Evaluation of Home Automated Telemanagement in COPD

慢性阻塞性肺病家庭自动远程管理的评估

基本信息

批准号：
7147438
负责人：
JOSEPH E FINKELSTEIN
金额：
$ 68.07万
依托单位：
UNIVERSITY OF MARYLAND BALTIMORE
依托单位国家：
美国
项目类别：
财政年份：
2003
资助国家：
美国
起止时间：
2003-12-26 至 2008-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7147438
关键词：
Accident and Emergency department Activities of Daily Living Acute Adherence Admission activity Adult Adult asthma Affect Age Anxiety Area Asthma Attitude Back Behavior Behavioral Bronchodilator Agents Cardiovascular system Caregivers Caring Case Manager Cessation of life Chronic Chronic Bronchitis Chronic Care Chronic Disease Chronic Obstructive Airway Disease Client satisfaction Clinical Clinical Research Clinical Trials Cognitive Communication Computer Interface Computer Literacy Computers Condition Control Locus Cost Effectiveness Analysis Counseling Death Rate Devices Direct Costs Disabled Persons Disease Disease Management Education Elderly Enrollment Evaluation Exercise Exercise Tolerance Failure Feasibility Studies Feedback Focus Groups Funding Goals Guidelines Hand Health Health Personnel Health behavior Health behavior change Health education Healthcare Home environment Hospitalization Hospitals Human Resources Individual Insurance Internet Intervention Irritants Knowledge Lead Length of Stay Logic Low income Lung Lung diseases Maintenance Measurement Medical Medical Care Costs Medicare Mental Depression Modeling Monitor Numbers Nurses Outcome Outpatients Patient Education Patient Noncompliance Patients Personal Digital Assistant Personal Satisfaction Persons Pharmaceutical Preparations Physicians Physiologic pulse Play Practice Guidelines Prevalence Process Provider Psychological reinforcement Psychosocial Factor Publications Publishing Pulmonary Emphysema Pulmonary Function Test/Forced Expiratory Volume 1 Pulse taking Qualitative Research Quality of life Questionnaires Randomized Randomized Clinical Trials Rate Rehabilitation Centers Rehabilitation Outcome Rehabilitation therapy Reporting Research Methodology Respiratory physiology Role Rosa Schedule Self Care Self Care outcome Self Efficacy Self Management Services Social Workers Social support Speed Standards of Weights and Measures Structure Supervision Supportive care Symptoms System Technology Telecommunications Telemedicine Test Result Testing Text Time Training Treatment Protocols United States United States National Institutes of Health Visit Voice Woman Work base chronic obstructive pulmonary disease education cigarette smoking clinical epidemiology compliance behavior computerized conditioning cost design disability evidence based guidelines expectation experience feeding follow-up health care service utilization improved inner city innovation input device medication compliance men multidisciplinary patient home care prescription document prescription procedure programs psychosocial respiratory smoking cessation social cognitive theory touchscreen treatment planning virtual

项目摘要

DESCRIPTION (provided by applicant): Interventions that enhance patient self-management and increase patient understanding of their chronic disease have been shown to reduce urgent care utilization and improve patients' quality of life. To date there have been no studies of self-management interventions for patients with Chronic Obstructive Pulmonary Disease (COPD) that have employed current advances in telecommunication technologies aimed to facilitate implementation of Global Initiative for Chronic Obstructive Lung Disease (GOLD) into routine clinical practice. The Internet-based Home Automated Telemanagement (HAT) system was designed to support a multi-disciplinary approach in patient self-management which includes regular patient assessment, disease-specific education, control of patient compliance with treatment plans, implementation of health behavior change models and social support both for patients and caregivers. In this proposal we will (1) refine the HAT System to fully implement the multidisciplinary model for telemanagement of COPD patients (2) evaluate in a feasibility study the magnitude of clinical impact of HAT on medical care of COPD patients. Patients will have the HAT units (Internet-enabled computer connected to spirometer and pulse oximeter) installed in their homes and will be instructed how to use it. They will be asked to do self-testing on a regular basis and to answer questions on their computer screen (symptoms, medication use, and other self-care actions). Each HAT session will include (1) patient assessment (objective measurements such as FEV1 or SaO2, which are automatically downloaded to the computer, and patient-reported parameters such as respiratory symptoms and medication use), (2) interpretation and advice according to individualized treatment plan generated by patient's physician, (3) structured COPD education, (4) patient counseling and health behavior adjustment (based on main constructs of Social Cognitive Theory, such as behavioral capability, self-efficacy, outcome expectations and reinforcement), (5) social support (virtual patient groups, communication with social worker), (6) optional direct telecommunication sessions (home exercise supervision, physician/nurse tele-visit using a web cam video-conferencing). A randomized clinical study will be conducted with 280 COPD patients who will be followed for 18 months. The outcome parameters will include quality of life, medical care utilization, ADL, treatment compliance, respiratory symptoms and psychosocial variables. Patient and clinician attitudes and concerns regarding HAT will be evaluated using qualitative research methods and standardized questionnaires. Finally, we will perform cost-effectiveness analysis of the HAT intervention in the COPD patients.

描述（由申请人提供）：已证明可以增强患者自我管理并增加患者对慢性疾病的理解的干预措施可减少紧急护理利用并改善患者的生活质量。迄今为止，还没有针对慢性阻塞性肺部疾病（COPD）患者进行自我管理干预措施的研究，这些患者旨在促进全球慢性阻塞性肺疾病（GOLD）促进常规临床实践的全球慢性阻塞性肺疾病（GOLD）倡议。基于Internet的家庭自动化远程管理系统（HAT）系统旨在支持患者自我管理中的多学科方法，其中包括定期患者评估，特定于疾病的教育，控制患者遵守治疗计划，对健康行为改变模型的实施以及对患者和护理人员的社会支持。在此提案中，我们将（1）完善HAT系统，以完全实施COPD患者的远程管理模型（2）在可行性研究中评估HAT对COPD患者医疗护理的临床影响的幅度。患者将安装在房屋中的帽子单元（以互联网为基础的计算机连接到螺旋仪和脉搏血氧仪），并将指示如何使用它。他们将被要求定期进行自我测试，并在计算机屏幕上回答问题（症状，用药和其他自我保健动作）。每次帽子会议将包括（1）患者评估（诸如FEV1或SAO2之类的客观测量，它们会自动下载到计算机上，以及患者报告的参数，例如呼吸症状和药物使用），（2）根据患者的身体咨询（（3）结构性copd的咨询，（4）根据患者的构建，（4）基于健康的咨询，（4）根据（4）根据（4）根据健康的治疗计划（4）根据（4）根据健康的治疗计划（4）调整了行为的行为，（4）能力，自我效能感，结果期望和强化），（5）社会支持（虚拟患者群体，与社会工作者的沟通），（6）可选的直接电信会议（家庭锻炼，医师/护士使用网络摄像机视频会议）。将对280名COPD患者进行一项随机临床研究，他们将持续18个月。结果参数将包括生活质量，医疗保健利用，ADL，治疗依从性，呼吸症状和社会心理变量。将使用定性研究方法和标准化问卷评估患者和临床医生对HAT的态度和关注。最后，我们将对COPD患者的HAT干预进行成本效益分析。