J. Med. Internet Res. - Assessment of the cost-effectiveness and clinical outcomes of a fourth-generation synchronous telehealth program for the management of chronic cardiovascular disease.

Tópicos

{ patient(2837) hospit(1953) medic(668) }
{ time(1939) patient(1703) rate(768) }
{ cost(1906) reduc(1198) effect(832) }
{ research(1218) medic(880) student(794) }
{ patient(2315) diseas(1263) diabet(1191) }
{ data(2317) use(1299) case(1017) }
{ age(1611) year(1155) adult(843) }
{ intervent(3218) particip(2042) group(1664) }
{ use(2086) technolog(871) perceiv(783) }
{ measur(2081) correl(1212) valu(896) }
{ method(1219) similar(1157) match(930) }
{ studi(2440) review(1878) systemat(933) }
{ extract(1171) text(1153) clinic(932) }
{ care(1570) inform(1187) nurs(1089) }
{ howev(809) still(633) remain(590) }
{ risk(3053) factor(974) diseas(938) }
{ data(1737) use(1416) pattern(1282) }
{ network(2748) neural(1063) input(814) }
{ treatment(1704) effect(941) patient(846) }
{ method(984) reconstruct(947) comput(926) }
{ search(2224) databas(1162) retriev(909) }
{ studi(1410) differ(1259) use(1210) }
{ system(1050) medic(1026) inform(1018) }
{ model(2656) set(1616) predict(1553) }
{ first(2504) two(1366) second(1323) }
{ patient(1821) servic(1111) care(1106) }
{ use(1733) differ(960) four(931) }
{ decis(3086) make(1611) patient(1517) }
{ method(1969) cluster(1462) data(1082) }
{ model(3404) distribut(989) bayesian(671) }
{ can(774) often(719) complex(702) }
{ imag(1947) propos(1133) code(1026) }
{ inform(2794) health(2639) internet(1427) }
{ system(1976) rule(880) can(841) }
{ imag(1057) registr(996) error(939) }
{ bind(1733) structur(1185) ligand(1036) }
{ sequenc(1873) structur(1644) protein(1328) }
{ featur(3375) classif(2383) classifi(1994) }
{ imag(2830) propos(1344) filter(1198) }
{ imag(2675) segment(2577) method(1081) }
{ take(945) account(800) differ(722) }
{ motion(1329) object(1292) video(1091) }
{ assess(1506) score(1403) qualiti(1306) }
{ surgeri(1148) surgic(1085) robot(1054) }
{ framework(1458) process(801) describ(734) }
{ problem(2511) optim(1539) algorithm(950) }
{ error(1145) method(1030) estim(1020) }
{ chang(1828) time(1643) increas(1301) }
{ learn(2355) train(1041) set(1003) }
{ concept(1167) ontolog(924) domain(897) }
{ clinic(1479) use(1117) guidelin(835) }
{ algorithm(1844) comput(1787) effici(935) }
{ method(1557) propos(1049) approach(1037) }
{ data(1714) softwar(1251) tool(1186) }
{ design(1359) user(1324) use(1319) }
{ control(1307) perform(991) simul(935) }
{ model(2220) cell(1177) simul(1124) }
{ general(901) number(790) one(736) }
{ featur(1941) imag(1645) propos(1176) }
{ case(1353) use(1143) diagnosi(1136) }
{ data(3963) clinic(1234) research(1004) }
{ perform(999) metric(946) measur(919) }
{ research(1085) discuss(1038) issu(1018) }
{ import(1318) role(1303) understand(862) }
{ model(2341) predict(2261) use(1141) }
{ visual(1396) interact(850) tool(830) }
{ compound(1573) activ(1297) structur(1058) }
{ perform(1367) use(1326) method(1137) }
{ studi(1119) effect(1106) posit(819) }
{ blood(1257) pressur(1144) flow(957) }
{ spatial(1525) area(1432) region(1030) }
{ record(1888) medic(1808) patient(1693) }
{ health(3367) inform(1360) care(1135) }
{ model(3480) simul(1196) paramet(876) }
{ monitor(1329) mobil(1314) devic(1160) }
{ ehr(2073) health(1662) electron(1139) }
