In first issue of Digital Medicine journal, study finds little evidence that remote patient monitoring improves outcomes

By Laura Lovett

Remote patient monitoring is one of the hot topics in digital health and has grown increasingly popular in the last decade. But a recent data analysis questions whether or not remote patient monitor is effective in improving clinical outcomes. 

A meta analysis published in the inaugural issue of Nature's Digital Medicine found that remote patient monitoring had no statistically significant impact on six reported clinical outcomes that the research studied including BMI, weight, waist circumference, percentage of body fat, systolic blood pressure, or diastolic blood pressure. 

“[D]espite anecdotal reports of RPM efficacy and growing interest in these new health technologies by researchers, providers, and patients alike, little empirical evidence exists to substantiate claims of its ability to improve clinical outcomes, and our research indicates many patients are not yet interested in or willing to share RPM data with their physicians,” authors of the study wrote. 

Researchers combed through 4,348 articles that were published on PubMed from January 2000 to October 2016. Out of those, a total of 27 randomized control trials from 13 different countries were used in the analysis. 

The average length of the study was 7.8 months, but some studies were as short as seven days and others were as long as 29 months. 

In total 16 of the studies were deemed high quality and 11 were considered low quality. The studies focused on different areas. Eleven of the studies looked at patients with cardiovascular disease including heart failure, arrhythmia, and hypertension. Six of those studies evaluated patients with pulmonary disease including emphysema, asthma, and sleep apnea. The other six studies looked at helping obese patients increase physical activity and prevent weight gain. 

In most of the studies the control group received the standard of care but weren't remotely monitored. But eight of the studies gave the control groups similar devices. Most of the studies also contained a feedback loop with a care providers, such as a physician or nurse who analyzed the patient data and communicated back with the patient to modify treatment regimine, improve adherence or consult, according to the analysis. 

Researchers created six groups of outcomes that had three or more studies, including body mass index, weight, waist circumference, body fat percentage, systolic blood pressure, and diastolic blood pressure. There was no statistically difference in outcome in any of the six groups. 

Researchers found that the validated health behavior model, care pathway, and tailored coaching for people trying to lose weight was the most successful intervention. Researchers also found that certain interventions worked better for certain populations. The analysis noted that in one hypertension study, only adults over 55 years old saw a benefit of RPM.

“Studies were highly heterogeneous in their design, device type, and outcomes,” authors of the study wrote. “Interventions based on health behavior models and personalized coaching were most successful. We found substantial gaps in the evidence base that should be considered before implementation of remote patient monitoring in the clinical setting.”

The analysis noted that studies on this type of device can be difficult. Most wearable device studies have an inherent shortcoming because it is difficult to make the study double-blind since wearables have to be worn on the participant's body. 

“For RPM interventions to impact healthcare, they will need to impact outcomes that matter to patients,” authors of the study wrote. “Examples include patient-reported health related quality of life (HRQOL), symptom severity, satisfaction with care, resource utilization, hospitalizations, readmissions, and survival. There is little data investigating the impact of RPM on these outcome measures. It may strengthen the interventions if they are developed directly in partnership with end-users—i.e. patients themselves.”

The article was published in the first issue of Nature’s Digital Medicine, which also included an editorial stating the mission of the journal.

"I think there hasn’t been a place for digital medicine to shine in terms of a peer-reviewed journal, especially an open-access one,” Dr. Eric Topol, editor-in-chief of Digital Medicine, told MobiHealthNews. “So we’re hoping this will be a great landing zone for high-quality contributions, both original research papers and reviews and perspectives. We’re thrilled that we got it launched and we’re getting a lot of excellent submissions. As we noted in our initial editorial, some day it won’t be called digital medicine. Some day it will just be medicine. In the interim years until we get there we’ll try to help advance the field by getting high quality work out there for the people who are really interested in this space."