Corrigendum and Editorial Warning Regarding Use of the MMAS-8 Scale (A Remote Medication Monitoring System for Chronic Heart Failure Patients to Reduce Readmissions: A Two-Arm Randomized Pilot Study).
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SUBMITTER: Hale TM
PROVIDER: S-EPMC6379813 | biostudies-literature | 2019 Feb
REPOSITORIES: biostudies-literature
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Corrigendum and Editorial Warning Regarding Use of the MMAS-8 Scale (A Remote Medication Monitoring System for Chronic Heart Failure Patients to Reduce Readmissions: A Two-Arm Randomized Pilot Study).
Hale Timothy M TM Jethwani Kamal K Kandola Manjinder Singh MS Saldana Fidencio F Kvedar Joseph C JC
Journal of medical Internet research 20190205 2
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Project description:BACKGROUND:Heart failure (HF) is a chronic condition affecting nearly 5.7 million Americans and is a leading cause of morbidity and mortality. With an aging population, the cost associated with managing HF is expected to more than double from US $31 billion in 2012 to US $70 billion by 2030. Readmission rates for HF patients are high-25% are readmitted at 30 days and nearly 50% at 6 months. Low medication adherence contributes to poor HF management and higher readmission rates. Remote telehealth monitoring programs aimed at improved medication management and adherence may improve HF management and reduce readmissions. OBJECTIVE:The primary goal of this randomized controlled pilot study is to compare the MedSentry remote medication monitoring system versus usual care in older HF adult patients who recently completed a HF telemonitoring program. We hypothesized that remote medication monitoring would be associated with fewer unplanned hospitalizations and emergency department (ED) visits, increased medication adherence, and improved health-related quality of life (HRQoL) compared to usual care. METHODS:Participants were randomized to usual care or use of the remote medication monitoring system for 90 days. Twenty-nine participants were enrolled and the final analytic sample consisted of 25 participants. Participants completed questionnaires at enrollment and closeout to gather data on medication adherence, health status, and HRQoL. Electronic medical records were reviewed for data on baseline classification of heart function and the number of unplanned hospitalizations and ED visits during the study period. RESULTS:Use of the medication monitoring system was associated with an 80% reduction in the risk of all-cause hospitalization and a significant decrease in the number of all-cause hospitalization length of stay in the intervention arm compared to usual care. Objective device data indicated high adherence rates (95%-99%) among intervention group participants despite finding no significant difference in self-reported adherence between study arms. The intervention group had poorer heart function and HRQoL at baseline, and HRQoL declined significantly in the intervention group compared to controls. CONCLUSIONS:The MedSentry medication monitoring system is a promising technology that merits continued development and evaluation. The MedSentry medication monitoring system may be useful both as a standalone system for patients with complex medication regimens or used to complement existing HF telemonitoring interventions. We found significant reductions in risk of all-cause hospitalization and the number of all-cause length of stay in the intervention group compared to controls. Although HRQoL deteriorated significantly in the intervention group, this may have been due to the poorer HF-functioning at baseline in the intervention group compared to controls. Telehealth medication adherence technologies, such as the MedSentry medication monitoring system, are a promising method to improve patient self-management,the quality of patient care, and reduce health care utilization and expenditure for patients with HF and other chronic diseases that require complex medication regimens. TRIAL REGISTRATION:ClinicalTrials.gov NCT01814696; https://clinicaltrials.gov/ct2/show/study/NCT01814696 (Archived by WebCite® at http://www.webcitation.org/6giqAVhno).
| S-EPMC4890732 | biostudies-literature
Project description:Heart failure (HF) is one of the most prevalent chronic diseases in the United States (U.S.), with an estimated prevalence of five million patients in the U.S. and an annual healthcare cost of greater than 30 billion dollars. Readmission rates for HF patients are astronomically high, with up to 25% of hospitalized patients with HF requiring readmission within 30 days of discharge. The Hospital Readmissions Reduction Program (HRRP) of the Patient Protection and Affordable Care Act aims to address these concerns by financially penalizing institutions with unacceptably high risk-adjusted 30-day readmission rates for HF patients. The introduction of the HRRP contributed to increased efforts of healthcare systems to reduce their 30-day readmission rates, often by the utilization of "transitional care clinics." Although the motivation for the creation of these programs is understandable, there exists a paucity of robust clinical trials supporting the efficacy of these programs to reduce 30-day readmission rates for HF patients. There is even less evidence to support the use of these programs in the unique healthcare environment of the U.S. Large, multicenter randomized controlled trials should be conducted to evaluate these interventions before more resources are dispersed toward their implementation. Alternatively, resources could be used to evaluate other interventions that may be more efficacious at reducing 30-day readmissions, such as implantable hemodynamic monitoring devices.
