National randomized controlled trial of virtual house calls for Parkinson disease

被引：154

作者：

Beck, Christopher A. ^{[1
]}

Beran, Denise B. ^{[2
]}

Biglan, Kevin M. ^{[3
]}

Boyd, Cynthia M. ^{[5
]}

Dorsey, E. Ray ^{[3
,4
]}

Schmidt, Peter N. ^{[2
]}

Simone, Richard ^{[6
]}

Willis, Allison W. ^{[7
,8
]}

Galifianakis, Nicholas B. ^{[9
]}

Katz, Maya ^{[9
]}

Tanner, Caroline M. ^{[9
]}

Dodenhoff, Kristen ^{[9
]}

Aldred, Jason ^{[10
]}

Carter, Julie ^{[11
]}

Fraser, Andrew ^{[11
]}

Jimenez-Shahed, Joohi ^{[12
]}

Hunter, Christine ^{[12
]}

Spindler, Meredith ^{[7
,8
]}

Reichwein, Suzanne ^{[7
,8
]}

Mari, Zoltan ^{[5
]}

Dunlop, Becky ^{[5
]}

Morgan, John C. ^{[13
]}

McLane, Dedi ^{[13
]}

Hickey, Patrick ^{[14
]}

Gauger, Lisa ^{[14
]}

Richard, Irene Hegeman ^{[3
]}

Mejia, Nicte I. ^{[15
]}

Bwala, Grace ^{[15
]}

Nance, Martha ^{[16
]}

Shih, Ludy C. ^{[17
]}

Singer, Carlos ^{[18
]}

Vargas-Parra, Silvia ^{[18
]}

Zadikoff, Cindy ^{[19
]}

Okon, Natalia ^{[19
]}

Feigin, Andrew ^{[20
]}

Ayan, Jean ^{[20
]}

Vaughan, Christina ^{[21
]}

Pahwa, Rajesh ^{[22
]}

Dhall, Rohit ^{[23
]}

Hassan, Anhar ^{[24
]}

DeMello, Steven ^{[25
]}

Riggare, Sara S. ^{[26
]}

Wicks, Paul ^{[27
]}

Achey, Meredith A. ^{[4
]}

Elson, Molly J. ^{[4
]}

Goldenthal, Steven ^{[4
]}

Keenan, H. Tait ^{[4
]}

Korn, Ryan ^{[4
]}

Schwarz, Heidi ^{[3
]}

Sharma, Saloni ^{[4
]}

机构：

[1] Univ Rochester, Dept Biostat & Computat Biol, Rochester, NY 14627 USA

[2] Natl Parkinson Fdn, Miami, FL USA

[3] Univ Rochester, Med Ctr, Dept Neurol, Rochester, NY 14627 USA

[4] Univ Rochester, Med Ctr, Ctr Human Expt Therapeut, Rochester, NY 14627 USA

[5] Johns Hopkins Univ, Sch Med, Dept Med, Div Geriatr Med & Gerontol, Baltimore, MD 21205 USA

[6] Simone Consulting, Sunnyvale, CA USA

[7] Univ Penn, Perelman Sch Med, Dept Neurol, Philadelphia, PA 19104 USA

[8] Univ Penn, Perelman Sch Med, Dept Biostat & Epidemiol, Philadelphia, PA 19104 USA

[9] Univ Calif San Francisco, San Francisco, CA 94143 USA

[10] Northwest Neurol PLLC, Spokane, WA USA

[11] Oregon Hlth & Sci Univ, Portland, OR 97201 USA

[12] Baylor Coll Med, Houston, TX 77030 USA

[13] Augusta Univ, Augusta, GA USA

[14] Duke Med Ctr, Durham, NC USA

[15] Massachusetts Gen Hosp, Boston, MA 02114 USA

[16] Struthers Parkinsons Ctr, Minneapolis, MN USA

[17] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA

[18] Univ Miami, Coral Gables, FL 33124 USA

[19] Northwestern Univ, Evanston, IL USA

[20] Northwell Hlth, Feinstein Inst Med Res, Manhasset, NY USA

[21] Med Univ South Carolina, Charleston, SC USA

[22] Univ Kansas, Med Ctr, Kansas City, KS 66103 USA

[23] Parkinsons Inst, Sunnyvale, CA USA

[24] Mayo Clin, Rochester, MN USA

[25] Univ Calif Berkeley, CITRIS, Berkeley, CA 94720 USA

[26] Karolinska Inst, Hlth Informat Ctr, Stockholm, Sweden

[27] PatientsLikeMe, Derby, England

来源：

NEUROLOGY | 2017年 / 89卷 / 11期

关键词：

CARE; TELEMEDICINE; ACCESS;

D O I：

10.1212/WNL.0000000000004357

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Objective: To determine whether providing remote neurologic care into the homes of people with Parkinson disease (PD) is feasible, beneficial, and valuable. Methods: In a 1-year randomized controlled trial, we compared usual care to usual care supplemented by 4 virtual visits via video conferencing from a remote specialist into patients' homes. Primary outcome measures were feasibility, as measured by the proportion who completed at least one virtual visit and the proportion of virtual visits completed on time; and efficacy, as measured by the change in the Parkinson's Disease Questionnaire-39, a quality of life scale. Secondary outcomes included quality of care, caregiver burden, and time and travel savings. Results: A total of 927 individuals indicated interest, 210 were enrolled, and 195 were randomized. Participants had recently seen a specialist (73%) and were largely college-educated (73%) and white (96%). Ninety-five (98% of the intervention group) completed at least one virtual visit, and 91% of 388 virtual visits were completed. Quality of life did not improve in those receiving virtual house calls (0.3 points worse on a 100-point scale; 95% confidence interval [CI] 22.0 to 2.7 points; p = 0.78) nor did quality of care or caregiver burden. Each virtual house call saved patients a median of 88 minutes (95% CI 70-120; p < 0.0001) and 38 miles per visit (95% CI 36-56; p < 0.0001). Conclusions: Providing remote neurologic care directly into the homes of people with PD was feasible and was neither more nor less efficacious than usual in-person care. Virtual house calls generated great interest and provided substantial convenience. ClinicalTrials.gov identifier: NCT02038959. Classification of evidence: This study provides Class III evidence that for patients with PD, virtual house calls from a neurologist are feasible and do not significantly change quality of life compared to in-person visits. The study is rated Class III because it was not possible to mask patients to visit type.

引用

页码：1152 / 1161

页数：10

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