{ state(1844) use(1261) util(961) }
{ medic(1828) order(1363) alert(1069) }
{ signal(2180) analysi(812) frequenc(800) }
{ group(2977) signific(1463) compar(1072) }
{ sampl(1606) size(1419) use(1276) }
{ gene(2352) biolog(1181) express(1162) }
{ data(3008) multipl(1320) sourc(1022) }
{ activ(1138) subject(705) human(624) }
{ can(981) present(881) function(850) }
{ analysi(2126) use(1163) compon(1037) }
{ health(1844) social(1437) communiti(874) }
{ structur(1116) can(940) graph(676) }
{ high(1669) rate(1365) level(1280) }
{ cancer(2502) breast(956) screen(824) }
{ use(976) code(926) identifi(902) }
{ drug(1928) target(777) effect(648) }
{ result(1111) use(1088) new(759) }
{ implement(1333) system(1263) develop(1122) }
{ survey(1388) particip(1329) question(1065) }
{ estim(2440) model(1874) function(577) }
{ process(1125) use(805) approach(778) }
{ activ(1452) weight(1219) physic(1104) }
{ method(2212) result(1239) propos(1039) }
{ detect(2391) sensit(1101) algorithm(908) }

Resumo

CKGROUND: Telehealth programs are a growing field in the care of patients. The evolution of information technology has resulted in telehealth becoming a fourth-generation synchronous program. However, long-term outcomes and cost-effectiveness analysis of fourth-generation telehealth programs have not been reported in patients with chronic cardiovascular diseases.OBJECTIVE: We conducted this study to assess the clinical outcomes and cost-effectiveness of a fourth-generation synchronous telehealth program for patients with chronic cardiovascular diseases.METHODS: We retrospectively analyzed 575 patients who had joined a telehealth program and compared them with 1178 patients matched for sex, age, and Charlson comorbidity index. The program included: (1) instant transmission of biometric data, (2) daily telephone interview, and (3) continuous decision-making support. Data on hospitalization, emergency department (ED) visits, and medical costs were collected from the hospital's database and were adjusted to the follow-up months.RESULTS: The mean age was 64.5 years (SD 16.0). The mean number of monthly ED visits (mean 0.06 SD 0.13 vs mean 0.09 SD 0.23, P<.001), hospitalizations (mean 0.05 SD 0.12 vs mean 0.11 SD 0.21, P<.001), length of hospitalization (mean 0.77 days SD 2.78 vs mean 1.4 SD 3.6, P<.001), and intensive care unit admissions (mean 0.01 SD 0.07 vs mean 0.036 SD 0.14, P<.001) were lower in the telehealth group. The monthly mean costs of ED visits (mean US$20.90 SD 66.60 vs mean US$37.30 SD 126.20, P<.001), hospitalizations (mean US$386.30 SD 1424.30 vs mean US$878.20 SD 2697.20, P<.001), and all medical costs (mean US$587.60 SD 1497.80 vs mean US$1163.60 SD 3036.60, P<.001) were lower in the telehealth group. The intervention costs per patient were US$224.80 per month. Multivariate analyses revealed that age, telehealth care, and Charlson index were the independent factors for ED visits, hospitalizations, and length of hospitalization. A bootstrap method revealed the dominant cost-effectiveness of telehealth care over usual care.CONCLUSIONS: Better cost-effectiveness and clinical outcomes were noted with the use of a fourth-generation synchronous telehealth program in patients with chronic cardiovascular diseases. The intervention costs of this new generation of telehealth program do not increase the total costs for patient care.

