Impact of At-Home Telemonitoring on Health Services Expenditure and Hospital Admissions in Patients With Chronic Conditions: Before and After Control Intervention Analysis

Abstract

BackgroundTelemonitoring is becoming increasingly important for the management of patients with chronic conditions, especially in countries with large distances such as Australia. However, despite large national investments in health information technology, little policy work has been undertaken in Australia in deploying telehealth in the home as a solution to the increasing demands and costs of managing chronic disease.ObjectiveThe objective of this trial was to evaluate the impact of introducing at-home telemonitoring to patients living with chronic conditions on health care expenditure, number of admissions to hospital, and length of stay (LOS).MethodsA before and after control intervention analysis model was adopted whereby at each location patients were selected from a list of eligible patients living with a range of chronic conditions. Each test patient was case matched with at least one control patient. Test patients were supplied with a telehealth vital signs monitor and were remotely managed by a trained clinical care coordinator, while control patients continued to receive usual care. A total of 100 test patients and 137 control patients were analyzed. Primary health care benefits provided to Australian patients were investigated for the trial cohort. Time series data were analyzed using linear regression and analysis of covariance for a period of 3 years before the intervention and 1 year after.ResultsThere were no significant differences between test and control patients at baseline. Test patients were monitored for an average of 276 days with 75% of patients monitored for more than 6 months. Test patients 1 year after the start of their intervention showed a 46.3% reduction in rate of predicted medical expenditure, a 25.5% reduction in the rate of predicted pharmaceutical expenditure, a 53.2% reduction in the rate of predicted unscheduled admission to hospital, a 67.9% reduction in the predicted rate of LOS when admitted to hospital, and a reduction in mortality of between 41.3% and 44.5% relative to control patients. Control patients did not demonstrate any significant change in their predicted trajectory for any of the above variables.ConclusionsAt-home telemonitoring of chronically ill patients showed a statistically robust positive impact increasing over time on health care expenditure, number of admissions to hospital, and LOS as well as a reduction in mortality.Trial RegistrationRetrospectively registered with the Australian and New Zealand Clinical Trial Registry ACTRN12613000635763; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364030 (Archived by WebCite at http://www.webcitation.org/6sxqjkJHW)

Effect of Seasonal Variation on Clinical Outcome in Patients with Chronic Conditions: Analysis of the Commonwealth Scientific and Industrial Research Organization (CSIRO) National Telehealth Trial

“…Of the 479 eligible patients, only 287 could commence the trial, of which 114 were allocated to the telemonitoring test group and 173 were allocated to the control group [ 8 ]. The test patients were supplied with a telemonitoring system and trained on its use at installation, whereas the control group received only normal care through their primary care physician.…”

“…Several trials have been carried out to analyze clinical, service, and economic benefits of telehealth systems [ 7 , 8 ]. These analyses are crucial to encourage wide-scale implementation of telehealth services.…”

“…The aim of this trial was to investigate health care outcomes as well as clinical and economic benefits of telehealth systems by introducing a telehealth model of service based on at-home telemonitoring of vital signs to patients with a range of chronic conditions supervised in either in hospital-based or community-based settings. The clinical protocols for the trial [ 9 ], the data architecture design [ 10 ], decision support and statistical trend analysis of vital signs data [ 11 ], and the impact of telemonitoring on health care expenditure, hospital admissions, and LOS [ 8 ] have been published previously.…”

Patient Adherence to Scheduled Vital Sign Measurements During Home Telemonitoring: Analysis of the Intervention Arm in a Before and After Trial (Preprint)

“…As reported in [8], of the 479 eligible patients, 128 (26.7%) declined to participate, 41 patients did not meet inclusion criteria at interview and 23 were unable to commence. Of the remaining 287 subjects who consented, 114 were allocated to the telemonitoring test group and 173 were allocated to the control group.…”

“…The trial was designed to explore a wide set of outcomes resulting from the introduction of a telehealth model of service based on at home telemonitoring of vital signs and the administration of a range of clinical questionnaires, to patients with a range of chronic conditions supervised in either hospital based or community based settings. The clinical protocols for the trial [12], the data architecture design [13], decision support and statistical trend analysis of vital signs data [14] and the impact of telemonitoring on health care expenditure, hospital admissions and length of stay [8] have been previously published.…”