Search

Background: The use of mobile health apps for remote monitoring has considerable potential for patient care. However, more research is needed to gather patients' experience with their use. This study evaluates heart failure patients' experience of the effects of remote monitoring on the management of heart failure (HF) using a smartphone app, the challenges faced in such use, and patients' suggestions for improving the efficacy of this device. Method: A qualitative study was conducted with all patients who had used the TakeCare™ app for at least three months during the exploratory phase of the Continuum project. Patients were recruited before COVID-19 began, and they used the app during this period. The app allows patients to submit their daily vital signs and answer questions about their symptoms to help the clinical professionals adjust their treatment plan as needed. Individual interviews were conducted by telephone or videoconference using a semi-structured individual interview guide. All interviews were recorded, transcribed and analyzed using the thematic analysis method. Results: Of the 29 patients invited, 5 had since died, 10 did not respond, two gave positive feedback on the app but declined the interview, and 12 patients agreed to participate in an individual interview. The participants all liked the app's ease of use. They particularly praised the contribution it made to monitoring their disease, both by themselves and by clinicians. The app also allowed them to stay connected to their clinical team and have better access to healthcare professionals. Patients suggested, as an improvement, that the feedback and communication features should be personalized to make them more individualized and interactive. Conclusion: The TakeCare™ smartphone app was well received by patients with heart failure. Its use could facilitate better remote monitoring of heart conditions in the home as well as improve access to clinical teams. [ABSTRACT FROM AUTHOR]

Abstract Background The use of mobile health apps for remote monitoring has considerable potential for patient care. However, more research is needed to gather patients’ experience with their use. This study evaluates heart failure patients’ experience of the effects of remote monitoring on the management of heart failure (HF) using a smartphone app, the challenges faced in such use, and patients’ suggestions for improving the efficacy of this device. Method A qualitative study was conducted with all patients who had used the TakeCare™ app for at least three months during the exploratory phase of the Continuum project. Patients were recruited before COVID-19 began, and they used the app during this period. The app allows patients to submit their daily vital signs and answer questions about their symptoms to help the clinical professionals adjust their treatment plan as needed. Individual interviews were conducted by telephone or videoconference using a semi-structured individual interview guide. All interviews were recorded, transcribed and analyzed using the thematic analysis method. Results Of the 29 patients invited, 5 had since died, 10 did not respond, two gave positive feedback on the app but declined the interview, and 12 patients agreed to participate in an individual interview. The participants all liked the app’s ease of use. They particularly praised the contribution it made to monitoring their disease, both by themselves and by clinicians. The app also allowed them to stay connected to their clinical team and have better access to healthcare professionals. Patients suggested, as an improvement, that the feedback and communication features should be personalized to make them more individualized and interactive. Conclusion The TakeCare™ smartphone app was well received by patients with heart failure. Its use could facilitate better remote monitoring of heart conditions in the home as well as improve access to clinical teams.

Concerns about the unsatisfactory condition of chronic disease management prompted the design and development of a telemonitoring home system based on user input. Patients, caring for themselves through self-care and monitoring, can control and prevent chronic disorders, restructuring the treatment process into a constant cooperative interaction between patients and health-care professionals. The primary major goal of this study is to highlight future research directions in remote health care and patient monitoring for chronic illnesses treatment and management, as well as to provide an overview of the current state of remote patient monitoring (RPM), its contemporary constraints, and possible future prospects that will aid to resolve those contemporary constraints. The methodology of this review is that an independent literature search was conducted on Medline, PubMed, and Google Scholar for the below-mentioned keywords, and studies published till April 2022 that had used any type of RPM intervention were screened for inclusion in the review. The conclusion of this review is that continuous RPM may increase patient adherence to medication and other guideline-recommended therapy strategies that have been linked to a reduction in clinical mortality and better prognosis. However, a number of technological, medical legal and economic barriers must be overcome before they may be widely used.

Background: Since data on the safety and effectiveness of home telemonitoring and oxygen therapy started directly after Emergency Department (ED) assessment in COVID-19 patients are sparse but could have many advantages, we evaluated these parameters in this study. Methods: All COVID-19 patients ≥18 years eligible for receiving home telemonitoring (November 2020-February 2022, Albert Schweitzer hospital, the Netherlands) were included: patients started directly after ED assessment (ED group) or after hospital admission (admission group). Safety (number of ED reassessments and hospital readmissions) and effectiveness (number of phone calls, duration of oxygen usage and home telemonitoring) were described in both groups. Results: 278 patients were included (n = 65 ED group, n = 213 admission group). ED group: 23.8% (n = 15) was reassessed, 15.9% (n = 10) was admitted and 7.7% (n = 5) ICU admitted. Admission group: 15.8% (n = 37) was reassessed, 6.5% (n = 14) was readmitted and 2.4% (n = 5) ICU (re)admitted. Ten patients died, of whom 7 due to COVID-19 (1 in ED group; 6 in the admission group). ED group: median duration of oxygen therapy was 9 (IQR 7–13) days; the total duration of home telemonitoring was 14 (IQR 9–18) days. Admission group: duration of oxygen therapy was 10 (IQR 6–16) days; total duration of home telemonitoring was 14 (IQR 10–20) days. Conclusion: it appears to be safe to start home telemonitoring and oxygen therapy directly after ED assessment. [ABSTRACT FROM AUTHOR]

