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Evaluation of Remote Monitoring in Home Health Care
Abstract
Remote telehealth monitoring has become a common practice in home health care in the United Sates. Further, there is growing evidence of the effectiveness of remote monitoring on patient outcomes. The Visiting Nurse of New York, the largest not-for-profit home health care agency in the country tested the impact of remote monitors on a sample of 132 patients compared to a matched control group (n=264). The results indicated that regardless of diagnosis, the rate of hospitalization for the control group was 45.5% and for the remote monitoring group it was 35.6%. The difference was not statistically significant (p=0.06). However, at the diagnosis level there were significant differences for congestive heart failure and hypertension patients. The diagnoses chosen for analysis were the most frequent (primary or secondary) among the remote monitoring patients with sample sizes greater than 20. Implications of these and other findings are discussed.
... Findings revealed that success expectancy has little impact on the patient's decisions to use IoT for eHealth, thus encouraging developers, medical professionals, and advertisers to enhance the design of connected devices, improve patient connectivity, and specifically target potential consumers (Arfi et al., 2021). R. J Rosati employed a methodology that involved over 100 remote monitors strategically placed in the homes of patients with significant cognitive deficiencies (Rosati, 2009). Supplementary information was collected to understand demographics, ongoing medications, social support, and clinical status. ...
... The research found a considerable reduction in the hospitalization rate (a testament to remote monitoring efficacy in the place of hospitalization). Regardless of diagnosis, the control group had 45.5% of hospitalization compared to 35.6% of patients on remote healthcare monitoring (Rosati, 2009). The study also found a significant reduction in nursing visits per week for remote monitor patients compared to the control group. ...
The Internet of Things (IoT) and artificial intelligence (AI) are two of the fastest-growing technologies in the world. With more people moving to cities, the concept of a smart city is not foreign. The idea of a smart city is based on transforming the healthcare sector by increasing its efficiency, lowering costs, and putting the focus back on a better patient care system. Implementing IoT and AI for remote healthcare monitoring (RHM) systems requires a deep understanding of different frameworks in smart cities. These frameworks occur in the form of underlying technologies, devices, systems, models, designs, use cases, and applications. The IoT-based RHM system mainly employs both AI and machine learning (ML) by gathering different records and datasets. On the other hand, ML methods are broadly used to create analytic representations and are incorporated into clinical decision support systems and diverse healthcare service forms. After carefully examining each factor in clinical decision support systems, a unique treatment, lifestyle advice, and care strategy are proposed to patients. The technology used helps to support healthcare applications and analyze activities, body temperature, heart rate, blood glucose, etcetera. Keeping this in mind, this paper provides a survey that focuses on the identification of the most relevant health Internet of things (H-IoT) applications supported by smart city infrastructure. This study also evaluates related technologies and systems for RHM services by understanding the most pertinent monitoring applications based on several models with different corresponding IoT-based sensors. Finally, this research contributes to scientific knowledge by highlighting the main limitations of the topic and recommending possible opportunities in this research area.
... Through that same network its connected to the mobile phone, which with it you can set the timing interval for the dose and also notifies you by many ways when the dose time comes. Also, we added a buzzer with a LED to make a type of physical warning, so that it leaves you no choice but to remember the pill time and take it [8], [9]. ...
Many medical errors are due to the fact that people in charge of patient or elder's medication have to deal with sorting huge amounts of pills each day. This paper consists on the conception, design and creation of a pillbox prototype intended to solve this deficiency in the medical area as it has the ability of sorting out the pills by itself as well as many other advanced features, with this device being intended to be used by hospitals or retirement homes. This medication pill box is focused on patients who frequently take medications or vitamin supplements, or attendants who deal with the more seasoned or patients. Our smart pill box is programmable that enables medical caretakers or clients to determine the pill amount and timing to take pills, and the service times for every day. Our shrewd pills box contains nine separate sub-boxes. In this manner, medical caretakers or clients can set data for nine distinct pills. At the point when the pill time has been set, the pillbox will remind clients or patients to take pills utilizing sound and light. The warning of pills should be taken will be shown by an android application which is held by the patient. Contrasted and the conventional pill box that requires clients or attendants to stack the crate each day or consistently. Our shrewd pill box would essentially discharge medical attendants or clients' weight on much of the time preloading pills for patients or clients and overlook the measurements which must be taken. Keywords: Smart Pill box, IoT, Health Care, Medicine Reminder
... Healthcare sectors need to take care of a large figure of old age subjects, who have memory loss problems. A caregiver is required to look after and monitor the movements of the patients [5]. Therefore, information and communication technologies play an important role in healthcare technology and in development of medical devices. ...
