A Randomized Controlled Trial of Telemonitoring in Older Adults With Multiple Health Issues to Prevent Hospitalizations and Emergency Department Visits

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Abstract
Increased life expectancy in developed countries has been a remarkable feat.1,2 Longer life expectancy challenges the health care system to optimally manage older patients at high risk for hospitalization.3 Caring for patients in their homes could provide a cost-effective approach using telemonitoring of clinical symptoms and biometrics. Telemonitoring systems offer biometrics tracking and videoconferencing asynchronously and in real time and allow data to be transmitted easily from patient to physician. Many care organizations will focus on high-risk older adults with multiple chronic illnesses as a part of medical home initiatives. Home telemonitoring may reduce hospitalizations and emergency department (ED) visits in this population. This is important because hospitalizations and ED visits may portend functional decline in older adults4 or mortality.5 Home telemonitoring has been shown to reduce hospital admissions, ED visits, and hospital length of stay in various chronic illnesses.6-8 Results of a systematic review suggest a 20% reduction in hospitalizations among patients with cardiovascular disease (primarily heart failure) using telemonitoring.9 However, the Tele–Heart Failure study10 showed no reductions in hospitalizations associated with telemonitoring. In patients with multiple chronic conditions, insufficient evidence supports the efficacy of telemonitoring to prevent hospitalizations or ED visits. To fill this gap, we conducted a randomized controlled trial comparing daily home telemonitoring (with biometrics, symptom reporting, and videoconference) vs usual care in older adults at high risk for hospitalization. We hypothesized that telemonitoring would reduce hospitalizations and ED visits compared with usual care.

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