• Home telemonitoring may partly substitute face-to-face contacts in stable outpatients with heart failure. • Stable heart failure patients receiving a non-invasive e-health adjusted care pathway had similar reduction in NT-proBNP values than those receiving usual care with on average four face-to-face contacts a year. • More studies are needed to evaluate substitution of face-to-face contacts by e-health. Home telemonitoring in heart failure (HF) patients may reduce workload of HF nurses by reducing face-to-face contacts. The aim of this study is to assess whether telemonitoring as a substitution could have negative effects as expressed by less reduction in circulating natriuretic peptide levels between baseline and one-year of follow up compared to usual care. A post-hoc analysis of the e-Vita HF trial, a three-arm parallel randomized trial conducted in stable HF patients. Patients were randomized into three arms: (i) usual HF outpatient care, (ii) usual care combined with the use of the website heartfailurematters.org, and (iii) telemonitoring (e-Vita HF platform) instead of face-to-face consultations. Mixed linear model analyses were applied to assess differences in the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels between the three arms over a year. A total of 223 participants could be included (mean age 67.1 ± 10.1 years, 27% women, New York Heart Association class I–IV; 39%, 38%, 14%, and 9%). The mean left ventricular ejection fraction was 35 ± 10%. The median of routine face-to-face contacts over a year was 1.0 lower (2.0 vs. 3.0) in the third arm compared with usual care. Median NT-proBNP levels did not significantly differ between the three arms. In stable and optimally treated HF patients, telemonitoring causing a reduction of routine face-to-face contacts seems not to negatively affect hemodynamic status as measured by NT-proBNP levels over time. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Heart failure and chronic obstructive pulmonary disease (COPD) are leading causes of disability and lead to substantial healthcare costs. The aim of this study was to evaluate the effectiveness of home telemonitoring in reducing healthcare usage and costs in patients with heart failure or COPD. Methods: The study was a retrospective observational study with a follow-up duration of up to 3 years in which for all participants data before and after enrollment in the telemonitoring program was compared. Hundred seventy-seven patients with heart failure (NYHA functional class 3 or 4) and 83 patients with COPD (GOLD stage 3 or 4) enrolled in a home telemonitoring program in addition to receiving usual hospital care. The primary outcome was the number of hospitalizations; the secondary outcomes were total number of hospitalization days and healthcare costs during the follow-up period. Generalized Estimating Equations were applied to account for repeated measurements, adjusting for sex, age and length of follow-up. Results: In heart failure patients, after initiation of home telemonitoring both the number of hospitalizations and the total number of hospitalization days significantly decreased (incidence rate ratio of 0.35 (95% CI: 0.26–0.48) and 0.35 (95% CI: 0.24–0.51), respectively), as did the total healthcare costs (exp(B) = 0.11 (95% CI: 0.08–0.17)), all p

The struggle to transform telemedicine from project level to daily clinical practice is ongoing. An assessment of the business models of telemedicine applications could provide insights into how to facilitate this transition. Our aim was to identify the qualitative characteristics of business models of long-term operational telemedicine providers in Denmark. A structured interview study design was applied to interviews of representatives from seven Danish companies providing home telemonitoring in long-term operation. Data was analysed using Osterwalder's Business Model Canvas framework. Multiple themes emphasized the importance of strong personal relationships between company representatives and healthcare providers. Personal relations could 1) secure a strong relationship to lead users and clinical ambassadors; 2) facilitate work with healthcare providers to develop, test and revise value propositions; 3) promote user support and education; 4) establish an indirect connection between companies and healthcare managers or decision makers. Thus, a strong personal relationship between company representatives and healthcare providers is of paramount importance when integrating home telemonitoring from project stage into clinical practice. However, this strategy could lack patient involvement, use of data, and business scalability. Additionally, companies with the ability to establish strong personal connections could be favoured over companies which provide strong clinical and economic evidence. [ABSTRACT FROM AUTHOR]

Home telemonitoring has been used as a solution to support the care of individuals living with chronic disease. While effectiveness of telemonitoring have been widely studied, more research is needed to understand the perceptions among patients and clinicians in incorporating telemonitoring into their daily routine and practices. This paper presents an investigation of patients’ and clinicians’ experiences in a care augmenting telemonitoring service, their perceived impact delivered through the service, and clinicians’ perceptions on how the service was introduced in their organizations. This work was embedded in a large multi-site trial of home telemonitoring using a mixed method approach for evaluation. Interviews with clinicians involved in the study were conducted at multiple time points during the trial. Questionnaires were administered to clinicians and patients at the end of the trial. Results showed that both patients and clinicians recognized the benefits of patient empowerment through telemonitoring, and patient-clinician interactions. Results identified the needs of a dedicated telemonitoring clinical care coordinator role, guidelines that translate telemonitoring services into clinical pathways and engagement of different healthcare providers, especially general practitioners, to support the integration of telemonitoring into chronic disease management programs and long-term organizational strategic plans. [ABSTRACT FROM AUTHOR]

Background: The results of telemedicine intervention studies in patients with heart failure (HF) to reduce rehospitalization rate and mortality by early detection of HF decompensation are encouraging. However, the benefits are lower than expected. A possible reason for this could be the fact that vital signs, including blood pressure, heart rate, heart rhythm, and weight changes, may not be ideal indicators of the early stages of HF decompensation but are more sensitive for acute events triggered by ischemic episodes or rhythm disturbances. Preliminary results indicate a potential role of ambient sensor-derived digital biomarkers in this setting., Objective: The aim of this study is to identify changes in ambient sensor system-derived digital biomarkers with a high potential for early detection of HF decompensation., Methods: This is a prospective interventional cohort study. A total of 24 consecutive patients with HF aged 70 years and older, living alone, and hospitalized for HF decompensation will be included. Physical activity in the apartment and toilet visits are quantified using a commercially available, passive, infrared motion sensing system (DomoHealth SA). Heart rate, respiration rate, and toss-and-turns in bed are recorded by using a commercially available Emfit QS device (Emfit Ltd), which is a contact-free piezoelectric sensor placed under the participant's mattress. Sensor data are visualized on a dedicated dashboard for easy monitoring by health professionals. Digital biomarkers are evaluated for predefined signs of HF decompensation, including particularly decreased physical activity; time spent in bed; increasing numbers of toilet visits at night; and increasing heart rate, respiration rate, and motion in bed at night. When predefined changes in digital biomarkers occur, patients will be called in for clinical evaluation, and N-terminal pro b-type natriuretic peptide measurement (an increase of >30% considered as significant) will be performed. The sensitivity and specificity of the different biomarkers and their combinations for the detection of HF decompensation will be calculated., Results: The study is in the data collection phase. Study recruitment started in February 2024. Data analysis is scheduled to start after all data are collected. As of manuscript submission, 5 patients have been recruited. Results are expected to be published by the end of 2025., Conclusions: The results of this study will add to the current knowledge about opportunities for telemedicine to monitor older patients with HF living at home alone by evaluating the potential of ambient sensor systems for this purpose. Timely recognition of HF decompensation could enable proactive management, potentially reducing health care costs associated with preventable emergency presentations or hospitalizations., Trial Registration: ClinicalTrials.gov NCT06126848; https://clinicaltrials.gov/study/NCT06126848., International Registered Report Identifier (irrid): PRR1-10.2196/55953., (©Benjamin Vögeli, Nisha Arenja, Narayan Schütz, Tobias Nef, Philipp Buluschek, Hugo Saner. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 31.05.2024.)

