Health information technology interventions reduce avoidable readmissions in cirrhosis: The HEROIC randomized controlled trial.

Enhanced engagement using health information technology (HIT) interventions and caregivers lowered readmissions in an open-label study of the Patient Buddy App (PBA).

在一项开放标签研究中，通过使用健康信息技术（HIT）干预和护理人员的增强参与，降低了患者伙伴应用程序（PBA）的再入院率。

Aim: Multicenter trial of PBA versus standard of care (SOC) to reduce avoidable readmissions.

目的：进行多中心试验，比较PBA与标准治疗（SOC）在减少可避免的再入院方面的效果。

approach_and_results

An open-label, randomized clinical trial was performed at 3 sites to study the effect of PBA (HIT) versus SOC in cirrhosis inpatients with adult caregivers (dyads).

在3个地点进行了一项开放标签、随机临床试验，以研究PBA（HIT）与SOC在有成人护理人员（双人组）的肝硬化住院患者中的效果。

Initial randomization was 1:1:1 between SOC, HIT only, and HIT+ visits.

初始随机化比例为1:1:1，分为标准治疗组（SOC）、仅高剂量他莫昔芬（HIT）组和高剂量他莫昔芬加访视（HIT+）组。

However, due to COVID-19, an unplanned study redesign required a combined HIT versus SOC.

然而，由于COVID-19疫情，研究进行了非计划性的重新设计，需要将高剂量他莫昔芬组（HIT）与标准治疗组（SOC）进行合并对比。

Primary outcome: Avoidable readmissions (decided by a blinded monitoring board).

主要结果：可避免的再入院（由一个盲法监测委员会决定）。

Secondary outcomes were all-cause readmission and stakeholder input.

次要结果包括全因再入院和利益相关者的反馈。

PBA focused on medication adherence, cognitive testing, and symptoms, and was remotely monitored by study staff.

PBA 专注于药物依从性、认知测试和症状，并由研究团队远程监控。

In all, 464 subjects (232 dyads) were enrolled [Virginia Commonwealth University (VCU): 120, Mayo: 40, Department of Veterans Affairs (VA): 72; 116 dyads/group].

共有464名受试者（232对）参与研究[弗吉尼亚联邦大学（VCU）：120名，梅奥诊所：40名，退伍军人事务部（VA）：72名；每组116对受试者]。

Avoidable readmissions were significantly higher in SOC versus HIT (19.8% vs. 10.3%, p =0.04) with OR of 2.14 (95% CI 1.01-4.54) and remained significant even after removing pre-COVID HIT+ visits patients (19.8% vs. 9.3%, p =0.040) with OR of 2.41 (95% CI 1.02-5.69).

SOC组的可避免再入院率显著高于HIT组（19.8%对比10.3%，p=0.04），优势比为2.14（95%置信区间1.01-4.54），即使在剔除COVID-19疫情前的HIT+访问患者后，差异仍然显著（19.8%对比9.3%，p=0.040），优势比为2.41（95%置信区间1.02-5.69）。

All-cause readmissions were higher in SOC versus HIT (48% vs. 30%, p =0.005).

SOC组的全因再入院率高于HIT组（48%对比30%，p=0.005）。

App evaluation/engagement: 1660 alerts were sent; mostly related to HE.

应用程序评估/参与度：发送了1660条警报；大多数与健康教育（HE）相关。

Most dyads were satisfied with the app.

大多数患者及其家属对应用程序感到满意。

Conclusions

In a multicenter randomized clinical trial of 464 cirrhosis inpatients and their CGs across several practice settings, the PBA was associated with lower avoidable readmissions at 30 days post-discharge compared to SOC.

在一项涉及464名肝硬化住院患者及其照顾者（CGs）的多中心随机临床试验中，与标准护理（SOC）相比，PBA与出院后30天内较低的可避免再入院率相关。