Home Telemonitoring to Reduce Readmission of High-Risk Patients: a Modified Intention-to-Treat Randomized Clinical Trial

Abstract

Background: Home telemonitoring has been used with discharged patients in an attempt to reduce 30-day readmissions with mixed results. Objective: To assess whether home 30-day telemonitoring after discharge for patients at high risk of readmission would reduce readmissions or mortality. Design: Prospective, randomized controlled trial. Patients: We compared 30-day readmission rates and mortality for patients at high risk for readmission who received home telemonitoring versus standard care between November 1, 2014, and November 30, 2018, in 2 tertiary care hospitals. Interventions: The intervention group received home-installed equipment to measure blood pressure, heart rate, pulse oximetry, weight if heart failure was present, and glucose if diabetes was present. Results were transmitted daily and reviewed by a nurse. Both groups received standard care. Main Measures: The primary outcome was a composite end point of hospital readmission or death within 30 days after discharge. The secondary outcome was an emergency department visit within 30 days after discharge. Key Results: A total of 1380 participants (mean [SD] age, 66 [14] years; 722 [52.3%] men and 658 [47.7%] women) participated in this study. Using a modified intention-to-treat analysis, the risk of readmission or death within 30 days among patients at high readmission risk was 23.7% (137/578) in the control group and 18.2% (87/477) in the telemonitoring group (absolute risk difference, − 5.5% [95% CI, − 10.4 to − 0.6%]; relative risk, 0.77 [95% CI, 0.61 to 0.98]; P =.03). Emergency department visits occurred within 30 days after discharge in 14.2% (81/570) of patients in the control group and 8.6% (40/464) of patients in the telemonitoring group (absolute risk difference, − 5.6% [95% CI, − 9.4 to − 1.8%]; relative risk, 0.61 [95% CI, 0.42 to 0.87]; P =.005). Conclusions: Thirty days of postdischarge telemonitoring may reduce readmissions of high-risk patients. Trial Registration: ClinicalTrials.gov identifier: NCT02136186.