Pedroso Aline F, Lin Zhenqiu, Ross Joseph S, Khera Rohan
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA.
medRxiv. 2024 Oct 16:2024.10.14.24315496. doi: 10.1101/2024.10.14.24315496.
Digital remote patient monitoring (RPM) enables longitudinal care outside traditional healthcare settings, especially in the vulnerable period after hospitalizations, with broad coverage of the service by payers. We sought to evaluate patterns of RPM service availability at US hospitals and the association of these services with 30-day readmissions for two key cardiovascular conditions, heart failure (HF) and acute myocardial infarction (AMI).
We used contemporary national data from the American Hospital Association (AHA) Annual Survey to ascertain US hospitals offering RPM services for post-discharge or chronic care and used census-based county-level data to define the characteristics of the communities they serve. We linked these with hospitals' benchmarked risk-standardized relative performance on readmissions (excess readmission ratio [ERR]) from CMS Hospital Quality Reports (2018-2022). We used mixed-effects multivariable regression to examine the association between RPM services at hospitals and hospital characteristics-adjusted ERR for HF and AMI.
There were 2,754 hospitals with CMS quality report data. Over five years of the study, there was a 38.3% increase in the number of hospitals offering RPM services, rising from 952 (42.0%) hospitals in 2018 to 1,237 (58.1%) in 2022. However, the availability of RPM services varied across different hospital groups with smaller, non-teaching hospitals, particularly those serving rural, low-income communities, and those located in the South, were less likely to offer RPM services. There was a consistent association between the availability of RPM services and better risk-standardized readmission performance for HF, with lower ERR for hospitals offering RPM compared with those not offering RPM (absolute difference, -0.016 [-0.023, -0.009], standardized difference, 24.6%, p<0.001). However, no such association was observed for AMI (-0.007 [-0.016, 0.002], standardized difference, 10.3%, p=0.19).
In this national study of US hospitals, there has been a large increase in the availability of RPM services but with large variation among hospitals, with lower availability in hospitals serving low-income and rural communities. RPM services were associated with lower hospital readmission rates for HF but not AMI.
数字远程患者监测（RPM）能够在传统医疗环境之外提供长期护理，尤其是在住院后的脆弱时期，并且支付方对该服务的覆盖范围广泛。我们试图评估美国医院RPM服务的可用性模式，以及这些服务与两种关键心血管疾病（心力衰竭（HF）和急性心肌梗死（AMI））30天再入院率之间的关联。
我们使用了美国医院协会（AHA）年度调查的当代全国数据，以确定提供出院后或慢性病护理RPM服务的美国医院，并使用基于人口普查的县级数据来定义这些医院所服务社区的特征。我们将这些数据与CMS医院质量报告（2018 - 2022年）中医院的基准风险标准化再入院相对表现（超额再入院率[ERR]）相联系。我们使用混合效应多变量回归来研究医院的RPM服务与经医院特征调整后的HF和AMI的ERR之间的关联。
有2754家医院拥有CMS质量报告数据。在这项为期五年的研究中，提供RPM服务的医院数量增加了38.3%，从2018年的952家（42.0%）增加到2022年的1237家（58.1%）。然而，RPM服务的可用性在不同医院组中存在差异，规模较小的非教学医院，特别是那些服务于农村、低收入社区以及位于南部的医院，提供RPM服务的可能性较小。RPM服务的可用性与HF更好的风险标准化再入院表现之间存在一致的关联，与未提供RPM服务的医院相比，提供RPM服务的医院ERR更低（绝对差异，-0.016 [-0.023, -0.009]，标准化差异，24.6%，p<0.001）。然而，对于AMI未观察到这种关联（-0.007 [-0.016, 0.002]，标准化差异，10.3%，p = 0.19）。
在这项针对美国医院的全国性研究中，RPM服务的可用性大幅增加，但医院之间差异很大，服务低收入和农村社区的医院可用性较低。RPM服务与HF较低的医院再入院率相关，但与AMI无关。
