Changes in healthcare utilisation during implementation of remote atrial fibrillation management: TeleCheck-AF project.

Abstract

To evaluate changes in healthcare utilisation and comprehensive packages of care activities and procedures (referred in the Netherlands to as 'diagnose-behandelcombinatie (DBC) care products) during the implementation of the TeleCheck-AF approach (teleconsultation supported by app-based heart rate/rhythm monitoring) in aDutch atrial fibrillation (AF) clinic. In the Maastricht University Medical Centre+ AF Clinic, data on healthcare utilisation and DBC care products for patients consulted by both aconventional approach in 2019 and the TeleCheck-AF approach in 2020 were analysed. Apatient experience survey was performed. Thirty-seven patients (median age 68years; 40% women) were analysed. With the conventional approach, 35face-to-face consultations and 0teleconsultations were conducted. After the implementation of TeleCheck-AF, the number of face-to-face consultations dropped by 80% (p < 0.001) and teleconsultations increased to 45 (p < 0.001). While 42electrocardiograms (ECGs) and 25Holter ECGs or echocardiograms were recorded when using the conventional approach, the number of ECGs decreased by 71% (p < 0.001) and Holter ECGs or echocardiograms by 72% (p < 0.001) with the TeleCheck-AF approach. The emergency department patient presentations showed no statistically significant change (p = 0.33). Overall, 57% of medium-weight DBC care products were changed to light-weight ones during implementation of the TeleCheck-AF approach. Patient satisfaction with the TeleCheck-AF approach was high. The implementation of TeleCheck-AF led to achange in healthcare utilisation, achange from medium-weight to light-weight DBC care products and areduction in patient burden. These results created the basis for anew reimbursement code for the TeleCheck-AF approach in the Netherlands.