Identifying Disparities in Care of Rural Patients with Cardiac Implantable Electronic Devices

确定使用心脏植入电子设备的农村患者的护理差异

基本信息

批准号：
10555010
负责人：
Emily Zeitler
金额：
$ 20.51万
依托单位：
DARTMOUTH-HITCHCOCK CLINIC
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-04-01 至 2028-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10555010
关键词：
Academic Medical Centers Achievement Address Age American Area Arrhythmia Cardiovascular system Caring Case Study Cellular Phone Characteristics Client satisfaction Clinical Community Outreach Consensus Country Data Defibrillators Devices Disease Progression Disparity Early Intervention Economics Elderly Electronics Eligibility Determination Equilibrium Evaluation Face Geographic Distribution Geography Guidelines Health Insurance Health Technology Health care facility Healthcare Home Hospital Referrals Hospitals Implant Implantable Defibrillators Informatics Infrastructure Inpatients Institution Internet Intervention Interview Lead Longevity Manufacturer Measures Medical Medicare Medicare claim Methods Monitor Outcome Pacemakers Pathway Analysis Patient Monitoring Patients Pattern Performance Periodicals Persons Physicians Policy Maker Population Positioning Attribute Prevalence Primary Care Physician Provider Qualitative Methods Qualitative Research Recommendation Reporting Research Research Methodology Research Personnel Resources Rural Rural Health Centers Science Services Site Speed Structure Surveys System Travel Uninsured Variant Work cardiac implant care delivery care outcomes community engagement cost digital digital health ethnic minority population experience geographic difference geographic disparity health care delivery health care disparity implantable device improved improved outcome medical specialties monitoring device mortality older patient population based preference racial minority population remote monitoring remote patient monitoring rural area rural patients rural setting rurality statistics uptake wireless

项目摘要

PROJECT SUMMARY/ABSTRACT Project 2 (Zeitler): Identifying Disparities in Care of Rural Patients with Cardiac Implantable Electronic Devices Patients in rural settings have significantly worse outcomes from cardiovascular conditions compared with patients in non-rural settings, including treatment of arrhythmias with a cardiac implantable electronic device (CIED), like a pacemaker or defibrillator. These ubiquitous implantable devices store copious amounts of medical information related to device function and disease progression, among other items. These data are available to treating physicians and other clinicians through remote monitoring (RM), which relies on wireless connectivity between patients, a remote server, health care facilities, and treating physicians. Monitoring of patients with a CIED through this RM paradigm as an adjunct to periodic in-person evaluations has been associated with a variety of improved outcomes over in-person evaluations alone, ranging from improvements in patient satisfaction to decreased mortality. Thus, RM is unequivocally recommended in combination with in- person evaluations. While known disparities in RM exist among the uninsured and elderly, the geographic distribution of RM remains unstudied. A number of factors suggest that RM of CIEDs may be particularly vulnerable to geographic disparities. For one, patients in rural areas face greater barriers to connectivity, including less access to high-speed internet and less-consistent cell phone coverage. These barriers couple with the challenge of greater geographic distances that must be traveled to access in-person subspecialty services, a necessary aspect of CIED care. With the guidance of a community engagement studio, the proposed work incorporates mixed methods to: 1) better understand barriers and facilitators of RM in rural areas; 2) identify geographic disparities in CIED care; and 3) exploit variation in RM referral networks to understand characteristics associated with optimal CIED care in rural areas. These efforts will be informed and supported by expert input from the Statistics, Informatics, and Qualitative Methods Core to evaluate variation in health care delivery and outcomes, as well as the deep experience in community engagement and qualitative research methods represented by the Community Engagement and Outreach Core. Findings from this research will constitute meaningful progress towards addressing geographic disparities in arrhythmia care while, enabling achievement of investigator independence.

项目概要/摘要项目 2（Zeitler）：确定使用心脏植入电子设备的农村患者的护理差异与农村地区的患者相比，农村患者的心血管疾病结局明显更差非农村地区的患者，包括使用心脏植入电子设备治疗心律失常 (CIED)，如起搏器或除颤器。这些无处不在的植入设备存储了大量的数据与设备功能和疾病进展等相关的医疗信息。这些数据是治疗医生和其他临床医生可以通过远程监控 (RM) 进行使用，远程监控依赖于无线患者、远程服务器、医疗保健设施和治疗医生之间的连接。监测通过这种 RM 范式作为定期亲自评估的辅助手段，CIED 患者已得到与单独的现场评估相比，与各种改进的结果相关，包括改进提高患者满意度以降低死亡率。因此，明确推荐 RM 与 in- 人的评价。虽然众所周知，未参保者和老年人之间的 RM 存在差异，但地域分布 RM 的分布尚未研究。许多因素表明 CIED 的 RM 可能特别容易受到地理差异的影响。为了第一，农村地区的患者面临更大的连接障碍，包括访问高速互联网的机会较少和不太一致的手机覆盖范围。这些障碍加上更大地理范围的挑战获得现场专科服务所需的距离，这是 CIED 护理的一个必要方面。在社区参与工作室的指导下，拟议的工作采用了混合方法：1）更好地了解农村地区风险管理的障碍和促进因素； 2) 确定 CIED 护理中的地理差异； 3) 利用 RM 推荐网络的变化来了解与最佳 CIED 相关的特征农村地区的护理。这些努力将得到统计局专家投入的信息和支持，信息学和定性方法核心，用于评估医疗保健服务和结果的变化作为以社区参与和定性研究方法为代表的丰富经验社区参与和外展核心。这项研究的结果将构成有意义的进展致力于解决心律失常护理方面的地理差异，同时使研究者能够实现独立。