Resumo Limpo

ckground telehealth program grow field care patient evolut inform technolog result telehealth becom fourthgener synchron program howev longterm outcom costeffect analysi fourthgener telehealth program report patient chronic cardiovascular diseasesobject conduct studi assess clinic outcom costeffect fourthgener synchron telehealth program patient chronic cardiovascular diseasesmethod retrospect analyz patient join telehealth program compar patient match sex age charlson comorbid index program includ instant transmiss biometr data daili telephon interview continu decisionmak support data hospit emerg depart ed visit medic cost collect hospit databas adjust followup monthsresult mean age year sd mean number month ed visit mean sd vs mean sd p hospit mean sd vs mean sd p length hospit mean day sd vs mean sd p intens care unit admiss mean sd vs mean sd p lower telehealth group month mean cost ed visit mean us sd vs mean us sd p hospit mean us sd vs mean us sd p medic cost mean us sd vs mean us sd p lower telehealth group intervent cost per patient us per month multivari analys reveal age telehealth care charlson index independ factor ed visit hospit length hospit bootstrap method reveal domin costeffect telehealth care usual careconclus better costeffect clinic outcom note use fourthgener synchron telehealth program patient chronic cardiovascular diseas intervent cost new generat telehealth program increas total cost patient care

Resumos Similares

J Telemed Telecare - A longitudinal study of health service utilization for diabetes patients in a care coordination home-telehealth programme. ( 0,83840347456293 )
Int J Med Inform - Prospective pilot study of a tablet computer in an Emergency Department. ( 0,828757698235305 )
Telemed J E Health - Reduced cost and mortality using home telehealth to promote self-management of complex chronic conditions: a retrospective matched cohort study of 4,999 veteran patients. ( 0,812313011603942 )
Int J Med Inform - Effects of electronic medical record in a Chinese hospital: a time series study. ( 0,809055773627394 )
J. Med. Internet Res. - Online social network use by health care providers in a high traffic patient care environment. ( 0,80806422576041 )
Telemed J E Health - Home-based preventative care in high-risk dialysis patients: a pilot study. ( 0,802705381523189 )
J. Med. Internet Res. - Clinical outcome and cost-effectiveness of a synchronous telehealth service for seniors and nonseniors with cardiovascular diseases: quasi-experimental study. ( 0,800328872062143 )
Int J Med Inform - Effects of a short text message reminder system on emergency department length of stay. ( 0,795454754802665 )
BMC Med Inform Decis Mak - A predictive model for the early identification of patients at risk for a prolonged intensive care unit length of stay. ( 0,771734382906064 )
Telemed J E Health - Emergency department physician telemedical triage. ( 0,771687502848235 )
Telemed J E Health - Clinical and economic impact of remote monitoring on the follow-up of patients with implantable electronic cardiovascular devices: an observational study. ( 0,764890924721692 )
AMIA Annu Symp Proc - Priority queuing models for hospital intensive care units and impacts to severe case patients. ( 0,764394321076839 )
Int J Med Inform - The positive financial impact of using an Intensive Care Information System in a tertiary Intensive Care Unit. ( 0,750239440194227 )
BMC Med Inform Decis Mak - Relationship between the population incidence of pertussis in children in New South Wales, Australia and emergency department visits with cough: a time series analysis. ( 0,74800056276779 )
J Am Med Inform Assoc - Patient reported barriers to enrolling in a patient portal. ( 0,741111446737766 )
J Telemed Telecare - Utilization of home telemonitoring in patients 75 years of age and over with complex heart failure. ( 0,738583130347076 )
J Med Syst - Variability of subspecialty-specific anesthesia-controlled times at two academic institutions. ( 0,737975617403189 )
