Telemonitoring Of Patients Research Articles

Telemedicine as a tool for bridging geographical inequity: insights in geospatial interactions from a study on chronic heart failure patients

IntroductionChronic heart failure patients experience large disparities in quality of and access to treatment, with rural populations receiving lower levels of care. Telemonitoring of patients is increasingly being used as an important tool for improving patient management and care and might reduce geographical inequities in healthcare.MethodsWe investigate the presence and magnitude of a geospatial interaction effect on the health benefit of a supplementary telemedicine intervention, by analyzing the relationship between distance to regular place of treatment and the benefit of telemedicine in a secondary analysis of data from a previously conducted RCT. We use change in EQ5D health status, SF-36 Physical component score and SF-36 Mental component score as the outcomes. In the unadjusted analysis, intervention group and distance group and the interaction term are included as the independent variables, in the adjusted analysis, multiple socioeconomic and health related variables are included to account for potential confounders.ResultsWe find evidence of a significant interaction between the effects of telemedicine and long distance to treatment for change in EQ5D health status (unadjusted: p = 0.016, adjusted p = 0.009) and unadjusted but not adjusted mental component score (unadjusted: p = 0.013, adjusted p = 0.0728), for the change in physical component score the interaction term was not significant (unadjusted: p = 0.118, adjusted p = 0.092).ConclusionIn our study we find that supplementary telemedicine is likely to reduce the health access inequities associated with geographical distance for chronic heart failure patients. However, our sample size was modest and further research is needed to confirm these findings.

Randomized Controlled Trial to Assess the Feasibility of a Novel Clinical Decision Support System Based on the Automatic Generation of Alerts through Remote Patient Monitoring

Background/Objectives: Early identification of complications in chronic and infectious diseases can reduce clinical deterioration, lead to early therapeutic interventions and lower morbidity and mortality rates. Here, we aimed to assess the feasibility of a novel clinical decision support system (CDSS) based on the automatic generation of alerts through remote patient monitoring and to identify the patient profile associated with the likelihood of severe medical alerts. Methods: A prospective, multicenter, open-label, randomized controlled trial was conducted. Patients with COVID-19 in home isolation were randomly assigned in a 1:1 ratio to receive either conventional primary care telephone follow-up plus access to a mobile app for self-reporting of symptoms (control group) or conventional primary care telephone follow-up plus access to the mobile app for self-reporting of symptoms and wearable devices for real-time telemonitoring of vital signs (case group). Results: A total of 342 patients were randomized, of whom 247 were included in the per-protocol analysis (103 cases and 144 controls). The case group received a more exhaustive follow-up, with a higher number of alerts (61,827 vs. 1825; p < 0.05) but without overloading healthcare professionals thanks to automatic alert management through artificial intelligence. Baseline factors independently associated with the likelihood of a severe alert were having asthma (OR: 1.74, 95% CI: 1.22–2.48, p = 0.002) and taking corticosteroids (OR: 2.28, 95% CI: 1.24–4.2, p = 0.008). Conclusions: The CDSS could be successfully implemented and enabled real-time telemonitoring of patients’ clinical status, providing valuable information to physicians and public health agencies.

Telemedicine and Remote Management of Patients with Heart Failure: From Theory to Daily Practice.

Background: Heart failure (HF) is responsible for a high number of hospitalizations, caused by a progressive worsening quality of life. Telemedicine allows for better management of patients' complex conditions, improving the care released. However, the risk of remaining at a testing stage often limits the integration of remote care in daily pathways for HF patients. The aim of this study is to outline the steps needed to integrate telemedicine activities into ordinary HF clinic practices. This methodology is applied to observe activities and trend improvements over a 12-month routine phase. Method: Three steps have been defined for an efficient introduction of remote care services in ordinary activities, integrating them with traditional in-person care: (i) introduction of temporary telemedicine projects, (ii) systematization of telemedicine pathways, and (iii) evaluation of monitoring phase. Observational data have been collected from structured interviews to show the rate of telemedicine activities achieved in clinical practice over the last year. Results: The methodology has been proposed in the HF clinic of the Italian hospital ASST Bergamo Est. After an initial testing phase, in which usability and user experience have been tested, four different remote activities were added: (i) telemonitoring for patients with an implantable device, (ii) follow-up televisits, (iii) nursing telephone support, and (iv) high-intensity telesurveillance pathways for patients after an HF acute event. During the last year, 218 telemonitoring pathways, 75 televisits, 500 telephone calls, and nine telesurveillance pathways have been performed. Success rates were high, and patients gave positive feedback. Conclusion: By integrating multiple telemedicine activities, it has been possible to better manage complex patients, keep track of disease progression, and improve their participation in care.

