TeleHealth Electronic Monitoring to reduce Post Discharge Vascular Complications. A Randomized Controlled Study
Ramez Morcos, MD1, Albeir Mousa, MD, FACS, RPVI, MPH, MBA2, Michael Yacoub, MD, FACS, RPVI2, Mike Broce, BA2, Elaine Davis, ED2, Mina Baskharoun, MD2, Zachary AbuRahma, DO2, Ali AbuRahma, MD, FACS, RPVI, RVI2
1Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.; 2Charleston Area Medical Center Vascular Center of Excellance, Charleston, WV, USA
Introduction: Post-operative vascular discharge complications result in increased hospital readmissions, cost, and patient dissatisfaction. Telehealth technology to monitor patients, especially those in geographically isolated areas, should reduce post-operative complications, improve health and financial outcomes. Objective: The primary objective was to compare outcomes between patients that received Telehealth electronic monitoring (THEM) to those with routine discharge instructions and no monitoring, standard of care. METHODS: This was a prospective randomized study of vascular surgery patients with groin incisions. THEM patients received a tablet and home monitoring devices that transmitted information to care managers. Monitoring tools included image capture, weight scales, blood pressure cuffs, thermometers and oxygen saturation monitors. Care managers used the TeleMed 2020 Enform™ platform to review alerts, real-time patient data, and dialogue with the care team. RESULTS: Thirty patients were enrolled in the study, of which 16 (53.3%) were randomized to the THEM and 14 (46.7%) control groups. Average age and BMI for THEM and control patients were similar (62.5 + 7.2 vs 65.7 + 7.3, p=0.234; and 27.7 + 4.3 vs 29.1 vs 7.1, p=0.487). THEM patients had significantly more hypercholesterolemia 93.8 vs 50.0%, p=0.012. There were no significant differences in wound or “any” 30-day readmissions (6.3% vs 7.1%, p=1.000; and 25.0% vs 14.3%, p=0.657). Interestingly, 30-day infection rates indicated care managers identified marginally more superficial wounds in the THEM group (31.3% vs 7.1%, p=0.175). Both groups reported an increase in SF8 physical summary scores, but was more pronounced in THEM patients (p=0.076). THEM patients reported a significantly greater improvement in quality of life on two of the SF8 quality subscales (Role-Physical and Role-Emotional; THEM Δ 8.7 vs Control Δ 1.1 and THEM Δ 6.1 Control Δ -0.5; both p<0.05). THEM patients reported trends for higher satisfaction in terms of general satisfaction, technical quality and accessibility for PSQ18 survey questions (4.2 vs 3.7,p=0.72; 4.5 vs 4.1, p=0.81; and 4.2 vs 3.8, p=0.63), respectively. Conclusion: THEM was technically feasible and provided significant benefit to patients in geographically disparate areas. THEM was associated with increased patient satisfaction. Additional findings suggested THEM patients embraced telehealth technology and took advantage of increased access to health care professionals. Telehealth successfully merged remotely generated information with care manager interaction. Presently, a larger study, preferably multicenter, is warranted and under consideration.
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