Tracking devices help the elderly patients to remain safe, secure and traceable in case of getting lost or in an emergency. This research work was conducted to evaluate the appropriateness of few commercially available tracking devices for aging people, by identifying their usefulness, efficiency, limitations and further improvements. Research involved two steps; literature review about two existing tracking devices simply termed device A and device B, followed by a performance and comparative analysis of the aforementioned devices by applying basic statistics on the results obtained from a questionnaire survey. Devices were used by two groups of people: aging (>70 year old) and middle-aged patients (less than 70 years old) who reported their satisfaction levels about the said devices on a scale of one to five. These devices were found helpful in reducing the dependency of the elderly on others and raised their privacy values. However, these were not recommended for severe memory loss or later stage of critical staged dementia patients because learning and memorizing the process of handling these devices can be difficult for them. Overall, the performance of device B outplayed device A while comparing all considered device parameters. The calling feature of device B appeared to be an appealing characteristic with mean satisfaction levels of 4.9 ± 0.32 and 4.7 ± 0.48 as reported by the middle-aged and aging groups, respectively. These devices will be helpful in decreasing unnecessary rush at health care centers or lost person reporting in police. In upcoming years, these devices can be developed to remotely monitor the movement of the patient.
... Various innovative models, including team-based care, 4-6 minute clinics, 7 and remote health services, 8,9 are being implemented worldwide to aid in the care of patients. We developed the Self Empowering and Enabling Kiosk (SEEK), an unmanned healthcare kiosk, integrated with the electronic medical record, to complement office-based PCP visits. ...
IntroductionThe global healthcare kiosk market is growing, and kiosks are projected to be a larger part of healthcare delivery in the coming decades. We developed an unmanned healthcare kiosk that automates the management of stable patients with chronic conditions to complement face-to-face primary care physician (PCP) visits. AimThe aim of our study was to show that the kiosk could be a feasible means of delivering care for stable patients with chronic conditions and could generate cost savings for the management of patients with stable chronic disease. Methods
We conducted a prospective single-arm study of 95 participants with well-controlled chronic cardiovascular diseases who visited our clinic in Singapore every 3 months for review and medication refill. During their subsequent appointments for chronic disease management at 3 and 6 months, participants used the kiosk instead of consulting a physician. All participants who used the kiosk were also evaluated by a nurse clinician (NC). The kiosk assessment of whether the patient was well controlled was then compared to the NC’s assessment to determine rates of agreement. Patient satisfaction was evaluated through a questionnaire, and any adverse outcomes were documented. ResultsCohen’s κ for agreement between the kiosk and the NC assessment of patients’ chronic care control was 0.575 (95% CI, 0.437–0.713). The modest agreement was due to differences in systolic blood pressure measurements between the kiosk and the NC. The 96% of participants who completed two kiosk visits were all satisfied with the kiosk as a care delivery alternative. None of the participants managed through the kiosk suffered any adverse outcomes. Use of the kiosk resulted in a reduction of 128 face-to-face PCP visits. Conclusions
Healthcare kiosks can potentially be used to complement primary care clinician visits for managing patients with stable chronic diseases and can generate cost savings.
... Remote health care is a possible optimistic way to solve these problems [3][4][5][6][7] . It could be very useful to particular patients, e.g., those with congestive heart failure or hypertension, and thus plays a more and more important role in preventing hospitalization [8] . So a remote health care system which is based on the theory of TCM, particularly CPD, can offer much better daily care. ...
