A randomized controlled trial of telemonitoring in older adults with multiple chronic conditions

The Tele-ERA study

Paul Y Takahashi, Gregory J. Hanson, Jennifer L. Pecina, Robert J. Stroebel, Rajeev Chaudhry, Nilay D Shah, James M Naessens

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Older adults with multiple chronic illnesses are at risk for worsening functional and medical status and hospitalization. Home telemonitoring may help slow this decline. This protocol of a randomized controlled trial was designed to help determine the impact of home telemonitoring on hospitalization. The specific aim of the study reads as follows: to determine the effectiveness of home telemonitoring compared with usual care in reducing the combined outcomes of hospitalization and emergency department visits in an at-risk population 60 years of age or older. Methods/Design: Two-hundred patients with the highest 10% Mayo Clinic Elder Risk Assessment scores will be randomly assigned to one of two interventions. Home telemonitoring involves the use of a computer device, the Intel Health Guide, which records biometric and symptom data from patients in their homes. This information is monitored by midlevel providers associated with a primary care medical practice. Under the usual care scenario, patients make appointments with their providers as problems arise and use ongoing support such as a 24-hour nurse line. Patients will have initial evaluations of gait and quality of life using instruments such as the SF-12 Health Survey, the Kokmen Short Test of Mental Status, and the PHQ-9 health questionnaire. Patients will be followed for 1 year for primary outcomes of hospitalizations and emergency department visits. Secondary analysis will include quality of life, compliance with the device, and attitudes about telemonitoring. Sample size is based on an 80% power to detect a 36% difference between the two groups. The primary analysis will involve Cox proportional time-to-event analysis. Secondary analysis will use t-test comparisons for continuous variables and the chi square test for proportional analysis. Discussion: Patients randomized to home telemonitoring will have daily assessments of their health status using the device. Registered nurse monitoring will assess any change in status followed by videoconferencing by a mid-level provider. We obtained trial registration and Institutional Review Board approval.

Original languageEnglish (US)
Article number255
JournalBMC Health Services Research
Volume10
DOIs
StatePublished - 2010

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Randomized Controlled Trials
Hospitalization
Equipment and Supplies
Hospital Emergency Service
Nurses
Quality of Life
Videoconferencing
Intelligence Tests
Research Ethics Committees
Health
Chi-Square Distribution
Health Surveys
Gait
Sample Size
Health Status
Primary Health Care
Appointments and Schedules
Multiple Chronic Conditions

ASJC Scopus subject areas

  • Health Policy

Cite this

A randomized controlled trial of telemonitoring in older adults with multiple chronic conditions : The Tele-ERA study. / Takahashi, Paul Y; Hanson, Gregory J.; Pecina, Jennifer L.; Stroebel, Robert J.; Chaudhry, Rajeev; Shah, Nilay D; Naessens, James M.

In: BMC Health Services Research, Vol. 10, 255, 2010.

Research output: Contribution to journalArticle

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abstract = "Background: Older adults with multiple chronic illnesses are at risk for worsening functional and medical status and hospitalization. Home telemonitoring may help slow this decline. This protocol of a randomized controlled trial was designed to help determine the impact of home telemonitoring on hospitalization. The specific aim of the study reads as follows: to determine the effectiveness of home telemonitoring compared with usual care in reducing the combined outcomes of hospitalization and emergency department visits in an at-risk population 60 years of age or older. Methods/Design: Two-hundred patients with the highest 10{\%} Mayo Clinic Elder Risk Assessment scores will be randomly assigned to one of two interventions. Home telemonitoring involves the use of a computer device, the Intel Health Guide, which records biometric and symptom data from patients in their homes. This information is monitored by midlevel providers associated with a primary care medical practice. Under the usual care scenario, patients make appointments with their providers as problems arise and use ongoing support such as a 24-hour nurse line. Patients will have initial evaluations of gait and quality of life using instruments such as the SF-12 Health Survey, the Kokmen Short Test of Mental Status, and the PHQ-9 health questionnaire. Patients will be followed for 1 year for primary outcomes of hospitalizations and emergency department visits. Secondary analysis will include quality of life, compliance with the device, and attitudes about telemonitoring. Sample size is based on an 80{\%} power to detect a 36{\%} difference between the two groups. The primary analysis will involve Cox proportional time-to-event analysis. Secondary analysis will use t-test comparisons for continuous variables and the chi square test for proportional analysis. Discussion: Patients randomized to home telemonitoring will have daily assessments of their health status using the device. Registered nurse monitoring will assess any change in status followed by videoconferencing by a mid-level provider. We obtained trial registration and Institutional Review Board approval.",
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