Objectives. Evaluation of the effectiveness of home care through a telemonitoring system in reducing the incidence of new colonization by Pseudomonas Aeruginosa in a population of patients with Cystic Fibrosis (CF) followed by the CF clinic of the Bambino Gesù Hospital in Rome over a period of 36 months. Materials and Methods. Two groups of patients were recruited, homogeneous for age, sex, BMI, FEV1, prevalence of CF-related Diabetes and CF-related Hepatopathy, access to new therapies with modulators: a) an IN group (N = 44 ) followed through a home telemonitoring system, b) an OUT control group (N = 110) followed according to the standards of care. The following parameters were detected for all patients: pulmonary colonization of the lungs, number and type of hospital admissions, respiratory function, BMI. Results. The OUT group had a statistically significant increase in the prevalence of Pseudomonas Aeruginosa infections during the observation period. Furthermore, a significant decrease in lung function assessed through FEV1 was also observed in the OUT group. Conclusions. Adolescent and adult patients belonging to the CF center who are not followed through the dedicated home telemonitoring service show, in the three-year period 2017-19, an increase in Pseudomonas Aeruginosa infections and a greater decrease in respiratory function. The use of telemedicine in CF is therefore an effective system not only in monitoring the disease but also as a treatment strategy, in the context of an evolving multidisciplinary model. As advantages, telemedicine can reduce the number of Pseudomonas Aeruginosa lung infections and the greater stability of respiratory function over time. [ABSTRACT FROM AUTHOR]

Home telemonitoring is a promising approach in the management of patients with chronic diseases. However, no study has assessed its acceptability and possible service charge in Nigeria. Therefore, this study aimed to evaluate willingness to pay for pharmacist-provided telemonitoring among patients with chronic diseases and to explore its determinants. Hence, using the contingent valuation method, a cross-sectional study was conducted among eligible patients visiting 15 selected community pharmacies in Enugu metropolis, over a period of 3 months. Of the 335 patients who participated in the study, about 40 percent (i.e. 39.4%) were willing to pay an average monthly fee of ₦915.91 ± 485.49 (US$2.99 ± 1.59) for home telemonitoring services. Significant predictors of willingness to pay for home telemonitoring were perceived insufficient income (odds ratio = 0.20, 95% confidence interval = 0.07–0.60, p = 0.040) and health insurance status (odds ratio = 0.39, 95% confidence interval = 0.18–0.86, p = 0.019). Our findings suggest a promising potential for adopting home telemonitoring services among patients with chronic diseases in Enugu metropolis. [ABSTRACT FROM AUTHOR]

This paper presents a system supporting clinical decisions for patients with Chronic Obstructive Pulmonary Disease (COPD). The system should partially fill the gaps highlighted during an analysis of the current state of the art of Clinical Decision Support Systems (CDSS) for telemonitoring patients affected by COPD. The first step taken was to replicate the performance of similar decision support systems found in the scientific literature. Using physiological parameters drawn from respiratory function tests on 414 patients, two predictive models were created using two machine-learning algorithms: neural network and support vector machine. Performance was comparable to that described in the literature. The results made it possible to affirm that the data available were sufficient to evaluate the extent of respiratory deficit. The next step was to create a new predictive model with better performance than previously obtained. The C5.0 Machine Learning Algorithm was chosen for the development of the model. The resulting performance on the data available was significantly better than with the two previous models. This new predictive model, called COPD, was then implemented in a user interface created using Java programming language. The new software developed, which enables the evaluation and classification of respiratory test results and which can be used in many clinical applications, provides excellent performance compared to the current state of the art. [ABSTRACT FROM AUTHOR]

Abstract Background Home telemonitoring has developed considerably over recent years in chronic diseases in order to improve communication between healthcare professionals and patients and to promote early detection of deteriorating health status. In the nephrology setting, home telemonitoring has been evaluated in home dialysis patients but data are scarce concerning chronic kidney disease (CKD) patients before and after renal replacement therapy. The eNephro study is designed to assess the cost effectiveness, clinical/biological impact, and patient perception of a home telemonitoring for CKD patients. Our purpose is to present the rationale, design and organisational aspects of this study. Methods eNephro is a pragmatic randomised controlled trial, comparing home telemonitoring versus usual care in three populations of CKD patients: stage 3B/4 (n = 320); stage 5D CKD on dialysis (n = 260); stage 5 T CKD treated with transplantation (n= 260). Five hospitals and three not-for-profit providers managing self-care dialysis situated in three administrative regions in France are participating. The trial began in December 2015, with a scheduled 12-month inclusion period and 12 months follow-up. Outcomes include clinical and biological data (e.g. blood pressure, haemoglobin) collected from patient records, perceived health status (e.g. health related quality of life) collected from self-administered questionnaires, and health expenditure data retrieved from the French health insurance database (SNIIRAM) using a probabilistic matching procedure. Discussion The hypothesis is that home telemonitoring enables better control of clinical and biological parameters as well as improved perceived health status. This better control should limit emergency consultations and hospitalisations leading to decreased healthcare expenditure, compensating for the financial investment due to the telemedicine system. Trial registration This study has been registered at ClinicalTrials.gov under NCT02082093 (date of registration: February 14, 2014).

