远程监测对减少芬兰心力衰竭患者住院及相关费用的有效性：一项非随机的远程监测前后研究。

Effectiveness of Telemonitoring in Reducing Hospitalization and Associated Costs for Patients With Heart Failure in Finland: Nonrandomized Pre-Post Telemonitoring Study.

机构信息

Tampere Heart Hospital, Tampere, Finland.

The Wellbeing Services County of Southwest Finland, Turku, Finland.

出版信息

JMIR Mhealth Uhealth. 2024 Feb 7;12:e51841. doi: 10.2196/51841.

DOI:10.2196/51841

PMID:38324366

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10896481/

Abstract

BACKGROUND

Many patients with chronic heart failure (HF) experience a reduced health status, leading to readmission after hospitalization despite receiving conventional care. Telemonitoring approaches aim to improve the early detection of HF decompensations and prevent readmissions. However, knowledge about the impact of telemonitoring on preventing readmissions and related costs remains scarce.

OBJECTIVE

This study assessed the effectiveness of adding a telemonitoring solution to the standard of care (SOC) for the prevention of hospitalization and related costs in patients with HF in Finland.

METHODS

We performed a nonrandomized pre-post telemonitoring study to estimate health care costs and resource use during 6 months on SOC followed by 6 months on SOC with a novel telemonitoring solution. The telemonitoring solution consisted of a digital platform for patient-reported symptoms and daily weight and blood pressure measurements, automatically generated alerts triggering phone calls with secondary care nurses, and rapid response to alerts by treating physicians. Telemonitoring solution data were linked to patient register data on primary care, secondary care, and hospitalization. The patient register of the Southern Savonia Social and Health Care Authority (Essote) was used. Eligible patients had at least 1 hospital admission within the last 12 months and self-reported New York Heart Association class II-IV from the central hospital in the Southern Savonia region.

RESULTS

Out of 50 recruited patients with HF, 43 completed the study and were included in the analysis. The hospitalization-related cost decreased (49%; P=.03) from €2189 (95% CI €1384-€2994; a currency exchange rate of EUR €1=US $1.10589 is applicable) during SOC to €1114 (95% CI €425-€1803) during telemonitoring. The number of patients with at least 1 hospitalization due to HF was reduced by 70% (P=.002) from 20 (47%) out of 43patients during SOC to 6 (14%) out of 43 patients in telemonitoring. The estimated mean total health care cost per patient was €3124 (95% CI €2212-€4036) during SOC and €2104 (95% CI €1313-€2895) during telemonitoring, resulting in a 33% reduction (P=.07) in costs with telemonitoring.

CONCLUSIONS

The results suggest that the telemonitoring solution can reduce hospital-related costs for patients with HF with a recent hospital admission.

摘要

背景

许多慢性心力衰竭（HF）患者的健康状况下降，尽管接受了常规治疗，但仍会在出院后再次入院。远程监测方法旨在改善 HF 失代偿的早期检测并预防再入院。然而，关于远程监测对预防再入院和相关成本的影响的知识仍然很少。

目的

本研究评估了在芬兰，为 HF 患者提供标准治疗（SOC）加新型远程监测解决方案，对预防住院和相关成本的效果。

方法

我们进行了一项非随机的预-后远程监测研究，以估计在 SOC 下进行 6 个月后的医疗保健成本和资源使用情况，然后在 SOC 下进行 6 个月，使用新型远程监测解决方案。远程监测解决方案包括一个用于患者报告症状和每日体重及血压测量的数字平台，自动生成警报，触发与二级护理护士的电话通话，并由主治医生快速响应警报。远程监测解决方案的数据与初级保健、二级保健和住院的患者登记数据相关联。使用了南萨沃尼亚社会和保健区（Essote）的患者登记。符合条件的患者在过去 12 个月内至少有 1 次住院治疗，并自报来自南萨沃尼亚地区中心医院的纽约心脏协会（NYHA）心功能分级 II-IV 级。

结果

在招募的 50 名 HF 患者中，有 43 名完成了研究并纳入分析。与住院相关的费用降低了（49%；P=.03），SOC 时为 2189 欧元（95% CI 1384-2994 欧元；适用的欧元/美元汇率为 1 欧元=1.10589 美元），远程监测时为 1114 欧元（95% CI 425-1803 欧元）。SOC 时因 HF 至少住院 1 次的患者人数减少了 70%（P=.002），从 43 名患者中的 20 名（47%）减少到远程监测时的 6 名（14%）。SOC 时每位患者的估计平均总医疗保健费用为 3124 欧元（95% CI 2212-4036 欧元），远程监测时为 2104 欧元（95% CI 1313-2895 欧元），远程监测时的费用降低了 33%（P=.07）。