title: Effect of telehealth on hospital utilisation and mortality in routine clinical practice: a matched control cohort study in an early adopter site.
abstract: OBJECTIVE
  To assess the effects of a home-based telehealth intervention on the use of secondary healthcare and mortality.
  
  
  METHODS
  Observational study of a mainstream telehealth service, using person-level administrative data. Time to event analysis (Cox regression) was performed comparing telehealth patients with controls who were matched using a machine-learning algorithm.
  
  
  METHODS
  A predominantly rural region of England (North Yorkshire).
  
  
  METHODS
  716 telehealth patients were recruited from community, general practice and specialist acute care, between June 2010 and March 2013. Patients had chronic obstructive pulmonary disease, congestive heart failure or diabetes, and a history of associated inpatient admission. Patients were matched 1:1 to control patients, also selected from North Yorkshire, with respect to demographics, diagnoses of health conditions, previous hospital use and predictive risk score.
  
  
  METHODS
  Telehealth involved the remote exchange of medical data between patients and healthcare professionals as part of the ongoing management of the patient's health condition. Monitoring centre staff alerted healthcare professionals if the telemonitored data exceeded preset thresholds. Control patients received usual care, without telehealth.
  
  
  METHODS
  Time to the first emergency (unplanned) hospital admission or death. Secondary metrics included time to death and time to first admission, outpatient attendance and emergency department visit.
  
  
  RESULTS
  Matched controls and telehealth patients were similar at baseline. Following enrolment, telehealth patients were more likely than matched controls to experience emergency admission or death (adjusted HR 1.34, 95% CI 1.16 to 1.56, p<0.001). They were also more likely to have outpatient attendances (adjusted HR=1.25, 1.11 to 1.40, p<0.001), but mortality rates were similar between groups. Sensitivity analyses showed that we were unlikely to have missed reductions in the likelihood of an emergency admission or death because of unobserved baseline differences between patient groups.
  
  
  CONCLUSIONS
  Telehealth was not associated with a reduction in secondary care utilisation.
authors: Data Analytics, The Health Foundation, London, UK.
authors: Adam
authors: A
authors: Steventon
authors: Data Analytics, The Health Foundation, London, UK.
authors: Cono
authors: C
authors: Ariti
authors: The Nuffield Trust, London, UK.
authors: Elizabeth
authors: E
authors: Fisher
authors: The Nuffield Trust, London, UK.
authors: Martin
authors: M
authors: Bardsley
mesh_terms: D000368:Aged; D015986:Confounding Factors, Epidemiologic; D003920:Diabetes Mellitus / Q000401:mortality / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012424:Rural Population; D017216:Telemedicine / Q000458:organization & administration*
keywords: PREVENTIVE MEDICINE