第四代实时同步远距照护之智慧医疗.pdf

第四代即時同步遠距照護之智慧醫療第四代即時同步遠距照護之智慧醫療 何奕倫教授何奕倫教授 臺大醫院內科部主任臺大醫院內科部主任 臺大醫院遠距照護中心主任臺大醫院遠距照護中心主任 1653 patients who had recently been hospitalized for heart failure to undergo either telemonitoring(826 patients)or usual care(827 patients).Telemonitoring was accomplished by means of a telephone-based interactive voice response system that collected daily information about symptoms and weight that was reviewed by the patients clinicians.N Engl J Med 2010;363:2301-9.We conducted amultisite randomized controlled trial at 4 sites within Mayo Clinics Employee and Community Health program.Telemonitoring deviceIntel Health Guide;Intel-GE)was used in the patients home.The device worked asynchronously,and data were downloaded to a health website,which was then reviewed by the health care team daily(J.L.P.,G.J.H.and others),including weekends and holidays.住院率與急診造訪率統計上無差別 遠距照護收案後住院率反而增加 遠距照護組死亡率增加 Mortality was higher in the tele-monitoring group(14.7%)than in the usual care group(3.9%)(P=.008).Information is not knowledge.By Albert Einstein 資訊不等於知識 愛因斯坦 資料傳輸 病況判斷與分析 結合電子病歷並提供後送醫院與聯絡原主治醫師 第一代 Asynchronous Non-immediate-第二代 Synchronous During office hours-第三代 Synchronous During and out-side office hours -第四代 Synchronous During and out-side office hours+Stefan D Anker et al.Lancet 2011;378:73139 Patient Measurement Case manager Monitor Consult Doctor Record Emergency Record Case Evaluation Telecare in NTUH 24 hrs Stand-by and Monitor Including MDs 10 11 個案即時傳輸 與管理系統 個案 居家系統 資訊 管理系統 個管師 交班系統 心電圖自動 判讀系統 術後傷口照片 感染判讀系統 遠距照護平台遠距照護平台 J Med Internet Res 2013;15(4):e87 Clinical Outcome and Cost-Effectiveness of a Synchronous Telehealth Service for Seniors and Nonseniors with Cardiovascular Diseases:Quasi-Experimental Study Taiwan ELEctroHEALTH study group Ying-Hsien Chen,Yen-Hung Lin,Chi-Sheng Hung,Ching-Chang Huang,Deng-Feng Yeih,Pao-Yu Chuang,Yi-Lwun Ho,Ming-Fong Chen Synchronous telehealth intervention by Telehealth Center National Taiwan University Hospital may reduce costs,decrease all-cause admission rates,and decrease durations of all-cause hospital stays in cardiovascular disease patients,regardless of age.CaseCase-Control studyControl study We retrospectively analyzed 576 patients who has joined telehealth care program at cardiovascular ward and outpatient clinic of National Taiwan University Hospital,to compare with 1178 patients with matched sex,age and Charlson socre.Telehealth care program included synchronized daily biometric data analysis,symptom reporting,and immediate drug adjustment or medical suggestion from an attending physician.The data of hospitalization,ED visit and medical cost were collected from electrical database at the hospital.2013/11/19 Dallas American Heart Association Annual Meeting J Med Internet Res 2014;16:e145 Primary Endpoints 遠距組遠距組(n=576)非遠距組非遠距組(N=1178)p f/u months 20.4 11.4 25.8 14.5 0.001 ER visit overall 1.03 2.06 1.38 2.68 0.001 -adjusted by f/u mo 0.059 0.132 0.094 