Home Telemonitoring to Reduce Readmission of High-Risk Patients: a Modified Intention-to-Treat Randomized Clinical Trial

Dawson, Nancy L.; Hull, Bryan P.; Vijapura, Priyanka; Dumitrascu, Adrian; Ball, Colleen T.; Thiemann, Kay M.B.; Maniaci, Michael J.; Burton, M. Caroline

doi:10.1007/s11606-020-06589-1

Cited by 28 publications

(31 citation statements)

References 23 publications

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“…This initiative has been expanded to accept HF patients being discharged from the ED and from the hospital. Prior research has indicated possible reductions in readmissions as a result of postdischarge telemonitoring 18. Our ED and inpatient teams have indicated an ability to discharge patients sooner due to the close outpatient follow-up and reliable team structure provided by this programme.…”

Section: Resultsmentioning

confidence: 97%

“…Prior research has indicated possible reductions in readmissions as a result of postdischarge telemonitoring. 18 Our ED and inpatient teams have indicated an ability to discharge patients sooner due to the close outpatient follow-up and reliable team structure provided by this programme. An HF hub was created for this programme expansion where RNs are only assigned HF patients and have fewer patients assigned to them because of the increased workload.…”

Section: Resultsmentioning

confidence: 99%

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Improving heart failure care and guideline-directed medical therapy through proactive remote patient monitoring-home telehealth and pharmacy integration

et al. 2022

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To address ambulatory care sensitive hospitalisations in heart failure (HF), we implemented a quality improvement initiative to reduce admissions and improve guideline-directed medical therapy (GDMT) prescription, through proactive integration of remote patient monitoring-home telehealth (RPM-HT) and pharmacist consultations. Each enrolled patient (n=38) was assigned an RPM-HT registered nurse (RN), cardiology licensed independent provider (provider), and, if referred, a clinical pharmacy specialist (pharmacist). The RN called patients weekly and for changes detected by RPM-HT, while the pharmacist worked to optimise GDMT. The RN and pharmacist communicated clinical status changes to the provider for expedited management. Process measures were the percentage of outbound RN weekly calls missed per enrolled patient; the weekly percentage of provider interventions missed; and the number of initiative-driven diuretic changes. Outcome measures included eligible GDMT medications prescribed, optimisation of those medications, and the pre–post difference in emergency department (ED) visits/hospitalisations. After a 4-week run-in period, RN weekly calls missed per enrolled patient decreased from a mean of 21.4% (weeks 5–15) to 10.2% (weeks 16–23). Weekly missed provider interventions decreased from a mean of 15.1% (weeks 1–15) to 3.4% (weeks 16–23), with special cause variation detected. The initiative resulted in 43 diuretic changes in 21 patients. Among 34 active patients, 65 ED visits (0.16 per person-month) occurred in 12 months pre intervention compared with 8 ED visits (0.04 per person-month) for 6 intervention months (p<0.001). Among 16 patients referred to pharmacist, the per cent of eligible GDMT medications prescribed increased by 17.1% (p<0.001); the number of patients receiving all eligible medications increased from 3 to 11 (p=0.008). Similarly, the per cent optimisation of GDMT doses increased by 25.3% (p<0.001), with the number of patients maximally optimised on GDMT increasing from 1 to 6 (p=0.06). We concluded that a cardiology, RPM-HT RN and pharmacist team improved prescription of GDMT and may have reduced HF admissions.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Improving heart failure care and guideline-directed medical therapy through proactive remote patient monitoring-home telehealth and pharmacy integration

et al. 2022

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“…This review included three RCTs that investigated the effectiveness of the telemonitoring intervention [25,27,34]. Fredrix et al's [27] were disqualified from the meta-analysis since they reported the number of days lost owing to hospital readmission rather than the actual number of readmissions.…”

Section: Effect Of Tcis On Hospital Readmissionsmentioning

confidence: 99%

“…ED visits were recorded as a result of the telemonitoring intervention by two RCTs [30,34], and as a result, they were both included in the meta-analysis depicted in Figure 5. A decrease in ED visits within 30 days of discharge has been concluded (RR, 0.62; 95% CI 0.42 to 0.94, p = 0.02).…”

Section: Effect Of Tci On Ed Visitsmentioning

confidence: 99%

“…For example, Van Spall and colleagues [30] arranged for primary care physician follow-up within one week of discharge, early home visits, and weekly phone calls by the nursing team. In contrast, Dawson and colleagues [34] arranged home visits 72 hours after discharge to install equipment; the follow-up was limited during the study to only when alerted to an abnormality by the telemonitoring device.…”