The effect of telemedicine employing telemonitoring instruments on readmissions of patients with heart failure and/or COPD: a systematic review.

Hospital readmissions pose a challenge for modern healthcare systems. Our aim was to assess the efficacy of telemedicine incorporating telemonitoring of patients' vital signs in decreasing readmissions with a focus on a specific patient population particularly prone to rehospitalization: patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD) through a comparative effectiveness systematic review. Three major electronic databases, including PubMed, Scopus, and ProQuest's ABI/INFORM, were searched for English-language articles published between 2012 and 2023. The studies included in the review employed telemedicine incorporating telemonitoring technologies and quantified the effect on hospital readmissions in the HF and/or COPD populations. Thirty scientific articles referencing twenty-nine clinical studies were identified (total of 4,326 patients) and were assessed for risk of bias using the RoB2 (nine moderate risk, six serious risk) and ROBINS-I tools (two moderate risk, two serious risk), and the Newcastle-Ottawa Scale (three good-quality, four fair-quality, two poor-quality). Regarding the primary outcome of our study which was readmissions: the readmission-related outcome most studied was all-cause readmissions followed by HF and acute exacerbation of COPD readmissions. Fourteen studies suggested that telemedicine using telemonitoring decreases the readmission-related burden, while most of the remaining studies suggested that it had a neutral effect on hospital readmissions. Examination of prospective studies focusing on all-cause readmission resulted in the observation of a clearer association in the reduction of all-cause readmissions in patients with COPD compared to patients with HF (100% vs. 8%). This systematic review suggests that current telemedicine interventions employing telemonitoring instruments can decrease the readmission rates of patients with COPD, but most likely do not impact the readmission-related burden of the HF population. Implementation of novel telemonitoring technologies and conduct of more high-quality studies as well as studies of populations with ≥2 chronic disease are necessary to draw definitive conclusions. This study is registered at the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), identifier (INPLASY202460097).

Telemonitoring of COPD Patients to Evaluate the "Rome Proposal".

For the first time in a telemonitoring context, we apply the Rome Proposal (RP), recently adopted by GOLD 2023, to assess the severity of exacerbations (ECOPD). So far, we have analysed 387 study weeks, which include only 18 ECOPDs; 4 mild, 13 moderate and 1 severe according to the criteria from RP. There is a promising potential of telemonitoring based on the RP.

Gamified Mobile App (MobERAS) for Telemonitoring Patients in the Postoperative Period Based on the Enhanced Recovery after Surgery Program: Development and Validation Study.

Digital technology and gamified apps can be useful in the health care context. Gamification uses technology to influence users' actions and motivations through experiences that resemble games. Patient adherence to the enhanced recovery after surgery (ERAS) program is crucial for achieving early recovery after surgery and continuous monitoring is essential for obtaining good results. This study aimed to describe the development and validation of a mobile app for enhanced recovery after surgery (MobERAS), a gamified mobile health app for telemonitoring patients in the postoperative period based on the ERAS program, and to evaluate its functionality and usability and the experience of patients, health care professionals, and computer professionals with its use. We developed MobERAS for postoperative telemonitoring, with active participation of patients in the process, and offering availability of real-time information for the health team. The app development process included idealization, interdisciplinary team formation, potential needs assessment, and product deployment. Usability tests were conducted throughout the development process with improvements, technical adjustments, and updates. After finalization, comprehensive verification tests were performed. The parameters evaluated are those that can influence the length of hospital stay, such as nausea, vomiting, pain scales, return to normal gastrointestinal function, and thromboembolic events. MobERAS was designed to be downloaded by users on their phones, tablets, or other mobile devices and to provide postoperative data. The app has a GPS that monitors the patient's walking time and distance and is connected to a virtual database that stores the collected data. Women undergoing medium and major gynecologic oncologic surgeries were included. We included 65 patients with an average age of 53.2 (SD 7.4, range 18-85) years. The time of use ranged from 23.4 to 70 hours (mean 45.1, SD 19.2 hours). Regarding adherence to the use of MobERAS, the mean fill rate was 56.3% (SD 12.1%, range 41.7%-100%), and ambulation data were obtained for 60 (92.3%) of the 65 patients. The researcher had access to the data filled out by the patients in real time. There was good acceptance of the use of MobERAS by the patients, with good evaluation of the app's usability. MobERAS was easy to use and considered attractive because of its gamified design. The app was rated as good or very good in all items by health care professionals (n=20) and professionals specializing in technological innovation (n=10). MobERAS is easy to use, safe, well accepted by patients, and well evaluated by experts. It can be of great use in clinical surgical practice and an important tool for greater engagement of patients and health care professionals with the ERAS program.