Nowadays, with improvements in the quality of life, people are paying more attention to their health. Traditional Chinese medicine offers great advantages for daily care. In this paper, we present the development of a remote health care system, namely, Chinese Pulse Condition Acquisition System (CPCAS), based on the principle of Chinese pulse diagnosis in Chinese medicine and a wireless sensor network. We designed a remote health care terminal with a mini-pulse collection bench to overcome the challenge of differences in pulse characters of different people. An effective measured pressure control algorithm is proposed to achieve a balance between control accuracy and control time. The special signal conditioning circuit showed good performance in analog pulse signal processing. We also performed significant research to address the challenges of symptom recognition. Other distinctive features of this system include the following: intelligent sensing, a wireless health care network, effective energy management, small size, lightweight, and the ability to be networked for remote management. In this paper, we have introduced the design and implementation of CPCAS. We also demonstrate the use of the system and give evaluations on this system by several experiments. Our results indicate that CPCAS has significant practical feasibility.
... The use of open standard like ISO/IEEE 11073-20601 group of standards addressing the interoperability of personal health devices 12 MQTT messaging protocol will best suited due to less memory, processor and bandwidth 13 The use of open source IOT cloud will be effective. RFID and RFID reader: RFID is utilized to give unique identification to user so that while remote monitoring the prescriber can distinguish the patient on same page 14 Web page: web page will be used for remote monitoring of medicine scheduled fallowed by patient and to upload the changes if any found after comparing the variation in medicine consuming activity in scheduling, quantity, timing of drug. ...
In modern society, busy life has made people forget many things in day to day life. The elderly people and the people victims of chronicle diseases who need to take the medicines timely without missing are suffering from dementia, which is forgetting things in their daily routine. Considering this situation study has been done in this. Paper reviewing the technologies of home health care which are currently used for improving this situation by reminding the scheduled of medicine, remote monitoring and update new medicine data of patients, which can be done by prescriber through web.
... Thus, in developed countries, a new way of practising telemedicine is emerging faster. It is known as Primary Remote Diagnostic Visits whereby a doctor uses devices to remotely examine and treat a patient preventing him accidental deaths (Rosati, 2009). ...
This paper presents a novel system capable of measuring and analysing the signal coming from six different vital signals. The system is based on a portable remote device, monitored via a mobile application running on an android platform, and connected to the patient via its different sensors. The results are displayed on the patient phone and sent remotely to his doctor's phone. The doctor can read any of the vital signs anytime by enabling the sensor connected to the patient. This system can also help the doctor to compare it to previous results, set new medications, update or define a schedule for a visit. Whenever a faulty signal of any of the vital signs is treated, an automatic message is sent to one of the patient relatives and to his doctor for a fast intervention. The tested results showed an almost error free system with an accuracy above 95%.
... Patients with chronic decease such as Alzheimer's sufferers who require constant monitoring would also benefit from this technology as it would be possible to track them down on a permanent basis. Telemedicine has been shown to reduce the number of hospital visits patients require [1] and is therefore perceived as an enabling technology to reduce costs and provide comfort to a growing part of the population. ...
The effects of a numerical and a physical phantom on different antenna configurations are evaluated. Input response, radiation patterns and efficiency are considered in the presence of the phantoms. In order to validate the phantoms as a substitute for human tissue, these effects are compared to those experienced due to the proximity of the human body. The detuning effects on a patch antenna due to the phantom were demonstrated and shown to match the effects of the human body. The radiation pattern of a loop antenna was measured on and off the phantom. The presence of the phantom was found to reduce the efficiency of the loop antenna by 88%.
... Regarding the educational field, there is a web-based remote control laboratory that employs a greenhouse scale model for teaching greenhouse climate control techniques using different hardware and software platforms ( Guzmán et al., 2005), and also a virtual laboratory that permits remote access via Transmission Control Protocol/Internet Protocol (TCP/IP), enabling control and supervision through the Internet ( Garbus et al., 2006). In addition, the results of an evaluation of remote monitoring in home health care show a reduction in nursing visit and hospitalization rates in the remote monitoring patient group (Rosati, 2009). The example list can be much longer. ...
In current society, occupied life has caused individuals to overlook numerous things in everyday life. The old individuals and the general population casualties of account maladies who need to take the meds opportune without missing are experiencing dementia, which is overlooking things in their day by day schedule. Considering this circumstance study has been done in this. Paper exploring the advancements of home wellbeing care which are as of now utilized for improving this circumstance by helping the planned to remember prescription, remote observing and update new drug information of patients, which should be possible by prescriber through web.
