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新冠疫情期间远程患者监测项目的评估:采用混合方法解释性序列设计的回顾性案例研究

Evaluation of a Remote Patient Monitoring Program During the COVID-19 Pandemic: Retrospective Case Study With a Mixed Methods Explanatory Sequential Design.

作者信息

Gunn Rose, Watkins Shelby L, Boston Dave, Rosales A Gabriela, Massimino Stefan, Navale Suparna, Fitzpatrick Stephanie L, Dickerson John, Gold Rachel, Lee George, McMullen Carmit K

机构信息

OCHIN, Inc, Portland, OR, United States.

Kaiser Permanente Center for Health Research, Kaiser Permanente, Portland, OR, United States.

出版信息

JMIR Form Res. 2024 Jul 9;8:e55732. doi: 10.2196/55732.

Abstract

BACKGROUND

Community health center (CHC) patients experience a disproportionately high prevalence of chronic conditions and barriers to accessing technologies that might support the management of these conditions. One such technology includes tools used for remote patient monitoring (RPM), the use of which surged during the COVID-19 pandemic.

OBJECTIVE

The aim of this study was to assess how a CHC implemented an RPM program during the COVID-19 pandemic.

METHODS

This retrospective case study used a mixed methods explanatory sequential design to evaluate a CHC's implementation of a suite of RPM tools during the COVID-19 pandemic. Analyses used electronic health record-extracted health outcomes data and semistructured interviews with the CHC's staff and patients participating in the RPM program.

RESULTS

The CHC enrolled 147 patients in a hypertension RPM program. After 6 months of RPM use, mean systolic blood pressure (BP) was 13.4 mm Hg lower and mean diastolic BP 6.4 mm Hg lower, corresponding with an increase in hypertension control (BP<140/90 mm Hg) from 33.3% of patients to 81.5%. Considerable effort was dedicated to standing up the program, reinforced by organizational prioritization of chronic disease management, and by a clinician who championed program implementation. Noted barriers to implementation of the RPM program were limited initial training, lack of sustained support, and complexities related to the RPM device technology.

CONCLUSIONS

While RPM technology holds promise for addressing chronic disease management, successful RPM program requires substantial investment in implementation support and technical assistance.

摘要

背景

社区卫生中心(CHC)的患者中慢性病患病率极高,且在获取可能有助于管理这些疾病的技术方面存在障碍。其中一种技术包括用于远程患者监测(RPM)的工具,在新冠疫情期间其使用量激增。

目的

本研究旨在评估一家社区卫生中心在新冠疫情期间如何实施远程患者监测项目。

方法

本回顾性案例研究采用混合方法解释性序列设计,以评估一家社区卫生中心在新冠疫情期间对一套远程患者监测工具的实施情况。分析使用了从电子健康记录中提取的健康结果数据,以及对参与远程患者监测项目的社区卫生中心工作人员和患者进行的半结构化访谈。

结果

该社区卫生中心为147名患者登记了高血压远程患者监测项目。使用远程患者监测6个月后,平均收缩压降低了13.4毫米汞柱,平均舒张压降低了6.4毫米汞柱,相应地,高血压控制率(血压<140/90毫米汞柱)从33.3%的患者提高到了81.5%。为启动该项目付出了巨大努力,慢性病管理的组织优先级以及一位支持项目实施的临床医生强化了这一努力。远程患者监测项目实施过程中遇到的明显障碍包括初始培训有限、缺乏持续支持以及与远程患者监测设备技术相关的复杂性。

结论

虽然远程患者监测技术有望解决慢性病管理问题,但成功实施远程患者监测项目需要在实施支持和技术援助方面进行大量投资。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef88/11267095/5cdc0e4db564/formative_v8i1e55732_fig1.jpg

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