Performance of an eHealth (NOMHAD) System Comprising Telemonitoring, Telenotification, and Telecoaching for Patients With Multimorbidity: Proof-of-Concept Study

Abstract

Background Management of patients with multiple chronic diseases is a growing public health challenge, especially in rural sectors where access to physicians may be limited. Connected medical devices monitoring vital signs, associated with eHealth program and structured telephone support, may improve complex patient management through early detection of disease complications, positive impact on patients’ health, and health resources consumption optimization. Objective The aim of this study was to evaluate the technical performance and user experience of the NOMHAD eHealth system in patients with multimorbidity. Methods This was a pilot, single-arm, interventional study. Patients with multimorbidity with any combination of chronic heart failure (CHF), chronic obstructive pulmonary disease, and diabetes were followed for 80-100 days using the NOMHAD eHealth system. This system used connected devices telemonitoring symptoms and vital signs (eg, body weight, oxygen saturation, pulse rate, blood pressure, and blood glucose), associated with structured telecoaching and educational support by call center nurses. An overall risk indicator (ORI) was automatically computed after each data teletransmission. The ORI was color coded; green indicated no action required; yellow, orange, and red (low to high priority, respectively) generated telenotifications and indicated to the nurses the need for a telecoaching action. Each ORI was calculated by combining 7 clinical stability system indicators based on symptom questionnaires and vital signs. Technical accuracy of the system was assessed by comparing system-generated ORIs with ORIs recalculated from raw data. Ease of use, usefulness, satisfaction, and acceptability of the system were assessed through patient adherence to self-assessments, and through self-administered questionnaires to patients, call center nurses, and physicians. Results A total of 23 patients were enrolled in this study and participated between April 2016 and March 2017 at 5 study centers in France. All patients were successfully equipped and evaluable for analysis. Mean age was 68.5 (SD 10.4) years and most patients were men (n=20). The most common multimorbidity was CHF + diabetes (n=15), followed by patients with all 3 diseases (n=5). Mean effective follow-up was 78.7 (SD 24.2) days. The system generated 6263 ORIs, as several ORIs could be generated on a single day for any patient. Overall system sensitivity was 99.2% (95% CI 98.9-99.4) and overall specificity was 91.3% (95% CI 87.7-94.1). Most patients (20/23, 87%) were satisfied with the system and agreed that it helped them to better understand and manage their diseases, and 19/23 (83%) valued the nurse regular contacts. Nurses and physicians were generally satisfied with the system and considered it useful. All users indicated they would agree to long-term use of the system. Conclusions This study provides evidence that the NOMHAD eHealth system is accurate, acceptable, informative, and feasible for patients with multimorbidity, supporting further investigation of its clinical benefits. Trial Registration Agence Nationale de Sécurité du Médicament et des Produits de Santé 2015-A01106-43; https://ictaxercb.ansm.sante.fr/Public/index.php

Telemedicine and home monitoring for COPD – a narrative review of recent literature

“…This study confirmed patients' acceptability, feasibility, and satisfaction regarding tele-psychological support services provided on-demand [7]. In line with the study of Gazzi et al, Chacornac et al [8] showed high levels of satisfaction both by patients, who reported that it helped them to understand better and manage their diseases, and by healthcare staff, as nurses and physicians considered it useful.…”

“…Six of the included studies specifically focused on the effectiveness of telemonitoring programs [7–11,12 ▪▪ ]. The program of Gazzi et al [7] consisted of a 6-month tele-assistance multidisciplinary support program that included psychologist support and focused on monitoring clinical problems in patients with advanced cardiorespiratory diseases.…”

“…The focus of the study on the NOMHAD eHealth system was mainly on the system's technical performance [8]. The system uses connected devices to telemonitor symptoms and vital signs and includes telecoaching and educational support.…”

La télésurveillance du patient insuffisant respiratoire chronique en France : l’opportunité d’organiser une prise en charge efficiente

“…À titre d'exemple, dans l'étude CHROMED, une mauvaise couverture du réseau mobile, empêchant une transmission des données ou une défaillance technique de l'équipement, représentait environ 6 % des données manquantes [13]. Plus récemment, Chacornac et al rapportaient également un taux moyen de non-transmission de moins de 5 % [14]. Si le patient a une action à réaliser (par exemple : pour mesurer sa saturation artérielle ou répondre à un questionnaire), un recueil erroné ou une absence de mesure peut également rendre le système inopérant.…”