A Randomized Controlled Trial of a Post-ICU Telehealth Care Model (WFIT)

Abstract

Rationale: Survivors of critical illness are at high risk for poor long-term outcomes, including readmissions, reduced quality of life, and mortality. A post-ICU telehealth care model may improve outcomes. Objectives: We sought to evaluate the cost-effectiveness and clinical efficacy of a post-ICU telehealth care model. Methods: We performed a single-center randomized controlled trial of 400 ICU patients with sepsis and/or acute respiratory failure, who had two or fewer hospital admissions in the past year, and who were not admitted from or discharged to hospice, a skilled nursing facility, or a long-term acute care hospital. The intervention group had scheduled telehealth visits at 1 and 2 weeks after ICU discharge and as needed for 6 months with a clinician trained in post-ICU recovery. The primary outcome is the cost-effectiveness of the intervention. Measurements and Main Results: Overall healthcare spending on emergency room (ER) visits and hospitalizations were a mean (SD, in U.S. dollars) $7,801.10 ($15,461.03) in the attention control group versus $8,086.50 ($17,464.87) in the intervention group, with a calculated incremental net benefit of $1,958.29 (-$5,779.56 to $9,696.14). ER visits to our healthcare system were the same between groups, but patient-reported ER visits to outside hospitals were different (0.97 per 100 patients per month in the attention control group vs. 2.43 in the intervention group; P = 0.03). Readmissions, mortality, quality-of-life scores, and overall patient satisfaction scores were similar between groups. Conclusions: This randomized controlled trial of a post-ICU telehealth intervention demonstrated wide variation but no clear incremental net benefit compared with standard care. Clinical trial registered with www.clinicaltrials.gov (NCT04576065).

Keywords: care transitions; critical care; post–intensive care syndrome; recovery; telehealth.