Remote Monitoring of Automated Peritoneal Dialysis Patients: Assessing Clinical and Economic Value

Makhija, Dilip; Alscher, Mark Dominik; Becker, Stefan; D'Alonzo, Silvia; Mehrotra, R. M. L.; Wong, Leslie P.; McLeod, Kim; Danek, Judy; Gellens, Mary; Kudelka, Timothy; Sloand, James A.; Laplante, Suzanne

doi:10.1089/tmj.2017.0046

Cited by 35 publications

(38 citation statements)

References 11 publications

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“…These benefits have been obtained at the same time with a reduction of in-person visits, maintaining the patient at home with excellent results. These results are in accordance with Nayak et al [13]: they speculated that RM of patients on APD offers benefits of real-time monitoring of the therapy, assuring patient safety through the surveillance of critical portions of the treatments, and, on the other hand, enabling early detection of noncompliance [10]. A system with 2-way communications and with an interactive interface allows a fast “troubleshooting” for problems: the physicians can change the prescription online, reducing the frequency of in-person visits to a PD center [13, 14].…”

Section: Discussionsupporting

confidence: 90%

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Remote Monitoring of Automated Peritoneal Dialysis Improves Personalization of Dialytic Prescription and Patient’s Independence

et al. 2018

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Background: Remote monitoring (RM) supports a healthcare model that enhances patients’ self-management. We evaluated the utility of RM in patients undergoing automated peritoneal dialysis (APD). Methods: We observed 37 RM-APD patients, 16 incidents, and 21 prevalents switched from traditional APD (T-APD). We observed the number of changes for APD prescription, the frequency of visits, and PD adequacy parameters during 1 year of RM utilization in APD. Results: The APD prescriptions were modified more frequently in RM-APD vs. T-APD in incident (p = 0.002) and prevalent patients (p = 0.045). Visits were significant less in RM-APD than in T-APD for incident patient (p = 0.008). No significant difference was found between prevalent populations. PD adequacy was similar in both groups. Conclusions: Our results demonstrate that RM allows an efficient use of healthcare resources, helping to improve personalization of APD prescription and to intervene early with “trouble shooting”, thereby reducing the frequency of in-person visits for emergency problems.

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Section: Discussionsupporting

confidence: 90%

“…Addressing non-adherence and understanding barriers to self-care are critical in order to address this issue and RM and telemedicine may help in this regard. Indeed, in a recent study, Makhija et al[10] speculated that early intervention enabled by RM can reduce healthcare resource utilization and associated costs.…”

Section: Introductionmentioning

confidence: 99%

Remote Monitoring of Automated Peritoneal Dialysis Improves Personalization of Dialytic Prescription and Patient’s Independence

et al. 2018

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“…Another study of 269 patients on PD who received an intervention of daily RTM of BP and weight coupled with video conferencing telehealth care showed that the adjusted risk of hospital admission was 46% (odds ratio, 0.54; 95% CI, 0.33 to 0.89) lower and hospital days was 54% (odds ratio, 0.46; 95% CI, 0.26 to 0.81) lower compared with before the intervention (15). It has been estimated that adoption of RTM systems to monitor PD treatments may also yield some economic benefits to healthcare systems in various countries (13,15). The influence of RTM on technique failure rates has not been reported previously in PD, yet the improvements we found are consistent with observations from RTM in the home HD population (16).…”

Section: Discussionmentioning

confidence: 99%

“…Remote monitoring systems broadly include an array of technologies and processes in the areas of telemedicine/telehealth such as telephonic/video assessments, connected health sensors, and health record portals (6). Prior reports of various types of remote monitoring systems tested in the PD population suggest they associate with improvements in patient satisfaction, quality of life, nutrition, exit-site infection rates, peritonitis rates, and hospitalization rates (7)(8)(9)(10)(11)(12)(13). However, patient groups included in the evaluations of remote monitoring systems to date are small and the findings may not be generalizable.…”

