Telemonitoring and experimentation in telemedicine for the improvement of healthcare pathways (ETAPES program). Sustainability beyond 2021: What type of organisational model and funding should be used?

Douarin, Yann Le; Traversino, Yannick; Graciet, Armelle; Josseran, Anne; Bili, Anne Briac; Blaise, Lucile; Châtellier, Gilles; Coulonjou, Hélène; Delval, Cécile; Detournay, B.; Durand-Zaleski, Isabelle; Forest, Jeremie; Saidani, N.; Vandenbergue, Julie

doi:10.1016/j.therap.2019.12.009

Cited by 17 publications

(10 citation statements)

References 19 publications

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“…This program initiated in 2018 for a 3-year period has been extended to 2022 to more clearly evaluate and define the role of telemedicine. Patients from the ETAPES program have been included between March 2018 and October 2020 and followed for at least 6 months ( 11 – 13 ).…”

Section: Methodsmentioning

confidence: 99%

Benefits of Interventional Telemonitoring on Survival and Unplanned Hospitalization in Patients With Chronic Heart Failure

Galinier

Itier

Matta

et al. 2022

Front. Cardiovasc. Med.

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AimsTo assess the effect of interventional specialized telemonitoring (ITM) compared to standard telemonitoring (STM) and standard of care (SC) on preventing all causes of death, cardiovascular mortality and unplanned hospitalization in heart failure (HF) patients.MethodsWe compared outcomes in three groups of HF patients followed by different modalities: SC, STM and ITM. The telemonitoring was performed by the specialized HF-cardiology staff at Toulouse University Hospital. All patients were followed with the same manner including daily weight monitoring using on-line scales, self-monitoring and reporting symptoms via a device. The difference between groups was in the management of the received alerts. In STM-group, patients were contacted by a member of telemedical center and the main responsibility for patient's therapy was taken by their primary care physicians while in the ITM-group, a cardiologist intervenes immediately in case of alerts for diuretic dose adjustment or escalation therapy or programmed hospitalization if necessary. Outcomes were compared between the three study groups and Kaplan-Meier analysis was performed.ResultsFour hundred fourteen HF-patients derived from two French cohorts (OSICAT and ETAPES) were included in this study and subsequently enrolled in the following three groups: ITM-group (n = 220), STM-group (n = 99), and SC-group (n = 95). During the mean follow-up period of 341 days, there were significantly fewer primary endpoints like unplanned hospitalization (13.6 vs. 34.3 vs. 36.8%, p < 0.05), all-causes of death (4.5 vs. 20.2 vs. 16.8%, p < 0.05) and cardiovascular mortality (3.2 vs. 15.2 vs. 8.4%, p < 0.05) in the ITM-group. The multivariable logistic regression revealed a significant negative association between the ITM and unplanned hospitalization [OR = 0.303 95% CI (0.165–0.555), p < 0.001) and all-causes of death [OR = 0.255 95% CI (0.103–0.628), p = 0.003], respectively. Kaplan Meier and log rank test showed significant difference in median event-free survival in favor of ITM-group.ConclusionsIn the ITM follow-up HF group, delivered by a cardiology team, the rate of unplanned hospitalization and all-causes of death are lower than SC or STM.

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Section: Methodsmentioning

confidence: 99%

Benefits of Interventional Telemonitoring on Survival and Unplanned Hospitalization in Patients With Chronic Heart Failure

Galinier

Itier

Matta

et al. 2022

Front. Cardiovasc. Med.

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“…1 Remote medical monitoring is also being investigated as a way to increase the cost-effectiveness of patient management by reducing hospital admissions, especially for chronic conditions such as HF. 7 The French ETAPES programme (Telemedicine Experiments for the Improvement of Health Care Paths), 7 launched in 2014, is investigating the use of telemonitoring in improving healthcare pathways in several patient groups, including those with CHF, and has been extended to 2022 to more clearly evaluate and define the role of telemonitoring. 8 The anticipated benefits of telemonitoring will be evaluated in ETAPES, based on healthcare resource consumption and associated costs, care organization, and patient satisfaction.…”

Section: Introductionmentioning

confidence: 99%

“…frail, living in a remote area, low socioeconomic status)—can lower patient transport costs and reduce the frequency of face‐to‐face consultations, the relevance of which was emphasized during the COVID‐19 pandemic 1 . Remote medical monitoring is also being investigated as a way to increase the cost‐effectiveness of patient management by reducing hospital admissions, especially for chronic conditions such as HF 7 …”