| S-EPMC5854320 | biostudies-literature
Project description:ObjectiveTo assess the efficacy of medication review as an isolated intervention and with several co-interventions for preventing hospital readmissions in older adults.MethodsOvid MEDLINE, Embase, The Cochrane Central Register of Controlled Trials and CINAHL were searched for randomized controlled trials evaluating the effectiveness of medication review interventions with or without co-interventions to prevent hospital readmissions in hospitalized or recently discharged adults aged ≥65, until September 13, 2019. Included outcomes were "at least one all-cause hospital readmission within 30 days and at any time after discharge from the index admission."ResultsTwenty-five studies met the inclusion criteria. Of these, 11 studies (7,318 participants) contributed to the network meta-analysis (NMA) on all-cause hospital readmission within 30 days. Medication review in combination with (a) medication reconciliation and patient education (risk ratio (RR) 0.45; 95% confidence interval (CI) 0.26-0.80) and (b) medication reconciliation, patient education, professional education and transitional care (RR 0.64; 95% CI 0.49-0.84) were associated with a lower risk of all-cause hospital readmission compared to usual care. Medication review in isolation did not significantly influence hospital readmissions (RR 1.06; 95% CI 0.45-2.51). The NMA on all-cause hospital readmission at any time included 24 studies (11,677 participants). Medication review combined with medication reconciliation, patient education, professional education and transitional care resulted in a reduction of hospital readmissions (RR 0.82; 95% CI 0.74-0.91) compared to usual care. The quality of the studies included in this systematic review raised some concerns, mainly regarding allocation concealment, blinding and contamination.ConclusionMedication review in combination with medication reconciliation, patient education, professional education and transitional care, was associated with a lower risk of hospital readmissions compared to usual care. An effect of medication review without co-interventions was not demonstrated. Trials of higher quality are needed in this field.
| S-EPMC8247962 | biostudies-literature
Project description:BackgroundAdvances in smart technology have expanded into the field of orthopedic surgery to deliver enhanced patient care. Smart technology has also raised important issues regarding protected patient information. The purpose of this study is to determine patient preferences regarding smart technology in their postarthroplasty care.MethodsPatient surveys were administered in the office setting of 2 adult reconstructive orthopedic surgeons during a 4-week period. Surveys queried patient demographics, twelve yes/no questions, five continuous agree/disagree statements, and a single free-text question. Logistic regression and statistical significance testing were performed.ResultsOf the study patients, 83.6% were willing to wear a device. Women were more likely to consent to a monitoring device and have activity data collected than men (P < .05). Younger patients were more likely to consent to a device and have data collected than octogenarians. Nearly 90% of respondents indicated peace of mind with data being constantly tracked. However, 64% of respondents had hesitations about a surgically implanted device that was independent of a previous arthroplasty surgery (P < .05).ConclusionsPatients are comfortable with smart technology being involved in their postoperative care, especially younger patients and women. Older individuals, possibly with less experience using smart technology in their lives, were not as willing to wear smart devices or have their data collected. Nearly two-thirds of patients had hesitations about surgically implanted smart devices. Further investigation is needed to understand hesitations concerning smart implants as the orthopedic community enters an era of commercially available smart implants in total joint arthroplasty.
| S-EPMC9713269 | biostudies-literature
Project description:ObjectiveChronic diseases are associated with increased unplanned acute hospital use. Remote patient monitoring (RPM) can detect disease exacerbations and facilitate proactive management, possibly reducing expensive acute hospital usage. Current evidence examining RPM and acute care use mainly involves heart failure and omits automated invasive monitoring. This study aimed to determine if RPM reduces acute hospital use.MethodsA systematic literature review of PubMed, Embase and CINAHL electronic databases was undertaken in July 2019 and updated in October 2020 for studies published from January 2015 to October 2020 reporting RPM and effect on hospitalisations, length of stay or emergency department presentations. All populations and disease conditions were included. Two independent reviewers screened articles. Quality analysis was performed using the Joanna Briggs Institute checklist. Findings were stratified by outcome variable. Subgroup analysis was undertaken on disease condition and RPM technology.ResultsFrom 2050 identified records, 91 studies were included. Studies were medium-to-high quality. RPM for all disease conditions was reported to reduce admissions, length of stay and emergency department presentations in 49% (n=44/90), 49% (n=23/47) and 41% (n=13/32) of studies reporting each measure, respectively. Remaining studies largely reported no change. Four studies reported RPM increased acute care use. RPM of chronic obstructive pulmonary disease (COPD) was more effective at reducing emergency presentation than RPM of other disease conditions. Similarly, invasive monitoring of cardiovascular disease was more effective at reducing hospital admissions versus other disease conditions and non-invasive monitoring.ConclusionRPM can reduce acute care use for patients with cardiovascular disease and COPD. However, effectiveness varies within and between populations. RPM's effect on other conditions is inconclusive due to limited studies. Further analysis is required to understand underlying mechanisms causing variation in RPM interventions. These findings should be considered alongside other benefits of RPM, including increased quality of life for patients.Prospero registration numberCRD42020142523.