Section: Effect Of Tci On Ed Visitsmentioning

confidence: 99%

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Effectiveness of Transitional Care Interventions for Heart Failure Patients: A Systematic Review With Meta-Analysis

Sattouf¹,

Farahat²,

Khatri³

2022

Cureus

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Heart failure is a leading cause of hospitalizations. Heart failure patients were found to have a high incidence of re-admission after discharge. This highlights a care gap during the transition from hospital to home environment and interventions were utilized to cover this care gap. The aim of this review was to evaluate the effectiveness of these interventions. This was investigated in terms of re-admissions, mortality, emergency department (ED) visits, and quality of life.An exhaustive systematic search was conducted in electronic databases, which include MEDLINE, CINAHL, AMED, Cochrane library, and PubMed. Databases were explored for literature published in English between April 2012 and April 2022. The review included 13 randomized controlled trials and comprised a total of 7,693 heart failure patients with 3,835 receiving transitional care interventions (TCIs) and 3,858 receiving standard care. It was found that implementing TCIs resulted in a reduction of all-cause re-admission and allcause mortality. Although it is controversial if TCIs improve quality of life, TCIs were noted to decrease the frequency of ED visits. Telephone support interventions proved most efficacious among other interventions in reducing hospital readmissions, and were found effective in reducing mortality in combination with other interventions, i.e. clinic visits. Additionally, telemonitoring is found beneficial in supporting patients just after discharge, the most vulnerable period, for medically optimizing and monitoring patients during the care gap.

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Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

Tyler,

Hodkinson,

Planner

et al. 2023

JAMA Netw Open

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ImportanceDischarge from the hospital to the community has been associated with serious patient risks and excess service costs.ObjectiveTo evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the hospital to the community.Data SourcesCENTRAL, Embase, MEDLINE, and PsycINFO were searched from inception until August 2022.Study SelectionRandomized clinical trials evaluating transitional care interventions from hospitals to the community were identified.Data Extraction and SynthesisAt least 2 reviewers were involved in all data screening and extraction. Random-effects network meta-analyses and meta-regressions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed.Main Outcomes and MeasuresThe primary outcomes were readmission at 30, 90, and 180 days after discharge. Secondary outcomes included emergency department visits, mortality, quality of life, patient satisfaction, medication adherence, length of stay, primary care and outpatient visits, and intervention uptake.ResultsOverall, 126 trials with 97 408 participants were included, 86 (68%) of which were of low risk of bias. Low-complexity interventions were associated with the most efficacy for reducing hospital readmissions at 30 days (odds ratio [OR], 0.78; 95% CI, 0.66 to 0.92) and 180 days (OR, 0.45; 95% CI, 0.30 to 0.66) and emergency department visits (OR, 0.68; 95% CI, 0.48 to 0.96). Medium-complexity interventions were associated with the most efficacy at reducing hospital readmissions at 90 days (OR, 0.64; 95% CI, 0.45 to 0.92), reducing adverse events (OR, 0.42; 95% CI, 0.24 to 0.75), and improving medication adherence (standardized mean difference [SMD], 0.49; 95% CI, 0.30 to 0.67) but were associated with less efficacy than low-complexity interventions for reducing readmissions at 30 and 180 days. High-complexity interventions were most effective for reducing length of hospital stay (SMD, −0.20; 95% CI, −0.38 to −0.03) and increasing patient satisfaction (SMD, 0.52; 95% CI, 0.22 to 0.82) but were least effective for reducing readmissions at all time periods. None of the interventions were associated with improved uptake, quality of life (general, mental, or physical), or primary care and outpatient visits.Conclusions and RelevanceThese findings suggest that low- and medium-complexity transitional care interventions were associated with reducing health care utilization for patients transitioning from hospitals to the community. Comprehensive and consistent outcome measures are needed to capture the patient benefits of transitional care interventions.

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Home Telemonitoring to Reduce Readmission of High-Risk Patients: a Modified Intention-to-Treat Randomized Clinical Trial

Cited by 28 publications

References 23 publications

Improving heart failure care and guideline-directed medical therapy through proactive remote patient monitoring-home telehealth and pharmacy integration

Improving heart failure care and guideline-directed medical therapy through proactive remote patient monitoring-home telehealth and pharmacy integration

Effectiveness of Transitional Care Interventions for Heart Failure Patients: A Systematic Review With Meta-Analysis

Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

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