The effect of a randomized trial of home telemonitoring on medical costs, 30-day readmissions, mortality, and health-related quality of life in a cohort of community-dwelling heart failure patients.
BACKGROUND
Telemonitoring has been advocated as a way of decreasing costs and improving outcomes, but no study has looked at true Medicare payments and 30-day readmission rates in a randomized group of well treated patients.


OBJECTIVE
The aim of this work was to analyze Medicare claims data to identify effects of home telemonitoring on medical costs, 30-day rehospitalization, mortality, and health-related quality of life.


METHODS
A total of 204 subjects were randomized to usual-care and monitored groups and evaluated with the SF-36 and Minnesota Living With Heart Failure Questionnaire (MLHF). Hospitalizations, Medicare payments, and mortality were also assessed. Monitored subjects transmitted weight, blood pressure, and heart rate, which were monitored by an experienced heart failure nurse practitioner.


RESULTS
Subjects were followed for 802 ± 430 days; 75 subjects in the usual-care group (316 hospitalizations) and 81 in the monitored group (327 hospitalizations) were hospitalized at least once (P = .51). There were no differences in Medicare payments for inpatient or emergency department visits, and length of stay was not different between groups. There was no difference in 30-day readmissions (P = .627) or mortality (P = .575). Scores for SF-36 and MLHF improved (P < .001) over time, but there were no differences between groups. The percentage of patients readmitted within 30 days was lower with telemonitoring for the 1st year, but this did not persist.


CONCLUSIONS
Telemonitoring did not result in lower total costs, decreased hospitalizations, improved symptoms, or improved mortality. A decrease in 30-day readmission rates for the 1st year did not result in decreased total cost or better outcomes.
Inova Fairfax Heart and Vascular Institute, Falls Church, Virginia. Electronic address: quie.blum@inova.org.
Kay
K
Blum
Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland; Baltimore Veterans Administration Medical Center, Baltimore, Maryland.
Stephen S
SS
Gottlieb
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000639:trends*; D006333:Heart Failure / Q000191:economics / Q000401:mortality / Q000628:therapy*; D006699:Home Care Services / Q000191:economics / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000639:trends*; D011788:Quality of Life / Q000523:psychology; D012111:Residence Characteristics; D017216:Telemedicine / Q000191:economics / Q000379:methods / Q000639:trends*; D013686:Telemetry / Q000191:economics / Q000379:methods / Q000639:trends*; D016896:Treatment Outcome
30-day readmissions; Home telemonitoring; cost of care; health related quality of life