한빛사논문
- 조회374
Jung‑Yeon Choi1†, Hongsoo Kim2,3,4†, Seungyeon Chun2, Young‑il Jung5, Sooyoung Yoo6, In‑Hwan Oh7, Gi‑Soo Kim8, Jin Young Ko9, Jae‑Young Lim9,10, Minho Lee11, Jongseon Lee12 and Kwang‑il Kim1,13*
1Departments of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
2Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
3Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea.
4Institute of Aging, Seoul National University, Seoul, Republic of Korea.
5Department of Environmental Health, Korea National Open University, Seoul, Republic of Korea.
6Healthcare ICT Research Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
7Department of Preventive Medicine, Kyung Hee University, Seoul, Republic of Korea.
8Department of Industrial Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea.
9Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
10Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
11Healthcare Convergence R&D Center, ezCaretech Co. Ltd, Seoul, Republic of Korea.
12Healthcare Convergence R&D Center, Healthconnect Co. Ltd, Seoul, Republic of Korea.
13Departments of Internal Medicine, Seoul National University College of Medicine, 82 Gumi‑ro, 173 Beon‑gil, Bundang‑gu, Seongnam‑si, Kyeongi‑do 13620, Republic of Korea.
†Jung-Yeon Choi and Hongsoo Kim contributed equally to this study.
*Correspondence: Kwang‑il Kim
Abstract
Background: To examine the effectiveness and safety of a data sharing and comprehensive management platform for institutionalized older patients.
Methods: We applied information technology-supported integrated health service platform to patients who live at long-term care hospitals (LTCHs) and nursing homes (NHs) with cluster randomized controlled study. We enrolled 555 patients aged 65 or older (461 from 7 LTCHs, 94 from 5 NHs). For the intervention group, a tablet-based platform comprising comprehensive geriatric assessment, disease management, potentially inappropriate medication (PIM) management, rehabilitation program, and screening for adverse events and warning alarms were provided for physicians or nurses. The control group was managed with usual care. Co-primary outcomes were (1) control rate of hypertension and diabetes, (2) medication adjustment (PIM prescription rate, proportion of polypharmacy), and (3) combination of potential quality-of-care problems (composite quality indicator) from the interRAI assessment system which assessed after 3-month of intervention.
Results: We screened 1119 patients and included 555 patients (control; 289, intervention; 266) for analysis. Patients allocated to the intervention group had better cognitive function and took less medications and PIMs at baseline. The diabetes control rate (OR = 2.61, 95% CI 1.37-4.99, p = 0.0035), discontinuation of PIM (OR = 4.65, 95% CI 2.41-8.97, p < 0.0001), reduction of medication in patients with polypharmacy (OR = 1.98, 95% CI 1.24-3.16, p = 0.0042), and number of PIMs use (ꞵ = - 0.27, p < 0.0001) improved significantly in the intervention group. There was no significant difference in hypertension control rate (OR = 0.54, 95% CI 0.20-1.43, p = 0.2129), proportion of polypharmacy (OR = 1.40, 95% CI 0.75-2.60, p = 0.2863), and improvement of composite quality indicators (ꞵ = 0.03, p = 0.2094). For secondary outcomes, cognitive and motor function, quality of life, and unplanned hospitalization were not different significantly between groups.
Conclusions: The information technology-supported integrated health service effectively reduced PIM use and controlled diabetes among older patients in LTCH or NH without functional decline or increase of healthcare utilization.
논문정보
- Research article
- 2024년 05월 (BRIC 등록일 2024-05-29)
- 국내 연구진
- 의약학 > 응용의학
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