J Telemed Telecare - Home-based telemanagement in chronic heart failure: an 8-year single-site experience. ( 0,73127272982867 )
Int J Med Inform - Use of web-based patient education sessions on psychiatric wards. ( 0,721023063272992 )
Int J Med Robot - Novel computer-assisted preoperative planning system for humeral shaft fractures: report of 43 cases. ( 0,720970720845475 )
J Telemed Telecare - Meta-analysis and meta-regression of telehealth programmes for patients with chronic heart failure. ( 0,71581349750645 )
J Telemed Telecare - The effect of real-time teleconsultations between hospital-based nurses and patients with severe COPD discharged after an exacerbation. ( 0,715680554522259 )
BMC Med Inform Decis Mak - A flexible simulation platform to quantify and manage emergency department crowding. ( 0,712969646729338 )
J Telemed Telecare - A pilot trial of telemedicine-assisted, integrated care for patients with advanced amyotrophic lateral sclerosis and their caregivers. ( 0,706284326162178 )
Telemed J E Health - Is telemedicine an answer to reducing 30-day readmission rates post-acute myocardial infarction? ( 0,70625166246107 )
BMC Med Inform Decis Mak - Impact of computerized physician order entry (CPOE) system on the outcome of critically ill adult patients: a before-after study. ( 0,698372920395979 )
AMIA Annu Symp Proc - Effectiveness of Evidence-Based Congestive Heart Failure (CHF) CPOE Order Sets Measured by Health Outcomes. ( 0,692164768420321 )
Telemed J E Health - Using nursing expertise and telemedicine to increase nursing collaboration and improve patient outcomes. ( 0,686859007506148 )
J Telemed Telecare - Systematic review of studies on telemonitoring of patients with congestive heart failure: a meta-analysis. ( 0,684978832578415 )
BMC Med Inform Decis Mak - Hidden in plain sight: bias towards sick patients when sampling patients with sufficient electronic health record data for research. ( 0,683339463116112 )
J. Med. Internet Res. - Supervised patient self-testing of warfarin therapy using an online system. ( 0,681879601398576 )
Int J Med Inform - Implementation and evaluation of an integrated computerized asthma management system in a pediatric emergency department: a randomized clinical trial. ( 0,679657249866548 )
J Clin Monit Comput - The implementation of an Intensive Care Information System allows shortening the ICU length of stay. ( 0,675121553866854 )
Telemed J E Health - A home telemonitoring program reduced exacerbation and healthcare utilization rates in COPD patients with frequent exacerbations. ( 0,67442130608123 )
Healthc (Amst) - Contributors to variation in hospital spending for critically ill patients with sepsis. ( 0,673734702784546 )
Telemed J E Health - The impact of remote patient monitoring (telehealth) upon Medicare beneficiaries with heart failure. ( 0,670936176672414 )
Int J Med Robot - Outpatient robotic hysterectomy: clinical outcomes and financial analysis of initial experience. ( 0,670672308018809 )
BMC Med Inform Decis Mak - Method for Assigning Priority Levels in Acute Care (MAPLe-AC) predicts outcomes of acute hospital care of older persons--a cross-national validation. ( 0,667463707274521 )
J. Med. Internet Res. - Long-term doctor-patient relationships: patient perspective from online reviews. ( 0,666109316950721 )
Telemed J E Health - Improved access and cycle time with an in-house patient-centered teleglaucoma program versus traditional in-person assessment. ( 0,6641757006763 )
Comput Methods Programs Biomed - Impact of glucocorticoids on insulin resistance in the critically ill. ( 0,663744463444671 )
Comput Math Methods Med - Risk factors for mortality among 2009 A/H1N1 influenza hospitalizations in Maricopa County, Arizona, April 2009 to March 2010. ( 0,661947421056998 )
Int J Med Inform - Using EHR data to predict hospital-acquired pressure ulcers: a prospective study of a Bayesian Network model. ( 0,661356004035968 )
Appl Clin Inform - Information technology improves Emergency Department patient discharge instructions completeness and performance on a national quality measure: a quasi-experimental study. ( 0,659213271844954 )