Continuous Temperature Telemonitoring of Patients with COVID-19 and Other Infectious Diseases Treated in Hospital-at-Home: Viture® System Validation.

Body temperature must be monitored in patients receiving Hospital-at-Home (HaH) care for COVID-19 and other infectious diseases. Continuous temperature telemonitoring (CTT) detects fever and patient deterioration early, facilitating decision-making. We performed a validation clinical study assessing the safety, comfort, and impact on healthcare practice of Viture®, a CTT system, compared with a standard digital axillary thermometer in 208 patients with COVID-19 and other infectious diseases treated in HaH at the Navarra University Hospital (HUN). Overall, 3258 pairs of measurements showed a clinical bias of -0.02 °C with limits of agreement of -0.96/+0.92 °C, a 95% acceptance rate, and a mean absolute deviation of 0.36 (SD 0.30) °C. Viture® detected 3 times more febrile episodes and revealed fever in 50% more patients compared with spot measurements. Febrile episodes were detected 7.23 h (mean) earlier and modified the diagnostic and/or therapeutic approach in 43.2% of patients. Viture® was validated for use in a clinical setting and was more effective in detecting febrile episodes than conventional methods.

Health outcomes of telemonitoring of patients with type-2 diabetes mellitus: One-year results from a randomized controlled trial (Optimizing care of Patients via Telemedicine In Monitoring and aUgmenting their control of diabetes Mellitus).

Telehealth increases care accessibility to patients with type-2 diabetes mellitus but the duration of its implementation to sustain optimal glycaemic control remains unclear. This study aimed to assess the health outcomes of these patients using the Optimizing care of Patients via Telemedicine In Monitoring and aUgmenting their control of diabetes Mellitus (OPTIMUM) home tele-monitoring (HTM) system 6 months post-intervention, compared to standard care. An open-labelled randomized controlled trial involving 330 participants with type-2 diabetes mellitus, aged 26-65 years, and suboptimal glycaemic control (HbA1c = 7.5%-10%) was conducted. Intervention group received OPTIMUM HTM for 6 months followed by usual care for another 6 months, while control group received usual care for 12 months. OPTIMUM HTM includes in-app video-based tele-education, tele-monitoring of the blood pressure, capillary glucose and weight via Bluetooth devices and mobile applications, followed by algorithm-based tele-management by the OPTIMUM HTM team. Assessments using self-care inventory scale and medication adherence were administered for both groups at baseline, 6-month, and 12-month timepoints. Complete data from 156 (intervention) and 159 (control) participants, with comparable demographic profiles, were analysed. Both groups showed a significant reduction in HbA1c from baseline (p < 0.001). From 6-month to 12-month time-points, the intervention group was twice as likely to maintain their HbA1c ≤ 8% (adjusted odds ratio = 2.02, 95%CI = 1.18-3.49; p < 0.011). The intervention group demonstrated higher scores for self-care behaviours (adjusted odds ratio = 3.83 [95%CI = 1.68-5.97], p = 0.001) and not skipping medications (adjusted odds ratio = 2.32 [95%CI = 1.09-4.97], p = 0.030) at 12 months. The OPTIMUM HTM system enabled patients to maintain their glycaemic control beyond the intervention period. The favourable outcomes could be the effect of telehealth in sustaining self-care behaviour and medication adherence.