| S-EPMC7929874 | biostudies-literature
Project description:AimsThe aim of this meta-analysis is to examine the impact of in-hospital pharmacist-led medication reviews in paediatric and adult patients.MethodsRelevant studies were identified from the Medline and Cochrane Library databases. Studies were included if they met the following criteria (without any language or date restrictions): design: randomized controlled trial; intervention: in-hospital pharmacist-led medication review (experimental group) vs. usual care (control group); participants: paediatric or adult population. The primary outcome was all-cause readmissions and/or emergency department (ED) visits at different time points. The secondary outcomes were all-cause readmissions, all-cause ED visits, drug-related readmissions, mortality, length of hospital stay, adherence and quality of life. We calculated the relative risk (RR) or mean differences (MD) with 95% confidence intervals (CIs) for each study. We used fixed and/or random effects models. Heterogeneity was assessed using the I2 statistic.ResultsWe systematically reviewed 19 randomized controlled trials (4805 participants). The readmission rates did not differ between the experimental group and the control group (RR = 0.97, 95% CI 0.89; 1.05, p = 0.470). The secondary outcomes did not differ between the two groups, except for in drug-related readmissions, which were lower in the experimental group (RR = 0.25, 95% CI 0.14; 0.45, p < 0.001), and all-cause ED visits (RR = 0.70, 95% CI 0.59; 0.85 p = 0.001).ConclusionThe low-quality evidence in this analysis suggests an impact of pharmacist-led medication reviews on drug-related readmissions and all-cause ED visits. Few studies reported on adherence and quality of life. More high-quality randomized clinical trials are needed to assess the impact of pharmacist-led medication reviews on patient-relevant outcomes, including adherence and quality of life.
| S-EPMC5099542 | biostudies-literature
Project description:BackgroundPatients with respiratory or cardiovascular diseases often experience higher rates of hospital readmission due to compromised heart-lung function and significant clinical symptoms. Effective measures such as discharge planning, case management, home telemonitoring follow-up, and patient education can significantly mitigate hospital readmissions.ObjectiveThis study aimed to determine the efficacy of home telemonitoring follow-up in reducing hospital readmissions, emergency department (ED) visits, and total hospital days for high-risk postdischarge patients.MethodsThis prospective cohort study was conducted between July and October 2021. High-risk patients were screened for eligibility and enrolled in the study. The intervention involved implementing home digital monitoring to track patient health metrics after discharge, with the aim of reducing hospital readmissions and ED visits. High-risk patients or their primary caregivers received education on using communication measurement tools and recording and uploading data. Before discharge, patients were familiarized with these tools, which they continued to use for 4 weeks after discharge. A project manager monitored the daily uploaded health data, while a weekly video appointment with the program coordinator monitored the heart and breathing sounds of the patients, tracked health status changes, and gathered relevant data. Care guidance and medical advice were provided based on symptoms and physiological signals. The primary outcomes of this study were the number of hospital readmissions and ED visits within 3 and 6 months after intervention. The secondary outcomes included the total number of hospital days and patient adherence to the home monitoring protocol.ResultsAmong 41 eligible patients, 93% (n=38) were male, and 46% (n=19) were aged 41-60 years, while 46% (n=19) were aged 60 years or older. The study revealed that home digital monitoring significantly reduced hospitalizations, ED visits, and total hospital stay days at 3 and 6 months after intervention. At 3 months after intervention, average hospitalizations decreased from 0.45 (SD 0.09) to 0.19 (SD 0.09; P=.03), and average ED visits decreased from 0.48 (SD 0.09) to 0.06 (SD 0.04; P<.001). Average hospital days decreased from 6.61 (SD 2.25) to 1.94 (SD 1.15; P=.08). At 6 months after intervention, average hospitalizations decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.01), and average ED visits decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.02). Average hospital days decreased from 7.48 (SD 2.32) to 6.03 (SD 3.12; P=.73).ConclusionsBy integrating home telemonitoring with regular follow-up, our research demonstrates a viable approach to reducing hospital readmissions and ED visits, ultimately improving patient outcomes and reducing health care costs. The practical application of telemonitoring in a real-world setting showcases its potential as a scalable solution for chronic disease management.
