Rita N Bakhru,Lori Flores,J Maycee Cain,Valesha Province,Jason Fanning,Himanshu Rawal,Richa Bundy,Corey S Obermiller,Adam Moses,Ajay Dharod,Lindsey Abdelfattah,Amresh Hanchate,D Clark Files
{"title":"icu后远程医疗模式(WFIT)的随机对照试验","authors":"Rita N Bakhru,Lori Flores,J Maycee Cain,Valesha Province,Jason Fanning,Himanshu Rawal,Richa Bundy,Corey S Obermiller,Adam Moses,Ajay Dharod,Lindsey Abdelfattah,Amresh Hanchate,D Clark Files","doi":"10.1164/rccm.202411-2167oc","DOIUrl":null,"url":null,"abstract":"RATIONALE\r\nSurvivors of critical illness are at high risk for poor long-term outcomes including readmissions, reduced quality of life, and mortality. A post-ICU telehealth care model may improve outcomes.\r\n\r\nOBJECTIVES\r\nWe sought to evaluate the cost-effectiveness and clinical efficacy of a post-ICU telehealth care model.\r\n\r\nMETHODS\r\nWe performed a single center randomized controlled trial of 400 ICU patients with sepsis and/or acute respiratory failure, who had ≤2 hospital admissions in the past year, and who were not admitted from or discharged to hospice, a skilled nursing facility or a long-term acute care hospital. The intervention group had scheduled telehealth visits at 1- and 2- weeks post-ICU discharge and as needed for six months with a clinician trained in post-ICU recovery. The primary outcome is cost-effectiveness of the intervention.\r\n\r\nMEASUREMENTS AND MAIN RESULTS\r\nOverall healthcare spending on ER visits and hospitalizations were a mean (SD, in USD) $7,801.10 (15,461.03) in the attention control group vs 8,086.50 (17,464.87) in the intervention group, with a calculated incremental net benefit of $1,958.29 (-$5,779.56, $9,696.14). ER visits to our health care system were the same between groups, but patient-reported ER visits to outside hospitals were different (0.97 per 100 patients per month in the attention control group vs 2.43 in the intervention group, p=0.03). Readmissions, mortality, quality of life scores and overall patient satisfaction scores were similar between groups.\r\n\r\nCONCLUSIONS\r\nThis randomized controlled trial of a post-ICU telehealth intervention demonstrated wide variation, but no clear incremental net benefit compared to standard care.","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"42 1","pages":""},"PeriodicalIF":19.4000,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A Randomized Controlled Trial of a Post-ICU Telehealth Care Model (WFIT).\",\"authors\":\"Rita N Bakhru,Lori Flores,J Maycee Cain,Valesha Province,Jason Fanning,Himanshu Rawal,Richa Bundy,Corey S Obermiller,Adam Moses,Ajay Dharod,Lindsey Abdelfattah,Amresh Hanchate,D Clark Files\",\"doi\":\"10.1164/rccm.202411-2167oc\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"RATIONALE\\r\\nSurvivors of critical illness are at high risk for poor long-term outcomes including readmissions, reduced quality of life, and mortality. A post-ICU telehealth care model may improve outcomes.\\r\\n\\r\\nOBJECTIVES\\r\\nWe sought to evaluate the cost-effectiveness and clinical efficacy of a post-ICU telehealth care model.\\r\\n\\r\\nMETHODS\\r\\nWe performed a single center randomized controlled trial of 400 ICU patients with sepsis and/or acute respiratory failure, who had ≤2 hospital admissions in the past year, and who were not admitted from or discharged to hospice, a skilled nursing facility or a long-term acute care hospital. The intervention group had scheduled telehealth visits at 1- and 2- weeks post-ICU discharge and as needed for six months with a clinician trained in post-ICU recovery. The primary outcome is cost-effectiveness of the intervention.\\r\\n\\r\\nMEASUREMENTS AND MAIN RESULTS\\r\\nOverall healthcare spending on ER visits and hospitalizations were a mean (SD, in USD) $7,801.10 (15,461.03) in the attention control group vs 8,086.50 (17,464.87) in the intervention group, with a calculated incremental net benefit of $1,958.29 (-$5,779.56, $9,696.14). ER visits to our health care system were the same between groups, but patient-reported ER visits to outside hospitals were different (0.97 per 100 patients per month in the attention control group vs 2.43 in the intervention group, p=0.03). Readmissions, mortality, quality of life scores and overall patient satisfaction scores were similar between groups.