Patient Engagement with a Novel Web-Based Telemonitoring System for Heart Failure Self-Management: A Pilot Study
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Abstract
Background: Intensive telemonitoring programs for heart failure (HF) have been successful in reducing costly readmissions, but may not be appropriate for all patients. There is an opportunity to leverage the increasing accessibility of the Internet and availability of new wireless telemonitoring devices to empower patients in monitoring their own health at home. iGetBetter (iGB), a secure web- and telephone (IVR)-based telemonitoring system for HF which emphasizes self-care, offers a creative solution at lower cost.
Objective: The objective of this feasibility pilot was to evaluate patient engagement with the iGB system and its effect on health outcomes.
Methods: 21 ambulatory, adult HF patients were enrolled to use the self-monitoring system for 3 months. Participants took daily weight, blood pressure, and heart rate readings using the RM devices provided, and logged daily care plan activities using either the IVR system or the web platform. Outcomes assessed included engagement with the program, hospitalizations, and HF-related quality of life (QoL). Descriptive statistics were used to summarize data and matched controls identified from the hospital EMR were used as comparison for hospital utilization.
Results: 20 patients (mean age 53 yrs) completed the study. The overall median engagement with the system was 84%, and engagement was sustained over the course of the study for 80% of patients. A number of patients (15%) relied on the IVR system for care plan logging, and did not make use of the web platform. 95% of patients reported feeling more connected to their healthcare team and feeling more confident in performing care plan activities, and 90% felt better prepared to start discussions about their health with their doctor. 80% of patients also believed that their disease was better controlled as a result of using the system. All patients liked the telemonitoring device components but 70% did not find the IVR system helpful. In total, patients receiving the intervention recorded 7 hospital admissions, of which 5 were planned, in addition to 2 urgent care visits over the course of the study period while 1 control patient recorded 3 unplanned hospital admissions and 1 urgent care visit. The mean unplanned hospital stay for the intervention group was 4 days compared to 8.7 days in the control group although no significant differences were observed between the two groups on hospital utilization or HF-related QoL.
Conclusions: This feasibility pilot demonstrated the usability of the iGB system and suggests that less intensive telemonitoring programs emphasizing self-management and using commercially available devices that monitor vitals can be a viable alternative for improving the care of HF patients. Although the study was not powered for statistical inference, our findings suggest greater patient satisfaction with care and improved outcomes for those receiving the intervention, albeit not without potential higher cost due to more frequent presentation in the hospital. The majority of patients displayed high and sustained engagement with the program. Further study within a larger sample size is needed to determine the extent of the benefits of the system on clinical outcomes in HF.
Objective: The objective of this feasibility pilot was to evaluate patient engagement with the iGB system and its effect on health outcomes.
Methods: 21 ambulatory, adult HF patients were enrolled to use the self-monitoring system for 3 months. Participants took daily weight, blood pressure, and heart rate readings using the RM devices provided, and logged daily care plan activities using either the IVR system or the web platform. Outcomes assessed included engagement with the program, hospitalizations, and HF-related quality of life (QoL). Descriptive statistics were used to summarize data and matched controls identified from the hospital EMR were used as comparison for hospital utilization.
Results: 20 patients (mean age 53 yrs) completed the study. The overall median engagement with the system was 84%, and engagement was sustained over the course of the study for 80% of patients. A number of patients (15%) relied on the IVR system for care plan logging, and did not make use of the web platform. 95% of patients reported feeling more connected to their healthcare team and feeling more confident in performing care plan activities, and 90% felt better prepared to start discussions about their health with their doctor. 80% of patients also believed that their disease was better controlled as a result of using the system. All patients liked the telemonitoring device components but 70% did not find the IVR system helpful. In total, patients receiving the intervention recorded 7 hospital admissions, of which 5 were planned, in addition to 2 urgent care visits over the course of the study period while 1 control patient recorded 3 unplanned hospital admissions and 1 urgent care visit. The mean unplanned hospital stay for the intervention group was 4 days compared to 8.7 days in the control group although no significant differences were observed between the two groups on hospital utilization or HF-related QoL.
Conclusions: This feasibility pilot demonstrated the usability of the iGB system and suggests that less intensive telemonitoring programs emphasizing self-management and using commercially available devices that monitor vitals can be a viable alternative for improving the care of HF patients. Although the study was not powered for statistical inference, our findings suggest greater patient satisfaction with care and improved outcomes for those receiving the intervention, albeit not without potential higher cost due to more frequent presentation in the hospital. The majority of patients displayed high and sustained engagement with the program. Further study within a larger sample size is needed to determine the extent of the benefits of the system on clinical outcomes in HF.
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