Home Telemonitoring System Research Articles

Early Warning of Acute Decompensation in Heart Failure Patients Using a Noncontact Measure of Stability Index.

Hospitalization due to heart failure (HF) continues to be a major clinical and economic challenge. To reduce hospitalization, this paper proposes a novel home telemonitoring system for an early warning of acute decompensation in patients with chronic stable New York Heart Association class II-IV HF. It is based on deriving nocturnal respiratory related time series using a noncontact radio-wave bio-motion sensor. The system generates an alert when there is a change in the underlying probability distribution of the time series which can be regarded as a surrogate marker of patient stability. The system's performance is evaluated using dual-site longitudinal data collected from 104 HF patients over 12-24 months. The system reported an average sensitivity of 0.62 to detect a change during an episode of acute decompensation and an average specificity of 0.67 on the blind validation set, when the frequency of alert was four weeks. The system also performed well to predict acute decompensation with an average sensitivity of 0.55 and specificity of 0.73 on the validation set, where an event window was defined as three weeks preceding an event. These results demonstrate that the design and implementation of such a system is a positive step toward developing noncontact systems capable of preventing acute decompensation, reducing readmissions to hospital and ensuring better quality of life for HF patients.

Technology-Intensified Diabetes Education Study (TIDES) in African Americans with type 2 diabetes: study protocol for a randomized controlled trial.

BackgroundCompared to American Whites, African Americans have a higher prevalence of type 2 diabetes mellitus (T2DM), experiencing poorer metabolic control and greater risks for complications and death. Patient-level factors, such as diabetes knowledge, self-management skills, empowerment, and perceived control, account for >90% of the variance observed in outcomes between these racial groups. There is strong evidence that self-management interventions that include telephone-delivered diabetes education and skills training are effective at improving metabolic control in diabetes. Web-based home telemonitoring systems in conjunction with active care management are also effective ways to lower glycosylated hemoglobin A1c values when compared to standard care, and provide feedback to patients; however, there are no studies in African Americans with poorly controlled T2DM that examine the use of technology-based feedback to tailor or augment diabetes education and skills training. This study provides a unique opportunity to address this gap in the literature.MethodsWe describe an ongoing 4-year randomized clinical trial, which will test the efficacy of a technology-intensified diabetes education and skills training (TIDES) intervention in African Americans with poorly controlled T2DM. Two hundred male and female AfricanAmerican participants, 21 years of age or older and with a glycosylated hemoglobin A1c level ≥8%, will be randomized into one of two groups for 12 weeks of telephone interventions: (1) TIDES intervention group or (2) a usual-care group. Participants will be followed for 12 months to ascertain the effect of the interventions on glycemic control. Our primary hypothesis is that, among African Americans with poorly controlled T2DM, patients randomized to the TIDES intervention will have significantly greater reduction in glycosylated hemoglobin A1c at 12 months of follow-up compared to the usual-care group.DiscussionResults from this study will add to the current literature examining how best to deliver diabetes education and skills training and provide important insight into effective strategies to improve metabolic control and hence reduce diabetes complications and mortality rates in African Americans with poorly controlled T2DM.Trial registrationThis study was registered with the National Institutes of Health Clinical Trials Registry on 13 March 2014 (ClinicalTrials.gov identifier# NCT02088658).

Randomized trial of the ForeseeHome monitoring device for early detection of neovascular age-related macular degeneration. The HOme Monitoring of the Eye (HOME) study design — HOME Study report number 1

ObjectiveTo evaluate the effects of a home-monitoring device with tele-monitoring compared with standard care in detection of progression to choroidal neovascularization (CNV) associated with age-related macular degeneration (AMD), the leading cause of blindness in the US. Patients and methodsParticipants, aged 55 to 90years, at high risk of developing CNV associated with AMD were recruited to the HOme Monitoring of Eye (HOME) Study, an unmasked, multi-center, randomized trial of the ForeseeHome (FH) device plus standard care vs. standard care alone. The FH device utilizes preferential hyperacuity perimetry and tele-monitoring to detect changes in vision function associated with development of CNV, potentially prior to symptom and visual acuity loss. After establishing baseline measurements, subsequent changes on follow-up are detected by the device, causing the monitoring center to alert the clinical center to recall participants for an exam. Standard care consists of instructions for self-monitoring visual changes with subsequent self-report to the clinical center. The primary objective of this study is to determine whether home monitoring plus standard care in comparison with standard care alone, results in earlier detection of incident CNV with better present visual acuity. The primary outcome is the decline in visual acuity at CNV diagnosis from baseline. Detection of CNV prior to substantial vision loss is critical as vision outcome following anti-angiogenic therapy is dependent on the visual acuity at initiation of treatment. DiscussionHOME Study is the first large scale study to test the use of home tele-monitoring system in the management of AMD patients.

