Department of Family, Population and Preventive Medicine, Stony Brook Medicine, Stony Brook, New York, 11794, USA.
BMC Fam Pract. 2020 Feb 7;21(1):27. doi: 10.1186/s12875-020-1094-5.
Poor transitions of care leads to increased health costs, over-utilization of emergency room departments, increased re-hospitalizations and causes poor patient experiences and outcomes. This study evaluated Telehealth feasibility in improving transitions of care.
This is a 12-month randomized controlled trial, evaluating the use of telehealth (remote patient monitoring and video visits) versus standard transitions of care with the primary outcomes of hospital readmission and emergency department utilization and secondary outcomes of access to care, medication management and adherence and patient engagement. Electronic Medical Record data, Health Information Exchange data and phone survey data was collected. Multi-variable logistic regression models were created to evaluate the effect of Telehealth on hospital readmission, emergency department utilization, medication adherence. Chi-square tests or Fisher's exact tests were used to compare the percentages of categorical variables between the Telehealth and control groups. T tests or Wilcoxon rank sum tests were used to compared means and medians between the two randomized groups.
The study conducted between June 2017 and 2018, included 102 patients. Compared with the standard of care, Telehealth patients were more likely to have medicine reconciliation (p = 0.013) and were 7 times more likely to adhere to medication than the control group (p = 0.03). Telehealth patients exhibited enthusiasm (p = 0.0001), and confidence that Telehealth could improve their healthcare (p = 0.0001). Telehealth showed no statistical significance on emergency department utilization (p = 0.691) nor for readmissions (p = 0.31). 100% of Telehealth patients found the intervention to be valuable, 98% if given the opportunity, reported they would continue using telehealth to manage their healthcare needs, and 94% reported that the remote patient monitoring technology was useful.
Telehealth can improve transitions of care after hospital discharge improving patient engagement and adherence to medications. Although this study was unable to show the effect of Telehealth on reduced healthcare utilization, more research needs to be done in order to understand the true impact of Telehealth on preventing avoidable hospital readmission and emergency department visits.
ClinicalTrials.Gov ID: NCT03528850 Date Registered (Retrospective): 5/18/2018. Status: Completed. IRB #: 970227.
较差的医疗服务转接会导致医疗费用增加、急诊部门过度使用、再次住院率增加，并导致患者体验和结果较差。本研究评估了远程医疗在改善医疗服务转接方面的可行性。
这是一项为期 12 个月的随机对照试验，评估远程医疗（远程患者监测和视频访问）与标准医疗服务转接的使用，主要结局为医院再入院和急诊部门利用，次要结局为获得医疗服务、药物管理和依从性以及患者参与度。收集电子病历数据、健康信息交换数据和电话调查数据。创建多变量逻辑回归模型，以评估远程医疗对医院再入院、急诊部门利用、药物依从性的影响。使用卡方检验或 Fisher 精确检验比较远程医疗组和对照组的分类变量百分比。使用 t 检验或 Wilcoxon 秩和检验比较两组随机分组的平均值和中位数。
该研究于 2017 年 6 月至 2018 年进行，共纳入 102 名患者。与标准护理相比，远程医疗组患者更有可能进行药物调整（p=0.013），且与对照组相比，患者服药依从性提高了 7 倍（p=0.03）。远程医疗组患者表现出热情（p=0.0001），并相信远程医疗可以改善他们的医疗保健（p=0.0001）。远程医疗在急诊部门利用率（p=0.691）和再入院率（p=0.31）方面均无统计学意义。100%的远程医疗患者认为干预措施有价值，如果有机会，98%的患者表示将继续使用远程医疗来管理他们的医疗需求，94%的患者表示远程患者监测技术很有用。
远程医疗可以改善出院后的医疗服务转接，提高患者的参与度和对药物的依从性。尽管本研究未能显示远程医疗对减少医疗服务利用的影响，但需要进一步研究以了解远程医疗在预防可避免的医院再入院和急诊就诊方面的真正影响。
ClinicalTrials.gov 注册号：NCT03528850 注册日期（回顾性）：2018 年 5 月 18 日。状态：已完成。IRB#：970227。
