scholarly journals The Effect of Noninvasive Telemonitoring for Chronic Heart Failure on Health Care Utilization: Systematic Review (Preprint)

2020 ◽  
Author(s):  
Stefan L Auener ◽  
Toine E P Remers ◽  
Simone A van Dulmen ◽  
Gert P Westert ◽  
Rudolf B Kool ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Chronic Heart Failure ◽  
Health Care Utilization ◽  
Health Care Costs ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Care Costs

BACKGROUND Chronic heart failure accounts for approximately 1%-2% of health care expenditures in most developed countries. These costs are primarily driven by hospitalizations and comorbidities. Telemonitoring has been proposed to reduce the number of hospitalizations and decrease the cost of treatment for patients with heart failure. However, the effects of telemonitoring on health care utilization remain unclear. OBJECTIVE This systematic review aims to study the effect of telemonitoring programs on health care utilization and costs in patients with chronic heart failure. We assess the effect of telemonitoring on hospitalizations, emergency department visits, length of stay, hospital days, nonemergency department visits, and health care costs. METHODS We searched PubMed, Embase, and Web of Science for randomized controlled trials and nonrandomized studies on noninvasive telemonitoring and health care utilization. We included studies published between January 2010 and August 2020. For each study, we extracted the reported data on the effect of telemonitoring on health care utilization. We used <i>P</i>&lt;.05 and CIs not including 1.00 to determine whether the effect was statistically significant. RESULTS We included 16 randomized controlled trials and 13 nonrandomized studies. Inclusion criteria, population characteristics, and outcome measures differed among the included studies. Most studies showed no effect of telemonitoring on health care utilization. The number of hospitalizations was significantly reduced in 38% (9/24) of studies, whereas emergency department visits were reduced in 13% (1/8) of studies. An increase in nonemergency department visits (6/9, 67% of studies) was reported. Health care costs showed ambiguous results, with 3 studies reporting an increase in health care costs, 3 studies reporting a reduction, and 4 studies reporting no significant differences. Health care cost reductions were realized through a reduction in hospitalizations, whereas increases were caused by the high costs of the telemonitoring program or increased health care utilization. CONCLUSIONS Most telemonitoring programs do not show clear effects on health care utilization measures, except for an increase in nonemergency outpatient department visits. This may be an unwarranted side effect rather than a prerequisite for effective telemonitoring. The consequences of telemonitoring on nonemergency outpatient visits should receive more attention from regulators, payers, and providers. This review further demonstrates the high clinical and methodological heterogeneity of telemonitoring programs. This should be taken into account in future meta-analyses aimed at identifying the effective components of telemonitoring programs.

scholarly journals The Effect of Noninvasive Telemonitoring for Chronic Heart Failure on Health Care Utilization: Systematic Review

10.2196/26744 ◽  
2021 ◽  
Vol 23 (9) ◽  
pp. e26744
Author(s):  
Stefan L Auener ◽  
Toine E P Remers ◽  
Simone A van Dulmen ◽  
Gert P Westert ◽  
Rudolf B Kool ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Chronic Heart Failure ◽  
Health Care Utilization ◽  
Health Care Costs ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Care Costs

Background Chronic heart failure accounts for approximately 1%-2% of health care expenditures in most developed countries. These costs are primarily driven by hospitalizations and comorbidities. Telemonitoring has been proposed to reduce the number of hospitalizations and decrease the cost of treatment for patients with heart failure. However, the effects of telemonitoring on health care utilization remain unclear. Objective This systematic review aims to study the effect of telemonitoring programs on health care utilization and costs in patients with chronic heart failure. We assess the effect of telemonitoring on hospitalizations, emergency department visits, length of stay, hospital days, nonemergency department visits, and health care costs. Methods We searched PubMed, Embase, and Web of Science for randomized controlled trials and nonrandomized studies on noninvasive telemonitoring and health care utilization. We included studies published between January 2010 and August 2020. For each study, we extracted the reported data on the effect of telemonitoring on health care utilization. We used P<.05 and CIs not including 1.00 to determine whether the effect was statistically significant. Results We included 16 randomized controlled trials and 13 nonrandomized studies. Inclusion criteria, population characteristics, and outcome measures differed among the included studies. Most studies showed no effect of telemonitoring on health care utilization. The number of hospitalizations was significantly reduced in 38% (9/24) of studies, whereas emergency department visits were reduced in 13% (1/8) of studies. An increase in nonemergency department visits (6/9, 67% of studies) was reported. Health care costs showed ambiguous results, with 3 studies reporting an increase in health care costs, 3 studies reporting a reduction, and 4 studies reporting no significant differences. Health care cost reductions were realized through a reduction in hospitalizations, whereas increases were caused by the high costs of the telemonitoring program or increased health care utilization. Conclusions Most telemonitoring programs do not show clear effects on health care utilization measures, except for an increase in nonemergency outpatient department visits. This may be an unwarranted side effect rather than a prerequisite for effective telemonitoring. The consequences of telemonitoring on nonemergency outpatient visits should receive more attention from regulators, payers, and providers. This review further demonstrates the high clinical and methodological heterogeneity of telemonitoring programs. This should be taken into account in future meta-analyses aimed at identifying the effective components of telemonitoring programs.

