Round-up of some of the recent emerging evidence
Savings, individual benefits and barriers to take-up of telehealth
Following on from the recent Veterans Healthcare Administration article, the New England Healthcare Institute has updated a report, previously published in 2004, which suggests that remote monitoring could reduce hospital admissions for heart failure by up to 50-60 per cent and could generate significant savings. Approximately 5.3 million people in the USA are living with congestive heart failure, of which it is considered that 1.59 million (30 per cent) with Class III and Class IV heart failure could benefit. The new data estimates an annual cost of $2,052 per patient for the monitoring technology; when disease management software is included, the price goes up to $2,802. The authors consider that the technology has the potential to save $4.7 billion to $6.4 billion a year. Despite this potential, the Institute consider that there are a number of significant barriers to adoption, including reimbursement, clinician concerns, patient awareness, electronic health records and interoperability.
One concern that is increasingly being recognised is how clinicians will handle the unprecedented amount of patient data that could be produced from remote monitoring on a regular basis. The New York Times picks up this and other issues in an article called Sensors help keep the elderly safe, and at home. As well as giving practical examples where patients are clearly benefiting, the article summarises the issues that all health care organisations are facing – the cost of the devices, the lack of available evidence, the fact that doctors are not trained or paid to treat patients using remote data and that most insurance plans do not cover these devices, the risk that electronic measurement substitutes for face-to-face contact and affects caregiver communications.
An industry analyst from Frost and Sullivan recently commented that progress on remote monitoring – potentially a million dollar market – was in 'desperate need of validation'. The analyst, Zachary Bujnoch, goes on to say, 'while these systems have an inherent potential for cost savings, implementation is the hinging point of success or failure. A careful monitoring of efficiency, true cost savings, and overall effective integration of these systems into a healthcare provider's setup is essential for the success of these highly customisable and diverse remote monitoring services.'
Important Medicare disease management study reported
Over at the Journal of the American Medical Association (JAMA 11 February 2009), in a study of Medicare disease management programmes designed to boost the care of chronically ill patients while reducing hospital admissions, only two of the 15 Medicare programmes resulted in reduced hospital admissions, and none generated net savings. The researchers analysed the results for patients with congestive heart failure, coronary artery disease and diabetes (many with several chronic diseases) who volunteered to participate in the 15 programmes between April 2002 and June 2005 and were randomly assigned to treatment or usual care.
Hospitalisations, Medicare expenditures and some quality-of-care outcomes were measured with claims data for 18,309 patients up to June 2006. A patient survey conducted 7–12 months after enrollment provided additional quality-of-care measures.
The programme included patient education and monitoring to improve the ability to communicate with physicians and the adherence to medication, diet, exercise and self-care regimens. Patients were contacted twice per month on average.
The study found that:
13 of the 15 programmes showed no significant reduction in hospitalisations
two programmes reduced hospitalizations, by 17 and 24 percent; however, the Charlestown retirement community in Maryland had a 19 percent increase in hospitalisations
none of the programmes reduced regular Medicare expenditures. Treatment group members in three programmes had monthly Medicare expenditures of 9 percent to 14 percent less than the control group.
And finally, the latest Telemedicine and e-Health Journal has a number of interesting articles for WSDAN subscribers.
Elderly Patient Monitoring System Using a Wireless Sensor Network – The proposed system is a network that supports various wearable sensors and contains on-board general computing capabilities for individual event detection, alerts, and communications with medical informatics services. The purpose of the system is to provide extended monitoring for elderly patients under drug therapy after infarction, data collection and remote consultation for elderly people.
Telemedicine for Post-Myocardial Infarction Patients: An Observational Study – Telemedicine subscribers had significantly higher survival rates at one year compared to the control group (4.4 per cent compared to 9.7 per cent). The researchers concluded that availability of medical call centres in the out-of-hospital setting for patients with suspected cardiac symptoms improves their motivation to seek timely and appropriate medical assistance.
Mike Clark is Co-project lead for WSDAN