At present, elderly people are suffering from dementia and Alzheimer’s disease across the world. The aged population has been increasing and will continue to do so in the coming decades. Those elderly who are suffering from dementia and Alzheimer's disease require continuous attention. So these people need a responsible person (either a nurse or family caretaker) to look after and provide support in any case of emergency. The number of these patients is dramatically increasing. This is difficult to care for them all by hiring a personal caretaker for each patient. Consequently, with the help of electronics and computer technology, scientists currently develop efficient and user-friendly devices that can help look after a patient easily or even remotely. Hence it is possible to look after not only a single patient but also monitor a number of patients at the same time. In this thesis, after a brief study about elderly tracking devices, the limitation was identified, and relevant improvements were suggested for the devices. A survey has been conducted to present the opinion of consumer of LDS Finder and Teltonika HandHeld tracking devices. A website was developed in which relevant information is available regarding the availability of the tracking devices for the elderly.
This article summarizes publicly available research related to outcomes and best practices in skilled home health and other kinds of home-based care. As the population ages and the home health care sector grows, the home health community must address current deficiencies in care and expand the use of evidence-based strategies to improve the quality and efficiency of care. Many promising innovations in service delivery currently exist, a wide variety of which have been tested and evaluated in postacute and long-term care settings. Our review found that home health agencies are well positioned to improve patient outcomes through a variety of approaches, including care coordination, telehealth, and data-driven quality of care monitoring. For the most part, evaluations of these interventions show that they can improve patient outcomes and/or cost-effectiveness.
Digital Image processing is a topic of great relevance for practically any project, either for
basic arrays of photodetectors or complex robotic systems using artificial vision. It is an
interesting topic that offers to multimodal systems the capacity to see and understand their
environment in order to interact in a natural and more efficient way.
The development of new equipment for high speed image acquisition and with higher
resolutions requires a significant effort to develop techniques that process the images in a
more efficient way. Besides, medical applications use new image modalities and need
algorithms for the interpretation of these images as well as for the registration and fusion of
the different modalities, so that the image processing is a productive area for the
development of multidisciplinary applications.
The aim of this chapter is to present different digital image processing algorithms using
LabView and IMAQ vision toolbox. IMAQ vision toolbox presents a complete set of digital
image processing and acquisition functions that improve the efficiency of the projects and
reduce the programming effort of the users obtaining better results in shorter time.
Therefore, the IMAQ vision toolbox of LabView is an interesting tool to analyze in detail
and through this chapter it will be presented different theories about digital image
processing and different applications in the field of image acquisition, image
transformations.
This chapter includes in first place the image acquisition and some of the most common
operations that can be locally or globally applied, the statistical information generated by
the image in a histogram is commented later. Finally, the use of tools allowing to segment or
filtrate the image are described making special emphasis in the algorithms of pattern
recognition and matching template.
Remote monitoring (RM) strategies have the potential to deliver specialised care and management to patients with heart failure (HF).
To determine the clinical effectiveness and cost-effectiveness of home telemonitoring (TM) or structured telephone support (STS) strategies compared with usual care for adult patients who have been recently discharged (within 28 days) from acute care after a recent exacerbation of HF.
Fourteen electronic databases (including MEDLINE, EMBASE, PsycINFO and The Cochrane Library) and research registers were searched to January 2012, supplemented by hand-searching relevant articles and contact with experts. The review included randomised controlled trials (RCTs) or observational cohort studies with a contemporaneous control group that included the following RM interventions: (1) TM (including cardiovascular implanted monitoring devices) with medical support provided during office hours or 24/7; (2) STS programmes delivered by human-to-human contact (HH) or human-to-machine interface (HM).
A systematic review and network meta-analysis (where appropriate) of the clinical evidence was carried out using standard methods. A Markov model was developed to evaluate the cost-effectiveness of different RM packages compared with usual care for recently discharged HF patients. TM 24/7 or using cardiovascular monitoring devices was not considered in the economic model because of the lack of data and/or unsuitability for the UK setting. Given the heterogeneity in the components of usual care and RM interventions, the cost-effectiveness analysis was performed using a set of costing scenarios designed to reflect the different configurations of usual care and RM in the UK.