Background: Home telemonitoring has developed considerably over recent years in chronic diseases in order to improve communication between healthcare professionals and patients and to promote early detection of deteriorating health status. In the nephrology setting, home telemonitoring has been evaluated in home dialysis patients but data are scarce concerning chronic kidney disease (CKD) patients before and after renal replacement therapy. The eNephro study is designed to assess the cost effectiveness, clinical/biological impact, and patient perception of a home telemonitoring for CKD patients. Our purpose is to present the rationale, design and organisational aspects of this study.Methods: eNephro is a pragmatic randomised controlled trial, comparing home telemonitoring versus usual care in three populations of CKD patients: stage 3B/4 (n = 320); stage 5D CKD on dialysis (n = 260); stage 5 T CKD treated with transplantation (n= 260). Five hospitals and three not-for-profit providers managing self-care dialysis situated in three administrative regions in France are participating. The trial began in December 2015, with a scheduled 12-month inclusion period and 12 months follow-up. Outcomes include clinical and biological data (e.g. blood pressure, haemoglobin) collected from patient records, perceived health status (e.g. health related quality of life) collected from self-administered questionnaires, and health expenditure data retrieved from the French health insurance database (SNIIRAM) using a probabilistic matching procedure.Discussion: The hypothesis is that home telemonitoring enables better control of clinical and biological parameters as well as improved perceived health status. This better control should limit emergency consultations and hospitalisations leading to decreased healthcare expenditure, compensating for the financial investment due to the telemedicine system.Trial Registration: This study has been registered at ClinicalTrials.gov under NCT02082093 (date of registration: February 14, 2014). [ABSTRACT FROM AUTHOR]

Introduction: During the initial COVID-19 pandemic peak, Stamford Hospital implemented a home oxygen program (HOP) to create a comprehensive, multi-disciplinary outpatient initiative without sacrificing a safe discharge. Primary care physicians monitored program participants, whose only indication for remaining admitted was an oxygen requirement. We retrospectively examined participant co-morbidities and outcomes, including death and readmission rates to evaluate HOP safety., Methods: A retrospective analysis of program participants discharged between April 2020-Janurary 2021 was performed. Variables included demographics, oxygen requirement, days enrolled in the HOP, and major comorbidities such as cardiovascular disease (CVD), diabetes (DM), hypertension (HTN), obesity, chronic kidney disease, malignancies and underlying chronic obstructive pulmonary disease (COPD)., Results: Among the 138 HOP participants, ages ranged from 23 to 96 (Mean 65.5), with 47.1% female and 52.9% male. The most represented ethnicity included White (48.6%), Hispanic (29.7%), and Black (15.2%). Patients' average time in the HOP was 19 days, requiring an average of 1.7 L/min of home oxygen. Thirteen patients (9.4%) were readmitted to the hospital with 2.9% secondary to worsening COVID-19 hypoxia, but no deaths occurred at home. A significant relationship was found between age and highest home oxygen need. Patients with COPD, HTN, and DM had significantly higher oxygen requirements (P-value <0.05)., Conclusion: Increasing age, underlying COPD, HTN, and DM were associated with higher oxygen requirements in participants. Given limited availability of hospital beds, and no occurrences of death at home, Stamford Hospital HOP safely helped provide care for sicker patients and enhanced resource allocation., Competing Interests: Conflict of interest The authors do not have any conflicts of interest in relation to this work., (© 2023 Greater Baltimore Medical Center.)

Background: Home blood pressure telemonitoring (HBPT) is witnessing rapid diffusion worldwide. Contemporary studies documented mainly short-term (6-12 months) effects of HBPT, and there are limited data about its uptake.Objective: The aim of this study was to explore the 3-year use and determinants of HBPT, and the interactions with systolic and diastolic blood pressure (SBP/DBP) and overall blood pressure (BP) control rate.Methods: HBPT records were obtained from a 3-year cohort of 5658 patients with hypertension in Jieshou, Anhui, China, and data from a structured household survey of a random sample (n=3005) of the cohort. The data analysis comprised (1) timeline trajectories of the rates of monthly active HBPT and mean SBP/DBP for overall and subgroups of patients with varied start-month SBP/DBP; and (2) multivariable linear, logistic, and percentile regression analyses using SBP/DBP, BP control rate, and yearly times of HBPT as the dependent variable, respectively.Results: HBPT was followed by mixed changes in mean monthly SBP/DBP for varied patient groups. The magnitude of changes ranged from -43 to +39 mmHg for SBP and from -27 to +15 mmHg for DBP. The monthly rates of active HBPT all exhibited a rapid and then gradually slower decline. When controlled for commonly reported confounders, times of HBPT in the last year were found to have decreasing correlation coefficients for SBP/DBP (from 0.16 to -0.35 and from 0.11 to -0.35, respectively) and for BP control rate (from 0.53 to -0.62).Conclusions: HBPT had major and "target-converging" effects on SBP/DBP. The magnitude of changes was much greater than commonly reported. BP, variation in BP, and time were the most important determinants of HBPT uptake. Age, education, duration of hypertension, family history, and diagnosis of hypertension complications were also linked to the uptake but at weaker strength. There is a clear need for differentiated thinking over the application and assessment of HBPT, and for identifying and correcting/leveraging potential outdated/new opportunities or beliefs. [ABSTRACT FROM AUTHOR]

