A Randomized Controlled Trial of Telemonitoring in Older Adults With Multiple Health Issues to Prevent Hospitalizations and Emergency Department Visits

Abstract

Background Efficiently caring for frail, older adults will become an increasingly important part of healthcare reform; telemonitoring within homes may be an answer to improve outcomes. This study sought to determine the difference in hospitalizations and emergency room (ER) visits in older adults using telemonitoring versus usual care. Methods This was a randomized trial of adults older than 60 years with high-risk for rehospitalization. Subjects were randomized to telemonitoring with daily input versus patient-driven usual care. Telemonitoring was accomplished by daily biometrics, symptom reporting and videoconference. The primary outcome included a composite end-point of hospitalization and ER visits in the 12 months following enrollment. Secondary end-points included hospital days, hospital admissions, and ER visits. Intention to treat analysis was performed. Results Two hundred and five subjects were enrolled with a mean age of 80.3 years. There was no difference in hospitalizations and ER visits between the telemonitoring group (63.7%) and the group receiving usual care (57.3%) (P value 0.345). There was no difference in individual outcomes including hospital days, hospital admissions and ER visits. There also was no significant change between hospitalizations and ER visits in the pre-enrollment and post-enrollment period. Mortality was higher in the telemonitoring group (14.7%), compared to usual care (3.9%) (P value 0.008). Conclusions Among elderly patients, telemonitoring did not result in lower hospitalizations or ER visits. There were no differences determined within the secondary outcomes. The cause of the mortality difference is unknown.

The E-Coach technology-assisted care transition system: a pragmatic randomized trial

“…Recent reports of IVR-assisted care transition interventions have been mixed [31][32][33]. Two randomized trials of telemonitoring in CHF patients [21] and COPD [34] patients did not show a reduction in rehospitalizations.…”

Cost Comparison Between Home Telemonitoring and Usual Care of Older Adults: A Randomized Trial (Tele-ERA)

“…4,5 We randomized a total of 205 participants ‡ 60 years (TELE group, n = 102; UC group, n = 103), all of whom lived in Southeastern Minnesota and were enrolled in the Employee and Community Health primary care panel at the Mayo Clinic (Rochester, MN). Eligible patients were identified based on their ERA Index score, which stratifies all patients for risk of hospitalizations and ED visits based on administrative data such as age, sex, previous hospitalizations and ED visits, and comorbid conditions.…”

“…The ratio of mean cost for decedents to survivors was 2.1 to 1 for the TELE group and 12.7 to 1 for the UC group. Mortality incidences (15 TELE, 4 UC) 4 occurred at least once a month except for 1 month. The average number of days that decedents were alive during the trial was 203 days for the TELE group and 198.5 days for the UC group.…”

“…The initial findings of the Tele-Elder Risk Assessment (ERA) trial indicated a lack of significant differences in the mean inpatient and ED visits and in hospital days between patients in the TELE and UC groups. 4 …”

Increased Mortality Following Telemonitoring in Frail Elderly Patients: Look Before You Leap!

“…The recent study by Takahashi et al 1 examining telemonitoring in vulnerable patients with mixed chronic diseases clearly reflects the need for meticulous scientific approaches to study these types of interventions. Telemonitoring aims at early detection and prompt action in the case of health deterioration.…”