mHealth Research Digest with Anupam Kumar

Chronically ill patients account for 78% of all medical costs in the United States; this figure is projected to increase as the U.S. population continues to age, necessitating innovation in disease management programs.

One such innovation is the use of remote patient monitoring (RPM) of chronically ill patients utilizing telehealth devices, which has been previously shown to improve outcomes in Medicare recipients with diabetes.

Gaps in follow-up care among patients hospitalized with heart failure, however, continue to present an ongoing challenge in preventing costly and frequent re-admissions.

In this recent study by Pekmezaris et al., randomized and matched-cohort studies were simultaneously conducted among patients recently hospitalized with a primary or secondary diagnosis of HF. These patients were drawn from two certified home health agencies operating in the New York metropolitan area.

In each study, patients were assigned to home care with RPM, receiving live nursing visits in addition to remote visits via a telecommunications device, or home care with live visits alone.

The utilized telecommunications technology allowed for close mimicry of a live visit; in fact, the American TeleCare #1010 video patient station allowed for not only two way video conferencing but also for nurses to observe patient weight measurement, listen to heart sounds with a built in stethoscope, and record blood pressure measurements with the included cuff.

The randomized study included 168 recently discharged patients while the matched-cohort analysis included 160 such patients. Hospitalization rates, time to first admission, length of stay, and costs to Medicare were analyzed after both 30 and 90 days. No significant difference in these outcomes was identified regardless of whether analysis included all patients or was limited to hospitalized patients only.

“Both studies consistently found no significant differences in primary outcome variables (hospital utilization, LOS, and cost measures) between patients receiving traditional (live) home care and patients receiving RPM at either 30 or 90 days…hospitalization rates, time to first admission, LOS, or costs to Medicare did not significantly differ between groups in either study”

However, RPM patients were hospitalized 1.5 to 4 days earlier than usual home care patients and mean per patient home care costs were increased in RPM; the authors attributed these trends to early detection of HF exacerbations and an increased number of total (live and video) visits.

In addition, the authors found that hospitalization costs were lower in the RPM group. The authors note that “hospital utilization and costs were lower in the matched-cohort study because patients did not receive RPM until they were deemed ‘stable.’” The patients enrolled in the randomized study received live and remote visits at an earlier stage in post-hospitalization care, and were thus predicted to have increased costs and hospitalizations. Pekmezaris and colleagues assert that the difference between the two study designs “does not detract from the interpretation of the data.”

As indicated by the study authors, the absence of a significant difference between RPM and usual care groups suggests that telehealth monitoring has great potential as a supplement to live nursing visits in home care management of HF. By avoiding significant costs associated with nurse travel time, it allows for efficient monitoring of a large, sick population in need of frequent monitoring. The increasing of burden of costs due to HF and other chronic illnesses in a global setting certainly speaks to the need for continued research on RPM strategies in different populations and care settings.

Authors:

  • Rene ́e Pekmezaris, Ph.D.
  • Irina Mitzner R.N., M.S.
  • Kathleen R. Pecinka, R.N., M.S.
  • Christian N. Nouryan, M.A.
  • Martin L. Lesser, Ph.D.
  • Meryl Siegel, M.P.A.
  • 
John W. Swiderski, M.A.
  • Gregory Moise, M.A.
  • 
Richard Younker Sr., R.N., M.B.A.
  • Kevin Smolich, M.B.A., M.A.S.

Institutions:

Population Health, North Shore-LIJ Health System, Great Neck, New York, USA.

Original Abstract:

PubMed