A nurse-led coaching intervention with home telemonitoring for patients with heart failure: Protocol for a feasibility randomized clinical trial

Poor treatment adherence and lack of self-care behaviors are significant contributors to hospital readmissions of people with heart failure (HF). A transitional program with non-invasive telemonitoring may help sustain patients and their caregivers to timely recognize signs and symptoms of exacerbation.We will conduct a Randomized Clinical Trial (RCT) to evaluate the feasibility and acceptability of a 6-month supportive intervention for patients discharged home after cardiac decompensation. Forty-five people aged 65 years and over will be randomized to either receive a supportive intervention in addition to standard care, which combines nurse-led telephone coaching and a home-based self-monitoring vital signs program, or standard care alone. Four aspects of the feasibility will be assessed using a mixed-methods approach: process outcomes (e.g., recruitment rate), resources required (e.g., adherence to the intervention), management data (e.g., completeness of data collection), and scientific value (e.g. 90- and 180-day all-cause and HF-related readmissions, self-care capacity, quality of life, psychological well-being, mortality, etc.). Participants will be interviewed to explore preferences and satisfaction with the intervention. The study is expected to provide valuable insight into the design of a definitive RCT.

66 - Efficacy outcomes and adherence to MAIA digital platform for telemonitoring and telerehabilitation in patients undergoing robot-assisted radical prostatectomy

66 - Efficacy outcomes and adherence to MAIA digital platform for telemonitoring and telerehabilitation in patients undergoing robot-assisted radical prostatectomy

Home Blood Pressure Telemonitoring and Nurse Case Management in Black and Hispanic Patients With Stroke

Black and Hispanic patients have high rates of recurrent stroke and uncontrolled hypertension in the US. The effectiveness of home blood pressure telemonitoring (HBPTM) and telephonic nurse case management (NCM) among low-income Black and Hispanic patients with stroke is unknown. To determine whether NCM plus HBPTM results in greater systolic blood pressure (SBP) reduction at 12 months and lower rate of stroke recurrence at 24 months than HBPTM alone among Black and Hispanic stroke survivors with uncontrolled hypertension. Practice-based, multicenter, randomized clinical trial in 8 stroke centers and ambulatory practices in New York City. Black and Hispanic study participants were enrolled between April 18, 2014, and December 19, 2017, with a final follow-up visit on December 31, 2019. Participants were randomly assigned to receive either HBPTM alone (12 home BP measurements/week for 12 months, with results transmitted to a clinician; n = 226) or NCM plus HBPTM (20 counseling calls over 12 months; n = 224). Primary outcomes were change in SBP at 12 months and rate of recurrent stroke at 24 months. Final statistical analyses were completed March 14, 2024. Among 450 participants who were enrolled and randomized (mean [SD] age, 61.7 [11.0] years; 51% were Black [n = 231]; 44% were women [n = 200]; 31% had ≥3 comorbid conditions [n = 137]; 72% had household income <$25 000/y [n = 234/324]), 358 (80%) completed the trial. Those in the NCM plus HBPTM group had a significantly greater SBP reduction than those in the HBPTM alone group at 12 months (-15.1 mm Hg [95% CI, -17.2 to -13.0] vs -5.8 mm Hg [95% CI, -7.9 to -3.7], respectively; P < .001). The between-group difference in SBP reduction at 12 months, adjusted for primary care physician clustering, was -8.1 mm Hg (95% CI, -11.2 to -5.0; P < .001) at 12 months. The rate of recurrent stroke was similar between both groups at 24 months (4.0% in the NCM plus HBPTM group vs 4.0% in the HBPTM alone group, P > .99). Among predominantly low-income Black and Hispanic stroke survivors with uncontrolled hypertension, addition of NCM to HBPTM led to greater SBP reduction than HBPTM alone. Additional studies are needed to understand the long-term clinical outcomes, cost-effectiveness, and generalizability of NCM-enhanced telehealth programs among low-income Black and Hispanic stroke survivors with significant comorbidity. Clinical Trials.gov Identifier: NCT02011685.

EPS4.05 A multi-center, randomized, controlled trial on coaching and telemonitoring in patients with cystic fibrosis (conneCT CF): interim analysis

EPS4.05 A multi-center, randomized, controlled trial on coaching and telemonitoring in patients with cystic fibrosis (conneCT CF): interim analysis