Advances in Patient Adherence to Medical Treatment Regimens: The Emerging Role of Technology in Adherence Monitoring and Management

AbstractAdherence is a term used to describe the extent to which an individual's behavior coincides with health‐related instructions or recommendations given by a healthcare provider in the context of a specific disease or disorder. Despite significant advances in biomedical science related to the treatment of disease, the problem of nonadherence remains pervasive and may be aptly described as a global public health concern. The recent proliferation of telemedicine coupled with the ubiquity of personal computers, mobile phones, and other wireless communication devices have, in part, led to the development and implementation of a variety of technology‐based methods used to assess, monitor, and manage adherence. As the chronic illness burden continues to grow, these methods may offer solutions to some of the limitations of traditional means particularly for conditions requiring complex self‐management and lifestyle adjustment. In this article, we briefly review recent advances in adherence monitoring and management including m‐health, home telemonitoring systems, web‐based support (i.e., self‐management websites and virtual support groups), and patient portals and personal health records before concluding with a brief account of some exciting new technologies under development in the context of patient adherence.

A Pilot Study of a Novel Home Telemonitoring System for Oncology Patients Receiving Chemotherapy

We examined the accuracy and acceptability of a home telemonitoring system for patients receiving chemotherapy. Patients undergoing two cycles of chemotherapy (over six weeks) used the telemonitoring system to analyse their own blood (capillary) and to enter symptom and temperature data. The blood results obtained from self-testing were compared with those from a venous blood sample analysed in the hospital laboratory analyser (the gold standard). We also documented the number and type of alerts generated by the telemonitoring system. Acceptability (ease of use and patient satisfaction) was assessed using questionnaires. Ten patients (mean age 61 years, 60% female) provided 48-paired samples. None of the patients succeeded in obtaining all blood results within pre-defined limits of agreement (i.e. within 15% for haemoglobin, haematocrit, white cell count; and 20% for neutrophil count) during the study. However, the level of clinical agreement between the system and the laboratory standard was good; only three out of the 48 samples and two out of the 10 patients had differences in blood results that might have had clinical implications. The telemonitoring system correctly generated 42 alerts. The patients found the telemonitoring system easy to use. With further refinement this should become an acceptable component of routine clinical practice for monitoring patients receiving chemotherapy.

Evaluation of a home telemonitoring service for adult patients with cystic fibrosis: a pilot study

We have conducted a pilot trial of a home telemonitoring system involving 60 adult patients with cystic fibrosis (CF) enrolled at four Italian CF centres. Thirty randomly selected patients received a home device to perform spirometry and to measure oxygen saturation. The data were transferred to a data centre which forwarded them to the patient's CF clinic. The telemonitoring system was evaluated using questionnaires completed by patients and their doctors. The doctors reported that telemonitoring was useful in monitoring their patients' health status and in decreasing the CF centre workload. The data transfer procedure posed no particular problems for the patients. The major difficulties reported by the patients were night-time saturimetry measurements, and in the first week of the study, data transmission to the data centre. The pilot trial was positive and therefore merits a larger study.

Feasibility of telemonitoring for active surveillance of influenza vaccine safety in the primary care setting in the Netherlands

We examined the feasibility of a commercial home telemonitoring system for monitoring adverse events related to vaccination and influenza-like illness (ILI) signs and outcomes in the primary care setting in The Netherlands. A prospective cohort of people eligible for influenza vaccination was monitored daily between mid-October 2007 and mid-March 2008. Adults from five primary care centres were invited to participate. A total of 245 people participated (response rate 75%). Their mean age was 61 years (SD = 15), 50% were female and 60% had a chronic disease. Most (73%) had no problems with installation of the system and 67% finished all sets of monitoring dialogues. The reported incidence of adverse events in the first week after vaccination was 8-38%. The reported incidence rates of ILI symptoms varied and were higher than reference data. A total of 39% of individuals consulted their general practitioner, 7% the hospital emergency department, 6% were hospitalized and 27% used medication. Of those in paid work, one-third reported absence of work due to ILI. Home telemonitoring appears to be feasible for monitoring vaccine adverse events and ILI symptoms and outcomes.