scholarly journals Comprehensive Support for Family Caregivers: Impact on Veteran Health Care Utilization and Costs

2017 ◽  
Vol 76 (1) ◽  
pp. 89-114 ◽  
Author(s):  
Courtney Harold Van Houtven ◽  
Valerie A. Smith ◽  
Karen M. Stechuchak ◽  
Megan Shepherd-Banigan ◽  
Susan Nicole Hastings ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Family Caregivers ◽  
Health Care Costs ◽  
Care Utilization ◽  
Control Group ◽  
Veteran Health ◽  
Primary Specialty ◽  
Veteran Health Care ◽  
Care Costs

This study aimed to examine the early impact of the Program of Comprehensive Assistance for Family Caregivers (PCAFC) on Veteran health care utilization and costs. A pre-post cohort design including a nonequivalent control group was used to understand how Veterans’ use of Veteran Affairs health care and total health care costs changed in 6-month intervals up to 3 years after PCAFC enrollment. The control group was an inverse probability of treatment weighted sample of Veterans whose caregivers applied for, but were not accepted into, PCAFC. Veterans in PCAFC had similar acute care utilization postenrollment when compared with those in the control group, but significantly greater primary, specialty, and mental health outpatient care use at least 30, and up to 36, months postenrollment. Estimated total health care costs for PCAFC Veterans were $1,500 to $3,400 higher per 6-month interval than for control group Veterans. PCAFC may have increased Veterans’ access to care.

Evaluation of Oncology Hospital at Home: Unplanned Health Care Utilization and Costs in the Huntsman at Home Real-World Trial

2021 ◽  
pp. JCO.20.03609
Author(s):  
Kathi Mooney ◽  
Karen Titchener ◽  
Benjamin Haaland ◽  
Lorinda A. Coombs ◽  
Brock O'Neil ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Health Care Costs ◽  
Care Utilization ◽  
Patients With Cancer ◽  
Hospital Stays ◽  
Hospital At Home ◽  
Unplanned Hospitalizations ◽  
Care Costs ◽  
At Home

PURPOSE Patients with cancer experience high rates of morbidity and unplanned health care utilization and may benefit from new models of care. We evaluated an adult oncology hospital at home program's rate of unplanned hospitalizations and health care costs and secondarily, emergency department (ED) use, length of hospital stays, and intensive care unit (ICU) admissions during the 30 days after enrollment. METHODS We conducted a prospective, nonrandomized, real-world cohort comparison of 367 hospitalized patients with cancer—169 patients consecutively admitted after hospital discharge to Huntsman at Home (HH), a hospital-at-home program, compared with 198 usual care patients concurrently identified at hospital discharge. All patients met clinical criteria for HH admission, but those in usual care lived outside the HH service area. Primary outcomes were the number of unplanned hospitalizations and costs during the 30 days after enrollment. Secondary outcomes included length of hospital stays, ICU admissions, and ED visits during the 30 days after enrollment. RESULTS Groups were comparable except that more women received HH care. In propensity-weighted analyses, the odds of unplanned hospitalizations was reduced in the HH group by 55% (odds ratio, 0.45, 95% CI, 0.29 to 0.70; P < .001) and health care costs were 47% lower (mean cost ratio, 0.53; 95% CI, 0.39 to 0.72; P < .001) over the 30-day period. Secondary outcomes also favored HH. Total hospital stay days were reduced by 1.1 days ( P = .004) and ED visits were reduced by 45% (odds ratio, 0.55; 95% CI, 0.33 to 0.92; P = .022). There was no evidence of a difference in ICU admissions ( P = .972). CONCLUSION This oncology hospital at home program shows initial promise as a model for oncology care that may lower unplanned health care utilization and health care costs.

