Despite mounting evidence that remote patient monitoring reduces hospital readmissions, a recent clinical trial found no statistically significant reduction of rehospitalizations for heart failure patients enrolled in a remote monitoring trial . The conflicting evidence leaves many clinicians wondering: do mobile health programs actually improve patient outcomes?
Outpatient Programs for CHF Patients
The first 180 days following a hospital stay are a crucial time period for patient outcomes, with rehospitalizations usually indicating poor outcomes. Accordingly, Medicare is now incentivizing care plans to incorporate outpatient programs that reduce hospital readmissions. Outpatient clinics are associated with improved medical outcomes and have also been shown to positively influence behavioural changes such as diet adjustment and smoking cessation—even when these clinics involve fewer meetings meetings with physicians [2,3].
Remote patient monitoring equips outpatient clinics with mobile health technology, meaning that patients can remotely measure biometric data—like heart rate and weight trends—and submit this data to their clinicians. Remote monitoring programs have been found to improve both patient engagement and medical outcomes for patients with congestive heart failure [4–7].
However, not all remote monitoring programs see the same success: a recent clinical trial found no statistically significant reduction of hospital readmissions for heart failure patients in the first 180 days after hospital discharge . This study found that both patients enrolled in their remote biomonitoring trial and the control group had hospital readmission rates of 50%. This number is simply too high, and thus any reduction in rehospitalizations will have clinically significant effects on patient outcomes.
The differences between this study and others highlight certain factors that can determine how a remote monitoring program will succeed in improving medical outcomes.
Improving Remote Patient Monitoring
In the recent CHF remote monitoring study that found no significant effects, patients used Bluetooth enabled biometric devices to collect data. But these patients and their family caregivers did not have direct access to this medical data, whereas some some remote patient monitoring apps allow patients to collect and review their medical data on the mobile devices they’re already familiar with, like iPads and smartphones.
Moreover, in this particular study, patient engagement with biomonitoring was only 55%, and the biometric data was transmitted to a research site and was not integrated into the medical records used by the patients’ regular care teams. In other studies that have found significant benefits to remote biomonitoring, a key factor was the ability of care teams to review real-time patient biometric trends and intervene according to their professional judgment .
The best remote patient monitoring apps provide clinicians with instant and actionable electronic medical documentation, achieving HIPAA-compliant interoperability with existing EHR systems. Effective mobile health programs are designed to fit the workflows of particular clinics, and use convenient technology to support patient engagement.
- Ong MK, et al. Effectiveness of Remote Patient Monitoring After Discharge of Hospitalized Patients With Heart Failure: The Better Effectiveness After Transition–Heart Failure (BEAT-HF) Randomized Clinical Trial. JAMA Internal Medicine. 2016 Mar;176(3):310–318.
- Page T, Lockwood C, Conroy-Hiller T. Effectiveness of nurse-led cardiac clinics in adult patients with a diagnosis of coronary heart disease. International Journal of Evidence Based Healthcare. 2005 Feb;3(1):2–26.
- Worchester MU, Stojcevski Z, Murphy B, Goble AJ. Long-term behavioural outcomes after attendance at a secondary prevention clinic for cardiac patients. Journal of Cardiopulmonary Rehabilitation. 2003 Nov-Dec;23(6):415–22.
- Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth Chronic Disease Management on Treatment Adherence and Patient Outcomes: A Systematic Review. Journal of Medical Internet Research. 2015 Feb;17(2):e52.
- Logan AG. Transforming hypertension management using mobile health technology for telemonitoring and self-care support. Canadian Journal of Cardiology. 2013 May;29(5):579–85.
- Nakamura N, Koga T, Iseki H. A meta-analysis of remote patient monitoring for chronic heart failure patients. Journal of Telemedicine and Telecare. 2014 Jan;20(1):11–17.
- Pandor A, Gomersall T, Stevens JW, et al. Remote monitoring after recent hospital discharge in patients with heart failure: a systematic review and network meta-analysis. Heart. 2013;99(23):1717–1726