Background: Evidence that home telemonitoring for patients with chronic heart failure (CHF) offers clinical benefit over usual care is controversial as is evidence of a health economic advantage. Methods: Between January 2010 and June 2013, patients with a confirmed diagnosis of CHF were enrolled and randomly assigned to 2 study groups comprising usual care with and without an interactive bi-directional remote monitoring system (Motiva®). The primary endpoint in CardioBBEAT is the Incremental Cost-Effectiveness Ratio (ICER) established by the groups' difference in total cost and in the combined clinical endpoint "days alive and not in hospital nor inpatient care per potential days in study" within the follow-up of 12 months. Results: A total of 621 predominantly male patients were enrolled, whereof 302 patients were assigned to the intervention group and 319 to the control group. Ischemic cardiomyopathy was the leading cause of heart failure. Despite randomization, subjects of the control group were more often in NYHA functional class III-IV, and exhibited peripheral edema and renal dysfunction more often. Additionally, the control and intervention groups differed in heart rhythm disorders. No differences existed regarding risk factor profile, comorbidities, echocardiographic parameters, especially left ventricular and diastolic diameter and ejection fraction, as well as functional test results, medication and quality of life. While the observed baseline differences may well be a play of chance, they are of clinical relevance. Therefore, the statistical analysis plan was extended to include adjusted analyses with respect to the baseline imbalances. Conclusions: CardioBBEAT provides prospective outcome data on both, clinical and health economic impact of home telemonitoring in CHF. The study differs by the use of a high evidence level randomized controlled trial (RCT) design along with actual cost data obtained from health insurance companies. Its results are conducive to informed political and economic decision-making with regard to home telemonitoring solutions as an option for health care. Overall, it contributes to developing advanced health economic evaluation instruments to be deployed within the specific context of the German Health Care System. [ABSTRACT FROM AUTHOR]

Background: From 1992 to 2008, older adults in the United States incurred more healthcare expense per capita than any other age group. Home telemonitoring has emerged as a potential solution to reduce these costs, but evidence is mixed. The primary aim of the study was to evaluate whether the mean difference in total direct medical cost consequence between older adults receiving additional home telemonitoring care (TELE) (n =102) and those receiving usual medical care (UC) (n =103) were significant. Inpatient, outpatient, emergency department, decedents, survivors, and 30-day readmission costs were evaluated as secondary aim. Materials and Methods: Multivariate generalized linear models (GLMs) and parametric bootstrapping method were used to model cost and to determine significance of the cost differences. We also compared the differences in arithmetic mean costs. Results: From the conditional GLMs, the estimated mean cost differences (TELE versus UC) for total, inpatient, outpatient, and ED were −$9,537 (p =0.068), −$8,482 (p =0.098), −$1,160 (p =0.177), and $106 (p =0.619), respectively. Mean postenrollment cost was 11% lower than the prior year for TELE versus 22% higher for UC. The ratio of mean cost for decedents to survivors was 2.1:1 (TELE) versus 12.7:1 (UC). Conclusions: There were no significant differences in the mean total cost between the two treatment groups. The TELE group had less variability in cost of care, lower decedents to survivors cost ratio, and lower total 30-day readmission cost than the UC group. [ABSTRACT FROM AUTHOR]

Background: Telehealth services based on at-home monitoring of vital signs and the administration of clinical questionnaires are being increasingly used to manage chronic disease in the community, but few statistically robust studies are available in Australia to evaluate a wide range of health and socio-economic outcomes. The objectives of this study are to use robust statistical methods to research the impact of at home telemonitoring on health care outcomes, acceptability of telemonitoring to patients, carers and clinicians and to identify workplace cultural factors and capacity for organisational change management that will impact on large scale national deployment of telehealth services. Additionally, to develop advanced modelling and data analytics tools to risk stratify patients on a daily basis to automatically identify exacerbations of their chronic conditions.Methods/design: A clinical trial is proposed at five locations in five states and territories along the Eastern Seaboard of Australia. Each site will have 25 Test patients and 50 case matched control patients. All participants will be selected based on clinical criteria of at least two hospitalisations in the previous year or four or more admissions over the last five years for a range of one or more chronic conditions. Control patients are matched according to age, sex, major diagnosis and their Socio-Economic Indexes for Areas (SEIFA). The Trial Design is an Intervention control study based on the Before-After-Control-Impact (BACI) design.Discussion: Our preliminary data indicates that most outcome variables before and after the intervention are not stationary, and accordingly we model this behaviour using linear mixed-effects (lme) models which can flexibly model within-group correlation often present in longitudinal data with repeated measures. We expect reduced incidence of unscheduled hospitalisation as well as improvement in the management of chronically ill patients, leading to better and more cost effective care. Advanced data analytics together with clinical decision support will allow telehealth to be deployed in very large numbers nationally without placing an excessive workload on the monitoring facility or the patient's own clinicians.Trial Registration: Registered with Australian New Zealand Clinical Trial Registry on 1st April 2013. Trial ID: ACTRN12613000635763. [ABSTRACT FROM AUTHOR]

