Lorie Donelle, Bradley Hiebert, Grace Warner, Michael Reid, Jennifer Reid, Salimah Shariff, Emily Richard, Sandra Regan, Lori Weeks, Kathleen Ledoux
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引用次数: 0
Abstract
Background: Researchers in Nova Scotia and Ontario, Canada, implemented a passive remote monitoring (PRM) model of home care unique to their health system contexts. Each PRM model integrated tailored PRM devices (eg, motion sensors, cameras, and door alarms) into home care patients' residences with the aim of linking patients, family and friend caregivers, and health care providers to support older adults' aging in place.
Objective: The purpose of this study was to examine the use of PRM technologies in the home to support older adults' safe aging in place and avoidance or delay of higher levels of care.
Methods: This multiprovincial pragmatic randomized controlled trial examined how PRM technologies support older adults to safely remain in their home and avoid or delay admission to higher levels of care. Pairs of home care patients and their family and friend caregivers were recruited in Ontario and Nova Scotia. Participant pairs were randomly assigned to one of two conditions: (1) standard home care (ie, control) or (2) standard home care plus study-provided PRM (ie, intervention). Participants provided their provincial health insurance numbers to link with provincial health administrative databases and identify if patients were admitted to higher levels of care after 1 year. Cox proportional hazards models were used to evaluate the primary outcome in each province.
Results: In total, 313 patient-caregiver pairs were recruited: 174 pairs in Ontario (intervention: n=60; control: n=114) and 139 pairs in Nova Scotia (intervention: n=45; control: n=94). Results indicate PRM was associated with a nonsignificant 30% reduction in risk of patients being admitted to higher levels of care in Ontario (hazard ratio 0.7, 95% CI 0.3-1.4) and no reduction in risk in Nova Scotia (hazard ratio 1.1, 95% CI 0.3-3.7). Adjusting for patient sex had no impact on model estimates for either province.
Conclusions: Limitations related, in part, to the impact of the COVID-19 pandemic may have contributed to the effectiveness of the intervention. While our study did not yield statistically significant results (P=.30 and P=.90) regarding the effectiveness of the PRM model in prolonging home stays, the observed trends suggest that technology-assisted aging in place may be a valuable goal for older adults. Further study is required to understand if longer follow-up time allows more effects of PRM on patients' avoidance of higher levels of care to be detected.
背景：加拿大新斯科舍省和安大略省的研究人员实施了一种针对其卫生系统背景的家庭护理被动远程监测（PRM）模式。每个PRM模型都将定制的PRM设备（例如，运动传感器，摄像头和门报警器）集成到家庭护理患者的住所中，目的是将患者，家人和朋友护理人员以及医疗保健提供者联系起来，以支持老年人的衰老。目的：本研究的目的是检查在家中使用PRM技术来支持老年人的安全老化，并避免或延迟更高水平的护理。方法：这项多省实用的随机对照试验研究了PRM技术如何支持老年人安全地留在家中，避免或延迟接受更高水平的护理。在安大略省和新斯科舍省招募了家庭护理患者及其家人和朋友护理人员。参与者对被随机分配到两个条件之一：(1)标准家庭护理（即对照组）或(2)标准家庭护理加研究提供的PRM（即干预）。参与者提供了他们的省级医疗保险号码，以便与省级卫生管理数据库连接，并确定患者在1年后是否接受了更高水平的护理。采用Cox比例风险模型评价各省的主要结局。结果：共招募了313对患者-护理者：安大略174对(干预：n=60；对照组：n=114)，新斯科舍省139对(干预组：n=45；控制:n = 94)。结果表明，在安大略省，PRM与患者入院接受更高级别护理的风险降低30%（风险比0.7,95% CI 0.3-1.4）相关，而在新斯科舍省，PRM与患者入院接受更高级别护理的风险没有降低相关（风险比1.1,95% CI 0.3-3.7）。调整患者性别对两省的模型估计都没有影响。结论：部分与COVID-19大流行影响相关的局限性可能有助于干预措施的有效性。而我们的研究没有产生统计学上显著的结果(P=。30和P=.90)关于PRM模型在延长家庭住宿方面的有效性，观察到的趋势表明，技术辅助老龄化可能是老年人的一个有价值的目标。需要进一步的研究来了解更长的随访时间是否允许检测到PRM对患者逃避更高水平护理的更多影响。试验注册：ISRCTN ISRCTN79884651；https://www.isrctn.com/ISRCTN79884651.International注册报告标识符（irrid）： RR2-10.2196/15027。
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