BMC Med Inform Decis Mak - Application of clinical pathway using electronic medical record system in pediatric patients with supracondylar fracture of the humerus: a before and after comparative study. ( 0,65802075664021 )
Telemed J E Health - Home telehealth in high-risk dialysis patients: a 3-year study. ( 0,657672397378992 )
AMIA Annu Symp Proc - Sustaining compliance with pediatric asthma inpatient quality measures. ( 0,650021192816628 )
Telemed J E Health - The neurosurgical telecounseling network in the Veneto Region: 4 years of experience of HEALTH OPTIMUM. ( 0,649595463597594 )
Med Decis Making - Factors relating to patient visit time with a physician. ( 0,646468774578761 )
Appl Clin Inform - Patient no-show predictive model development using multiple data sources for an effective overbooking approach. ( 0,64452487810642 )
Appl Clin Inform - Association between use of a health information exchange system and hospital admissions. ( 0,64267721503712 )
Comput. Biol. Med. - Using HL7 in hospital staff assignments. ( 0,641976148442039 )
AMIA Annu Symp Proc - Event detection: a clinical notification service on a health information exchange platform. ( 0,641091480870944 )
Med Decis Making - Estimating the cost of no-shows and evaluating the effects of mitigation strategies. ( 0,633825431964587 )
J Telemed Telecare - Telemedicine in vascular surgery: clinical experience in a single centre. ( 0,630361896524317 )
BMC Med Inform Decis Mak - Real-time automatic hospital-wide surveillance of nosocomial infections and outbreaks in a large Chinese tertiary hospital. ( 0,629147471427742 )
J Telemed Telecare - Clinical and psychological telemonitoring and telecare of high risk heart failure patients. ( 0,625502166844675 )
J Telemed Telecare - A pilot study of tele-anaesthesia by virtual private network between an island hospital and a mainland hospital in Japan. ( 0,625246864766251 )
Telemed J E Health - Robotic telepresence versus standardly supervised stroke alert team assessments. ( 0,621562942463607 )
J Am Med Inform Assoc - The potential for community-based health information exchange systems to reduce hospital readmissions. ( 0,62133676273406 )
Healthc (Amst) - Post-acute referral patterns for hospitals and implications for bundled payment initiatives. ( 0,619814987525475 )
J Med Syst - The effect of electronic medical record application on the length of stay in a Chinese general hospital: a department- and disease-focused interrupted time-series study. ( 0,619400242207397 )
J Med Syst - Time series modelling and forecasting of emergency department overcrowding. ( 0,618687759924875 )
Med Decis Making - Patient time costs associated with sensor-augmented insulin pump therapy for type 1 diabetes: results from the STAR 3 randomized trial. ( 0,618432585847025 )
AMIA Annu Symp Proc - A clinical decision tool for predicting patient care characteristics: patients returning within 72 hours in the emergency department. ( 0,616335790451994 )
BMC Med Inform Decis Mak - Detecting and diagnosing hotspots for the enhanced management of hospital Emergency Departments in Queensland, Australia. ( 0,615494059230309 )
Telemed J E Health - Hot spot: impact of July 2011 heat wave in southern Italy (Apulia) on cardiovascular disease assessed by emergency medical service and telemedicine support. ( 0,614756965937823 )
J Telemed Telecare - The effect of ICU telemedicine on mortality and length of stay. ( 0,613420377555654 )
Int J Med Inform - An asthma management system in a pediatric emergency department. ( 0,612247574185121 )
Telemed J E Health - Telemental health evaluations enhance access and efficiency in a critical access hospital emergency department. ( 0,611085271054225 )
Inform Health Soc Care - Design and implementation of wireless patient monitoring system for postoperative patients on general care floor. ( 0,610781414265669 )
Telemed J E Health - Challenges in implementing a pediatric cardiovascular home telehealth project. ( 0,606555605559268 )