The literature searches identified 3060 citations. Six RCTs met the inclusion criteria and were added to the 15 trials identified from the previous systematic reviews giving a total of 21 RCTs included in the systematic review. No trials of cardiovascular implanted monitoring devices or observational studies met the inclusion criteria. The methodological quality of the studies varied widely and reporting was generally poor. Compared with usual care, RM was beneficial in reducing all-cause mortality for STS HH [hazard ratio (HR) 0.77, 95% credible interval (CrI) 0.55 to 1.08], TM during office hours (HR 0.76, 95% CrI 0.49 to 1.18) and TM 24/7 (HR 0.49, 95% CrI 0.20 to 1.18); however, these results were statistically inconclusive. The results for TM 24/7 should be treated with caution because of the poor methodological quality of the only included study in this network. No favourable effect on mortality was observed with STS HM. Similar reductions were observed in all-cause hospitalisations for TM interventions, whereas STS interventions had no major effect. A sensitivity analysis, in which a study was excluded because it provided better-than-usual support to the control group, showed larger beneficial effects for most outcomes, particularly for TM during office hours. In the cost-effectiveness analyses, TM during office hours was the most cost-effective strategy with an estimated incremental cost-effectiveness ratio (ICER) of £11,873 per quality-adjusted life-year (QALY) compared with usual care, whereas STS HH had an ICER of £228,035 per QALY compared with TM during office hours. STS HM was dominated by usual care. Similar results were observed in scenario analyses performed using higher costs of usual care, higher costs of STS HH and lower costs of TM during office hours.
The RM interventions included in the review were heterogeneous in terms of monitored parameters and HF selection criteria and lacked detail in the components of the RM care packages and usual care (e.g. communication protocols, routine staff visits and resources used). As a result, the economic model developed scenarios for different RM classifications and their costs were estimated using bottom-up costing methods. Although the users can decide which of these scenarios is most representative of their setting, uncertainties still remain about the assumptions made in the estimation of these costs. In addition, the model assumed that the effectiveness of the interventions was constant over time, irrespective of the duration of deployment, and that the intervention was equally effective in different age/severity groups.
Despite wide variation in usual care and RM strategies, cost-effectiveness analyses suggest that TM during office hours was an optimal strategy (in most costing scenarios). However, clarity was lacking among descriptions of the components of RM packages and usual care and there was a lack of robust estimation of costs. Further research is needed in these areas.
PROSPERO registration no. CRD42011001368.
The National Institute for Health Research Health Technology Assessment programme.
Health monitoring systems have rapidly evolved during the past two decades and have the potential to change the way health care is currently delivered. Although smart health monitoring systems automate patient monitoring tasks and, thereby improve the patient workflow management, their efficiency in clinical settings is still debatable. This paper presents a review of smart health monitoring systems and an overview of their design and modeling. Furthermore, a critical analysis of the efficiency, clinical acceptability, strategies and recommendations on improving current health monitoring systems will be presented. The main aim is to review current state of the art monitoring systems and to perform extensive and an in-depth analysis of the findings in the area of smart health monitoring systems. In order to achieve this, over fifty different monitoring systems have been selected, categorized, classified and compared. Finally, major advances in the system design level have been discussed, current issues facing health care providers, as well as the potential challenges to health monitoring field will be identified and compared to other similar systems.
Governments in under developing countries face serious problems for offering quality healthcare services at reasonable cost due to rapidly graying population and patients with chronic diseases. Due to currently healthcare resources are not sufficient, many deaths without medication are produced. Thus, this increasing important issue needs to be attended. Our approach to tackle this issue is based on Multi-agent system (MAS) architecture. Our Remote Patient Monitoring (RPM) system monitors patients taking into account physiological and environmental parameters. In this way, RPM provides reliable and low-cost healthcare to elderly, chronically, and acutely people either indoor or outdoor environment. Our hypothesis is that an effective use of healthcare resources, entails reduction of unnecessary hospitalizations, minimizes among others: cost, treatment, and monitoring. However, despite of RPM potential applications, it has not become an integrated part of patient care in heterogeneous environments, mainly due to the lack of knowledge and infrastructure. This paper presents the design and implemented MAS architecture for RPM, identifying barriers and providing perspectives for the future.
