背景:社区卫生中心(CHC)患者的慢性病患病率过高,并且在获得可能支持这些疾病管理的技术方面存在障碍。一种这样的技术包括用于远程患者监测(RPM)的工具,在COVID-19大流行期间,其使用激增。
目的:本研究的目的是评估CHC在COVID-19大流行期间如何实施RPM计划。
方法:这项回顾性案例研究使用了一种混合方法解释性序贯设计来评估CHC在COVID-19大流行期间对一套RPM工具的实施。分析使用电子健康记录提取的健康结果数据以及与CHC的工作人员和参与RPM计划的患者的半结构化访谈。
结果:CHC招募了147名高血压患者RPM计划。RPM使用6个月后,平均收缩压(BP)降低13.4mmHg,平均舒张压降低6.4mmHg,与高血压控制(BP<140/90mmHg)从33.3%增加到81.5%相对应。相当大的努力致力于支持这个项目,通过慢性病管理的组织优先次序得到加强,以及一位支持项目实施的临床医生。注意到实施RPM计划的障碍是有限的初始培训,缺乏持续的支持,以及与RPM装置技术相关的复杂性。
结论:虽然RPM技术有望解决慢性病管理问题,成功的RPM计划需要在实施支持和技术援助方面进行大量投资。
BACKGROUND: Community health center (CHC) patients experience a disproportionately high prevalence of chronic conditions and barriers to accessing technologies that might support the management of these conditions. One such technology includes tools used for remote patient monitoring (RPM), the use of which surged during the COVID-19 pandemic.
OBJECTIVE: The aim of this study was to assess how a CHC implemented an RPM program during the COVID-19 pandemic.
METHODS: This retrospective
case study used a mixed methods explanatory sequential design to evaluate a CHC\'s implementation of a suite of RPM tools during the COVID-19 pandemic. Analyses used electronic health record-extracted health outcomes data and semistructured interviews with the CHC\'s staff and patients participating in the RPM program.
RESULTS: The CHC enrolled 147 patients in a hypertension RPM program. After 6 months of RPM use, mean systolic blood pressure (BP) was 13.4 mm Hg lower and mean diastolic BP 6.4 mm Hg lower, corresponding with an increase in hypertension control (BP<140/90 mm Hg) from 33.3% of patients to 81.5%. Considerable effort was dedicated to standing up the program, reinforced by organizational prioritization of chronic disease management, and by a clinician who championed program implementation. Noted barriers to implementation of the RPM program were limited initial training, lack of sustained support, and complexities related to the RPM device technology.
CONCLUSIONS: While RPM technology holds promise for addressing chronic disease management, successful RPM program requires substantial investment in implementation support and technical assistance.