Section: Introductionmentioning

confidence: 99%

Remote Treatment Monitoring on Hospitalization and Technique Failure Rates in Peritoneal Dialysis Patients

et al. 2020

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Background An integrated kidney disease healthcare company implemented a peritoneal dialysis (PD) remote treatment monitoring (RTM) application in 2016. We assessed if RTM utilization associates with hospitalization and technique failure rates.Methods We used data from adult (age $18 years) patients on PD treated from October 2016 through May 2019 who registered online for the RTM. Patients were classified by RTM use during a 30-day baseline after registration. Groups were: nonusers (never entered data), moderate users (entered one to 15 treatments), and frequent users (entered .15 treatments). We compared hospital admission/day and sustained technique failure (required .6 consecutive weeks of hemodialysis) rates over 3, 6, 9, and 12 months of follow-up using Poisson and Cox models adjusted for patient/clinical characteristics.Results Among 6343 patients, 65% were nonusers, 11% were moderate users, and 25% were frequent users. Incidence rate of hospital admission was 22% (incidence rate ratio [IRR]50.78; P50.002), 24% (IRR50.76; P,0.001), 23% (IRR50.77; P#0.001), and 26% (IRR50.74; P#0.001) lower in frequent users after 3, 6, 9, and 12 months, respectively, versus nonusers. Incidence rate of hospital days was 38% (IRR50.62; P50.013), 35% (IRR50.65; P50.001), 34% (IRR50.66; P#0.001), and 32% (IRR50.68; P,0.001) lower in frequent users after 3, 6, 9, and 12 months, respectively, versus nonusers. Sustained technique failure risk at 3, 6, 9, and 12 months was 33% (hazard ratio [HR]50.67; P50.020), 31% (HR50.69; P50.003), 31% (HR50.69; P50.001), and 27% (HR50.73; P50.001) lower, respectively, in frequent users versus nonusers. Among a subgroup of survivors of the 12-month follow-up, sustained technique failure risk was 26% (HR50.74; P50.023) and 21% (HR50.79; P50.054) lower after 9 and 12 months, respectively, in frequent users versus nonusers.Conclusions Our findings suggest frequent use of an RTM application associates with less hospital admissions, shorter hospital length of stay, and lower technique failure rates. Adoption of RTM applications may have the potential to improve timely identification/intervention of complications.

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“…Our results confirm the data described by Wallace et al [16] who reported that replacing the face-to-face encounter with a telehealth monitor can reduce patient driving time, time spent in waiting rooms, and travel costs. In this context, Makhija et al [17] performed a study based on a simulated environment and estimated the reduction of health-care resource utilization and associated costs by early intervention using RM on APD patients.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Experience with Remote Monitoring for Automated Peritoneal Dialysis Patients

Manani¹,

Rosner

Virzì³

et al. 2019

Nephron

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Background: Peritoneal dialysis (PD) is an ideal model for testing remote monitoring (RM). In this study, we evaluated the RM application longitudinally in stable patients undergoing automated PD (APD). Methods: This was an observational study, comparing outcomes in patients with (current patients) and without (historical data) exposure of RM. We analyzed cost-effectiveness of RM-APD measuring the number of night alarms, number of hospital visits, direct and indirect costs. Results: Changes in APD prescription were almost double in the case group (RM) compared to the control group (p = 0.0005). The need for in-person visits and nocturnal alarms was significantly less in RM-APD than in traditional APD (p = 0.01 and p = 0.002, respectively). The distance traveled by patients in the case of RM-APD was reduced by 1,134 km with a time saving of 1,554 min for patients. The overall cost reduction for the PD center in terms of time/nurse and time/physician was 2,647 and 3,673 min, respectively. All these advantages were obtained in the presence of an improved technique survival with a significant reduction of dropouts. All patients found that it is easy to use the RM system and were satisfied with the high level of interaction with the care team and with the possibility of timely resolving technical problems. Conclusion: These data confirm the long-term benefits of RM applied to APD. RM-APD is cost-effective; it allows early detection and resolution of problems, improved treatment compliance, reduction of patient’s access to hospital center for technical and clinical complications with consequent savings, and improved patient’s quality of life.

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Remote Monitoring of Automated Peritoneal Dialysis Patients: Assessing Clinical and Economic Value

Abstract: In a simulated environment, early intervention enabled by RTM reduced healthcare resource utilization and associated costs.

Cited by 35 publications

References 11 publications

Remote Monitoring of Automated Peritoneal Dialysis Improves Personalization of Dialytic Prescription and Patient’s Independence

Remote Monitoring of Automated Peritoneal Dialysis Improves Personalization of Dialytic Prescription and Patient’s Independence

Remote Treatment Monitoring on Hospitalization and Technique Failure Rates in Peritoneal Dialysis Patients

Longitudinal Experience with Remote Monitoring for Automated Peritoneal Dialysis Patients

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