Background: Remote monitoring (RM) strategies have the potential to deliver specialised care and management to patients with heart failure (HF). Objective: To determine the clinical effectiveness and cost-effectiveness of home telemonitoring (TM) or structured telephone support (STS) strategies compared with usual care for adult patients who have been recently discharged (within 28 days) from acute care after a recent exacerbation of HF. Data sources: Fourteen electronic databases (including MEDLINE, EMBASE, PsycINFO and The Cochrane Library) and research registers were searched to January 2012, supplemented by hand-searching relevant articles and contact with experts. The review included randomised controlled trials (RCTs) or observational cohort studies with a contemporaneous control group that included the following RM interventions: (1) TM (including cardiovascular implanted monitoring devices) with medical support provided during office hours or 24/7; (2) STS programmes delivered by human-to-human contact (HH) or human-to-machine interface (HM). Review methods: A systematic review and network meta-analysis (where appropriate) of the clinical evidence was carried out using standard methods. A Markov model was developed to evaluate the cost-effectiveness of different RM packages compared with usual care for recently discharged HF patients. TM 24/7 or using cardiovascular monitoring devices was not considered in the economic model because of the lack of data and/or unsuitability for the UK setting. Given the heterogeneity in the components of usual care and RM interventions, the cost-effectiveness analysis was performed using a set of costing scenarios designed to reflect the different configurations of usual care and RM in the UK. Results: The literature searches identified 3060 citations. Six RCTs met the inclusion criteria and were added to the 15 trials identified from the previous systematic reviews giving a total of 21 RCTs included in the systematic review. No trials of cardiovascular implanted monitoring devices or observational studies met the inclusion criteria. The methodological quality of the studies varied widely and reporting was generally poor. Compared with usual care, RM was beneficial in reducing all-cause mortality for STS HH [hazard ratio (HR) 0.77, 95% credible interval (CrI) 0.55 to 1.08], TM during office hours (HR 0.76, 95% CrI 0.49 to 1.18) and TM 24/7 (HR 0.49, 95% CrI 0.20 to 1.18); however, these results were statistically inconclusive. The results for TM 24/7 should be treated with caution because of the poor methodological quality of the only included study in this network. No favourable effect on mortality was observed with STS HM. Similar reductions were observed in all-cause hospitalisations for TM interventions, whereas STS interventions had no major effect. A sensitivity analysis, in which a study was excluded because it provided better-than-usual support to the control group, showed larger beneficial effects for most outcomes, particularly for TM during office hours. In the cost-effectiveness analyses, TM during office hours was the most cost-effective strategy with an estimated incremental cost-effectiveness ratio (ICER) of £11,873 per quality-adjusted life-year (QALY) compared with usual care, whereas STS HH had an ICER of £228,035 per QALY compared with TM during office hours. STS HM was dominated by usual care. Similar results were observed in scenario analyses performed using higher costs of usual care, higher costs of STS HH and lower costs of TM during office hours. Limitations: The RM interventions included in the review were heterogeneous in terms of monitored parameters and HF selection criteria and lacked detail in the components of the RM care packages and usual care (e.g. communication protocols, routine staff visits and resources used). As a result, the economic model developed scenarios for different RM classifications and their costs were estimated using bottom-up costing methods. Although the users can decide which of these scenarios is most representative of their setting, uncertainties still remain about the assumptions made in the estimation of these costs. In addition, the model assumed that the effectiveness of the interventions was constant over time, irrespective of the duration of deployment, and that the intervention was equally effective in different age/severity groups. Conclusion: Despite wide variation in usual care and RM strategies, cost-effectiveness analyses suggest that TM during office hours was an optimal strategy (in most costing scenarios). However, clarity was lacking among descriptions of the components of RM packages and usual care and there was a lack of robust estimation of costs. Further research is needed in these areas. Study registration: PROSPERO registration no. CRD42011001368. Funding: The National Institute for Health Research Health Technology Assessment programme.

The management of long-term conditions such as chronic heart failure (CHF) will need to change due to a growing ageing population and the need to deliver health care within finite resources. Telehealth (or remote patient monitoring) is being introduced as a possible solution to meet these demands and has implications for the way nursing care is delivered and how services are reorganised. This paper guides nurses and their managers on how to meet the challenges of implementing a telehealth service for CHF management by exploring the possible barriers and pitfalls to its introduction, and comparing the advantages and disadvantages of different nursing telehealth service models in use in the UK. [ABSTRACT FROM AUTHOR]

Background Telemonitoring has been advocated as a way of decreasing costs and improving outcomes, but no study has looked at true Medicare payments and 30-day readmission rates in a randomized group of well treated patients. Objective The aim of this work was to analyze Medicare claims data to identify effects of home telemonitoring on medical costs, 30-day rehospitalization, mortality, and health-related quality of life. Methods A total of 204 subjects were randomized to usual-care and monitored groups and evaluated with the SF-36 and Minnesota Living With Heart Failure Questionnaire (MLHF). Hospitalizations, Medicare payments, and mortality were also assessed. Monitored subjects transmitted weight, blood pressure, and heart rate, which were monitored by an experienced heart failure nurse practitioner. Results Subjects were followed for 802 ± 430 days; 75 subjects in the usual-care group (316 hospitalizations) and 81 in the monitored group (327 hospitalizations) were hospitalized at least once (P = .51). There were no differences in Medicare payments for inpatient or emergency department visits, and length of stay was not different between groups. There was no difference in 30-day readmissions (P = .627) or mortality (P = .575). Scores for SF-36 and MLHF improved (P < .001) over time, but there were no differences between groups. The percentage of patients readmitted within 30 days was lower with telemonitoring for the 1st year, but this did not persist. Conclusions Telemonitoring did not result in lower total costs, decreased hospitalizations, improved symptoms, or improved mortality. A decrease in 30-day readmission rates for the 1st year did not result in decreased total cost or better outcomes. [ABSTRACT FROM AUTHOR]

