Telehealth reduces healthcare use, but produces too many alerts

Self-monitoring along with nurse oversight helped reduce care costs by $2,931 per person among patients with chronic obstructive pulmonary disease (COPD) in an Australian study published in Telemedicine and e-Health.

Participants were taught to measure their blood pressure, weight, temperature, pulse, and oxygen saturation levels daily and transmit that information by telephone to a secure website, monitored by a nurse. There were fewer emergency room visits and hospital admissions among the telehealth group--nearly half as many--vs. a control group, though not at a statistically significant level. However, the cost savings added up from the use of fewer resources, according to the paper.

In addition, the telehealth participants reported increased confidence in their ability to manage their condition and less anxiety.

However, a review of health failure patients treated by a Massachusetts home health agency monitoring similar data found only three percent of alerts were associated with ED visits and hospitalizations. Because the nurses had to follow up on every alert, that meant they spent a lot of time trying not to miss the few meaningful alerts, according to a second study at Telemedicine and e-Health.

Many of the false alarms were generated when patients did a poor job of taking their vitals. Meanwhile, 22 percent of cardiac-related ED visits and hospitalizations had no alerts associated with them. The study points to anxiety as a key predictor of ED visits and hospitalizations among heart-failure patients, a factor that must be addressed, the authors said.

While telehealth offers the opportunity to reinforce self-management and observe patient health trends, the sea of alerts generated can result in "alert fatigue," the authors wrote. They suggest a decision-support system could help filter out false alarms and help nurses spend their time more constructively.

As the Affordable Care Act takes hold, telemedicine could be the key to caring for more patients while keeping costs stable, Mario Gutierrez, executive director for the Center for Connected Health Policy recently told Time magazine.

Clearly there are issues still to be worked out, though. The Patient-Centered Outcomes Research Institute (PCORI) recently handed out grants totaling more than more than $114 million for comparative clinical effectiveness research projects including telehealth.

The U.S. Department of Health & Human Services also recently awarded $300,000 each to Maine, Montana, and Alaska to improve remote care for veterans in rural areas.

To learn more:
- read the first Telemedicine and e-Health paper (.pdf)
- here's the second study (.pdf)

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