Section: Introductionmentioning

confidence: 99%

Healthcare costs of a telemonitoring programme for heart failure: indirect deterministic data linkage analysis

et al. 2022

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Aims We aim to evaluate the costs associated with healthcare resource consumption for chronic heart failure (HF) management in patients allocated to telemonitoring versus standard of care (SC). Methods and results OSICAT‐ECO involved 745 patients from the OSICAT trial (NCT02068118) who were successfully linked to the French national healthcare database through an indirect deterministic data linkage approach. OSICAT compared a telemonitoring programme with SC follow‐up in adults hospitalized for acute HF ≤ 12 months. Healthcare resource costs included those related to hospital and ambulatory expenditure for HF and were restricted to direct costs determined from the French health data system over 18 months of follow‐up. Most of the total costs (69.4%) were due to hospitalization for HF decompensation, followed by ambulatory nursing fees (11.8%). During 18‐month follow‐up, total costs were 2% lower in the telemonitoring versus the SC group, due primarily to a 21% reduction in nurse fees. Among patients with NYHA class III/IV, a 15% reduction in total costs (€3131 decrease) was observed over 18‐month follow‐up in the telemonitoring versus the SC group, with the highest difference in hospital expenditure during the first 6 months, followed by a shift in costs from hospital to ambulatory at 12 months. Conclusions HF hospitalization and ambulatory nursing fees represented most of the costs related to HF. No benefit was observed for telemonitoring versus SC with regard to cost reductions over 18 months. Patients with severe HF showed a non‐significant 15% reduction in costs, largely related to hospitalization for HF decompensation, nurse fees, and medical transport.

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“…Moreover, this program is a prefiguration for integrating the RPM funding model for routine clinical activities into a model that has not yet been defined. 15 The objective of this study was to describe the French funding program for RPM (ETAPES) and an RPM solution provider (Satelia®) for CHF.…”

Section: Introductionmentioning

confidence: 99%

Remote patient monitoring for chronic heart failure in France: When an innovative funding program (ETAPES) meets an innovative solution (Satelia® Cardio)

et al. 2022

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Introduction Remote patient monitoring (RPM) is a telehealth activity to collect and analyze patient health or medical data. Its use has expanded in the past decade and has improved medical outcomes and care management of non-communicable chronic diseases. However, implementation of RPM into routine clinical activities has been limited. The objective of this study was to describe the French funding program for RPM (known as ETAPES) and one of the RPM solution providers (Satelia®) dedicated to chronic heart failure (CHF). Methods A descriptive assessment of both the ETAPES funding program and Satelia® RPM solution was conducted. Data were collected from official legal documents and information that was publicly available online from the French Ministry of Health. Results and Discussion ETAPES was formally created in 2016 based on previous legislation pertaining to the national health insurance funding strategy. However, it only started to operate in 2018. Patients with CHF were only eligible if they were at medium or high risk of re-hospitalization with a New York Heart Association (NYHA) score superior or equal to two and a BNP>100 pg/ml or NT pro BNP>1000 pg/ml. Medical monitoring was supported through the therapeutic education of a patient on the RPM model of care with a minimum of three training sessions during the first six months. The use of Satelia® Cardio is noteworthy since it relies only on symptomatic monitoring through which the patient manually reports their information by answering a simple questionnaire on a regular basis and does not rely on any connected devices. Conclusion Innovative funding programs and solutions for RPM need real-world evaluation in the future.

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Telemonitoring and experimentation in telemedicine for the improvement of healthcare pathways (ETAPES program). Sustainability beyond 2021: What type of organisational model and funding should be used?

Cited by 17 publications

References 19 publications

Benefits of Interventional Telemonitoring on Survival and Unplanned Hospitalization in Patients With Chronic Heart Failure

Benefits of Interventional Telemonitoring on Survival and Unplanned Hospitalization in Patients With Chronic Heart Failure

Healthcare costs of a telemonitoring programme for heart failure: indirect deterministic data linkage analysis

Remote patient monitoring for chronic heart failure in France: When an innovative funding program (ETAPES) meets an innovative solution (Satelia® Cardio)

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