As home telemonitoring (HTM) moves away from randomised controlled trials and towards the mainstreaming of services, a clear set of guidance on how to evaluate them is needed. Without appropriate and systematic evaluations, the healthcare sector and those who commission its services will not be able to learn important lessons about which aspects of HTM work best. This article will discuss the advantages and disadvantages of different strategies that can be employed by commissioners and service providers in the evaluation of HTM services. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Évaluer l’état de développement de la télémédecine en Allemagne en 2013, identifier les forces et les faiblesses des organisations en place, ainsi que les perspectives à moyen terme. Méthodes: Collecte des données à partir du registre constitué par l’institut für Arbeit und Technik, et les propres statistiques de la Société allemande de télémédecine DGTelemed. Résultats: Deux cent soixante-dix projets de télémédecine sont recensés, la quasi-totalité ayant un promoteur industriel et/ou hospitalier. Seuls 2 projets ont été intégrés dans les organisations sanitaires officielles : le projet Schwester Agnes qui concerne des visites à domicile réalisées par une infirmière téléassistée par le médecin de famille, le projet TEMPIS qui concerne les patients atteints d’AVC ischémique, intégrant deux centres universitaires spécialisés en neurologie vasculaire de Bavière, reliés à 15 hôpitaux régionaux qui n’ont pas de neurologues, dans le but de réaliser au plus vite le traitement thrombolytique. Parmi les autres projets phares : la télésurveillance au domicile des patients en insuffisance cardiaque (« Partnership for the Heart », Fontane Projekt), le télésuivi des patients diabétiques (Herz- und Diabeteszentrum Karl Katsch, Herz- und Diabeteszentrum Nordrhein-Westfalen Bad Oeynhausen, Asklepios Hôpital Birkenwerder) et celui de la téléassistance en urgence des patients atteints de maladies respiratoires comme la broncho-pneumopathie chronique obstructive (BPCO) et l’asthme (le programme A.T.E.M de Bosch Healthcare), le projet « STEMO » qui concerne les soins d’urgence pré-hospitaliers, notamment la prise en charge des AVC dans une ambulance équipée d’un scanner et d’un laboratoire de biologie reliée par télémédecine au centre des urgences de la Charité à Berlin. Les besoins d’un développement de la télémédecine dans le secteur ambulatoire sont analysés : désertification médicale des zones rurales, concentration des médecins spécialistes dans les villes, féminisation de la profession médicale, etc. Les freins à lever sont deux ordres : une définition légale de la télémédecine et la reconnaissance par les caisses d’assurance maladie d’une nomenclature spécifique aux actes de télémédecine pour obtenir leur financement. Conclusion: La promulgation récente d’une loi sur l’organisation des soins en Allemagne, incluant la pratique de la télémédecine, et la mise en place d’une stratégie nationale de développement par le ministère fédéral de la Santé sont des signes en faveur d’un développement plus rapide de la télémédecine. [Copyright &y& Elsevier]

Purpose: Telemonitoring is being increasingly used for chronic disease monitoring. While the primary aim of telemonitoring is to improve chronic disease management and decrease hospitalizations, the potential impact on patient’s health-related quality of life may be an additional benefit. Methods: Two hundred and five patients aged 60 years and older with multiple medical conditions were enrolled in a one-year randomized controlled trial of daily home telemonitoring. Health-related quality of life was measured with the 12-Item Short-Form at the beginning and at the completion of the study. Per protocol analysis of the 166 patients responding to the follow-up survey was performed. Results: Among the 166 responders, there were no significant differences at baseline in the physical component summary (PCS) scores ( p value = 0.32), nor the mental component summary (MCS) scores ( p value = 0.12) between the telemonitored group and the usual care group. There was also no difference in the 12-month PCS scores ( p value = 0.39) or MCS scores ( p value = 0.10) between groups. There was no difference in the change from baseline to 12-month MCS scores between groups ( p value = 0.89); however, there was a significant difference in the baseline to 12-month change of PCS scores between groups, with the telemonitored group having a greater decrease in PCS scores (−4.3 ± 9.3), compared to the usual care group (−1.2 ± 8.5) over the course of the study ( p value = 0.03). Conclusion: Home telemonitoring in older adults with multiple comorbidities does not significantly improve self-perception of mental well-being (as measured by MCS scores) and may worsen self-perception of physical health (as measured by PCS scores). [ABSTRACT FROM AUTHOR]

Copyright of European Research in Telemedicine / La Recherche Européenne en Télémédecine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: There have been very few assessments of the economics of home telemonitoring, and the quality of evidence has often been weakened by methodological flaws. This has made it difficult to compare telehomecare with traditional home care for the chronic diseases studied. This economic analysis is an attempt to address this gap in the literature.Methods: We have analyzed the consumption of healthcare services by 95 patients with various chronic diseases over a 21-month period, that is, 12 months before, 4 months during home telemonitoring use, and over 5 months after withdraw of the technology.Results: Our findings indicate significant benefits to the home telemonitoring program as evidenced by large reductions in number of hospitalizations, length of average hospital stay, and, to a lesser extent, number of emergency room visits. Contrary to expectations, however, the number of home visits by nurses increased both during and after the telemonitoring intervention. In terms of the financial analysis, the telehomecare program resulted in significant savings: the equivalent of over CAD1,557 per patient as calculated on an annualized basis. This represents a net gain of 41 percent as compared to traditional home care.Conclusions: While the present economic analysis led to positive results, additional assessments should be conducted to confirm the cost-effectiveness of this mode of care delivery. [ABSTRACT FROM AUTHOR]

The aging ofthe population is expected to place an unprecedented strain on health care systems over the next two decades and beyond. Emerging electronic monitoring technologies provide opportunities to learn about the aging process, age-related diseases, and contribute to new cost effective care models that preserve independence at home for older adults at risk. The goals of this article are to familiarize the reader with emerging technologies and potential applications to older adults' at-risk, review the current literature about the clinical and economic outcomes of emerging technologies, and to outline future directions and challenges. [ABSTRACT FROM AUTHOR]

Background: Heart failure is a major health concern associated with significant morbidity, mortality, and reduced quality of life in patients. Home telemonitoring (HTM) facilitates frequent or continuous assessment of disease signs and symptoms, and it has shown to improve compliance by involving patients in their own care and prevent emergency admissions by facilitating early detection of clinically significant changes. Diagnostic algorithms (DAs) are predictive mathematical relationships that make use of a wide range of collected data for calculating the likelihood of a particular event and use this output for prioritizing patients with regard to their treatment., Objective: This study aims to assess the cost-effectiveness of HTM and a DA in the management of heart failure in the Netherlands. Three interventions were analyzed: usual care, HTM, and HTM plus a DA., Methods: A previously published discrete event simulation model was used. The base-case analysis was performed according to the Dutch guidelines for economic evaluation. Sensitivity, scenario, and value of information analyses were performed. Particular attention was given to the cost-effectiveness of the DA at various levels of diagnostic accuracy of event prediction and to different patient subgroups., Results: HTM plus the DA extendedly dominates HTM alone, and it has a deterministic incremental cost-effectiveness ratio compared with usual care of €27,712 (currency conversion rate in purchasing power parity at the time of study: €1=US $1.29; further conversions are not applicable in cost-effectiveness terms) per quality-adjusted life year. The model showed robustness in the sensitivity and scenario analyses. HTM plus the DA had a 96.0% probability of being cost-effective at the appropriate €80,000 per quality-adjusted life year threshold. An optimal point for the threshold value for the alarm of the DA in terms of its cost-effectiveness was estimated. New York Heart Association class IV patients were the subgroup with the worst cost-effectiveness results versus usual care, while HTM plus the DA was found to be the most cost-effective for patients aged <65 years and for patients in New York Heart Association class I., Conclusions: Although the increased costs of adopting HTM plus the DA in the management of heart failure may seemingly be an additional strain on scarce health care resources, the results of this study demonstrate that, by increasing patient life expectancy by 1.28 years and reducing their hospitalization rate by 23% when compared with usual care, the use of this technology may be seen as an investment, as HTM plus the DA in its current form extendedly dominates HTM alone and is cost-effective compared with usual care at normally accepted thresholds in the Netherlands., (©Fernando Albuquerque de Almeida, Isaac Corro Ramos, Maiwenn Al, Maureen Rutten-van Mölken. Originally published in JMIR Cardio (https://cardio.jmir.org), 04.08.2022.)