This paper describes a design and implementation of a portable physiological signal recorder. The device is designed for measuring electrocardiography, bioimpedance, and user's activity. The bioimpedance measures the dynamic changes in the impedance, and its main application is monitoring user's respiration. Activity is measured with three-axis acceleration sensor. During the design, a special attention is paid on the device's power consumption and the target has been set to a 24-h operating time. Functionality of the implemented measurement device is proven with test measurements, which include, e.g., comparison of measurement signals against reference signals, testing the device operation under vigorous upper body movements, and during a light exercise. In order to verify the device operation during real-life activities, one full day, 24-h long, measurement is carried out. The measurement system is tested with both commercial Ag/AgCl gel-paste electrodes and custom-made textile electrodes. Device is proven to be operational with both electrodes, but textile electrodes are found to be more sensitive for movement artifacts. This paper also gives a small review of other existing portable and wearable physiological measurement devices and discusses some general requirements of these devices.
To determine whether remote monitoring (structured telephone support or telemonitoring) without regular clinic or home visits improves outcomes for patients with chronic heart failure.
15 electronic databases, hand searches of previous studies, and contact with authors and experts.
Two investigators independently screened the results.
Published randomised controlled trials comparing remote monitoring programmes with usual care in patients with chronic heart failure managed within the community.
14 randomised controlled trials (4264 patients) of remote monitoring met the inclusion criteria: four evaluated telemonitoring, nine evaluated structured telephone support, and one evaluated both. Remote monitoring programmes reduced the rates of admission to hospital for chronic heart failure by 21% (95% confidence interval 11% to 31%) and all cause mortality by 20% (8% to 31%); of the six trials evaluating health related quality of life three reported significant benefits with remote monitoring, and of the four studies examining healthcare costs with structured telephone support three reported reduced cost and one no effect.
Programmes for chronic heart failure that include remote monitoring have a positive effect on clinical outcomes in community dwelling patients with chronic heart failure.
Previous studies have found that home-based intervention programs reduce readmission rates for patients with heart failure. Only one previous trial has compared telephone and videophone to traditional care to deliver a home-based heart failure intervention program. The objective of this study was to evaluate the efficacy of a telehealth-facilitated postdischarge support program in reducing resource use in patients with heart failure. Patients at a Midwestern Department of Veterans Affairs Medical Center were randomized to telephone, videophone, or usual care for follow-up care after hospitalization for heart failure exacerbation. Outcome measures included readmission rates; time to first readmission; urgent care clinic visits; survival; and quality of life. The intervention resulted in a significantly longer time to readmission but had no effect on readmission rates or mortality. There were no differences in hospital days or urgent care clinic use. All subjects reported higher disease-specific quality of life scores at 1 year. There was evidence of the value of telephone follow-up, but there was no evidence to support the benefit of videophone care over telephone care. Rigorous evaluation is needed to determine which patients may benefit most from specific telehealth applications and which technologies are most cost-effective.
Patient outcomes and cost were compared when home healthcare was delivered by telemedicine or by traditional means for patients receiving skilled nursing care at home. A randomized controlled trial was established using three groups. The first group, control group C, received traditional skilled nursing care at home. The second group, video intervention group V, received traditional skilled nursing care at home and virtual visits using videoconferencing technology. The third group, monitoring intervention group M, received traditional skilled nursing care at home, virtual visits using videoconferencing technology, and physiologic monitoring for their underlying chronic condition. Discharge to a higher level of care (hospital, nursing home) within 6 months of study participation was 42% for C subjects, 21% for V subjects, and 15% for M subjects. There was no difference in mortality between the groups. Morbidity, as evaluated by changes in the knowledge, behavior and status scales of the Omaha Assessment Tool, showed no differences between groups except for increased scores for activities of daily living at study discharge in the V and M groups. The average visit costs were 22.11 for average virtual visits (video group), and 38.62 for average monitoring group visits for congestive heart failure and chronic obstructive pulmonary disease subjects, respectively. This study has demonstrated that virtual visits between a skilled home healthcare nurse and chronically ill patients at home can improve patient outcome at lower cost than traditional skilled face-to-face home healthcare visits.