| S-EPMC11437225 | biostudies-literature
Project description:Early detection of agricultural drought can alert farmers and authorities, enhancing the resilience of the food sector. A framework is proposed for developing a novel regional agricultural drought index (RegCDI) by combining remotely sensed vegetation health, soil moisture and crop water stress via a transparent Shannon's entropy weighting method. The framework consists of the selection of suitable datasets based on their regional performance, the aggregation of selected drought indicators, the validation of the combined index against crop yield, and the testing of predictive capabilities. The creation and performance of RegCDI are demonstrated for the drought prone Indian state of Odisha. MODIS surface reflectance is selected for crop water stress and GLDAS-2 for assessing soil moisture deficits and vegetation health. Three selected indicators (SMCI, TCI, and SIWSI-1) are combined into RegCDI for Odisha. The performance of RegCDI is evaluated (a) against other popular drought indices and (b) by comparing with seasonal crop yields. RegCDI is used to identify drought hotspots based on drought severity, duration, and propensity over the study area. A reforecast evaluation of RegCDI (up to three months ahead) showed that the indicators based on soil moisture deficit and crop water stress could predict drought conditions up to two months ahead with no less than 80% accuracy. This demonstrated the potential of the RegCDI framework and its component indicators for early warning of drought in Odisha.
| S-EPMC11525277 | biostudies-literature
Project description:BackgroundHeart failure is a prevalent health problem associated with costly hospital readmissions. Transitional care programs have been shown to reduce readmissions but are costly to implement. Evidence regarding the effectiveness of telemonitoring in managing the care of this chronic condition is mixed. The objective of this randomized controlled comparative effectiveness study is to evaluate the effectiveness of a care transition intervention that includes pre-discharge education about heart failure and post-discharge telephone nurse coaching combined with home telemonitoring of weight, blood pressure, heart rate, and symptoms in reducing all-cause 180-day hospital readmissions for older adults hospitalized with heart failure.Methods/designA multi-center, randomized controlled trial is being conducted at six academic health systems in California. A total of 1,500 patients aged 50 years and older will be enrolled during a hospitalization for treatment of heart failure. Patients in the intervention group will receive intensive patient education using the 'teach-back' method and receive instruction in using the telemonitoring equipment. Following hospital discharge, they will receive a series of nine scheduled health coaching telephone calls over 6 months from nurses located in a centralized call center. The nurses also will call patients and patients' physicians in response to alerts generated by the telemonitoring system, based on predetermined parameters. The primary outcome is readmission for any cause within 180 days. Secondary outcomes include 30-day readmission, mortality, hospital days, emergency department (ED) visits, hospital cost, and health-related quality of life.DiscussionBEAT-HF is one of the largest randomized controlled trials of telemonitoring in patients with heart failure, and the first explicitly to adapt the care transition approach and combine it with remote telemonitoring. The study population also includes patients with a wide range of demographic and socioeconomic characteristics. Once completed, the study will be a rich resource of information on how best to use remote technology in the care management of patients with chronic heart failure.Trial registrationClinicalTrials.gov # NCT01360203.
| S-EPMC3990010 | biostudies-literature
Project description:BackgroundDespite many recent advances in heart failure (HF) therapies, there remains an unmet need in patients with HF with preserved ejection fraction (HFpEF) for adequate treatment and follow-up, with the potential to reduce associated mortality and morbidity. Increased intracardiac and intrapulmonary pressures have been shown to precede the onset of symptoms of decompensated HF by several days or even weeks, so there have been several attempts to influence the prognosis of HF by monitoring through various methods. One of these is ambulatory pulmonary pressure monitoring to guide treatment in anticipation of decompensation.Case summaryWe present the case of a 65-year-old woman with rheumatic valve disease and mechanical aortic and mitral prosthesis since 2003 and pacemaker since 2014, with development of severe tricuspid regurgitation in 2018 and with new valve implantation and multiple decompensations of HFpEF despite optimal medical treatment. Under follow-up in the Heart Failure Unit and after multiple unsuccessful treatment adjustments, it was decided to implant a pulmonary artery pressure monitoring device-CardioMEMS®-in order to optimize patient follow-up and treatment. The procedure was carried out without complications and early optimization of treatment was possible, resulting in a significant reduction in decompensations and admissions for HF.DiscussionAmbulatory pulmonary pressure monitoring is shown to be a safe and effective option to anticipate treatment of heart failure decompensation even with preserved left ventricular ejection fraction, with a significantly positive impact on hospital readmissions and consequent benefit on morbidity and mortality.
| S-EPMC9581212 | biostudies-literature