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首页> 外文期刊>JMIR Medical Informatics >Impact on Readmission Reduction Among Heart Failure Patients Using Digital Health Monitoring: Feasibility and Adoptability Study
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Impact on Readmission Reduction Among Heart Failure Patients Using Digital Health Monitoring: Feasibility and Adoptability Study

机译：利用数字健康监测对心力衰竭患者进行再次入院的影响：可行性和养护研究

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Background Heart failure (HF) is a condition that affects approximately 6.2 million people in the United States and has a 5-year mortality rate of approximately 42%. With the prevalence expected to exceed 8 million cases by 2030, projections estimate that total annual HF costs will increase to nearly US $70 billion. Recently, the advent of remote monitoring technology has significantly broadened the scope of the physician’s reach in chronic disease management. Objective The goal of our program, named the Heart Health Program, was to examine the feasibility of using digital health monitoring in real-world home settings, ascertain patient adoption, and evaluate impact on 30-day readmission rate. Methods A digital medicine software platform developed at Mount Sinai Health System, called RxUniverse, was used to prescribe a digital care pathway including the HealthPROMISE digital therapeutic and iHealth mobile apps to patients’ personal smartphones. Vital sign data, including blood pressure (BP) and weight, were collected through an ambulatory remote monitoring system that comprised a mobile app and complementary consumer-grade Bluetooth-connected smart devices (BP cuff and digital scale) that send data to the provider care teams. Care teams were alerted via a Web-based dashboard of abnormal patient BP and weight change readings, and further action was taken at the clinicians’ discretion. We used statistical analyses to determine risk factors associated with 30-day all-cause readmission. Results Overall, the Heart Health Program included 58 patients admitted to the Mount Sinai Hospital for HF. The 30-day hospital readmission rate was 10% (6/58), compared with the national readmission rates of approximately 25% and the Mount Sinai Hospital’s average of approximately 23%. Single marital status (P=.06) and history of percutaneous coronary intervention (P=.08) were associated with readmission. Readmitted patients were also less likely to have been previously prescribed angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (P=.02). Notably, readmitted patients utilized the BP and weight monitors less than nonreadmitted patients, and patients aged younger than 70 years used the monitors more frequently on average than those aged over 70 years, though these trends did not reach statistical significance. The percentage of the 58 patients using the monitors at least once dropped from 83% (42/58) in the first week after discharge to 46% (23/58) in the fourth week. Conclusions Given the increasing burden of HF, there is a need for an effective and sustainable remote monitoring system for HF patients following hospital discharge. We identified clinical and social factors as well as remote monitoring usage trends that identify targetable patient populations that could benefit most from integration of daily remote monitoring. In addition, we demonstrated that interventions driven by real-time vital sign data may greatly aid in reducing hospital readmissions and costs while improving patient outcomes.
机译：背景心力衰竭（HF）是影响美国约有620万人的条件，具有5年的死亡率约为42％。随着2030年的预期预期超过800万个案例，预测估计年度总HF成本将增加到近7000亿美元。最近，远程监测技术的出现显着扩大了医生急性疾病管理的范围。目的是我们计划的目标，命名为心脏健康计划，是为了审查在现实世界家庭环境中使用数字健康监测的可行性，确定患者采用，并评估对30日入院率的影响。方法采用位于鲁道维亚的山地卫生系统中开发的数字医学软件平台，用于规定患者个人智能手机的数字护理途径，包括Healthpromise Digital Therualutic和iHealth移动应用程序。通过包括用于将数据发送到提供商护理的移动应用和互补的消费者级蓝牙连接的智能设备（包括血压（BP）和重量，包括血压（BP）和重量，包括血压（BP）和重量。团队。通过基于Web的异常患者BP和体重变化读数提醒护理团队，并在临床医生自行决定采取进一步的行动。我们使用统计分析来确定与30天的全部导致入伍相关的风险因素。结果总体而言，心脏健康计划包括58名患者入住西奈山医院的HF。 30天医院入院率为10％（6/58），与国家入院率约为25％，西奈山山平均约23％。单一婚姻状况（p = .06）和经皮冠状动脉干预的历史（p = .08）与再入次。预留患者也不太可能先前规定的血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂（P = .02）。值得注意的是，Readcited患者使用的BP和体重监测器小于非患者，而年龄小于70岁的患者平均超过70岁的监视器，尽管这些趋势没有达到统计学意义。使用监测器的58名患者的百分比至少在第四周排放到46％（23/58）后的83％（42/58）下降。结论鉴于HF负荷越来越多，需要为医院排放后的HF患者有效和可持续的远程监测系统。我们确定了临床和社会因素，以及远程监测使用趋势，以确定可能受益于每日远程监控的大多数可能受益的患者群体。此外，我们证明，通过实时生命体征数据驱动的干预措施可能会在改善患者结果的同时减少医院入院和成本。

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