Many hospitals and rehabilitation facilities have begun to place home-telemonitoring devices with discharged patients with the intention of reducing readmissions, but when clinician researchers at Mayo Clinic looked at this possibility, they were not convinced it would work. “The literature was very unclear if there was actual benefit, so we wanted to answer the question,” said Nancy L. Dawson, MD, FACP, a hospitalist at Mayo Clinic in Florida.
To do that, her research team conducted a randomized controlled trial comparing 30-day readmission rates and mortality for patients at high risk for readmission who received home telemonitoring versus standard care from Nov. 1, 2014, through Nov. 30, 2018, at Mayo Clinic in Florida. Mayo Clinic in Arizona was added as a study site on Jan. 1, 2017.
How it works
For 1,380 patients at high risk of readmission, the hospital provided standard care, which included but was not limited to teach-back education, medication reconciliation, and a follow-up phone call within 72 hours of discharge by a trained nurse.
In addition, 690 of these patients also received telemonitoring for 30 days. Within 72 hours of discharge, an equipment company provided a blood pressure cuff, a heart rate monitor, a pulse oximeter, a scale if patients had congestive heart failure and a glucose monitor if they had diabetes, and a communication console. The cost of the monitoring equipment was about $70 per patient, and in-home installation linked the monitoring devices to the communication unit using cellular or phone line connections.
Patients then took their device readings daily, and these readings were uploaded automatically to the cloud, Dr. Dawson said. “A nurse in our organization looked at the daily data, and any readings that were outside of preset parameters initiated a contact with the patient by the nurse,” she said.
For patients who were monitored, the risk of readmission or death within 30 days was about 18% versus 24% in the group randomized to standard care, for a relative risk of 0.77 (P=0.03), according to results published online in January by the Journal of General Internal Medicine. ED visits occurred within 30 days after discharge in about 14% of patients in the control group and in about 9% of those in the telemonitoring group, a relative risk of 0.61 (P=0.005).
“I was actually surprised,” said Dr. Dawson, who was lead author of the study. “I didn't think the telemonitoring would make much difference in the readmission rate, but it actually did.”
The main challenge was recruiting telemonitoring participants, she said. “I assumed that most patients would welcome additional monitoring once they got home, particularly since there was no cost to them,” Dr. Dawson said. “But most of the [invited] patients actually declined to participate, and the most common reason was that they didn't want to be bothered with any additional tasks once they got home.”
The hospitals are now using telemonitoring as one of the tactics to reduce readmissions, Dr. Dawson said, and the research team is doing a subgroup analysis to look at contributing factors to the intervention's success. “We are looking at the patients who received the telemonitoring to see if those who had nurse contact due to out-of-parameter [data] had a lower readmission rate than those who didn't,” she said. “In other words, was it the nurse contact that helped reduce the rate of readmission in these patients?”
Dr. Dawson added that another interesting aspect to study would be even newer technology to monitor patients at home after care transitions. “There are now devices that can monitor activity, time out of bed, etc., and these parameters would be interesting to track to help our patients be successful after discharge,” she said.
Words of wisdom
Dr. Dawson said the study findings have reversed her initial skepticism of the benefit of telemonitoring devices. “I am now in favor of using these monitoring devices after discharge because it does appear that they help patients be successful at home,” she said.