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5th February 2025
Device-based remote monitoring decreases hospital service use by nearly three-quarters when used to monitor patients requiring ongoing care and 24/7 support, according to a new study.
The researchers conducted a systematic review of cluster randomised control trials (RCTs) examining device-based remote monitoring in Europe and the US, compared to usual care in patients of all ages and with any health condition.
They included studies where device-based remote monitoring used telecommunications to transmit patient-related physiological data to the hospital, using either a non-implantable, implantable or mobile device for clinical decision-making.
Frequently studied health conditions were heart failure (45%), COPD (14%), diabetes (6%), and arrhythmia (6%). Reported outcomes included hospitalisation or re-hospitalisation, the length of hospital stay, and the number of emergency or outpatient clinic visits.
The researchers identified 3,083 studies and included 118 analyses (from 116 unique RCTs). In nearly three-quarters of the studies (n=85/118, 72%), the device-based remote monitoring group showed a decrease in hospital service use compared to standard care. The reductions in hospital use for the device-based remote monitoring group were mostly condition-related hospitalisations (53%), followed by all-cause hospitalisations (35%).
The most commonly used devices were non-implantable devices such as wearables and scales, and these were associated with the smallest decrease in hospital service use (69%). Implanted or mobile devices were used less commonly but resulted in a greater reduction in hospital service use, at 89% and 76%, respectively.
Daily monitoring was the most common, with 69% of studies using daily measurements and 65% using daily data transmission. However, this resulted in a lower percentage reduction in hospital service use than continuous or less frequent monitoring. The frequency of data assessment by a healthcare worker also did not significantly affect the reduction in hospital service use.
In most studies, device-based remote monitoring involved doctors and nurses who were already participating in patient care. This scenario resulted in a smaller reduction in hospital service use (67%) than when healthcare providers outside the typical care team were involved (76%). An additional caregiver at home reduced hospital service use by 65%.
Finding that 72% of the included studies showed a decrease in at least some aspects of hospital service use indicates that device-based remote monitoring could play an essential role in healthcare.
The researchers concluded that with the addition of tailored support, automated processing and optimised care redesign, device-based remote monitoring has the potential to significantly improve hospital care at home.
Reference
Jansen, AJ et al. Device based monitoring in digital care and its impact on hospital service use. npj Digit. Med. 2025; Jan. 08: DOI: 10.1038/s41746-024-01427-8.
20th September 2024
A remote monitoring programme has helped reduce emergency department attendances by almost 40% in Frimley integrated care system.
The programme, which was first implemented in December 2022, is available to patients in the highest need groups such as those with long-term conditions and frailty.
Analysis of its first 3,673 patients who used the programme showed a 38.6% reduction in emergency department attendances, 53.7% reduction in hospital admissions and 26.7% fewer outpatient appointments.
There was also a fall of 19.4% in GP appointments and 36.9% in calls to NHS 111, alongside a 7.6% reduction in the volume of prescriptions used for the remotely monitored patients.
The analysis, by Strategia and advised by Imperial College, also estimated the reduction in hospital attendance would save the system around £5-8m annually.
Patients were identified for the programme through local population health management tools, which were developed in collaboration with IT provider Graphnet Health.
Those involved were given equipment such as blood pressure monitors and thermometers and could share updates with their digital health team, which included nurses, care navigators and care coordinators.
Sharon Boundy, NHS Frimley transformation director, said: ‘Our secure technology, including shared care records and population health management tools, allow healthcare professionals access to the most accurate and up-to-date information and analysis.
‘We are pleased to share our findings to support this emerging proactive care and remote monitoring model. This allows us to move from a model of care that is reactive and unscheduled towards more proactive and scheduled care.’
Sam Burrows, NHS Frimley chief transformation, delivery and digital officer, added: ‘Our remote monitoring programme enables us to provide patients with timely advice and care when they need it and our residents and professionals report feeling more reassured and satisfied as a result.
‘It is great to see emerging methodology around calculating the savings at a system-wide level and we are keen to spread the learnings and maximise its potential use across the NHS.
‘Our workforce is under immense pressure, but early intervention means we are helping more patients to stay well and reducing unscheduled care.’
A recent Europe-wide consensus survey seeking to identify and address everyday external stressors in emergency departments to improve sustainable working conditions revealed that the highest ratings for negative conditions were for ‘overcrowding’.
A version of this article was originally published by our sister publication Healthcare Leader.
13th October 2022
Heart failure patients who receive remote disease monitoring and consultations may experience short-term cardiovascular and mortality benefits.
Digital health interventions (DHIs) have contributed to the transformation of healthcare delivery in the past decade and especially since the COVID-19 pandemic when interventions such as telemedicine for remote consultations became the ‘norm’ in many specialities.
Nevertheless, while imposed in many therapy areas during the pandemic, there are actually potential benefits for patients cardiovascular disease. For example, connected health technologies, such as mobile phones, smartphones, tablets, wearable devices, smartwatches and personal health sensors, all provide an opportunity to revolutionise cardiovascular disease prevention through personalised, convenient, and easily accessible patient education and behaviour change support.
The value of DHIs for the prevention of cardiovascular disease was explored in a systematic review and meta-analysis in 2015, in which the authors concluded that the available data provide evidence that DHIs can reduce cardiovascular disease (CVD) outcomes and have a positive impact on risk factors for CVD.
However, given that the data used in the aforementioned meta-analysis was collected more than 8 years ago and the COVID-19 pandemic lead to enforced telemedicine and remote monitoring, for the present study, a Malaysian team of researchers sought to update the effectiveness of DHIs for patients with cardiovascular disease.
The researchers included randomised trials, observational and cohort studies that specifically addressed the effect of a telemedicine intervention on cardiovascular outcomes for those either at risk (i.e. for primary prevention) or those with established CVD (secondary prevention).
The primary outcome was cardiovascular-related mortality, whereas secondary outcomes included hospitalisation, all-cause mortality and all-cause hospitalisation. Interventions were categorised as remote consultations; remote monitoring of health or diagnostic measures; transmission of medical data and finally remote case management.
A total of 72 studies with 127,869 participants (65% male) were included in the analysis. The duration of studies ranged from 1 to 79 months and 49 were short-term (< 12 months) and 22 long-term (> 12 months). Overall, 39 studies included patients with heart failure, 19 addressed secondary prevention and 12 primary prevention.
For heart failure patients, combined remote monitoring and consultation were associated with a 17% reduced risk of cardiovascular mortality (risk ratio, RR = 0.83, 95% CI 0.70 – 0.99, p = 0.036). In addition, this combination significantly reduced hospitalisation for a cardiovascular cause (RR = 0.71, 95% CI 0.58 – 0.87, p = 0.0002) though this was largely in short-term (i.e. < 12 month) studies.
However, telemedicine had no effect on all-cause hospitalisation among those with heart failure (RR = 1.02, 95% CI 0.94 – 1.10, p = 0.71).
In secondary prevention studies, the combination of remote monitoring and consultation was associated with a small reduction in systolic blood pressure (mean difference = -3.59, p < 0.0001) but not on diastolic pressure. There was also a small but significant effect of remote consultations on body-mass index (p < 0.0064) in primary prevention.
The authors concluded that a combination of remote disease monitoring and consultation appeared to reduce cardiovascular-related hospitalisation and mortality risk among patients with heart failure in the short-term.
They called for future research to evaluate the sustained effect of telemedicine interventions.
Citation
Kuan PX et al. Efficacy of telemedicine for the management of cardiovascular disease: a systematic review and meta-analysis Lancet Digit Health 2022.
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