Telemonitoring did not reduce hospitalizations or ED visits in high-risk elderly patients

From the Annals of Internal Medicine:

QUESTION In elderly patients at high risk for hospitalization, does home telemonitoring reduce hospitalizations and emergency department (ED) visits compared with usual care? METHODS DESIGN Randomized controlled trial. ClinicalTrials.gov NCT01056640. ALLOCATION {Concealed}*.† BLINDING Blinded† ({outcome assessors}* and data analysts). FOLLOW-UP PERIOD 1 year. SETTING 4 primary care clinics in Minnesota, USA. PATIENTS 205 patients > 60 years of age (mean age 80 y, 54% women) who were enrolled in the clinic’s Employee and Community Health program and had an Elder Risk Assessment Index score > 15 (based on age, sex, previous hospitalizations, and comorbid conditions [stroke, dementia, heart disease, diabetes mellitus, and chronic obstructive pulmonary disease]). Exclusion criteria were residence in a nursing home, dementia, Kokmen mental status score ≤ 29, and inability to use the telemonitoring device. INTERVENTION Home telemonitoring using the Intel Health Guide (Intel-GE) device (n = 102) or usual care (n = 103). Telemonitoring comprised daily patient entry of symptoms and biometrics using peripheral scales, blood pressure cuff, glucometer, pulse oximeter, and peak flow meter. Data were reviewed daily by registered nurses who triaged patients using decision support from the medical record, consulted with primary physicians, and communicated with patients by telephone or videoconference as needed. OUTCOMES Primary outcome was a composite of hospitalizations and ED visits. Secondary outcomes included hospitalizations, ED visits, and mortality. With 100 patients per group, the study had 80% power to detect a 36% relative reduction (from 38% to 24%) in the composite endpoint at 1 year (α = 0.05). PATIENT FOLLOW-UP 81% (intention-to-treat analysis). MAIN RESULTS Telemonitoring did not reduce hospitalizations or ED visits, combined or alone, but increased mortality (Table). CONCLUSIONS In high-risk elderly patients, telemonitoring did not reduce hospitalizations or emergency department visits compared with usual care but increased mortality.Telemonitoring vs usual care in high-risk elderly patients‡OutcomesEvent ratesAt 1 yTelemonitoringUsual careRRI (95% CI)NNH (CI)Hospitalizations and ED visits64%57%11% (-11 to 40)NSHospitalizations52%44%19% (-11 to 59)NSED visits35%28%25% (-16 to 88)NSMortality15%3.9%279% (38 to 961)10 (6 to 33)‡ED = emergency department; NS = not significant; other abbreviations defined in Glossary. RRI, NNH, and CI calculated from event rates in article.