Kevin W. Lobdell MD , Shannon Crotwell BS, CCRN , Larry T. Watts MD , Bradley LeNoir MD , Eric R. Skipper MD , Thomas Maxey MD , Gregory B. Russell MS , Robert Habib PhD , Geoffrey A. Rose MD , John Frederick MD
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引用次数: 0
Abstract
Background
Our remote patient monitoring (RPM) program for adult cardiac surgery patients aims to remove barriers to access, provide continuity of expert care, and increase their time-at-home. The RPM program integrates novel biosensors, an application for audiovisual visits, messaging, biometric data tracking, patient-reported outcomes, and scheduling with the aim of reducing postoperative length of stay and 30-day readmissions, while simultaneously increasing the rate of patients discharged to home.
Methods
Our institutional database was utilized for this retrospective review of 1000 consecutive RPM patients who underwent coronary artery bypass, valve, and coronary artery bypass + valve, at 3 hospitals from July 2019 through April 2023. The study cohort was compared with 1000 propensity-matched controls from the same three hospitals (1:1, nearest neighbor matching where propensity scores were generated with RPM as the outcome measure). Patient characteristics, procedures, and outcomes are defined as per The Society of Thoracic Surgeons Adult Cardiac Database.
Results
RPM patients experienced statistically significant shorter median postoperative length of stay (1 day less, a 16.7% relative difference; P < .0001) and a 33% relative reduction in 30-day readmission (7.0 ± 0.8 vs 4.7 ± 0.7, P = .027), while 5.6% more patients were discharged to home (97.8% vs 92.2%, P < .0001) when compared with the non-RPM cohort.
Conclusions
Patient engagement and management with a RPM platform are feasible and associated with significantly shorter postoperative length of stay, fewer 30-day readmissions, and an increased rate of discharge to home.
我们针对成人心脏手术患者的远程患者监测(RPM)项目旨在消除访问障碍,提供连续的专家护理,并增加他们在家的时间。RPM项目集成了新型生物传感器,用于视听访问、信息传递、生物识别数据跟踪、患者报告结果和调度,旨在减少术后住院时间和30天再入院,同时提高患者出院回家的率。方法利用我们的机构数据库,对2019年7月至2023年4月在3家医院连续接受冠状动脉旁路、瓣膜置换术和冠状动脉旁路+瓣膜置换术的1000例RPM患者进行回顾性分析。将研究队列与来自同一三家医院的1000名倾向匹配对照进行比较(1:1,最近邻匹配,倾向得分以RPM作为结果测量)。根据胸外科学会成人心脏数据库定义患者特征、程序和结果。结果rpm患者术后中位住院时间较短(少1天,相对差异为16.7%;P & lt;0.0001), 30天再入院相对减少33%(7.0±0.8 vs 4.7±0.7,P = 0.027),而出院回家的患者增加5.6% (97.8% vs 92.2%, P <;.0001)与非rpm队列相比。结论使用RPM平台对患者进行参与和管理是可行的,并且显著缩短了术后住院时间,减少了30天的再入院率,增加了出院率。