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Randomized Controlled Trial
. 2021 Nov;36(11):3395-3401.
doi: 10.1007/s11606-020-06589-1. Epub 2021 Jan 27.

Home Telemonitoring to Reduce Readmission of High-Risk Patients: a Modified Intention-to-Treat Randomized Clinical Trial

Nancy L Dawson  1 , Bryan P Hull  2 , Priyanka Vijapura  3 , Adrian G Dumitrascu  3 , Colleen T Ball  4 , Kay M Thiemann  5 , Michael J Maniaci  3 , M Caroline Burton  6
Affiliations
Randomized Controlled Trial

Home Telemonitoring to Reduce Readmission of High-Risk Patients: a Modified Intention-to-Treat Randomized Clinical Trial

Nancy L Dawson et al. J Gen Intern Med. 2021 Nov.

Abstract

Background: Home telemonitoring has been used with discharged patients in an attempt to reduce 30-day readmissions with mixed results.

Objective: To assess whether home 30-day telemonitoring after discharge for patients at high risk of readmission would reduce readmissions or mortality.

Design: Prospective, randomized controlled trial.

Patients: We compared 30-day readmission rates and mortality for patients at high risk for readmission who received home telemonitoring versus standard care between November 1, 2014, and November 30, 2018, in 2 tertiary care hospitals.

Interventions: The intervention group received home-installed equipment to measure blood pressure, heart rate, pulse oximetry, weight if heart failure was present, and glucose if diabetes was present. Results were transmitted daily and reviewed by a nurse. Both groups received standard care.

Main measures: The primary outcome was a composite end point of hospital readmission or death within 30 days after discharge. The secondary outcome was an emergency department visit within 30 days after discharge.

Key results: A total of 1380 participants (mean [SD] age, 66 [14] years; 722 [52.3%] men and 658 [47.7%] women) participated in this study. Using a modified intention-to-treat analysis, the risk of readmission or death within 30 days among patients at high readmission risk was 23.7% (137/578) in the control group and 18.2% (87/477) in the telemonitoring group (absolute risk difference, - 5.5% [95% CI, - 10.4 to - 0.6%]; relative risk, 0.77 [95% CI, 0.61 to 0.98]; P = .03). Emergency department visits occurred within 30 days after discharge in 14.2% (81/570) of patients in the control group and 8.6% (40/464) of patients in the telemonitoring group (absolute risk difference, - 5.6% [95% CI, - 9.4 to - 1.8%]; relative risk, 0.61 [95% CI, 0.42 to 0.87]; P = .005).

Conclusions: Thirty days of postdischarge telemonitoring may reduce readmissions of high-risk patients.

Trial registration: ClinicalTrials.gov identifier: NCT02136186.

Keywords: communication; risk assessment; telemedicine.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Participant flow diagram.
See this image and copyright information in PMC

References

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