By Melinda Young
EXECUTIVE SUMMARY
A collection of six new studies revealed positive outcomes with remote patient monitoring for a variety of illnesses and conditions.
- The COVID-19 pandemic accelerated adoption, use, and benefits of remote patient monitoring.
- In one study, Veterans Affairs patients who were remotely monitored following a stroke recorded fewer ED visits than patients who were not monitored.
- Remote monitoring also helped alleviate patients’ severity of symptoms, particularly with cancer treatment.
Remote monitoring of patients with chronic disease can be cost-effective, improve adherence to therapies, improve care, and help alleviate symptoms, a collection of new studies show.1-7
“We found that remote patient monitoring has really gained speed since the onset of the COVID pandemic,” says Beth Devine, PhD, PharmD, MBA, professor at the Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute at the University of Washington. Devine wrote an editorial about the research and the implications from a care management perspective.1
“For the approximate past 10 years, investigators in this arena, who investigate the effectiveness and outcomes of new interventions, were putting a lot of work into conducting studies by which we intended to ensure remote monitoring is as safe and effective as face-to-face monitoring or face-to-face visits,” Devine explains. “The COVID pandemic accelerated all of that. Investigators no longer had the luxury of all those years ahead of them to conduct those studies.”
When remote patient monitoring took off during the pandemic, the field moved forward, resulting in six published studies that collectively show remote patient monitoring can be safe and effective within different contexts.
“As editors at the Journal of Value and Health, we called for themed studies on remote patient monitoring about 1.5 years ago,” Devine explains. “It was open to anyone, and investigators submitted their own work to be considered for publication.”
The six studies selected provide a good look at how remote patient monitoring has worked, particularly in the context of the COVID-19 pandemic. “Each of the six studies are unique in many ways,” Devine says. “They represent four countries of Uganda, Australia, the United States, and the Netherlands.”
The studies demonstrated remote patient monitoring can be safe and effective in different contexts and in different countries and with different disease states. “The studies were conducted between 2016 and 2021,” Devine says. “Some started before COVID.”
The research shows remote patient monitoring solutions can be cost-effective for patient care. “We determine the trade-off between costs and benefits and harms, too,” Devine says. “It doesn’t mean there were cost savings, necessarily, but it means the money spent is worth it in terms of providing value with no secondary effects to patients.”
The programs can be expensive to implement. But once they are underway, hospitals can start accruing the benefits.
Overall, the studies show remote patient monitoring solutions offer these benefits:
- Improve adherence to therapies;
- Improve guideline-concordant care;
- Contribute to more rapid symptom resolution.
“They do require investment and resources, but the quality is improved, and patients benefit from it,” Devine says.
Monitoring COVID-19 Patients at Home
The authors of one study assessed ways to to keep COVID-19 patients at home to alleviate hospital overcrowding and prevent ED visits.7
“This U.S. health system did a rapid response,” Devine says. “To keep patients from returning to the emergency department, they quickly implemented a system where they monitored patients at home.”
The health system used remote pulse oximetry monitoring of these moderately ill patients. Their symptoms were checked remotely. If symptoms escalated, the patients could return to the hospital.
The program reduced costs and improved outcomes, resulting in 87% fewer hospitalizations and 77% fewer deaths among the patients with access to remote pulse oximetry monitoring.7
Telestroke Program Improved Outcomes
A study conducted by Veterans Affairs (VA) described a telestroke program that connected stroke specialists with ED staff at facilities that did not employ an on-site stroke expert.2
“They’d give advice and guidance to those outlying hospitals,” Devine says. “The intervention’s goal was to decrease the time for patients to receive their therapy when they were having a stroke.”
Patients who participated in the VA’s National TeleStroke Program (NTSP) had fewer visits to VA emergency care, averaging 0.49 ED visits in the first 90 days, compared with non-NTSP patients averaging 0.89 visits in the first 90 days. Both the 529 patients in the control period, which was before the NTSP was implemented, and the 471 patients in the NTSP period were studied before the COVID-19 pandemic.
Although the researchers did not find an improvement in cost within the first year of the program, it is possible patients would improve over the long term, Devine notes. The most consistent finding was a decline in emergency medicine and home health costs, but these were relatively small.
“I’m a firm believer that we need to move toward our digital age in every way, and I think healthcare is behind in doing that,” Devine says. “Anything we can do to make care more efficient and convenient for patients and to keep them out of hospitals is worth the investment.”
Managing Symptoms Remotely
Remote monitoring also is important for helping patients alleviate the severity of their symptoms, as researchers found when studying electronic symptom management of patients undergoing cancer treatment. Investigators used smartphones and computers to send weekly symptom management surveys to patients who received chemotherapy.3
“Clinicians would look at the survey results and get in touch with patients who reported severe symptoms,” Devine explains. “They tracked them more closely than they would have if [patients] just came in for follow-up appointments. [Clinicians] intervened more quickly.”
The researchers found patients were happy to complete the surveys, and the tracking method used was feasible. Also, the provider calls helped patients resolve their symptoms faster without an office or clinic visit.
As healthcare technology advances, health systems should thoughtfully implement programs that use whatever tech is available and fits the purpose. “Studies like these are important to give ideas to investigators, administrators, and clinicians as we move forward on all fronts,” Devine notes.
But health systems should exercise some caution. “As we implement these programs, we need to ensure that they’re designed correctly so patients like them and use them, and clinicians like them and use them,” Devine says. “Programs that are not [designed] adequately are abandoned. How to design a website, a survey, and how to alert the provider when the patient has a symptom out of range all are things that need to be studied.”
REFERENCES
- Devine B. Assessing the value of remote patient monitoring solutions in addressing challenges in patient care. Value Health 2022;25:887-889.
- Wagner TH, Schoemaker L, Gehlert E, et al. One-year cost associated with Veterans Affairs National TeleStroke Program. Value Health 2022;25:937-943.
- Wujcik D, Dudley WN, Dudley M, et al. Electronic patient symptom management program to support patients receiving cancer treatment at home during the COVID-19 pandemic. Value Health 2022;25: 931-936.
- De Guzman KR, Snoswell CL, Taylor ML, et al. Economic evaluations of remote patient monitoring for chronic disease: A systematic review. Value Health 2022;25:897-913.
- Smits M, Nacar M, Ludden GDS, van Goor H. Stepwise design and evaluation of a values-oriented ambient intelligence healthcare monitoring platform. Value Health 2022;25:914-923.
- Thompson RR, Kityamuwesi A, Kuan A, et al. Cost and cost-effectiveness of a digital adherence technology for tuberculosis treatment support in Uganda. Value Health 2022;25: 924-930.
- Padula WV, Miano MA, Kelley MA, et al. A cost-utility analysis of remote pulse-oximetry monitoring of patients with COVID-19. Value Health 2022;25:890-896.
Remote monitoring of patients with chronic disease can be cost-effective, improve adherence to therapies, improve care, and help alleviate symptoms, a collection of new studies shows.
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