Evaluating the effects of telemonitoring with cVitals: where do you start?
One of the things I do is evaluate the impact of telemonitoring with cVitals. But how do you go about studying its effect on patients and healthcare organizations? What’s the first step? In this blog, I’ll be telling you more about the problems - or rather challenges - I’ve been facing and what comes next.
But maybe I should go back and start at the beginning. What’s this all about? We developed cVitals to give patients more control and greater independence regarding their own health: to provide patient care at the right time so that any deterioration could be detected quickly. But when can you actually say that the remote monitoring of patients with COPD and heart failure is truly beneficial?
The effects on patients
‘I think the most important objective is gaining or regaining a better quality of life. And this is what we want to evaluate'I think the most important objective is gaining or regaining a better quality of life. And this is what we want to evaluate. So many factors can play a part in this, and they’re different for every patient. Some patients will experience a definite improvement in their health due to fewer lung attacks (and, thus, fewer strenuous hospital admissions). For other patients, it is simply reassuring to know that a nurse is keeping an eye on their condition and that they can check their own vital signs every day to know first-hand that they are doing OK.
Hurrah! This is exactly what we’d like to see!
And what about the effects on primary and secondary care?
This is all well and good, but it’s still not enough to get care providers to use a product. For them, more factors are involved: providing more efficient care at lower costs along with better patient outcomes. So we also have to look at the effect on the number of readmissions, the average hospital stay, and the number of outpatient visits.
But these effects apply only to second-line care. What about the costs and income associated with first-line care? Is there actually a shift taking place from second-line to first-line care?
What if the consumption of health care provided by hospitals would decrease due to the introduction of a new innovative product? Good news, you might think, since it could mean saving thousands of dollars in inpatient days. Unfortunately, this is not how it works. After all, it would mean that hospitals could not declare as many care activities so their income would decrease. This would also have a financial impact on specialists. Gone would be their incentive to start innovating. Meanwhile, this is exactly what they want: to team up for better care.
At the same time, the investments needed for first-line care (although many times less expensive than costs involved in hospital admissions) are receiving scarcely if any funding. In short, we still have a long way to go before these financial flows are evenly distributed!
Constructing a research design for cVitals
Now, after identifying all these issues, creating a good research design should be a snap, right? If it were only that simple, I’d be a lot further along than I am now. Well, it’s not that simple - you also have to consider the issues of research fields, outcome evaluations - or even whether you’ll arrive at any significant conclusion at all. What is the best research design in terms of a scientific approach (such as double-blind studies)? What is the best research design in terms of reliability based on a large enough sample? These are the two ends of the spectrum: the first would exclude some patients from participation in telemonitoring, and the second would have you start all of them in the program.
And just comparing the findings obtained before and after the use of cVitals wouldn’t satisfy me either. What I want in my role of researcher is to be able to demonstrate a correlation between the effects evidenced among patients receiving remote care by means of cVitals in conjunction with a measuring device, and a randomized (randomly categorized) control group not making use of cVitals. This is the only way to allocate any differences in the findings between allocating or not allocating remote care to deployment of the cVitals service itself.
This is logical, of course, but what if patient participation lags behind expectations? And another thing: you can’t withhold the use of cVitals from some patients. After all, this should be available to everyone, right?
Telemonitoring among patients with heart failure: effective or not?
Last week, I read the findings of a major telemonitoring study conducted in the U.S. among patients with heart failure. This was a randomized multicenter study that included almost 1500 patients (a number I’d like to have as well!). The conclusion: the telemonitoring of patients had no effect on the number of readmissions. How could this be?
‘When considered more specifically, we see a significant decrease in the number of readmissions and mortality as compared to the population as a whole.'
As it turns out, it’s not just about the patients who ‘want to start telemonitoring’. It’s the fact that this group includes the vast majority of heart failure patients older than 50 who were evaluated for in the hospital for the first time. When we look more specifically at the group of patients who are usually very responsible about taking their pulse, measuring their blood pressure and checking their weight at the proper intervals, we see a significant decrease in the number of readmissions and mortality as compared to the entire population. For these patients, telemonitoring results in a significantly better effect.
Conclusion? It’s not necessarily that worthwhile to start all patients leaving the hospital on cVitals. More important is that the patients themselves want to do so and realize that this would be to their benefit. Following through with the demands of therapy is absolutely essential.
The next step in the research process
This emphasizes, thus, the importance of the patient’s participation. Although we can’t change a patient’s motivation just like that, what we can do is involve patients in helping to develop a cVitals product that will be as easy to use as possible. In this regard, developing user-friendly, reliable wearables is essential.
So what decisions will we have to make to accomplish this? These are questions for another blog!
As a Product Researcher at FocusCura, I am operating in the world of advanced home care technology and, at the same time, I’m working among the patients and physicians at the University Medical Center Utrecht on my research as a PhD candidate. This blog provides updates about my doctoral research, ‘A Safe Path from ICU to Home’ and the developments involved in research into cVitals.