Remote monitoring pilots may drop hospitalizations, but what happens when the program ends?

By Jonah Comstock
08:38 am
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Partners HealthCare Center for Connected Health's 2010 Progress Report, Forward CurrentsA retrospective matched-pair cohort study of 348 patients in Partners HealthCare's Boston-area hospitals shows that remote monitoring in congestive heart failure patients can reduce 120-day hospitalizations and mortality. Interestingly, while the reduction in mortality held beyond the 120 days of the study, the hospitalizations for the monitoring cohort actually went up after the monitoring stopped.

In the study, published in the Journal of Medical Internet Research, Partners used EHR data to match 174 control patients with 174 patients enrolled in the Connected Cardiac Care Program, or CCCP, based on age and gender. Participants in the four-month CCCP used connected devices to monitor relevant physiologic parameters like blood pressure, heart rate, weight, and blood oxygen saturation, and answered questions about heart failure-related symptoms on a touch-screen computer each day. Information was then sent to nurses, who monitored the data and reached out to patients in the case of unusual readings. Patients also received biweekly educational sessions by phone on topics like diet, exercise, and proper monitoring.

After 30 days, about half as many CCCP patients had been hospitalized as control patients (24 compared to 49). After 60 days, it was about two thirds as many (43 compared to 68). And at the end of the four-month program, CCCP patients had three-quarters as many readmissions (75 versus 97). And at the end of the four months, five CCCP patients had died compared to 12 control patients.

Eight months after the program ended, however the CCCP group actually had more hospitalizations (though it still had a lower mortality rate). At the eight-month follow-up, there were 180 hospitalizations in the monitoring group compared to 151 in the control group. Neither follow-up figure was statistically significant.

Researchers suggest that those numbers might not show what they seem to show, however. First off, the fact that sicker control patients died earlier than CCCP patients could contribute to a higher rate of hospitalizations in the CCCP population. Second, it's possible that the educational components of the program made CCCP patients more sensitive to early warning signs of disease, making them more likely to make the decision to head to the hospital. On the other hand, the remote monitoring patients might also have failed to develop self-management skills because of the close attention they received during remote monitoring.

Based on this research, Partners is considering modifying the CCCP approach to better wean patients off the monitoring at the end of the four-month period, and place a greater emphasis on learning disease self-management throughout the program.