130: Use of Home Telemonitoring System in Hemodialysis Patients at High Risk for Volume Overload

130: Use of Home Telemonitoring System in Hemodialysis Patients at High Risk for Volume Overload

Home telemonitoring in heart failure patients: the HHH study (Home or Hospital in Heart Failure)

The Home or Hospital in Heart failure (HHH) study was a European Community-funded, multinational, randomized controlled clinical trial, conducted in the UK, Poland, and Italy, to assess the feasibility of a new system of home telemonitoring (HT). The HT system was used to monitor clinical and physiological parameters, and its effectiveness (compared with usual care) in reducing cardiac events in heart failure (HF) patients was evaluated. Measurements were patient-managed. From 2002 to 2004, 461 HF patients (age 60 +/- 11 years, New York Heart Association class 2.4 +/- 0.6, left ventricular ejection fraction 29 +/- 7%) were enrolled at 11 centres and randomized (1:2) to either usual outpatient care or HT administered as three randomized strategies: (i) monthly telephone contact; (ii) strategy 1 plus weekly transmission of vital signs; and (iii) strategy 2 plus monthly 24 h recording of cardiorespiratory activity. Patients completed 81% of vital signs transmissions, as well as 92% of cardiorespiratory recordings. Over a 12-month follow-up, there was no significant effect of HT in reducing bed-days occupancy for HF or cardiac death plus HF hospitalization. Post hoc analysis revealed a heterogeneous effect of HT in the three countries with a trend towards a reduction of events in Italy. Home or Hospital in Heart failure indicates that self-managed HT of clinical and physiological parameters is feasible in HF patients, with surprisingly high compliance. Whether HT contributes to a reduction of cardiac events requires further investigation.

Patients' acceptance of CareLink home telemonitoring system

2 for T-wave oversensing, and 1 for interference).Complications were encountered in 5 patients (7%) (1 had a pneumothorax post implantation and 4 were device related). Conclusion: In a routine clinical heart failure population, prophylactic ICD implantation provided appropriate therapy for potentially lifethreatening arrhythmias in 25% of the population over a two year follow up, a rate similar to that reported in the clinical trials. With a relatively low complication rate these data indicate translation of clinical trial benefits to the general heart failure population.

Towards New Scopes: Sensor-enhanced Regional Health Information Systems

To analyze utilization of sensor technology in telemonitoring and home care and to discuss concepts and challenges of sensor-enhanced regional health information systems (rHIS). The study is based upon experience in sensor-based telemedicine and rHIS projects, and on an analysis of HIS-related journal publications from 2003 to 2005 conducted in the context of publishing the IMIA Yearbook of Medical Informatics. Health-related parameters that are subject to sensor-based measurement in home care and telemonitoring are identified. Publications related to telemonitoring, home care and smart houses are analyzed concerning scope and utilization of sensor technology. Current approaches for integrating sensor technology in rHIS based on a corresponding eHealth infrastructure are identified. Based on a coarse architecture of home care and telemonitoring systems ten challenges for sensor-enhanced rHIS are identified and discussed: integration of home and health telematic platforms towards a sensor-enhanced telematic platform, transmission rate guarantees, ad hoc connectivity, cascading data analysis, remote configuration, message and alert logistic, sophisticated user interfaces, unobtrusiveness, data safety and security, and electronic health record integration. Utilization of sensor technology in health care is an active field of research. Currently few research projects and standardization initiatives focus on general architectural considerations towards suitable telematic platforms for establishing sensor-enhanced rHIS. Further research finalized by corresponding standardization is needed. Part 2 of this paper will present experiences with a research prototype for a sensor-enhanced rHIS telematic platform.