\\r\\n\\r\\nCONCLUSIONS\\r\\nThis randomized controlled trial of a post-ICU telehealth intervention demonstrated wide variation, but no clear incremental net benefit compared to standard care.\",\"PeriodicalId\":7664,\"journal\":{\"name\":\"American journal of respiratory and critical care medicine\",\"volume\":\"42 1\",\"pages\":\"\"},\"PeriodicalIF\":19.4000,\"publicationDate\":\"2025-06-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of respiratory and critical care medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1164/rccm.202411-2167oc\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of respiratory and critical care medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1164/rccm.202411-2167oc","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
A Randomized Controlled Trial of a Post-ICU Telehealth Care Model (WFIT).
RATIONALE
Survivors of critical illness are at high risk for poor long-term outcomes including readmissions, reduced quality of life, and mortality. A post-ICU telehealth care model may improve outcomes.
OBJECTIVES
We sought to evaluate the cost-effectiveness and clinical efficacy of a post-ICU telehealth care model.
METHODS
We performed a single center randomized controlled trial of 400 ICU patients with sepsis and/or acute respiratory failure, who had ≤2 hospital admissions in the past year, and who were not admitted from or discharged to hospice, a skilled nursing facility or a long-term acute care hospital. The intervention group had scheduled telehealth visits at 1- and 2- weeks post-ICU discharge and as needed for six months with a clinician trained in post-ICU recovery. The primary outcome is cost-effectiveness of the intervention.
MEASUREMENTS AND MAIN RESULTS
Overall healthcare spending on ER visits and hospitalizations were a mean (SD, in USD) $7,801.10 (15,461.03) in the attention control group vs 8,086.50 (17,464.87) in the intervention group, with a calculated incremental net benefit of $1,958.29 (-$5,779.56, $9,696.14). ER visits to our health care system were the same between groups, but patient-reported ER visits to outside hospitals were different (0.97 per 100 patients per month in the attention control group vs 2.43 in the intervention group, p=0.03). Readmissions, mortality, quality of life scores and overall patient satisfaction scores were similar between groups.
CONCLUSIONS
This randomized controlled trial of a post-ICU telehealth intervention demonstrated wide variation, but no clear incremental net benefit compared to standard care.
期刊介绍:
The American Journal of Respiratory and Critical Care Medicine focuses on human biology and disease, as well as animal studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients. Papers that are solely or predominantly based in cell and molecular biology are published in the companion journal, the American Journal of Respiratory Cell and Molecular Biology. The Journal also seeks to publish clinical trials and outstanding review articles on areas of interest in several forms. The State-of-the-Art review is a treatise usually covering a broad field that brings bench research to the bedside. Shorter reviews are published as Critical Care Perspectives or Pulmonary Perspectives. These are generally focused on a more limited area and advance a concerted opinion about care for a specific process. Concise Clinical Reviews provide an evidence-based synthesis of the literature pertaining to topics of fundamental importance to the practice of pulmonary, critical care, and sleep medicine. Images providing advances or unusual contributions to the field are published as Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences.
A recent trend and future direction of the Journal has been to include debates of a topical nature on issues of importance in pulmonary and critical care medicine and to the membership of the American Thoracic Society. Other recent changes have included encompassing works from the field of critical care medicine and the extension of the editorial governing of journal policy to colleagues outside of the United States of America. The focus and direction of the Journal is to establish an international forum for state-of-the-art respiratory and critical care medicine.