Remotely monitoring patients after they have been released from the hospital for serious infections does not reduce their risk of readmission, particularly for older adults, a randomized trial suggests.
The findings, released simultaneously in JAMA Network Open and at the Critical Care Reviews annual meeting in Belfast, emphasize the importance of studying potentially beneficial care models in real-world scenarios.
Remote monitoring involves the use of resources such as smartphone-based questionnaires, internet-connected scales, or blood pressure monitoring to allow patients to leave hospital.
These enable clinicians to monitor health from afar, while acting on alerts to ensure timely care.
While patients might prefer this type of care, the trial suggested that remote monitoring should be re-evaluated and individually tailored after acute care for sepsis and lower respiratory tract infections.
It did not increase the days patients spent at home and did not support U.S. federal agency efforts to reduce hospital readmissions by reimbursing remote monitoring.
“Health systems, insurers and policymakers all want to reduce hospital readmissions, and most patients prefer to recover safely at home,” explained lead researcher Sachin Yende, PhD, from the University of Pittsburgh.
“Remote monitoring has been held up as a solution, is reimbursed by the Centers of Medicare & Medicaid and its use has grown. But, aside from a few conditions, there’s a dearth of high-quality data to show it reduces readmissions.”
In an attempt to source this information, Yende and team conducted a complex trial in 1286 adults, with a median age of 63 years, who were recovering at home after hospitalization for sepsis or lower respiratory tract infections at 19 institutions. Of these patients, 32.6% received intensive care.
Participants were randomly assigned to one of four remote monitoring strategies or usual care.
Usual care generally involved a phone call from a nurse after discharge followed by continuing management from a primary care physician. The remote monitoring interventions consisted of short or long health questionnaire with standard or enhanced clinical response teams.
The standard response involved nurses who responded to alerts highlighted in the questionnaires together with coordinated care involving the patient’s primary and specialty clinicians.
Enhanced care included certified registered nurse practitioners with palliative care expertise who could coordinate some of the care response and also access social workers.
The primary endpoint was days at home at 90 days after discharge.
The trial showed that remote monitoring programs with high- or low-intensity questionnaires combined with a nurse response team or a nurse practitioner-led response team did not increase the time spent at home.
At least one readmission occurred among 37.8% of patients in the control group, receiving usual care.
This compared with 39.7% in patients receiving the shorter questionnaire and standard response team, 44.2% for those receiving the long questionnaire with standard clinical response, 37.3% receiving the shorter questionnaire but enhanced response team, and 36.3% for those receiving the long questionnaire with enhanced clinical response.
These differences did not reach statistical significance.
However, among patients aged 65 years and older, the remote monitoring programs did reduced time spent at home and increased readmission rates compared with usual care.
In this older age group, both the standard and enhanced response groups had fewer home days compared with usual care, with corresponding cumulative odds ratios of 0.56 and 0.67.
“These findings support reevaluating and tailoring remote monitoring in post–acute care following sepsis and lower respiratory tract infection to support further alignment with patients’ needs and desire for personalized monitoring,” the researchers concluded.
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