Aims: We sought to test the utility of weight gain algorithms to predict episodes of worsening heart failure (WHF) using home-telemonitoring data collected as part of the TEN-HMS study. [ABSTRACT FROM PUBLISHER]

Aims: The Home or Hospital in Heart failure (HHH) study was a European Community-funded, multinational, randomized controlled clinical trial, conducted in the UK, Poland, and Italy, to assess the feasibility of a new system of home telemonitoring (HT). The HT system was used to monitor clinical and physiological parameters, and its effectiveness (compared with usual care) in reducing cardiac events in heart failure (HF) patients was evaluated. Measurements were patient-managed. [ABSTRACT FROM PUBLISHER]

Abstract: Background: The Home or Hospital in Heart Failure Study (HHH) is a European Community funded trial (QLGA-CT-2001-02424) which compares usual care of heart failure (HF) with three home-based interventions in a multicenter, multicountry (Italy, Poland and UK), randomized controlled clinical trial. Home telemonitoring (HT) of clinical parameters represents a potential alternative (or addition) to traditional home care models. Nocturnal respiratory disorders (periodic breathing, sleep apnea) are very common in HF, and are associated with increased morbidity and mortality. We developed an integrated HT system for monitoring of both vital signs and respiration. All measurements were patient-managed. This paper describes the architecture of this system, and assesses its feasibility. Methods and results: 461 clinically stable patients were randomized first to usual vs home-monitored care; the latter were further randomized to 3 strategies. Over a 12-month follow-up 2 of these 3 groups (195 patients, age: 60±11 years, NYHA class II–III: 97%, LVEF 28±7%) underwent self-administered home monitoring of vital signs (weekly — 12 parameters using an interactive voice response system) and respiration (monthly — 24-hour recording). Data were transmitted over conventional telephone lines; 81% of actually practicable vital signs measurements were completed by the patients (range: 75% (PL)–93% (UK)), as well as 92% of practicable respiratory recordings (range: 85% (PL)–99% (UK)). 87% of nighttime recordings were eligible for the study (good quality signals for ≥2.5 h). Conclusions: This study, the largest so far, demonstrates that self-managed home telemonitoring of both vital signs and respiration is feasible in HF patients, with surprisingly high compliance. We found an excellent rate of acceptable nocturnal respiratory recordings, which are those with the greatest clinical relevance. [Copyright &y& Elsevier]

Abstract Background General practitioners (GP) in rural areas of Germany are struggling to find successors for their private practices. Telemonitoring at home offers an option to support remaining GPs and specialists in ambulatory care. Methods We assessed the knowledge and attitude towards telemedicine in the population of North Rhine-Westphalia (NRW), Germany, in a population-based telephone survey. Results Out of 2,006 participants, 734 (36.6%) reported an awareness of telemedical devices. Only 37 participants (1.8%) have experience in using them. The majority of participants were in favour of using them in case of illness (72.2%). However, this approval declined with age. These findings were similar in rural and urban areas. Participants who were in favour of telemedicine (n = 1,480) strongly agreed that they would have to see their doctor less often, and that the doctor would recognize earlier relevant changes in their vital status. Participants who disliked to be monitored by telemedical devices preferred to receive immediate feedback from their physician. Especially, the elderly fear the loss of personal contact with their physician. They need the direct patient-physician communication. Conclusions The fear of being left alone with the technique needs to be compensated for today's elderly patients to enhance acceptance of home telemonitoring as support for remaining doctors either in the rural areas or cities.

Objectives: Evaluation of the effectiveness of home care through a telemonitoring system in reducing the incidence of new colonization by Pseudomonas Aeruginosa in a population of patients with Cystic Fibrosis (CF) followed by the CF clinic of the Bambino Gesù Hospital in Rome over a period of 36 months., Materials and Methods: Two groups of patients were recruited, homogeneous for age, sex, BMI, FEV1, prevalence of CF-related Diabetes and CF-related Hepatopathy, access to new therapies with modulators: a) an IN group (N = 44 ) followed through a home telemonitoring system, b) an OUT control group (N = 110) followed according to the standards of care. The following parameters were detected for all patients: pulmonary colonization of the lungs, number and type of hospital admissions, respiratory function, BMI., Result: The OUT group had a statistically significant increase in the prevalence of Pseudomonas Aeruginosa infections during the observation period. Furthermore, a significant decrease in lung function assessed through FEV1 was also observed in the OUT group., Conclusion: Adolescent and adult patients belonging to the CF center who are not followed through the dedicated home telemonitoring service show, in the three-year period 2017-19, an increase in Pseudomonas Aeruginosa infections and a greater decrease in respiratory function. The use of telemedicine in CF is therefore an effective system not only in monitoring the disease but also as a treatment strategy, in the context of an evolving multidisciplinary model. As advantages, telemedicine can reduce the number of Pseudomonas Aeruginosa lung infections and the greater stability of respiratory function over time.