UCLA researchers found that combined health coaching and remote monitoring did not reduce all-cause 180-day hospital readmissions among heart failure patients, and did not have significant effects on 30-day hospital readmissions, 30-day mortality or 180-day mortality. The researchers found that intervention patients reported significantly improved quality of life at 180 days when compared to usual care patients based on the widely used Minnesota Living with Heart Failure questionnaire.
Increasingly, patients and health care providers are interested in using remote monitoring devices to help with their health care. The researchers sought to determine if these devices could be useful in preventing 180-day all-cause hospital readmissions for heart failure patients. They enrolled 1,437 patients from UCLA, UC Davis, UC Irvine, UC San Diego, UC San Francisco and Cedars-Sinai Medical Center in Los Angeles.
Subjects were randomized into two groups. One received pre-discharge self-management health coaching and a Bluetooth-enabled scale, a Bluetooth blood pressure/text messaging device and a transmission pod, and patients were asked to do daily measurements and answer questions about their symptoms. Data was checked daily by a nurse call center; if measurements were too high or too low, patients were called to determine the problem and, if necessary, were referred to their health care provider or an emergency department. Patients also received scheduled reinforcement of health coaching on a weekly basis for the first month and then monthly through six months. The other group received standard care.
The enrollment procedures had very few exclusion criteria in order to mirror potential actual use by health systems, so that patients with a wide range of socioeconomic backgrounds and health comorbidities were enrolled in the study.
Some of the findings were previously reported at the American Heart Association scientific meeting on Nov. 8, 2015. The newly published study reports additional quality-of-life findings that were not presented at the AHA meeting.
The use of remote monitoring technology is not yet ready for widespread adoption for the purposes of reducing readmissions. Further research should determine which patients can adhere to using these technologies and how to improve adherence. Also, further research is needed to evaluate quality-of-life benefits.
Dr. Michael Ong, associate professor in residence of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, was the study’s lead investigator.
JAMA Internal Medicine, Feb. 8
The study was supported by the Agency for Healthcare Research and Quality (R01 HS019311), the National Heart Lung and Blood Institute (RC2 HL101811), the National Center for Advancing Translational Science UCLA CTSI (UL1TR000124), the Robert Wood Johnson Foundation (66336), the Sierra Health Foundation, the University of California Center for Health Quality and Innovation and the participating institutions.
UCLA has received an additional $46 million gift from longtime supporter and legendary entertainment visionary David Geffen, a reinvestment that brings the amount of the David Geffen Medical Scholarship Fund to $146 million.