Cardiovascular disease
Conditions
Interventions
Intervention group:Establishment of a Multidisciplinary Team
Patient Admission and Ongoing Assessment
Nursing Assessment and Health Education
Remote Monitoring
Comprehensive Case Management
Control Group:Routine treatment and management in a regular ward
Sponsors
Shanghai Jiaotong University School of Medicine Renji Hospital
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Inclusion criteria
Inclusion criteria: 1.Diagnosed with a cardiovascular condition—such as coronary artery disease, valvular heart disease, or arrhythmia—by a qualified specialist. 2.The patient's clinical condition is stable and currently managed at the secondary care level. 3.The patient has either: been transferred from the Cardiac Intensive Care Unit (CCU) to a general ward in accordance with established discharge/transfer criteria, or been discharged directly to their home. 4.Aged 18 years or older. 5.Willing to attend follow-up visits at the hospital outpatient clinic. 6.Resides with a primary caregiver. 7.Has provided informed consent and signed the consent form.
Exclusion criteria
Exclusion criteria: 1.Diagnosed with a severe mental illness or intellectual disability that impairs the ability to express their own wishes independently. 2.Currently participating in another health intervention program.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| patient safety and physiological function(Length of hospital stay (measured from the time of transfer out of the CCU), Incidence of adverse events during hospitalization, Cardiac function parameters, Duration of physical activity, Coping and adaptive capacity); | — |
Secondary
| Measure | Time frame |
|---|---|
| Patient and Caregiver Experience(Satisfaction of patients and caregivers, Perceived quality of service, Evaluation of referral and transfer processes);Healthcare Cost Expenditure (Labor costs of tertiary hospital professionals are typically reflected in service fees. In the HaH (Hospital-at-Home) intervention group, other related examination costs are calculated based on their occurrence, frequency, and timing);Utilization of Service Resources (Control Group: Based on the detailed discharge billing statement. Intervention Group: Based on daily records of intervention items, personnel involvement, and utilization of internet outpatient resources); | — |
Countries
China
Contacts
Public ContactLi Xu
Shanghai Jiaotong University School of Medicine, Renji Hospital
Outcome results
None listed