Study raises questions about home health monitoring

By Neil Versel

Neil_Versel_LargeMaybe home-based patient monitoring is not quite ready to take off after all.

Some of you may be aware that I was looking for the right piece of monitoring technology not too long ago to help my family keep tabs on my 93-year-old grandmother, who had been living alone far from the rest of us. That's not an issue for the moment because she's been staying with my parents for the last month or so, and she may not be able to go back into her home anyway because a wireless monitor can't cook dinner or do laundry.

Meantime, I had heard anecdotally that another elderly relative had opted for – and then stopped using – a wireless accelerometer because the device had returned several false positives. Maybe it's better to be safe than sorry, but the system automatically called for help, thinking the wearer had fallen, when this relative had sat down a little too quickly.

I really have no idea if false alarms are a chronic problem with personal accelerometers, but a recently published study provides some scientific evidence that home monitors need work and are not appropriate in many cases.

Researchers at the Mayo Clinic and the Purdue University School of Industrial Engineering observed greater mortality in elderly patients with multiple health issues who were provided Intel Health Guide base stations and several pieces of monitoring equipment, compared to those receiving typical, "patient-driven" care. In fact, the mortality rate was three times higher.

According to the paper, published last week in the Archives of Internal Medicine, 14.7 percent of those remotely monitored died within 12 months of being enrolled in the study, while just 3.9 percent in the control group died during the same timeframe.

There wasn't much difference in the number of hospitalizations or visits to the emergency room, whether the patients had home monitoring or not, and the researchers did not have an explanation for the higher mortality. Also, they noted that patients without the monitoring systems had regular telephone contact with nurse case managers, so these patients may have been more aware of serious symptoms than others who did not talk to nurses often.

The researchers further suggested that there might not be enough infrastructure in place yet to "fully optimize" case management in this vulnerable population. (The mean age of study participants was 80.3 years.)

Still, the findings raise a lot of questions, and not just from reporters. In fact, two physicians from the University of Iowa Carver College of Medicine provided commentary in the same Annals of Internal Medicine issue.

"The results of this study are important and sobering and warrant careful consideration. It might be tempting to discount the lack of benefit of the telehealth intervention for any number of reasons. For example, it might be possible that the lack of effect in the telehealth intervention compared with usual care was a consequence of the fact that usual care was already outstanding because the comparator group was already receiving care from a top-tier integrated delivery system (Mayo Clinic, Rochester, Minnesota)," write Dr. Scott R. Wilson and Dr. Peter Cram.

"We would caution against such discounting of this study and its negative findings. In contrast, we would argue that this study joins a growing body of literature suggesting that home telehealth does not reduce readmissions or ED visits," they add. However, they caution against reading this study as a "blanket indictment of a potentially useful technology."

What was the study trying to accomplish, they wonder? It is unclear whether the researchers were trying to reduce hospitalizations and ED visits or save lives. Nor do they know if Mayo Clinic staff received proper training on the technology. "It seems almost certain that these subtle differences in strategy and training of telehealth providers would have major influences on study results, but these sorts of details are often difficult to describe adequately within the constraint of published articles," Wilson and Cram.

Clearly, telemonitoring is not appropriate in all cases, but I don't have to be a scientist to know that it might be an effective tool for a lot of people.

Wilson and Cram offer some very good advice: "While awaiting the answers to these questions, we would advise payers and physicians to move slowly in implementing telehealth programs on a wide scale." But I see no good reason not to try if clinicians or insurers have specific goals in mind and they figure out what types of patients stand the best chance of benefiting from home monitoring technology.