Nouryan Christian N, Morahan Stephanie, Pecinka Kathleen, Akerman Meredith, Lesser Martin, Chaikin Dale, Castillo Stacy, Zhang Meng, Pekmezaris Renee
1 Department of Medicine, Northwell Health, Manhasset, New York.
2 Feinstein Institute for Medical Research, Manhasset, New York.
Telemed J E Health. 2019 Jun;25(6):447-454. doi: 10.1089/tmj.2018.0099. Epub 2018 Jul 23.
Background:Home telemonitoring (HTM) is a promising approach to improve quality of life (QoL) and decrease hospital utilization.
Methods:This randomized-controlled study followed 89 community-dwelling Medicare outpatients with heart failure (HF) after discharge from home care for 6 months. Patients were randomized to HTM or comprehensive outpatient management (COM). HTM received weekly (video) televisits with daily vital sign monitoring. COM was contacted weekly by telephone. Outcomes included emergency department (ED) and inpatient utilization and QoL.
Results: Average age at enrollment was 81.4 for HTM and 84.9 for COM. Thirty-eight percent of HTM had ≥1 ED visit versus 60% of COM (p = 0.04), while 48% of HTM had ≥1 hospitalization versus 55% of COM (p = 0.47). Length of stay (LOS) (days) was 4.0 for HTM versus 7.4 for COM (p = 0.39). Costs were $38,990 for HTM versus $50,943 for COM (p = 0.91). QoL improved by -9.66 for HTM and -3.56 for COM (p = 0.02). Although HF-related utilization did not differ between groups, HTM patients who were highly adherent obtained better all-cause outcomes than those with low adherence.
Conclusions:Significantly improved all-cause ED utilization, LOS, and QoL were found for HTM; other differences were not significant. More research is needed to determine how to best utilize this technology to improve patient outcomes.
家庭远程监测（HTM）是一种有望改善生活质量（QoL）并减少医院利用率的方法。
这项随机对照研究对89名社区居住的医疗保险门诊心力衰竭（HF）患者出院后进行了6个月的随访。患者被随机分为HTM组或综合门诊管理（COM）组。HTM组每周进行（视频）远程会诊，并每日监测生命体征。COM组每周通过电话联系。结果包括急诊室（ED）就诊和住院利用率以及生活质量。
HTM组入组时的平均年龄为81.4岁，COM组为84.9岁。HTM组38%的患者有≥1次急诊就诊，而COM组为60%（p = 0.04），HTM组48%的患者有≥1次住院，而COM组为55%（p = 0.47）。住院时间（LOS）（天）HTM组为4.0天，COM组为7.4天（p = 0.39）。HTM组的费用为38,990美元，COM组为50,943美元（p = 0.91）。HTM组的生活质量改善了-9.66，COM组改善了-3.56（p = 0.02）。尽管两组之间与HF相关的利用率没有差异，但高依从性的HTM患者比低依从性患者获得了更好的全因结局。
发现HTM组的全因急诊利用率、住院时间和生活质量有显著改善；其他差异不显著。需要更多研究来确定如何最好地利用这项技术来改善患者结局。