We conducted a systematic review to identify studies on the effect of home telehealth on clinical care outcomes. The search was restricted to peer-reviewed publications (published between 2001 and 2007) about studies conducted in home or residential settings. The search yielded 154 potential articles and dissertations. A total of 29 articles met the inclusion criteria and were included in a meta-analysis. The weighted mean effect size for the overall meta-analysis was 0.50, and the z-statistic was 3.0, indicating that telehealth had a moderate, positive and significant effect (P < or = 0.01) on clinical outcomes. Subanalyses also indicated positive significant effects of telehealth for some disease categories (heart disease and psychiatric conditions), but not others (diabetes), patient populations and telehealth interventions. Overall, the meta-analysis indicated that telehealth positively affects clinical outcomes of care, even in different patient populations.
OBJECTIVES. This article describes one approach to measuring outcomes across the continuum of care. METHODS. Development and testing of the outcome-based quality-improvement methodology as developed by the University of Colorado Center for Health Services Research in Denver, Colorado are summarized. RESULTS. Reliable and valid measures for home health care covering end results (pure outcome), intermediate results (instrumental outcome), and use (proxy outcome) were developed and are useful in demonstrating patient improvement or stabilization as well as decline. Further, these measures can be aggregated by agency and, with appropriate severity or risk adjustment, can be used to compare outcomes over time and across agencies. CONCLUSIONS. National testing of the methodology is currently ongoing, with refinements underway in measures, risk adjustment, and operational implementation.
We assessed the utilization of health-care services and clinical outcomes in veterans with diabetes who were enrolled in two care coordination/home telehealth programmes. One group of patients was monitored weekly (n = 197), with more intensive evaluations, while the other was monitored daily (n = 100), but less intensively. Although patients in the two groups were fairly similar in demographic terms and in their clinical characteristics at baseline, they had different service utilization patterns during the 12-month pre-enrollment period. Over the 12-month study period, the proportion of one or more hospital admissions and number of bed days of care decreased in the daily monitoring group, and increased in the weekly monitoring group, more or less doubling in the former and being halved in the latter. Unscheduled primary care clinic visits were lower in the daily monitored group than in the weekly monitored group. The differences between the two groups were significant (P < 0.01). There were no significant differences between the groups in the clinical outcomes. Future research should employ randomized controlled trial designs to determine if intensities of home monitoring lead to differences in service utilization and health outcomes.
Propensity-score methods are increasingly being used to reduce the impact of treatment-selection bias in the estimation of treatment effects using observational data. Commonly used propensity-score methods include covariate adjustment using the propensity score, stratification on the propensity score, and propensity-score matching. Empirical and theoretical research has demonstrated that matching on the propensity score eliminates a greater proportion of baseline differences between treated and untreated subjects than does stratification on the propensity score. However, the analysis of propensity-score-matched samples requires statistical methods appropriate for matched-pairs data. We critically evaluated 47 articles that were published between 1996 and 2003 in the medical literature and that employed propensity-score matching. We found that only two of the articles reported the balance of baseline characteristics between treated and untreated subjects in the matched sample and used correct statistical methods to assess the degree of imbalance. Thirteen (28 per cent) of the articles explicitly used statistical methods appropriate for the analysis of matched data when estimating the treatment effect and its statistical significance. Common errors included using the log-rank test to compare Kaplan-Meier survival curves in the matched sample, using Cox regression, logistic regression, chi-squared tests, t-tests, and Wilcoxon rank sum tests in the matched sample, thereby failing to account for the matched nature of the data. We provide guidelines for the analysis and reporting of studies that employ propensity-score matching.
The purpose of this randomized field study was to determine the effects of telehomecare on hospitalization, emergency department (ED) use, mortality, and symptoms related to sodium and fluid intake, medication use, and physical activity. The sample consists of 284 patients with heart failure. The authors used logistic regression to study the effects of telehomecare on health services utilization and mortality and a general linear model to analyze changes in self-reported symptoms. On average, patients in the telehomecare groups had a lower probability of hospitalizations and ED visits than did patients in the control group. Differences were statistically significant at 60 days but not 120 days. Results show a greater reduction in symptoms for patients using telehomecare compared to control patients. The technology enables frequent monitoring of clinical indices and permits the home health care nurse to detect changes in cardiac status and intervene when necessary.
Risk adjustment for measuring health care outcomes
- L I Iezzoni