Christian N Nouryan1,2,3, Stephanie Morahan1, Kathleen Pecinka4, Meredith Akerman2, Martin Lesser2, Dale Chaikin1, Stacy Castillo1, Meng Zhang2, Renee Pekmezaris1,2,3,5. 1. 1 Department of Medicine, Northwell Health, Manhasset, New York. 2. 2 Feinstein Institute for Medical Research, Manhasset, New York. 3. 3 Zucker School of Medicine Hofstra/Northwell, Hempstead, New York. 4. 4 Queensboro Community College, Queens, New York. 5. 5 Department of Occupational Medicine Epidemiology and Prevention, Northwell Health, Great Neck, New York.
Abstract
Background: Home telemonitoring (HTM) is a promising approach to improve quality of life (QoL) and decrease hospital utilization. Methods: This randomized-controlled study followed 89 community-dwelling Medicare outpatients with heart failure (HF) after discharge from home care for 6 months. Patients were randomized to HTM or comprehensive outpatient management (COM). HTM received weekly (video) televisits with daily vital sign monitoring. COM was contacted weekly by telephone. Outcomes included emergency department (ED) and inpatient utilization and QoL. Results: Average age at enrollment was 81.4 for HTM and 84.9 for COM. Thirty-eight percent of HTM had ≥1 ED visit versus 60% of COM (p = 0.04), while 48% of HTM had ≥1 hospitalization versus 55% of COM (p = 0.47). Length of stay (LOS) (days) was 4.0 for HTM versus 7.4 for COM (p = 0.39). Costs were $38,990 for HTM versus $50,943 for COM (p = 0.91). QoL improved by -9.66 for HTM and -3.56 for COM (p = 0.02). Although HF-related utilization did not differ between groups, HTM patients who were highly adherent obtained better all-cause outcomes than those with low adherence. Conclusions: Significantly improved all-cause ED utilization, LOS, and QoL were found for HTM; other differences were not significant. More research is needed to determine how to best utilize this technology to improve patient outcomes.
RCT Entities:
Background: Home telemonitoring (HTM) is a promising approach to improve quality of life (QoL) and decrease hospital utilization. Methods: This randomized-controlled study followed 89 community-dwelling Medicare outpatients with heart failure (HF) after discharge from home care for 6 months. Patients were randomized to HTM or comprehensive outpatient management (COM). HTM received weekly (video) televisits with daily vital sign monitoring. COM was contacted weekly by telephone. Outcomes included emergency department (ED) and inpatient utilization and QoL. Results: Average age at enrollment was 81.4 for HTM and 84.9 for COM. Thirty-eight percent of HTM had ≥1 ED visit versus 60% of COM (p = 0.04), while 48% of HTM had ≥1 hospitalization versus 55% of COM (p = 0.47). Length of stay (LOS) (days) was 4.0 for HTM versus 7.4 for COM (p = 0.39). Costs were $38,990 for HTM versus $50,943 for COM (p = 0.91). QoL improved by -9.66 for HTM and -3.56 for COM (p = 0.02). Although HF-related utilization did not differ between groups, HTM patients who were highly adherent obtained better all-cause outcomes than those with low adherence. Conclusions: Significantly improved all-cause ED utilization, LOS, and QoL were found for HTM; other differences were not significant. More research is needed to determine how to best utilize this technology to improve patient outcomes.
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