Page 5 Case Studies in Telehealth Adoption Partners Health Care Connecting Heart Failure Patients to Through Monitoring

PArTners heAlThcAre: connecTing heArT FAilure PATienTs To Providers Through remoTe moniToring 5

Care Outcomes that introducing telemonitoring not only affected care
Remote monitoring improves the health of ambula- outcomes but also indicated a trend toward a decreas-
tory patients who have been recently hospitalized ing need for nurse visits. The studies did not have a
for heart failure and leads to reductions in hospital large enough sample to definitively demonstrate cost
readmissions. A 2006 pilot study of CCCP with 150 savings, nor did they indicate that telemonitoring
heart failure patients, with an average age of 70, who would replace home visits. However, telemonitoring
had been admitted to Massachusetts General Hospital was seen as providing a critical adjunct to patient care
and received six months of follow-up care did not and workload efficiency for nurses. The impact was
reach statistical significance. However, the results significant enough to support adoption of telemonitor-
indicated a positive trend in reducing readmissions ing as part of the care plan for heart failure patients.
(Exhibit 3). Sixty-eight patients received usual care for This led Partners in 2007 to fund the program’s expan-
heart failure; the remaining 82 patients were offered sion systemwide for all heart failure patients that met
remote monitoring. Forty-two patients accepted and 40 the inclusion criteria. To date, more than 1,200 patients
declined to participate. The remote monitoring group have been enrolled. Exhibit 4 shows that the proportion
had a lower rate of all-cause readmissions compared of enrollees in CCCP with one or more heart failure
with usual-care patients and nonparticipants. Patients hospitalizations in the year following disenrollment
in the remote monitoring group also had fewer heart was 13.3 percent compared with 39.8 percent one year
failure–related readmissions. However, all-cause emer- prior to enrollment.
gency room (ER) visits were higher among the remote-
monitoring group than for usual care and nonpartici- User Satisfaction
pating patients. This higher frequency of reporting to Eleven research studies were conducted at Partners-
the ER may be a result of closer monitoring. affiliated hospitals to measure patient perceptions of
connected health technologies; namely, if patients feel
Process Efficiencies empowered to better manage their care, if they have
Initial studies of CCCP that involved patients receiving increased satisfaction with care, and if their overall
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skilled nursing care from a home care provider found health is improved. Patients in CCCP reported the

Exhibit 3. Remote Monitoring CCCP Pilot Results at Six-Month Follow-Up

Control Intervention Nonparticipant
(n=68) (n=42) (n=40)
Mean rate Mean rate Mean rate
(± standard (± standard (± standard
deviation) deviation) deviation) P-value
Hospital readmissions

l All-cause 0.73 (±1.51) 0.64 (±0.87) 0.75 (±1.05) .75
l Heart failure–related 0.38 (±1.06) 0.19 (±0.45) 0.42 (±0.93) .56
Emergency room visits
l All-cause 0.57 (±1.43) 0.83 (±1.08) 0.65 (±1.0) .10
l Heart failure–related 0.25 (±1.02) 0.26 (±0.49) 0.35 (±0.80) .31
Length of stay

l All-cause 10.64 (±9.7) 9.16 (±9.00) 13.2 (±13.4) .85
l Heart failure–related 8.52 (±8.3) 10.57 (±12.5) 10.78 (±9.1) .78
Source: A. Kulshreshtha, J. C. Kvedar, A. Goyal et al., “Use of Remote Monitoring to Improve Outcomes in Patients with Heart Failure: A Pilot Trial,” International Journal of
Telemedicine and Applications, published online May 19, 2010.