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首页> 外文期刊>Telemedicine and e-health: the official journal of the American Telemedicine Association >Home-Based Telehealth Hospitalization for Exacerbation of Chronic Obstructive Pulmonary Disease: Findings from 'The Virtual Hospital' Trial
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Home-Based Telehealth Hospitalization for Exacerbation of Chronic Obstructive Pulmonary Disease: Findings from 'The Virtual Hospital' Trial

机译：慢性阻塞性肺疾病恶化的家庭远程医疗住院：“虚拟医院”试验的发现

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Background: Telehealth interventions for patients with chronic obstructive pulmonary disease (COPD) have focused primarily on stable outpatients. Telehealth designed to handle the acute exacerbation that normally requires hospitalization could also be of interest. The aim of this study was to compare the effect of home-based telehealth hospitalization with conventional hospitalization for exacerbation in severe COPD. Materials and Methods: A two-center, noninferiority, randomized, controlled effectiveness trial was conducted between June 2010 and December 2011. Patients with severe COPD admitted because of exacerbation were randomized 1:1 either to home-based telehealth hospitalization or to continue standard treatment and care at the hospital. The primary outcome was treatment failure defined as re-admission due to exacerbation in COPD within 30 days after initial discharge. The noninferiority margin was set at 20% of the control group's risk of re-admission. Secondary outcomes were mortality, need for manual or mechanical ventilation or noninvasive ventilation, length of hospitalization, physiological parameters, health-related quality of life, user satisfaction, healthcare costs, and adverse events. Results: In total, 57 patients were randomized: 29 participants in the telehealth group and 28 participants in the control group. Testing the incidence of re-admission within 30 days after discharge could not confirm noninferiority (lower 95% confidence limit [CL], -24.8%; p=0.35). Results were also nonsignificant at 90 days (lower 95% CL, -16.2%; p=0.33) and 180 days (lower 95% CL, -16.6%; p =0.33) after discharge. Superiority testing on secondary outcomes showed nonsignificant differences between groups. Healthcare costs have not yet been evaluated. Conclusions: Whether home-based telehealth hospitalization is noninferior to conventional hospitalization requires further investigation. The results indicate that a subgroup of patients with severe COPD can be treated for acute exacerbation at home using telehealth, without the physical presence of health professionals and with a proper organizational "back-up."
机译：背景：针对慢性阻塞性肺疾病（COPD）患者的远程医疗干预主要集中在稳定的门诊患者上。旨在处理通常需要住院的急性加重的远程医疗也可能引起人们的兴趣。这项研究的目的是比较以家庭为基础的远程医疗住院与常规住院治疗对重度COPD恶化的影响。材料和方法：在2010年6月至2011年12月之间进行了一项两中心，非劣效，随机，对照的临床试验。因病情加重而严重COPD的患者按1：1比例随机分配到家庭远程医疗住院或继续接受标准治疗和在医院护理。主要结果是治疗失败，定义为首次出院后30天内因COPD恶化而再次入院。非劣质性边缘被设定为对照组再入院风险的20％。次要结果是死亡率，手动或机械通气或无创通气的需要，住院时间，生理参数，与健康相关的生活质量，用户满意度，医疗保健费用和不良事件。结果：总共有57名患者被随机分组​​：远程医疗组29名参与者和对照组28名参与者。测试出院后30天内再次入院的发生率不能确定是否存在自卑感（较低的95％置信限[CL]，-24.8％; p = 0.35）。出院后90天（较低的95％CL，-16.2％; p = 0.33）和180天（较低的95％CL，-16.6％; p = 0.33）结果也不显着。对次要结果的优势测试表明，各组之间无显着差异。医疗费用尚未评估。结论：家庭远程医疗住院是否不逊于常规住院需要进一步调查。结果表明，患有重度COPD的亚组患者可以通过远程医疗在家中接受急性加重治疗，而无需医疗专业人员的亲自到场并进行适当的组织“备份”。

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