title: A randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits.
abstract: BACKGROUND
  Efficiently caring for frail older adults will become an increasingly important part of health care reform;telemonitoring within homes may be an answer to improve outcomes. This study sought to assess differences in hospitalizations and emergency department (ED) visits among older adults using telemonitoring vs usual care.
  
  
  METHODS
  A randomized controlled trial was performed among adults older than 60 years at high risk for rehospitalization. Participants were randomized to telemonitoring (with daily input) or to patient-driven usual care. Telemonitoring was accomplished by daily biometrics,symptom reporting, and videoconference. The primary outcome was a composite end point of hospitalizations and ED visits in the 12 months following enrollment. Secondary end points included hospitalizations,ED visits, and total hospital days. Intent-to-treat analysis was performed.
  
  
  RESULTS
  Two hundred five participants were enrolled,with a mean age of 80.3 years. The primary outcome of hospitalizations and ED visits did not differ between the telemonitoring group (63.7%) and the usual care group(57.3%) (P=.35). No differences were observed in secondary end points, including hospitalizations, ED visits,and total hospital days. No significant group differences in hospitalizations and ED visits were found between the pre-enrollment period vs the post-enrollment period. Mortality was higher in the telemonitoring group (14.7%)than in the usual care group (3.9%) (P=.008).
  
  
  CONCLUSIONS
  Among older patients, telemonitoring did not result in fewer hospitalizations or ED visits. Secondary outcomes demonstrated no significant differences between the telemonitoring group and the usual care group.The cause of greater mortality in the telemonitoring group is unknown.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, 200 First St NW, Rochester, MN 55905, USA. takahashi.paul@mayo.edu
authors.forename: Paul Y
authors.initials: PY
authors.lastname: Takahashi
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Pecina
authors.forename: Benjavan
authors.initials: B
authors.lastname: Upatising
authors.forename: Rajeev
authors.initials: R
authors.lastname: Chaudhry
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: Holly
authors.initials: H
authors.lastname: Van Houten
authors.forename: Steve
authors.initials: S
authors.lastname: Cha
authors.forename: Ivana
authors.initials: I
authors.lastname: Croghan
authors.forename: James M
authors.initials: JM
authors.lastname: Naessens
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Hanson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D017046:Cost Savings; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D011786:Quality Control; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D017216:Telemedicine / Q000191:economics / Q000379:methods*