息

Front Cardiovasc Med. 2023 Aug 14;10:1062232. doi: 10.3389/fcvm.2023.1062232. eCollection 2023.

DOI:10.3389/fcvm.2023.1062232

PMID:37645519

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10461473/

Abstract

BACKGROUND

During the COVID-19 pandemic, telemedicine has been recognised as a powerful modality to shorten the length of hospital stay and to free up beds for the sicker patients. Lombardy, and in particular the areas of Bergamo, Brescia, and Milan, was one of the regions in Europe most hit by the COVID-19 pandemic. The primary aim of the MIRATO project was to compare the incidence of severe events (hospital readmissions and mortality) in the first three months after discharge between COVID-19 patients followed by a Home-Based Teleassistance and Teleconsultation (HBTT group) program and those discharged home without Telemedicine support (non-HBTT group).

METHODS

The study was designed as a matched case-control study. The non-HBTT patients were matched with the HBTT patients for sex, age, presence of COVID-19 pneumonia and number of comorbidities. After discharge, the HBTT group underwent a telecare nursing and specialist teleconsultation program at home for three months, including monitoring of vital signs and symptoms. Further, in this group we analysed clinical data, patients' satisfaction with the program, and quality of life.

RESULTS

Four hundred twenty-two patients per group were identified for comparison. The median age in both groups was 70 ± 11 years (62% males). One or more comorbidities were present in 86% of the HBTT patients and 89% in the non-HBTT group ( = ns). The total number of severe events was 17 (14 hospitalizations and 3 deaths) in the HBTT group and 40 (26 hospitalizations and 16 deaths) in the non-HBTT group ( = 0.0007). The risk of hospital readmission or death after hospital discharge was significantly lower in HBTT patients (Log-rank Test = 0.0002). In the HBTT group, during the 3-month follow-up, 5,355 teleassistance contacts (13 ± 4 per patient) were performed. The number of patients with one or more symptoms declined significantly: from 338 (78%) to 183 (45%) ( < 0.00001). Both the physical (ΔPCS12: 5.9 ± 11.4) component and the mental (ΔMCS12: 4.4 ± 12.7) component of SF-12 improved significantly ( < 0.0001). Patient satisfaction with the program was very high in all participants.

CONCLUSIONS

Compared to usual care, an HBTT program can reduce severe events (hospital admissions/mortality) at 3-months from discharge and improve symptoms and quality of life.

CLINICAL TRIAL REGISTRATION

www.ClinicalTrials.gov, NCT04898179.

摘要

背景

在新冠疫情期间，远程医疗被认为是一种有效的方式，可缩短住院时间，并为病情较重的患者腾出床位。伦巴第大区，尤其是贝加莫、布雷西亚和米兰地区，是欧洲受新冠疫情影响最严重的地区之一。MIRATO项目的主要目的是比较接受居家远程协助和远程会诊（HBTT组）计划的新冠患者与出院后无远程医疗支持（非HBTT组）的患者出院后前三个月内严重事件（再次入院和死亡率）的发生率。

方法

本研究设计为配对病例对照研究。非HBTT患者与HBTT患者在性别、年龄、是否患有新冠肺炎以及合并症数量方面进行匹配。出院后，HBTT组在家中接受为期三个月的远程护理和专科远程会诊计划，包括生命体征和症状监测。此外，在该组中我们分析了临床数据、患者对该计划的满意度以及生活质量。

结果

每组确定422例患者进行比较。两组的中位年龄均为70±11岁（男性占62%）。86%的HBTT患者和89%的非HBTT组患者存在一种或多种合并症（P = 无统计学差异）。HBTT组严重事件总数为17例（14例住院和3例死亡），非HBTT组为40例（26例住院和16例死亡）（P = 0.0007）。HBTT患者出院后再次入院或死亡的风险显著较低（对数秩检验P = 0.0002）。在HBTT组，在3个月的随访期间，进行了5355次远程协助联系（每位患者13±4次）。有一个或多个症状的患者数量显著下降：从338例（78%）降至183例（45%）（P < 0.00001）。SF - 12的身体成分（ΔPCS12：5.9±11.4）和精神成分（ΔMCS12：4.4±12.7）均显著改善（P < 0.0001）。所有参与者对该计划的患者满意度都非常高。