FUNCTIONAL MODEL OF ORGANIZATION OF REMOTE CARDIOLOGICAL REHABILITATION ON THE BASIS OF INTERNET- AND MOBILE TECHNOLOGIES
The development and introduction of modern technologies of cardiac rehabilitation (CR) and secondary prevention, implementing the principles of patient-orientation, suggest a certain organizational transformation, the purpose of which is to increase the role of the patient. Modern communications linking different levels of rehabilitation observation (early inpatient, specialized inpatient, outpatient) increase the availability of specialized observation as a whole. Objective study: to develop a functional model of the organization of an outpatient hospital using electronic and mobile health care tools. Material and methods. The design used the PDCA methodology (Deming cycle) with the implementation of a step-by-step algorithm for doctor-patient interactions: «Plan - Do - Chec - Akt». The conceptual model is built on the principles of the patient’s “managed self-help”. The main elements of the functional model are: office computerized counseling, remote monitoring based on home registration devices with the function of feedback and decision-making of the doctor and patient in the system of remote cardiac rehabilitation (DKR). Results. The step-by-step PDCA algorithm is implemented as a block (modular) type of grouping of elements. The modular structure of the DKR organization is presented with a description of the functionality, execution tools and results of the model stages. Discussion. In the described model, the DKR organization attempted to combine 1) traditional CR methods with proven safety and efficiency; 2) principles of organization of patient-oriented care; 3) the methodology for continuous quality improvement of PDCA; 4) remote patient monitoring technology. Conclusion. The results of the presented development were correlated with the capabilities of modern information and communication technologies and evidence-based knowledge in the field of the Kyrgyz Republic and are proposed as a potential method of overcoming organizational barriers and the development of modern methods of providing rehabilitation assistance.
About the authorsKotel’nikova Elena V.
Aronov D.M., Kozlova L.V., Bubnova M.G. The current state and problems of cardiac rehabilitation in Russia. CardioSomatika. 2017; 8(3): 5-9. Doi: http://dx.doi.org/10.26442/2221-7185_8.3.5-9 (in Russian)
Bubnova M.G., Aronov D.M., Ivanova G.E., Boytsov S.A., Andreev A.G., Barbarash O.L., et al. Pilot project «Development of the system of rehabilitation of patients with cardiovascular diseases in medical institutions of the Russian Federation». The results of a three-year observation. Vestnik vosstanovitel’noy meditsiny. 2015; (4): 2-11. (in Russian)
Aronov D.M., Bubnova M.G. Problems of introducing a new cardiorehabilitation system in Russia. Rossiyskiy kardiologicheskiy zhurnal. 2013; (4):14-22. Doi: http://dx.doi.org/10.15829/1560-4071-2013-4-14-22 (in Russian)
Anderson L., Oldridge N., Thompson D.R., Zwisler A., Rees.K., Martin.N., et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Systematic Review and Meta-analysis. J. Am. Coll. Card. 2016; 67(1): 1-12. Doi: http://dx.doi.org/10.1016/j.jacc.2015.10.044
Dressler C. Using the theory of planned behaviour when designing motivational letters: Exploring through patient interviews how determinants of behaviour are operationalised in letters of invitation to cardiac rehabilitation. Nurs. Pract. Today. 2018; 5(4): 403-12. Doi: https://doi.org/10.18502/npt.v5i4.119
WHO. World Report on Disability. Summary. Geneva; 2011. Available at: https://apps.who.int/iris/bitstream/handle/10665/70670/WHO_NMH_VIP_11.01_eng.pdf
Nolte E., McKee M. Caring for people with chronic conditions: a health system perspective. 2008. Available at: http://www.euro.who.int/__data/assets/pdf_file/0006/96468/E91878.pdf
Clark A.M., King-Shier K.M, Spaling M.A., Duncan A.S., Stone J.A., Jaglal S.B., et al. Factors influencing participation in cardiac rehabilitation programmes after referral and initial attendance: qualitative systematic review and meta-synthesis. Clin. Rehabil. 2012; 27(10): 948-59. Doi: http://dx.doi.org/10.1177/0269215513481046
Riegel B., Moser D.K., Anker S.D., Appel L.J., Dunbar S.B., Grady K.L., et al. State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association. Circulation. 2009; 120(12):1141-63. Doi: http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192628
Deming W.E. Out of the Crisis. Cambridge, MA: MIT Center for Advanced Engineering Study; 1982.
Attfieldt S.J., Adams A., Blandford A. Patient in formation needs: pre- and post-consultation. Health Informatics J. 2006; 12(2): 165-77. Doi: http://dx.doi.org/10.1177/14604582060638117
Russian clinical guidelines. Acute myocardial infarction with ST segment elevation of an electrocardiogram: rehabilitation and secondary prevention. CardioSomatika. 2014; (Suppl. 1): 5-41. (in Russian)
Kraal J.J., Van den Akker-Van Marle M.E., Abu-Hanna A., Stut W., Peek N., Kemps H.M. Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: Results of the FIT@Home study. Eur. J. Prev. Cardiol. 2017; 24(12): 1260-73. Doi: http://dx.doi.org/10.1177/2047487317710803
Keib C.N, Reynolds N.R., Ahijevych K.L. Poor сardiac rehabilitation utilization among older adults: a self-regulatory model for tailored interventions. Heart Lung. 2010; 39(6): 504-11. Doi: http://dx.doi.org/10.1016/j.hrtlng.2009.11.006
Jackson L., Leclerc J., Erskine Y., Linden W. Getting the most out of cardiac rehabilitation: a review of referral and adherence predictors. Heart. 2005; 91(1): 10-4. Doi: http://dx.doi.org/10.1136/hrt.2004.045559
WHO. Innovative care for chronic conditions: building blocks for action. WHO global report. 2002. Available at: https://apps.who.int/iris/bitstream/handle/10665/42500/WHO_NMC_CCH_02.01.pdf
Rohrbach G., Schopfer D.W., Krishnamurthi N., Pabst M., Bettencourt M., Loomis J., et al. The Design and Implementation of a Home-Based Cardiac Rehabilitation Program. Fed. Pract. 2017; 34(5): 34-9.
Taylor M.J., McNicholas C., Nicolay C., Darzi A., Bell D., Reed J.E. Systematic review of the application of the plan-do-study-act method to improve quality in health care. BMJ Qual. Saf. 2014; 23(4): 290-8. Doi: http://dx.doi.org/10.1136/bmjqs-2013-001862
Hammill B.G., Curtis L.H., Schulman K.A., Whellan D.J. Relationship between cardiac rehabilitation and long-term risks of death and myocardial infarction among elderly Medicare beneficiaries. Circulation. 2010; 121(1):63-70. Doi: http://dx.doi.org/10.1161/CIRCULATIONAHA.109.876383.
Smith S.C., Benjamin E.I., Bonou R.O., Braun L.T., Creager M.A., Franklin B.A., et al. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011; 124(22): 2458-73. Doi: http://dx.doi.org/10.1161/CIR.0b013e318235eb4d.
WHO. Global diffusion of еHealth: Making universal health coverage achievable. Report of the third global survey on eHealth. Global Observatory for eHealth. 2016. Available at: https://apps.who.int/iris/bitstream/handle/10665/252529/9789241511780-eng.pdf
Lyamina N.P., Kotel’nikova E.V. Computer technology in the organization of rehabilitation activities in primary health care in patients with coronary heart disease. Zdravookhranenie Rossiyskoy Federatsii. 2010; 54(5): 32-5. (in Russian)
- Refbacks are not listed
Контент доступен под лицензией Creative Commons Attribution 3.0 License.