News 5/9/12

Travis,

Here is the Continua Health Alliance response to the Mayo study which we found very flawed

Mayo RPM and Continua Response

Continua Health Alliance Members:

Rigorous clinical research is an important step in validating the effectiveness of connected health programs to deliver high quality care, improve outcomes and better manage healthcare resources. Continua supports ongoing research efforts to study telehealth programs to determine the most effective model of care delivery in specific patient populations. Providers, payers, patients, policy makers, and technology developers are all encouraged by the positive results achieved in numerous clinical studies showing improved engagement, adherence, and outcomes.

As you may be aware, the telemonitoring study conducted by researchers from the Mayo Clinic and Purdue University, published in Archives of Internal Medicine last week, has caused some controversy. The study found no difference in hospitalization rates, emergency department visits and hospital day rates between older adults at high risk for re-hospitalization participating in telemonitoring, compared to a group of similar adults not enrolled in a telemonitoring program (n=205 patients; median age 80.3 years). This study further reported an increase in mortality in the telemonitoring group (14.7%) over the usual care group (3.9%). For the purpose of this study, telemonitoring included daily biometric measures of blood pressure and weight, symptom reporting and videoconferencing. “High risk” was defined as a score above 15 on the Elder Risk Assessment Index, which evaluates risk based on age, sex, previous hospitalizations, and co-morbid conditions (stroke, dementia, heart disease, diabetes mellitus and chronic obstructive pulmonary disease).

When considering the study results, it is also important to keep in mind that the authors of this study noted that “the lack of efficacy of telemonitoring may reflect the number of patients in the trial or may indicate a lack of effective infrastructure needed to fully optimize case management.” We believe it is important to offer some additional perspective on these study results and provide a summary of several other research programs that have demonstrated the effectiveness of telemonitoring and other approaches to connected health.

The results of this study are in stark contrast to dozens of well-designed studies that included thousands of patients with a variety of conditions, many of them at high risk:

* Analysis of data from the Veterans Health Administration (VHA) Care Coordination/Home Telehealth (CCHT) program, from a cohort of 17,025 CCHT patients (65+ years old; predominantly male) demonstrated the following results:
* 25% reduction in numbers of bed days of care
* 19% reduction in the number of hospital admissions
* 86% mean satisfaction score

CCHT is now a routine service for VHA patients with chronic conditions as they age, to help avoid unnecessary admission to long-term institutional care.

* For the last six years, the Center for Connected Health (CCH) at Partners HealthCare has been offering the Connected Cardiac Care Program (CCCP) to non-homebound patients with heart failure. To date, more than 1,000 patients have been enrolled in this program resulting in close to a 50% reduction in hospital readmission rates overall. Patients use remote monitoring equipment in their home to submit weight, blood pressure, heart rate, and symptoms on a daily basis. Telemonitoring nurses monitor these vitals, respond to out-of-parameter alerts, and guide patients through structured biweekly heart failure education. 84.7% of patients reported they were able to gain control over their heart failure while in the program.

* In February, Geisinger Health Plan announced that its interactive voice response post-hospital discharge telemonitoring solution demonstrated a 44% reduction in 30-day hospital readmissions. Approximately 1,000 heart failure patients are in the remote monitoring program at any given time; patient compliance has been greater than 85%. Because of the success of the telemonitoring heart failure program, Geisinger has expanded the program to include patients with hypertension and diabetes.

* In Germany, numerous remote monitoring studies have demonstrated positive outcomes, including:
* Telemedicine for the Heart project, which showed 21.5% fewer hospitalizations and a 51.7% reduction in mortality within the first year in patients with chronic heart failure
* A randomized, controlled study of 214 heart failure patients (NYHA stages I-IV) demonstrated a 48% reduction in the number of days in the hospital and a 14.7% mortality rate, compared with 27.1% in the control group (observed during the 6-18 month observation period)

* The Ontario Telemedicine Network, part of the Canadian Ministry of Health and Long-Term Care, recently completed a successful remote monitoring program involving more than 800 patients with congestive heart failure or COPD, demonstrating significant results:
* 65% reduction in hospital admissions
* 72% reduction in Emergency Room visits
* 95% reduction in the walk-in clinic visits

* Healthcare Unwired, a 2010 report published by PricewaterhouseCoopers Health Research Institute, cites data from several remote monitoring studies, including:
* Congestive heart failure patients receiving care via a trans-European home care management system saw a 35% decrease in inpatient length of stay, a 10% reduction in office visits, and a 65% drop in home health visits
* In Canada, COPD patients participating in a remote monitoring program reduced hospital readmissions by 50% and acute home exacerbations by 55%

* A three year study conducted by the UK Department of Health, including nearly 6,200 patients with heart failure, diabetes or COPD, demonstrated that remote monitoring reduced mortality rates by 45%. Additional results included:
* 15% reduction in emergency visits
* 20% reduction in emergency admissions
* 14% reduction in elective admissions
* 14% reduction in number of bed days of care

* Earlier this month, researchers from the Stanford Prevention Research Center reported that Smartphone applications can raise awareness and motivate older adults to improve their health. Smartphones were loaned to 31 adults (45 to 77 years old) who had never owned or regularly used this type of phone. Each phone included an app targeting at least one health behavior (increased walking, decreased sitting time, improved diet). After eight weeks, 80% of participants reported increased awareness regarding the targeted health behavior and three-quarters said the apps helped track the behavior; two-thirds indicated the apps increased their motivation to make improvements.

We encourage you to review the Mayo Clinic study as well as those referenced above, and to share these data with your colleagues. We look forward to a continued dialogue about the value of personal connected health.

Continua Health Alliance is working to provide accurate, unbiased information and resources to our members, the healthcare and health IT communities, and the media to support the advancement of personal connected health. Our goal remains, to move health and wellness into the day-to-day lives of consumers and improve health management, quality of life, and clinical outcomes, while reducing costs.

We are currently developing a library of business case studies and clinical abstracts to demonstrate the effectiveness of personal connected health, and will continue to share this information with our members. If you have data or case studies you would like to share with us in support of this effort, please contact Continua’s public relations representative: Gina Cella, Cella Communications, ginacella@comcast.net.