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. 2022 Mar 11;6(3):e32205.
doi: 10.2196/32205.

Performance of an eHealth (NOMHAD) System Comprising Telemonitoring, Telenotification, and Telecoaching for Patients With Multimorbidity: Proof-of-Concept Study

Mathieu Chacornac  1 , Aurélien Faoro, Joëlle Texereau  2   3 , Catherine Billoet  4 , Stéphane Hominal  5
Affiliations

Performance of an eHealth (NOMHAD) System Comprising Telemonitoring, Telenotification, and Telecoaching for Patients With Multimorbidity: Proof-of-Concept Study

Mathieu Chacornac et al. JMIR Form Res. .

Abstract

Background: Management of patients with multiple chronic diseases is a growing public health challenge, especially in rural sectors where access to physicians may be limited. Connected medical devices monitoring vital signs, associated with eHealth program and structured telephone support, may improve complex patient management through early detection of disease complications, positive impact on patients' health, and health resources consumption optimization.

Objective: The aim of this study was to evaluate the technical performance and user experience of the NOMHAD eHealth system in patients with multimorbidity.

Methods: This was a pilot, single-arm, interventional study. Patients with multimorbidity with any combination of chronic heart failure (CHF), chronic obstructive pulmonary disease, and diabetes were followed for 80-100 days using the NOMHAD eHealth system. This system used connected devices telemonitoring symptoms and vital signs (eg, body weight, oxygen saturation, pulse rate, blood pressure, and blood glucose), associated with structured telecoaching and educational support by call center nurses. An overall risk indicator (ORI) was automatically computed after each data teletransmission. The ORI was color coded; green indicated no action required; yellow, orange, and red (low to high priority, respectively) generated telenotifications and indicated to the nurses the need for a telecoaching action. Each ORI was calculated by combining 7 clinical stability system indicators based on symptom questionnaires and vital signs. Technical accuracy of the system was assessed by comparing system-generated ORIs with ORIs recalculated from raw data. Ease of use, usefulness, satisfaction, and acceptability of the system were assessed through patient adherence to self-assessments, and through self-administered questionnaires to patients, call center nurses, and physicians.

Results: A total of 23 patients were enrolled in this study and participated between April 2016 and March 2017 at 5 study centers in France. All patients were successfully equipped and evaluable for analysis. Mean age was 68.5 (SD 10.4) years and most patients were men (n=20). The most common multimorbidity was CHF + diabetes (n=15), followed by patients with all 3 diseases (n=5). Mean effective follow-up was 78.7 (SD 24.2) days. The system generated 6263 ORIs, as several ORIs could be generated on a single day for any patient. Overall system sensitivity was 99.2% (95% CI 98.9-99.4) and overall specificity was 91.3% (95% CI 87.7-94.1). Most patients (20/23, 87%) were satisfied with the system and agreed that it helped them to better understand and manage their diseases, and 19/23 (83%) valued the nurse regular contacts. Nurses and physicians were generally satisfied with the system and considered it useful. All users indicated they would agree to long-term use of the system.

Conclusions: This study provides evidence that the NOMHAD eHealth system is accurate, acceptable, informative, and feasible for patients with multimorbidity, supporting further investigation of its clinical benefits.

Trial registration: Agence Nationale de Sécurité du Médicament et des Produits de Santé 2015-A01106-43; https://ictaxercb.ansm.sante.fr/Public/index.php.

Keywords: chronic disease; chronic heart failure; chronic obstructive pulmonary disease; diabetes; multimorbidity; telehealth; telemonitoring.

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Conflict of interest statement

Conflicts of Interest: JT is an employee of VitalAire France, a home health care provider, an Air Liquide health care subsidiary. CB is an employee of Air Liquide Santé International. MC, AF, and SH received honoraria from Air Liquide Santé International for the conduct of the trial.

Figures

Figure 1
Figure 1
Overview of the NOMHAD eHealth system. The NOMHAD eHealth system consists of the NOMHAD Chronic software platform and the remote NOMHAD Mobile app installed on an interactive tablet, which is used by the patient to enter vital sign data, either manually or through connected devices, and answer questionnaires. These data are transferred to the NOMHAD Chronic software platform using available 3G, 4G, or Wi-Fi connections. The NOMHAD eHealth system is a global system including health care technicians, call center nurses, study physicians, and referring physicians. 3G: third generation; 4G: fourth generation; SpO2: arterial oxygen saturation; Wi-Fi: wireless fidelity.
Figure 2
Figure 2
Study flow for the patient. The total study duration for a patient was approximately 15 weeks.
See this image and copyright information in PMC

References

    1. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1545–1602. doi: 10.1016/S0140-6736(16)31678-6. http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(16)31678-6 S0140-6736(16)31678-6 - DOI - PMC - PubMed
    1. The top 10 causes of death. World Health Organization. 2016. [2018-12-17]. http://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death .
    1. Agence nationale d’appui à la performance des établissements de santé et médico sociaux . La télémédecine en action: 25 projets passés à la loupe. Un éclairage pour le déploiement national. Tome 1: les grands enseignements. Paris, France: ANAP; 2012. [2021-07-09]. http://www.anap.fr/ressources/publications/detail/actualites/la-telemede...
    1. Lutte contre les déserts médicaux : ce qu'il faut savoir (Battle against medical isolation: what is necessary to know) French Government. [2021-07-09]. https://www.gouvernement.fr/lutte-contre-les-deserts-medicaux-ce-qu-il-f... .
    1. Bloom D, Cafiero E, Jané-Llopis E, Abrahams-Gessel S, Bloom L, Fathima S. The Global Economic Burden of Noncommunicable Diseases. Program on the Global Demography of Aging. 2012. [2021-07-09]. https://EconPapers.repec.org/RePEc:gdm:wpaper:8712 .