Med Decis Making - Accounting for costs, QALYs, and capacity constraints: using discrete-event simulation to evaluate alternative service delivery and organizational scenarios for hospital-based glaucoma services. ( 0,601854387465935 )
J Med Syst - Migration of patients between five urban teaching hospitals in Chicago. ( 0,601778711723287 )
J Med Syst - Impact of technological innovation on a nursing home performance and on the medication-use process safety. ( 0,60173247315661 )
J Med Syst - Is computerized physician order entry use associated with a decrease in hospital resource utilization in hospitals that care for children? ( 0,599266143756321 )
Methods Inf Med - DPC in acute-phase inpatient hospital care. Visualization of amount of nursing care provided and accessibility to nursing care. ( 0,598194250029188 )
Healthc (Amst) - Assessing variation in utilization for acute myocardial infarction in New York State. ( 0,597767691559133 )
Int J Med Inform - Improving hospital bed utilisation through simulation and optimisation: with application to a 40% increase in patient volume in a Norwegian General Hospital. ( 0,597483379107663 )
J. Med. Internet Res. - Use of home telemonitoring to support multidisciplinary care of heart failure patients in Finland: randomized controlled trial. ( 0,596709917606473 )
J Med Syst - Intelligent analysis of acute bed overflow in a tertiary hospital in Singapore. ( 0,596097410058857 )
Methods Inf Med - Does Co-morbidity provide significant improvement on age adjustment when predicting medical outcomes? ( 0,593903686347535 )
J Med Syst - Economic and quality scheduling for effective utilization of operating rooms. ( 0,593402256295919 )
Telemed J E Health - New hospital telemedicine services: potential market for a nighttime telehospitalist service. ( 0,592154370972573 )
J Telemed Telecare - Early text page alarms sent to cardiologists reduce door-to-balloon times in ST-elevation myocardial infarction. ( 0,590973612573867 )
Int J Med Robot - Comparison of robotic adrenalectomy with traditional laparoscopic adrenalectomy with a lateral transperitoneal approach: a single-surgeon experience. ( 0,590735251351271 )
Comput Methods Programs Biomed - Manual nurse messaging with patient information using a mobile whiteboard system. ( 0,590045798030209 )
Appl Clin Inform - Use of clinical decision support to improve the quality of care provided to older hospitalized patients. ( 0,588081593929538 )
J Clin Monit Comput - Early goal-directed therapy based on endotracheal bioimpedance cardiography: a prospective, randomized controlled study in coronary surgery. ( 0,585984495532981 )
BMC Med Inform Decis Mak - Patient access to complex chronic disease records on the Internet. ( 0,585899727695282 )
Healthc (Amst) - Opening the ICU doors. ( 0,585839735210431 )
J Clin Monit Comput - Transcutaneous continuous carbon dioxide tension monitoring reduced incidence, degree and duration of hypercapnia during combined regional anaesthesia and monitored anaesthesia care in shoulder surgery patients. ( 0,581436851082602 )
Telemed J E Health - Telephotography in trauma: a 2-year clinical experience. ( 0,579974923657221 )
Med Decis Making - Analyzing discharge strategies during acute care: a discrete-event simulation study. ( 0,579697600930444 )
BMC Med Inform Decis Mak - Evaluation of an automated safety surveillance system using risk adjusted sequential probability ratio testing. ( 0,57840908347551 )
J Telemed Telecare - An international pilot study of asynchronous teleconsultation for oropharyngeal dysphagia. ( 0,576773920154673 )
BMC Med Inform Decis Mak - Summary of data reported to CDC's national automated biosurveillance system, 2008. ( 0,5764548256724 )
J. Med. Internet Res. - An analysis of online evaluations on a physician rating website: evidence from a German public reporting instrument. ( 0,576186370150451 )
Appl Clin Inform - Evaluation of the pressure ulcer prevention clinical decision report for bedside nurses in acute care hospitals. ( 0,576173768507243 )
J Telemed Telecare - A pilot project for improving paediatric diabetes outcomes using a website: the Pediatric Diabetes Education Portal. ( 0,574503026048104 )