Home telemonitoring of vital signs and cardiorespiratory signals in heart failure patients: System architecture and feasibility of the HHH model

Background The Home or Hospital in Heart Failure Study (HHH) is a European Community funded trial (QLGA-CT-2001-02424) which compares usual care of heart failure (HF) with three home-based interventions in a multicenter, multicountry (Italy, Poland and UK), randomized controlled clinical trial. Home telemonitoring (HT) of clinical parameters represents a potential alternative (or addition) to traditional home care models. Nocturnal respiratory disorders (periodic breathing, sleep apnea) are very common in HF, and are associated with increased morbidity and mortality. We developed an integrated HT system for monitoring of both vital signs and respiration. All measurements were patient-managed. This paper describes the architecture of this system, and assesses its feasibility. Methods and results 461 clinically stable patients were randomized first to usual vs home-monitored care; the latter were further randomized to 3 strategies. Over a 12-month follow-up 2 of these 3 groups (195 patients, age: 60 ± 11 years, NYHA class II–III: 97%, LVEF 28 ± 7%) underwent self-administered home monitoring of vital signs (weekly — 12 parameters using an interactive voice response system) and respiration (monthly — 24-hour recording). Data were transmitted over conventional telephone lines; 81% of actually practicable vital signs measurements were completed by the patients (range: 75% (PL)–93% (UK)), as well as 92% of practicable respiratory recordings (range: 85% (PL)–99% (UK)). 87% of nighttime recordings were eligible for the study (good quality signals for ≥ 2.5 h). Conclusions This study, the largest so far, demonstrates that self-managed home telemonitoring of both vital signs and respiration is feasible in HF patients, with surprisingly high compliance. We found an excellent rate of acceptable nocturnal respiratory recordings, which are those with the greatest clinical relevance.

ECG and XML: An instance of a possible XML schema for the ECG telemonitoring

Management of many types of chronic diseases relies heavily on patients' self-monitoring of their disease conditions. In recent years, Internet-based home telemonitoring systems allowing transmission of patient data to a central database and offering immediate access to the data by the care providers have become available. The adoption of Extensible Mark-up Language (XML) as a W3C standard has generated considerable interest in the potential value of this language in health informatics. However, the telemonitoring systems often work with only one or a few types of medical devices. This is because different medical devices produce different types of data, and the existing telemonitoring systems are generally built around a proprietary data schema. In this paper, we describe a generic data schema for a telemonitoring system that is applicable to different types of medical devices and different diseases, and then we present an architecture for the exchange of clinical information as data, signals of telemonitoring and clinical reports in the XML standard, up-to-date information in each electronic patient record and integration in real time with the information collected during the telemonitoring activities in the XML schema, between all the structures involved in the healthcare process of the patient.

An empirical analysis of a telehealth system in terms of cost-sharing.

We interviewed 348 users of a home telemonitoring system and asked questions about their willingness to pay (WTP). Assuming that the functional form of demand was logistic, the best estimate of the WTP was yen 4519 per user per month. We also analysed how the benefits of the system (expressed in terms of WTP) were attributed to four factors: stabilizing illness; enhancement of health consciousness; less anxiety in day-to-day life; and a decrease in medical expenditures. All except the last were significant. According to the resulting model, individual users should bear yen 2763 in costs, while society should reimburse yen 349. Surprisingly, the value of yen 2763 obtained here is very close to the amount ( yen 2500) actually charged by Kamaishi City.

The feasibility of a telecommunications service in support of outpatient congestive heart failure care in a diverse patient population.

A home telemonitoring system for patients with congestive heart failure was studied for feasibility and efficacy in a diverse patient population. Fifty patients used the service, in which they weighed themselves and answered yes/no questions about symptoms. Changes in patient weights or symptoms prompted a nurse to call the patient and/or the physician. Patients were given educational and quality of life surveys at enrollment, at 30 days, and at 6 months. The average daily usage rate was 94%. Patients were contacted 57 times--prompting 57 physician notifications, eight medication changes, and 11 nonroutine clinic visits. Patient response to lifestyle surveys showed an improvement in quality of life and improved understanding of prevention measures. Eighty-four percent of patients and 65% of physicians reported satisfaction with the system. This pilot study suggests that home telemonitoring is feasible and has clinical utility in diverse patient groups, and may improve patients' satisfaction and knowledge of self-care. (c)2000 by CHF, Inc.

Feasibility of a home telemonitoring system for prevention of congestive heart failure exacerbation

Feasibility of a home telemonitoring system for prevention of congestive heart failure exacerbation