ENGAGEMENT AND ATTRITION IN A TELEHEALTH SERVICE FOR HYPERTENSIVE PATIENTS. A SINGLE CENTER EXPERIENCE

Objective: To investigate engagement with blood pressure telemonitoring and counselling (BPTM) in patients with hypertension (HTN) and its predictors. Design and method: Patients with uncontrolled HTN (office systolic (S) BP &gt;140 mm Hg) were recruited consecutively in a large reference center. Only patients who were motivated and willing to participate were included. The telehealth system consisted of a home BP telemonitoring service and an on-demand text chat with the patient's attending physician. The BPTM continued for 3 months with mandatory baseline and follow-up visits, as well as completion of the HYPE (HYpertension imPact quEstionnaire) to assess quality of life. Patients who did not report BP readings for 2 weeks + after 2 alerts were termed ’quit’. Others comprised the ’continued’ group. Results: A total of 92 patients were included in the final analysis (median age 43 years, 69 men, 49 at low-intermediate CVD risk). At baseline, median office SBP was 155 mm Hg (150;162) and office diastolic (DBP) was 95 mm Hg (90;102). Over the 3 months, SBP and DBP decreased significantly (-16 and -11 mm Hg, respectively; p &lt;0.001 for both). There was a greater reduction in SBP at home (-8 mm Hg from 1 week to 3 months, p &lt;0.001). A total of 43 patients continued BPTM and 48 patients discontinued BP telemonitoring (85% of them after 1 month). The groups were well matched for age, sex, and baseline BP. The δSBP did not differ between the two groups, nor did the median number of questions (3 consultations/patient). Higher baseline office SBP (β = 0.03, p = 0.043) and male sex (β = 1.15, p = 0.041) were predictors of high engagement with the telehealth service after adjustment for other covariates. Quality of life at 3 months was higher in the ’continuing’ patients. (δ+8 points HYPE). Conclusions: Telemonitoring and remote counseling are effective in patients with HTN. Even when patients are motivated to use telehealth, more than half of them discontinue during the first months, predominantly female patients with mild uncontrolled HTN. Patients who continue BPTM experience a higher quality of life.

Enhancing Precision of Telemonitoring of COVID-19 Patients through Expert System Based on IoT Data Elaboration

The emergence of the highly contagious coronavirus disease has led to multiple pandemic waves, resulting in a significant number of hospitalizations and fatalities. Even outside of hospitals, general practitioners have faced serious challenges, stretching their resources and putting themselves at risk of infection. Telemonitoring systems based on Internet of things technology have emerged as valuable tools for remotely monitoring disease progression, facilitating rapid intervention, and reducing the risk of hospitalization and mortality. They allow for personalized monitoring strategies and tailored treatment plans, which are crucial for improving health outcomes. However, determining the appropriate monitoring intensity remains the responsibility of physicians, which poses challenges and impacts their workload, and thus, can hinder timely responses. To address these challenges, this paper proposes an expert system designed to recommend and adjust the monitoring intensity for COVID-19 patients receiving home treatment based on their medical history, vital signs, and reported symptoms. The system underwent initial validation using real-world cases, demonstrating a favorable performance (F1-score of 0.85). Subsequently, once integrated with an Internet of Things telemonitoring system, a clinical trial will assess the system’s reliability in creating telemonitoring plans comparable with those of medics, evaluate its effectiveness in reducing medic–patient interactions or hospitalizations, and gauge patient satisfaction and safety.

Weight telemonitoring of heart failure versus standard of care in a real-world setting: Results on mortality and hospitalizations in a 6-month nationwide matched cohort study.

Evaluating the benefit of telemonitoring in heart failure (HF) management in real-world settings is crucial for optimizing the healthcare pathway. The aim of this study was to assess the association between a 6-month application of the telemonitoring solution Chronic Care Connect™ (CCC) and mortality, HF hospitalizations, and associated costs compared with standard of care (SOC) in patients with a diagnosis of HF. From February 2018 to March 2020, a retrospective cohort study was conducted using the largest healthcare insurance system claims database in France (Système National des Données de Santé) linked to the CCC telemonitoring database of adult patients with an ICD-10-coded diagnosis of HF. Patients from the telemonitoring group were matched with up to two patients from the SOC group based on their high-dimensional propensity score, without replacement, using the nearest-neighbour method. A total of 1358 telemonitored patients were matched to 2456 SOC patients. The cohorts consisted of high-risk patients with median times from last HF hospitalization to index date of 17.0 (interquartile range: 7.0-66.0) days for the telemonitoring group and 27.0 (15.0-70.0) days for the SOC group. After 6 months, telemonitoring was associated with mortality risk reduction (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.56-0.89), a higher risk of first HF hospitalization (HR 1.81, 95% CI 1.55-2.13), and higher HF healthcare costs (relative cost 1.38, 95% CI 1.26-1.51). Compared with the SOC group, the telemonitoring group experienced a shorter average length of overnight HF hospitalization and fewer emergency visits preceding HF hospitalizations. The results of this nationwide cohort study highlight a valuable role for telemonitoring solutions such as CCC in the management of high-risk HF patients. However, for telemonitoring solutions based on weight and symptoms, consideration should be given to implement additional methods of assessment to recognize imminent worsening of HF, such as impedance changes, as a way to reduce mortality risk and the need for HF hospitalizations. Further studies are warranted to refine selection of patients who could benefit from a telemonitoring system and to confirm long-term benefits in high-risk and stable HF patients.

