A Randomized Controlled Trial of a Post-ICU Telehealth Care Model (WFIT).

A post-ICU telehealth care model may improve outcomes.

一种基于ICU后的远程医疗护理模式可能会改善这些结果。

Objectives: We sought to evaluate the cost-effectiveness and clinical efficacy of a post-ICU telehealth care model.

目的：我们旨在评估重症监护病房（ICU）出院后远程医疗护理模式的成本效益和临床疗效。

Methods: We performed a single-center randomized controlled trialof 400 ICU patients with sepsis and/or acute respiratory failure, who had two or fewer 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 after ICU discharge and as needed for 6 months with a clinician trained in post-ICU recovery.

方法：我们进行了一项单中心随机对照试验，纳入了400名患有败血症和/或急性呼吸衰竭的ICU患者，这些患者在过去一年内住院次数不超过两次，并且没有从临终关怀机构、专业护理设施或长期急性护理医院转入或转出。干预组在ICU出院后1周和2周进行了预定的远程医疗访问，并在随后的6个月内根据需要与接受过ICU康复培训的临床医生进行远程医疗访问。

The primary outcome is the cost-effectiveness of the intervention.

主要结果是干预措施的成本效益。

Measurements and Main Results: Overall healthcare spending on emergency room (ER) visits and hospitalizations were a mean (SD, in U.S. dollars) $7,801.10 ($15,461.03) in the attention control group versus $8,086.50 ($17,464.87) in the intervention group, with a calculated incremental net benefit of $1,958.29 (-$5,779.56 to $9,696.14).

测量和主要结果：急诊（ER）就诊和住院的总体医疗支出在注意力对照组中平均（标准差，以美元计）为7,801.10美元（15,461.03美元），而在干预组中为8,086.50美元（17,464.87美元），计算得出的增量净效益为1,958.29美元（-5,779.56美元至9,696.14美元）。

ER visits to our healthcare 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).

我们医疗系统中的急诊室（ER）就诊次数在两组之间没有差异，但患者报告的在其他医院的急诊室就诊次数有所不同（对照组为每100名患者每月0.97次，干预组为2.43次；P = 0.03）。

Readmissions, mortality, quality-of-life scores, and overall patient satisfaction scores were similar between groups.

两组之间的再入院率、死亡率、生活质量评分以及总体患者满意度评分相似。

Conclusions: This randomized controlled trialof a post-ICU telehealth intervention demonstrated wide variation but no clear incremental net benefit compared with standard care.

结论：这项针对ICU后远程医疗干预的随机对照试验显示了广泛的变化，但与标准护理相比，并没有明确的增量净效益。

Clinical trial registered with www.clinicaltrials.gov (NCT04576065).

该临床试验已在www.clinicaltrials.gov注册（NCT04576065）。