Association of SHI coverage and level of healthcare utilization and costs in the Philippines: a 10-year pooled analysis

2019 ◽  
Vol 42 (4) ◽  
pp. e496-e505
Author(s):  
Nel Jason L Haw ◽  
Jhanna Uy ◽  
Beverly Lorraine Ho
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Utilization ◽  
Health Care Costs ◽  
Inpatient Care ◽  
The Philippines ◽  
Care Utilization ◽  
Health Coverage ◽  
Outpatient Services ◽  
Care Costs

Abstract Background The Philippine Health Insurance Corporation (PhilHealth), which manages the Philippine national health insurance program, is a critical actor in the country’s strategy for universal health coverage. Over the past decade, PhilHealth has passed significant coverage, benefits and payment reforms to contain costs and improve the affordability care for high-cost diseases, inpatient care and select outpatient services. Methods We studied the association of PhilHealth with health care utilization and health care costs using three rounds of the Philippine Demographic and Health Survey with data on individual outpatient and inpatient visits from 2008 to 2017. Results PhilHealth membership was associated with 42% greater odds of outpatient utilization and 47–100% greater odds inpatient utilization depending on survey year. Depending on facility type, use of PhilHealth to pay for care was associated with higher average health care costs of 244–865% for outpatient care and 135–206% for inpatient care. Conclusions PhilHealth has likely decreased barriers to health care utilization but may have inadvertently driven up health care costs in the country. Results align with past studies that suggest that reforms in the prior decade have done little to contain health care costs for Filipinos.

scholarly journals The Effects of Medication Supply on Hospitalizations and Health-Care Costs in Patients with Chronic Heart Failure

2012 ◽  
Vol 15 (1) ◽  
pp. S9-S14 ◽  
Author(s):  
Piyemeth Dilokthornsakul ◽  
Nathorn Chaiyakunapruk ◽  
Piyarat Nimpitakpong ◽  
Napawan Jeanpeerapong ◽  
Rosarin Sruamsiri
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Chronic Heart Failure ◽  
Health Care Costs ◽  
Care Costs

scholarly journals A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors

2015 ◽  
Author(s):  
Cinnamon S. Bloss ◽  
Nathan E. Wineinger ◽  
Melissa Peters ◽  
Debra L. Boeldt ◽  
Lauren Ariniello ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Costs ◽  
Health Management ◽  
Self Management ◽  
Care Utilization ◽  
Randomized Controlled ◽  
Digital Medicine ◽  
Study Participants ◽  
Care Costs

ABSTRACTBackgroundMobile health and digital medicine technologies are becoming increasingly used by individuals with common, chronic diseases to monitor their health. Numerous devices, sensors, and apps are available to patients and consumers – some of which have been shown to lead to improved health management and health outcomes. However, no randomized controlled trials have been conducted which examine health care costs, and most have failed to provide study participants with a truly comprehensive monitoring system.MethodsWe conducted a prospective randomized controlled trial of adults who had submitted a 2012 health insurance claim associated with hypertension, diabetes, and/or cardiac arrhythmia. The intervention involved receipt of one or more mobile devices that corresponded to their condition(s) and an iPhone with linked tracking applications for a period of 6 months; the control group received a standard disease management program. Moreover, intervention study participants received access to an online health management system which provided participants detailed device tracking information over the course of the study. This was a monitoring system designed by leveraging collaborations with device manufacturers, a connected health leader, health care provider, and employee wellness program – making it both unique and inclusive. We hypothesized that health resource utilization with respect to health insurance claims may be influenced by the monitoring intervention. We also examined health-self management.Results & ConclusionsThere was little evidence of differences in health care costs or utilization as a result of the intervention. Furthermore, we found evidence that the control and intervention groups were equivalent with respect to most health care utilization outcomes. This result suggests there are not large short-term increases or decreases in health care costs or utilization associated with monitoring chronic health conditions using mobile health or digital medicine technologies. Among secondary outcomes there was some evidence of improvement in health self-management which was characterized by a decrease in the propensity to view health status as due to chance factors in the intervention group.Disclosure of FundingThis research is funded in part by a NIH/NCATS flagship Clinical and Translational Science Award Grant (1UL1 TR001114), Qualcomm Foundation Scripps Health Digital Medicine Research Grant, and Scripps Health’s Division of Innovation and Human Capital and Division of Scripps Genomic Medicine. Support for the study is also provided by HealthComp Third Party Administrator, Sanofi, AliveCor, and Accenture.Trial Registration: clinicaltrials.gov Identifier NCT01975428

scholarly journals PCV11 EFFECTS OF MEDICATION SUPPLY ON HEALTH-CARE COSTS AND RE-HOSPITALIZATIONS IN PATIENTS WITH CHRONIC HEART FAILURE

2010 ◽  
Vol 13 (7) ◽  
pp. A518
Author(s):  
R Sruamsiri ◽  
P Dilokthornsakul ◽  
P Nimpitakpong ◽  
N Jeanpeerapong ◽  
N Chaiyakunapruk
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Chronic Heart Failure ◽  
Health Care Costs ◽  
Care Costs
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