A Novel Semi-Supervised Learning Model for Smartphone-Based Health Telemonitoring

Telemonitoring is the use of electronic devices such as smartphones to remotely monitor patients. It provides great convenience and enables timely medical decisions. To facilitate the decision making for each patient, a model is needed to translate the data collected by the patient’s smartphone into a predicted score for his/her disease severity. To train a robust predictive model, semi-supervised learning (SSL) provides a viable approach by integrating both labeled and unlabeled samples to leverage all the available data from each patient. There are two challenging issues that need to be simultaneously addressed in using SSL for this problem: (1) feature selection from high-dimensional noisy telemonitoring data; and (2) instance selection from many, possibly redundant unlabeled samples. We propose a novel SSL model allowing for simultaneous feature and instance selection, namely the S2SSL model. We present a real-data application of telemonitoring for patients with Parkinson’s Disease using their smartphone-collected activity data such as tapping and speaking. A total of 382 features were extracted from the activity data of each patient. 74 labeled and 563 unlabeled instances from 37 patients were used to train S2SSL. The trained model achieved a high accuracy of 0.828 correlation between the true and predicted disease severity scores on a validation dataset. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Note to Practitioners</i> —Telemonitoring is an emerging health care platform enabled by smartphones and wearables. Because it allows for health data to be collected anytime and anywhere, patients can be frequently monitored and medical decisions can be made more timely and effectively. This paper addresses the data science challenges in leveraging the telemonitoring platform to benefit patient care. Specifically, we propose a new model, S2SSL, to tackle these challenges and provide better robustness, accuracy, and efficiency. This paper may be interesting to health care practitioners seeking advanced analytics capabilities to model and integrate the data collected through telemonitoring devices, with ultimate purposes of improving the decision in treating each patient and increasing patient access to specialized care.

Improving the management of patients with chronic cardiac and respiratory diseases by extending pulse-oximeter uses: the dynamic pulse-oximetry.

Respiratory and cardio-vascular chronic diseases are among the most common noncommunicable diseases (NCDs) worldwide, accounting for a large portion of health-care costs in terms of mortality and disability. Their prevalence is expected to rise further in the coming years as the population ages. The current model of care for diagnosing and monitoring NCDs is out of date because it results in late medical interventions and/or an unfavourable cost-effectiveness balance based on reported symptoms and subsequent inpatient tests and treatments. Health projects and programs are being implemented in an attempt to move the time of an NCD's diagnosis, as well as its monitoring and follow up, out of hospital settings and as close to real life as possible, with the goal of benefiting both patients' quality of life and health system budgets. Following the SARS-CoV-2 pandemic, this implementation received additional impetus. Pulseoximeters (POs) are currently used in a variety of clinical settings, but they can also aid in the telemonitoring of certain patients. POs that can measure activities as well as pulse rate and oxygen saturation as proxies of cardio-vascular and respiratory function are now being introduced to the market. To obtain these data, the devices must be absolutely reliable, that is, accurate and precise, and capable of recording for a long enough period of time to allow for diagnosis. This paper is a review of current pulse-oximetry (POy) use, with the goal of investigating how its current use can be expanded to manage not only cardio-respiratory NCDs, but also acute emergencies with telemonitoring when hospitalization is not required but the patients' situation is debatable. Newly designed devices, both "consumer" and "professional," will be scrutinized, particularly those capable of continuously recording vital parameters on a 24-hour basis and coupling them with daily activities, a practice known as dynamic pulse-oximetry.

