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Randomized Controlled Trial
. 2012 May 28;172(10):773-9.
doi: 10.1001/archinternmed.2012.256.

A randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits

Paul Y Takahashi  1 , Jennifer L Pecina, Benjavan Upatising, Rajeev Chaudhry, Nilay D Shah, Holly Van Houten, Steve Cha, Ivana Croghan, James M Naessens, Gregory J Hanson
Affiliations
Randomized Controlled Trial

A randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits

Paul Y Takahashi et al. Arch Intern Med. .

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.

Trial registration: ClinicalTrials.gov NCT01056640.

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Figure 1
Figure 1
Trial recruitment. Failed Kokmen indicates the individual had a score of 29 or less on the short test of mental status by Kokmen et al.
Figure 2
Figure 2
Combined end point for time-to-event analysis of mortality, hospitalizations, and emergency department (ED) visits.
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References

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