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WWW to assist post-surgical cardiac patients

A team led by UW-Madison Professor Patricia Flatley Brennan is researching how computer networks can provide the presence of a nurse to heart patients, and potentially those with AIDS, diabetes and a variety of chronic diseases. With a $1 million grant from the National Library of Medicine and the National Institutes of Nursing, the group is designing a customized Internet computer support system called HeartCare.

Working with Brennan are fellow Department of Industrial and Systems Engineering Professor David H. Gustafson, Shirley M. Moore of Case Western Reserve University, and Ralph O'Brien of Cleveland Clinic Foundation.

Brennan explains the need for such a system: "Twenty years ago, if you had open heart surgery you were in the operating room for eight hours, on a ventilator for two to three days and in the intensive care unit (ICU) for a week. The whole hospital stay was two to three weeks. Today you're in the operating room for three hours, on the ventilator for an hour, in the ICU for eight hours and you're home in four days."

Medical examining room with computer

Professor Patricia Flatley Brennan is finding ways computers can improve post-hospital care for patients. (large image)

That means patients must now do at home what nurses used to do for them in the hospital. This includes monitoring discharge and watching cardiac rhythms. Most people don't get home nursing care after cardiac surgery and are not sick enough for a visit with a doctor until four to six weeks after surgery, Brennan says. The HeartCare system will be a mechanism to help patients make the transition from hospital to home to recovery.

The system uses the World Wide Web to tailor specific instructions to an individual's preferred style of information. Each of the first six days after the patient is discharged, nurses build a Web page for the patient. After that, one new page is constructed every three days. It progresses to a new page every week for three weeks, and then a new page every two weeks for the remaining recovery period.

"We will see them two to three times while they are in the hospital and then send them home with the system," Brennan said. "As soon as they are home they have a resource for recovery and e-mail to a nurse and physician."

In addition to detailed recovery instructions, patients will have links to forums where they can discuss topics with other patients. People more interested in scientific explanations will get more links to places like the National Institutes of Health. Those that like more behavioral explanations will be pointed to other resources.

The system will run on a secure computer in a newly fitted lab in the Mechanical Engineering Building. The initial patients will be 500 miles away in Cleveland, Ohio. The test group involves 120 men and women receiving standard post-operative care. They will be randomly divided to receive either HeartCare or an audiotape coaching program for comparison. Some patients will serve as a control group by receiving a data-collection-only visit from the research nurse. Patient outcomes to be measured will include physical function, symptom distress, psychological distress, perceived family function and adherence to cardiac risk behavior modification at four points in time.

Brennan's background in both nursing and industrial engineering makes her particularly well suited for the investigation. She earned a bachelor's and master's of nursing and an MS and PhD in industrial engineering from UW-Madison. In the fall of '96 she accepted an appointment as full professor in the Department of Industrial and Systems Engineering and the School of Nursing. She received the first Moehlman Bascom professorship, established by Lillian S. Moehlman to support faculty with expertise in any area of nursing.

Ideally, Brennan would like the HeartCare system to run on Internet 2, a proposed high-speed, dedicated network for researchers.

"It would be so much better if we could conduct the program on a system like that. Some of the information we will be dealing with is very time sensitive. It also has legal implications regarding privacy issues," Brennan said. "If an Internet 2 is built, we could take this program nationwide."