A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors

Abstract

Background. Mobile health and digital medicine technologies are becoming increasingly used by individuals with common, chronic diseases to monitor their health. Numerous devices, sensors, and apps are available to patients and consumers–some of which have been shown to lead to improved health management and health outcomes. However, no randomized controlled trials have been conducted which examine health care costs, and most have failed to provide study participants with a truly comprehensive monitoring system. Methods. We conducted a prospective randomized controlled trial of adults who had submitted a 2012 health insurance claim associated with hypertension, diabetes, and/or cardiac arrhythmia. The intervention involved receipt of one or more mobile devices that corresponded to their condition(s) (hypertension: Withings Blood Pressure Monitor; diabetes: Sanofi iBGStar Blood Glucose Meter; arrhythmia: AliveCor Mobile ECG) and an iPhone with linked tracking applications for a period of 6 months; the control group received a standard disease management program. Moreover, intervention study participants received access to an online health management system which provided participants detailed device tracking information over the course of the study. This was a monitoring system designed by leveraging collaborations with device manufacturers, a connected health leader, health care provider, and employee wellness program–making it both unique and inclusive. We hypothesized that health resource utilization with respect to health insurance claims may be influenced by the monitoring intervention. We also examined health-self management. Results & Conclusions. There was little evidence of differences in health care costs or utilization as a result of the intervention. Furthermore, we found evidence that the control and intervention groups were equivalent with respect to most health care utilization outcomes. This result suggests there are not large short-term increases or decreases in health care costs or utilization associated with monitoring chronic health conditions using mobile health or digital medicine technologies. Among secondary outcomes there was some evidence of improvement in health self-management which was characterized by a decrease in the propensity to view health status as due to chance factors in the intervention group.

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

“…However, more data are needed to assess the utility of these devices for future home monitoring. 10 Physician input is critical because inappropriate use of home monitoring can do more harm than good. 11 Clinical Scenarios: Neonatal Cardiology Table 1 provides a comprehensive list of 33 publications in pediatric tele-echocardiography, 16 of which are from institutions outside the continental United States, reflecting the global interest in telemedicine in pediatric cardiology.…”

Mobile Apps to Support the Self-Management of Hypertension: Systematic Review of Effectiveness, Usability, and User Satisfaction (Preprint)

“…The publication year of the studies ranged from 2012 to 2017 (see Table 1). Most studies (n=11) were conducted in the US [24][25][26][27][28][29][30][31][32] and Canada [33,34], while seven were carried out in European countries, including France [35], Sweden [36][37][38], Spain [39,40] and Italy [41]. The remaining three studies were conducted in China [42,43] and South Korea [44. Nine studies were randomised controlled trials (RCTs) [24,25,27,28,30,[33][34][35]42], ten were nonrandomised studies [26,29,31,32,37,[39][40][41]43,44], and two were qualitative studies [36,38].…”

“…Participants' average age ranged from 42.4 years [27] to 69.5 [42] years. The population groups of the studies included individuals with hypertension [24][25][26][27][28][29][30]32,[36][37][38][39][41][42][43][44], metabolic syndrome risk factors [34], and obstructive sleep apnoea with high cardiovascular risk [35], as well as overweight individuals [31]. Of the 21 included studies, 5 reported to have used behavioural theories, such as selfdetermination theory [24,26,27], motivational interviewing [30] and theory of planned behaviour [43] to underpin and guide the intervention methods and/or the development of the technology.…”

“…The other 11 studies mainly involved clinicians or other HCPs remotely monitoring patient data and health status [24][25][26][27][28][30][31][32][39][40][41], whilst the remaining study involved the researcher remotely monitoring patient data and alerting physicians if needed [34,36]. In these 11 studies involving HCPs, the HCPs provided feedback, including a medication plan or adjustments [24][25][26][27]39,41], regular online coaching consultation [31] instructions [28,30] or communication with patients [40,42]. …”

“…In most studies an app was supplemented with other interventions, such as a website [28,[36][37][38][39]41], voice telephone messages [33], exercise prescription [34], a nasal mask and an autotitrating machine [35], an electronic medication tray, email, and SMS or phone call [24][25][26][27], and education provided by a nurse [28]. The control group in the controlled studies had usual care.…”