title: Telehealth by an Interprofessional Team in Patients With CKD: A Randomized Controlled Trial.
abstract: BACKGROUND
  Telehealth and interprofessional case management are newer strategies of care within chronic disease management. We investigated whether an interprofessional team using telehealth was a feasible care delivery strategy and whether this strategy could affect health outcomes in patients with chronic kidney disease (CKD).
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  Minneapolis Veterans Affairs Health Care System (VAHCS), St. Cloud VAHCS, and affiliated clinics March 2012 to November 2013 in patients with CKD (estimated glomerular filtration rate < 60mL/min/1.73m(2)).
  
  
  METHODS
  Patients were randomly assigned to receive an intervention (n=451) consisting of care by an interprofessional team (nephrologist, nurse practitioner, nurses, clinical pharmacy specialist, psychologist, social worker, and dietician) using a telehealth device (touch screen computer with peripherals) or to usual care (n=150).
  
  
  RESULTS
  The primary end point was a composite of death, hospitalization, emergency department visits, or admission to skilled nursing facilities, compared to usual care.
  
  
  RESULTS
  Baseline characteristics of the overall study group: mean age, 75.1±8.1 (SD) years; men, 98.5%; white, 97.3%; and mean estimated glomerular filtration rate, 37±9mL/min/1.73m(2). Telehealth and interprofessional care were successfully implemented with meaningful engagement with the care system. One year after randomization, 208 (46.2%) patients in the intervention group versus 70 (46.7%) in the usual-care group had the primary composite outcome (HR, 0.98; 95% CI, 0.75-1.29; P=0.9). There was no difference between groups for any component of the primary outcome: all-cause mortality (HR, 1.46; 95% CI, 0.42-5.11), hospitalization (HR, 1.15; 95% CI, 0.80-1.63), emergency department visits (HR, 0.92; 95% CI, 0.68-1.24), or nursing home admission (HR, 3.07; 95% CI, 0.71-13.24).
  
  
  CONCLUSIONS
  Older population, mostly men, potentially underpowered/wide CIs.
  
  
  CONCLUSIONS
  Telehealth by an interprofessional team is a feasible care delivery strategy in patients with CKD. There was no statistically significant evidence of superiority of this intervention on health outcomes compared to usual care.
authors.affiliation: Section of Renal Diseases and Hypertension, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN; Division of Renal Diseases and Hypertension, University of Minnesota Medical School, Minneapolis, MN. Electronic address: isha0012@umn.edu.
authors.forename: Areef
authors.initials: A
authors.lastname: Ishani
authors.affiliation: Section of Renal Diseases and Hypertension, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN.
authors.forename: Juleen
authors.initials: J
authors.lastname: Christopher
authors.affiliation: Section of Renal Diseases and Hypertension, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Palmer
authors.affiliation: Section of Renal Diseases and Hypertension, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN.
authors.forename: Sara
authors.initials: S
authors.lastname: Otterness
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN.
authors.forename: Barbara
authors.initials: B
authors.lastname: Clothier
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN.
authors.forename: Sean
authors.initials: S
authors.lastname: Nugent
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN.
authors.forename: David
authors.initials: D
authors.lastname: Nelson
authors.affiliation: Division of Renal Diseases and Hypertension, University of Minnesota Medical School, Minneapolis, MN.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Rosenberg
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D010348:Patient Care Team; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D017216:Telemedicine; D016896:Treatment Outcome
keywords: Telemedicine; case management; chronic disease management; chronic kidney disease (CKD); hospitalization; hypertension; interprofessional relations; mortality; patient education; randomized controlled trial; remote monitoring; video monitoring; virtual visit