0.234 0.001 Hospitalization times 0.85 1.83 1.35 2.21 0.001 -adjusted by f/u mo 0.05 0.12 0.11 0.21 0.001 Hospitalization days 10 27.7 15.3 32.3 0.001 -adjusted by f/u mo 0.77 2.78 1.4 3.6 0.001 ICU times .18.49.33.6 0.001 -adjusted by f/u mo .011 .067.036.141 0.001 OPD times 33 33.7 43.7 48.5 0.003 -adjusted by f/u mo 1.57 1.12 1.66 1.78 0.75 unit:NT$/month;p:by ranksum test 2013/11/19 Dallas American Heart Association Annual Meeting/J Med Internet Res 2014;16:e145 Medical cost,mean(SD)Case Control p value Emergency department costs 20.9(66.6)37.3(126.2).001 Hospitalization costs 386.3(1424.3)878.2(2697.2).001 Outpatient clinic visit costs 180.4(278.6)248.2984.6).06 Total medical costs 587.6(1497.8)1163.6(3036.6).001 Total healthcare costs 812.4(1497.8)1163(3036.6).001 Medical cost(US$,per patient-month)2013/11/19 Dallas American Heart Association Annual Meeting Journal of Medical Internet Ressearch 2014;16:e145 接受遠距照護服務，可顯著降低個案接受遠距照護服務，可顯著降低個案死亡率。死亡率。16 慢性心血管疾病的病患進行世代研究，在遠距照護組有53 人(9.3%)死亡，而在對照組有 136人(11.5%)死亡。結果發現遠距照護對於整體死亡率的風險比(hazard ratio)為0.866。顯示第四代遠距照護在考慮所有慢性共病症之下，比對照組仍有較少的死亡率。J Med Internet Res.2016 May 13;18(5):e102.Hazard Ratio of Allcause Mortality(N=1754)Clinical predictors Hazard ratio(95%Confidence interval)p-value Age(years)1.019(1.018 1.021)69.809(years)1.890(1.810 1.974)69.809(years)Telehealth 0.837(0.788 0.889).001 Male 1.152(1.125 1.179).001 Telehealth 0.866(0.810 0.926).001 Telehealth Time-to-mortality(days)0.9997(0.9996 0.9998).001 Myocardial infarction 1.097(1.051 1.146)65 N=439 總計 N=965 敏感度 100.00%(39.76%100.00%)9444%(72.71%99.86%)95.45%(77.16%99.88%)特異度 98.66%(97.26%99.46%)96.44%(94.19%97.99%)97.67%(96.49%98.53%)陽性預測值 36.36%(21.49%54.39%)53.12%(40.51%65.35%)48.84%(38.47%59.30%)陰性預測值 100.00%99.75%(98.37%99.96%)99.89%(99.27%99.98%)疾病盛行率 0.68%(4/590)5.42%(18/332)2.39%(22/922)AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm is feasible.JMIR Mhealth and Uhealth 2017;5(9):e135 JMIR Mhealth and Uhealth 2017;5(9):e135 通訊診察門診 6/12/2020 29 通訊診察門診 1.2009年榮獲教育部98年度政府服務品質獎 2.2009年遠距照護中心主任何奕倫醫師獲頒第一屆遠距照護聯盟傑出貢獻獎 3.2010年榮獲第二屆政府服務品質獎 4.2012年獲得國家生技醫療品質獎特色醫療組SNQ國家品質標章認證 5.2013年獲得國家生技醫療品質獎護理組SNQ國家品質標章認證 6.2013年獲得國家生技醫療品質獎醫療院所類/醫院特色組SNQ國家品質標章認證 7.2013年獲得醫策會智慧醫院資訊整合專案獎座第一名之最高殊榮 8.2013年獲得醫策會智慧醫院資訊整合專案認證標章 9.2013年榮獲經濟部第三屆產業創新學術獎 10.2013年遠距照護中心主任何奕倫醫師榮獲經理人雜誌第六屆100MVP經理人 11.2014年榮獲第十一屆國家生技醫療產業策進會國家新創獎 12.2014年獲得國家生技醫療品質獎護理組SNQ國家品質標章認證 13.2014年獲得國家生技醫療品質獎醫療院所類/醫院特色組SNQ國家品質標章認證 14.2015年榮獲經濟部第四屆國家產業創新獎-創新菁英獎 15.2016年榮獲第19屆國家生技醫療品質獎-銀獎 16.2016年榮獲第13屆國家新創獎-學研新創獎 17.2016年獲得國家生技醫療品質獎護理組SNQ國家品質標章認證 18.2016年獲得國家生技醫療品質獎醫療院所類/醫院特色組SNQ國家品質標章認證 19.2017年榮獲財團法人醫院評鑑暨醫療品質策進會第18屆醫療品質獎(HQIC)競賽-佳作 20.2017年獲得財團法人醫院評鑑暨醫療品質策進會第18屆醫療品質獎(HQIC)標章 21.2017年獲得國家生技醫療品質獎醫療院所類/醫院特色組SNQ國家品質標章認證 22.2017年獲得國家生技醫療品質獎護理照護服務類/護理特色專科組SNQ國家品質標章認證 23.2018年獲得國家生技醫療品質獎醫療院所類/醫院特色組SNQ國家品質標章認證 24.2019年獲得國家生技醫療品質獎醫療院所類/醫院特色組SNQ國家品質標章認證 25.2019年獲得第十六屆國家生技醫療產業策進會續獎通過-創新型遠距照護服務啟動未來健康促進新模式 獲獎記錄獲獎記錄 31 LANDSCAPELANDSCAPE 台灣大學研發處 Landscape 2019 Jan;6:25