Newcard telemonitoring system improves survival at a lower cost than traditional approaches in chronic heart failure patients as assessed by data extract from the French National Health Data System

Abstract Background Despite widespread use of telemonitoring (TLM) for chronic heart failure (CHF) patients, outcome data remain scarce and medico – economic assessment not routinely addressed. In this setting, the French National Health Data System (SNDS) can be used to comprehensively collect health care costs for the entire French population whatever the type of TLM system. Purpose The aim of this study is to assess the health economic impact of telemonitoring among 1057 patients presenting heart failure matched with a control group selected in the SNDS Methods All patients TLM at least 3 months between 2017 and 2020 were included. For each patient identified by his single social security number (case), anonymised data was retrieved from the SNDS. A control group (CG) was randomly selected from an exhaustive extraction of SNDS of patients with heart failure without TLM. This CG was matched in a 1:3 ratio to TLM patients using a propensity score including baseline characteristics (i.e. gender, age group, social disadvantage index, presence of comorbidities (renal insufficiency, coronary disease, diabetes, cancer), presence of treatments (beta blockers, Sacubitril, aldosterone antagonists, aspirin/Clopidogrel, anticoagulants)). Costs were evaluated using French National Health Insurance perspective using €2022. Binomial negative GEE models were used on matched data sets to assess differences. Results The matching rate between patients included in the TLM arm and the SNDS database was excellent at 99%. Hence, 1,057 TLM patients were matched to 3,171 patients with heart failure. In the telemonitoring group (TLM), patients were 74 years old (±12,3), 68.4 % male, mean left ventricular ejection fraction 41 % and the mean follow-up by the TLM system was 618 days. At 1-year, 2-year and 3-year follow-up, survival rates were respectively of 96%, 91% and 87% for TLM patients vs 93%, 83% and 76% among CG patients (p&amp;lt;0.0001, figure 1). At 6 months, the monthly cost for managing patients was 1,403.2 € in the TLM group vs 1,251.5 € in the CG (p=0.0064). At 12 months, 949.52 € in the TLM group vs 1,114.40 in the CG (p&amp;lt;0.0001). At 24 months, 591.31 € in the TLM group vs 1,064.20 in the CG (p&amp;lt;0.0001). Conclusion While using common evaluation methods seems to be unsatisfactory, economic evaluation both costs and outcomes of an intervention could be more appropriate. The French SNDS is a powerful tool to implement such a type of study. The results presented here show on one hand a significant decrease in mortality in the TLM. On the economic hand, we show here an increase in cost during the first 6 months of the telemonitoring balanced with a significant decrease at 12 and 24 months. Especially, those data place telemonitoring of heart failure as a real improvement in the care pathway which needs time to be effective but is able to have an effect even on the mortality rate

Telehealth nursing interventions for phenotypes of older adults with COPD: an exploratory study.

Inconclusive results exist around the effectiveness of telemonitoring for patients with COPD, and studies recommended conducting subgroup analyses to identify patient phenotypes that could benefit from these services. This exploratory study investigated what type of COPD patients were receiving which type of telenursing interventions more frequently using the telemonitoring platform. A sample of 36 older adults with COPD were receiving telenursing services for 12 months and were asked to answer five COPD-symptom related questions and submit their vital signs daily. Findings revealed two phenotypes of older adults for whom the frequency of telenursing calls and related interventions differed. Although no statistically significant differences were observed in participants' GOLD grades and hospitalizations, cluster one participants used their COPD action plan significantly more frequently, and were in frequent contact with the telenurse. It is paramount that further research is needed on the development of patient phenotypes who may benefit from telemonitoring.

Level of Technological Maturity of Telemonitoring Systems Focused on Patients with Chronic Kidney Disease Undergoing Peritoneal Dialysis Treatment: A Systematic Literature Review

In the field of eHealth, several works have proposed telemonitoring systems focused on patients with chronic kidney disease (CKD) undergoing peritoneal dialysis (PD) treatment. Nevertheless, no secondary study presents a comparative analysis of these works regarding the technology readiness level (TRL) framework. The TRL scale goes from 1 to 9, with 1 being the lowest level of readiness and 9 being the highest. This paper analyzes works that propose telemonitoring systems focused on patients with CKD undergoing PD treatment to determine their TRL. We also analyzed the requirements and parameters that the systems of the selected works provide to the users to perform telemonitoring of the patient’s treatment undergoing PD. Fourteen works were relevant to the present study. Of these works, eight were classified within TRL 9, two were categorized within TRL 7, three were identified within TRL 6, and one within TRL 4. The works reported with the highest TRL partially cover the requirements for appropriate telemonitoring of patients based on the specialized literature; in addition, those works are focused on the treatment of patients in the automated peritoneal dialysis (APD) modality, which limits the care of patients undergoing the continuous ambulatory peritoneal dialysis (CAPD) modality.