Lin Cheng-Fu, Chang Pei-Jung, Chang Hui-Min, Chen Ching-Tsung, Hsu Pi-Shan, Wu Chieh-Liang, Lin Shih-Yi
Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect 4, Taichung, 407219, Taiwan, 886 4-2359-2525, 886 4-2359-5046.
Division of Occupational Medicine, Department of Emergency, Taichung Veterans General Hospital, Taichung, Taiwan.
JMIR Med Inform. 2024 Dec 26;12:e63425. doi: 10.2196/63425.
Telehealth programs and wearable sensors that enable patients to monitor their vital signs have expanded due to the COVID-19 pandemic. The electronic National Early Warning Score (e-NEWS) system helps identify and respond to acute illness.
This study aimed to implement and evaluate a comprehensive telehealth system to monitor vital signs using e-NEWS for patients receiving integrated home-based medical care (iHBMC). The goal was to improve the early detection of patient deterioration and enhance care delivery in home settings. The system was deployed to optimize remote monitoring in iHBMC and reduce emergency visits and hospitalizations.
The study was conducted at a medical center and its affiliated home health agency in central Taiwan from November 1, 2022, to October 31, 2023. Patients eligible for iHBMC were enrolled, and sensor data from devices such as blood pressure monitors, thermometers, and pulse oximeters were transmitted to a cloud-based server for e-NEWS calculations at least twice per day over a 2-week period. Patients with e-NEWSs up to 4 received nursing or physician recommendations and interventions based on abnormal physiological data, with reassessment occurring after 2 hours.
A total of 28 participants were enrolled, with a median age of 84.5 (IQR 79.3-90.8) years, and 32% (n=9) were male. All participants had caregivers, with only 5 out of 28 (18%) able to make decisions independently. The system was implemented across one medical center and its affiliated home health agency. Of the 28 participants, 27 completed the study, while 1 exited early due to low blood pressure and shortness of breath. The median e-NEWS value was 4 (IQR 3-6), with 397 abnormal readings recorded. Of the remaining 27 participants, 8 participants had earlier home visits due to abnormal readings, 6 required hypertension medication adjustments, and 9 received advice on oxygen supplementation. Overall, 24 out of 28 (86%) participants reported being satisfied with the system.
This study demonstrated the feasibility of implementing a telehealth system integrated with e-NEWS in iHBMC settings, potentially aiding in the early detection of clinical deterioration. Although caregivers receive training and resources for their tasks, the system may increase their workload, which could lead to higher stress levels. The small sample size, short monitoring duration, and regional focus in central Taiwan may further limit the applicability of the findings to areas with differing countries, regions, and health care infrastructures. Further research is required to confirm its impact.
由于新冠疫情，能够让患者监测自身生命体征的远程医疗项目和可穿戴传感器得到了扩展。电子国家早期预警评分（e-NEWS）系统有助于识别和应对急性疾病。
本研究旨在实施并评估一个综合远程医疗系统，该系统使用e-NEWS为接受居家综合医疗护理（iHBMC）的患者监测生命体征。目标是改善对患者病情恶化的早期检测，并加强居家护理服务。该系统的部署是为了优化iHBMC中的远程监测，并减少急诊就诊和住院次数。
该研究于2022年11月1日至2023年10月31日在台湾中部的一家医疗中心及其附属的居家健康机构进行。招募符合iHBMC条件的患者，并将来自血压计、温度计和脉搏血氧仪等设备的传感器数据传输到基于云的服务器，以便在为期2周的时间内每天至少进行两次e-NEWS计算。e-NEWS评分达到4分及以下的患者根据异常生理数据接受护理或医生的建议及干预，并在2小时后进行重新评估。
总共招募了28名参与者，中位年龄为84.5岁（四分位间距79.3 - 90.8岁），32%（n = 9）为男性。所有参与者都有护理人员，28人中只有5人（18%）能够独立做出决策。该系统在一家医疗中心及其附属的居家健康机构中实施。28名参与者中，27人完成了研究，1人因低血压和呼吸急促提前退出。e-NEWS的中位值为4（四分位间距3 - 6），记录到397次异常读数。在其余27名参与者中，8人因读数异常提前进行了家访，6人需要调整高血压药物，9人接受了吸氧建议。总体而言，28名参与者中有24人（86%）表示对该系统满意。
本研究证明了在iHBMC环境中实施与e-NEWS集成的远程医疗系统的可行性，这可能有助于早期发现临床病情恶化。尽管护理人员接受了任务培训并获得了相关资源，但该系统可能会增加他们的工作量，从而导致更高的压力水平。样本量小、监测时间短以及研究集中在台湾中部地区，可能会进一步限制研究结果在不同国家、地区和医疗基础设施的地区的适用性。需要进一步的研究来证实其影响。
