Telemedicine Impact on Reducing Cardiovascular Risk in Underserved Patients?,William P. Santamore, PhD, Carol Homko, PhD, Robert Cross, MD, Michele Masucci, PhD, Philip Berger, Alfred A. Bove, MD, PhD Temple University, Philadelphia, PA 15th GW-ICC 2004,Temple Telemedicine Research Center 远程医疗研究中心,我愿借此机会向盛情邀请我为本次长城会议 主席团成员的胡大一先生表示由衷的感谢。 同时也对那些为此而付出辛勤劳动的工作人员表示感谢。 我还要感谢我的同事们： Bove, Homko, Masucci, and Cross 医生, 以及我们的试验员 Philip Berger,What is Telemedicine?,Use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or health care provider for the purpose of improving patient care,Telemedicine - Approaches,Non-Face-to-Face Transactions,Traditional Approach,Image, X-ray,Mailed,Medical Specialists Reviews and Sends a Report,Telemedicine Approach,Electronic Transfer,Image, X-ray,Medical Specialists Reviews and Sends a Report,Examples - Radiology, Dermatology, Pathology,Telemedicine - Approaches,Traditional Face-to-Face,Patient (+ Doctor),Patient (+ Doctor),Doctor or Specialists,Doctor or Specialists,Via Video Conferencing,In Same Room,Traditional Approach,Telemedicine Approach,Examples Office Visit, Consultation,Telemedicine - Approaches,Non-Traditional Asynchronous Doctor not in direct contact with Patient,Examples Letter to Doctor Telephone Call to Nurse E-mail,Telemedicine - Approaches,Non-Traditional Asynchronous,Telemedicine Approach,BP, Weight, Steps,Patient,Doctor,Internet,Secure Telemedicine System,Internet,Outline,Elements Driving Design National Priority Computerize Medical System High Rate of CVD Risk Factors Obesity Cost,Increased Risk for Cardiovascular Disease in African-Americans,Compared with white women, African-American women are more likely to live in poverty, and have less education; Experience greater weight gain during childhood, and have lower resting metabolic rates, physical activity energy expenditures. About half of African-American women are considered obese (BMI 30), more than 15% between 40 to 59 yrs old have extreme obesity (BMI 40),Increased Risk for Cardiovascular Disease in African-Americans,AAs have a prevalence of diabetes: 19% for AA women compared to 7% for white women, and 16% for AA men compared to 8% for white men AAs have a 40% greater prevalence of hypertension compared to whites. Roughly 1 in 3 AAs has hypertension. AAs have a rate of multiple risk factors.,2002,Obesity Trends* Among U.S. Adults BRFSS, 1991-2002,No Data 10% 10%14% 15%19% 20%24% 25%,(*BMI 30, or 30 lbs overweight for 5 4” woman),Implications,African-American have a high prevalence of CVD risk factors. These risk factors can be effective treated with current medical therapy. Suboptimal control of risk factors contributes to the excess CVD mortality among AAs.,Main Study,Test if a Telemedicine System by Frequent Communication with Health Care Providers and by Education Can Decrease Cardiovascular Disease Risk in Underserved Patient Populations.,Main Study,Design 450 patients with 10% or Greater CVD Risk & with treatable CVD Risk Factors Goal 5% in CVD Risk Subjects - AA and Rural White PA Patients Expected Outcome 25% Controls in CVD Risk 37.5% Telemedicine in CVD Why in Medication Better Control of HTN, Hyerlipidermia Less Tobacco Abuse Diabetes Control Timing Office Visits, Lab Testing,Increased Risk,Telemedicine Intervention,Change in Behavior,Reduced Risk,Cognitive Change,Patient Factors,Doctor Factors,Baseline Assessment,Blood Pressure, Lipids, Smoking, Diabetes Questionnaires Medical Knowledge, Health Locus of Control, Self-Efficacy, Diabetes Empowerment Six Minute Walk Test,CVD Risk at Baseline,Typical CVD Risk at Baseline,* Circulation 97:1837-,Telemedicine Screens,Patient Doctor Input Data Pt Review Medications Medications Current Risk Lab Data Trends Scheduler Education User Log,Feedback to Practice,TTRC,Telemedicine System,Doctor,Patient,Monthly and Quarterly Reports Sent to Both Patient and Doctor,Feedback to Practice,“Your patient has been provided with a copy.” Framingham CVD Risk Score: 12%,Telemedicine Current Use,Telemedicine Patient Trends,Telemedicine Patient Trends,Telemedicine Patient Trends,Expected Outcomes,Telemedicine Group CVD Risk than the Control Group Why Better control of BP, Lipids, Smoking Cessation Determine Factors Contributing to Success and to Failure,Planned Updates,Temple Telemedicine Research Center,Thank You Williamsantamore,WEB,DB,Internet,T1,Internal Network,Switch,VLAN-Capable Switch to support Logical VLANs,VLAN1,VLAN2,VLAN4,Clustered Web Servers,VLAN5-6,Router,Backup Server,VLAN3,Database Server,IDS,Monitoring Workstation,Security,