Effect of telehealth on hospital utilisation and mortality in routine clinical practice: a matched control cohort study in an early adopter site.

To assess the effects of a home-based telehealth intervention on the use of secondary healthcare and mortality. Observational study of a mainstream telehealth service, using person-level administrative data. Time to event analysis (Cox regression) was performed comparing telehealth patients with controls who were matched using a machine-learning algorithm. A predominantly rural region of England (North Yorkshire). 716 telehealth patients were recruited from community, general practice and specialist acute care, between June 2010 and March 2013. Patients had chronic obstructive pulmonary disease, congestive heart failure or diabetes, and a history of associated inpatient admission. Patients were matched 1:1 to control patients, also selected from North Yorkshire, with respect to demographics, diagnoses of health conditions, previous hospital use and predictive risk score. Telehealth involved the remote exchange of medical data between patients and healthcare professionals as part of the ongoing management of the patient's health condition. Monitoring centre staff alerted healthcare professionals if the telemonitored data exceeded preset thresholds. Control patients received usual care, without telehealth. Time to the first emergency (unplanned) hospital admission or death. Secondary metrics included time to death and time to first admission, outpatient attendance and emergency department visit. Matched controls and telehealth patients were similar at baseline. Following enrolment, telehealth patients were more likely than matched controls to experience emergency admission or death (adjusted HR 1.34, 95% CI 1.16 to 1.56, p<0.001). They were also more likely to have outpatient attendances (adjusted HR=1.25, 1.11 to 1.40, p<0.001), but mortality rates were similar between groups. Sensitivity analyses showed that we were unlikely to have missed reductions in the likelihood of an emergency admission or death because of unobserved baseline differences between patient groups. Telehealth was not associated with a reduction in secondary care utilisation.

Steventon A ，Ariti C ，Fisher E ，Bardsley M ... -  《BMJ Open》

Effect of telephone health coaching (Birmingham OwnHealth) on hospital use and associated costs: cohort study with matched controls.

Steventon A ，Tunkel S ，Blunt I ，Bardsley M ... -  《BMJ-British Medical Journal》

Effects of care management and telehealth: a longitudinal analysis using medicare data.

To evaluate mortality and healthcare utilization effects of an intervention that combined care management and telehealth, targeting individuals with congestive heart failure, chronic obstructive pulmonary disease, or diabetes mellitus. Retrospective matched cohort study. Northwest United States. High-cost Medicare fee-for-service beneficiaries (N = 1,767) enrolled in two Centers for Medicare and Medicaid Services demonstration participating clinics and a propensity-score matched control group. The Health Buddy Program, which integrates a content-driven telehealth system with care management. Mortality, inpatient admissions, hospital days, and emergency department (ED) visits during the 2-year study period were measured. Cox-proportional hazard models and negative binomial regression models were used to assess the relationship between the intervention and survival and utilization, controlling for demographic and health characteristics that were statistically different between groups after matching. At 2 years, participants offered the Health Buddy Program had 15% lower risk-adjusted all-cause mortality (hazard ratio (HR) = 0.85, 95% confidence interval (CI) = 0.74-0.98; P = .03) and had reductions in the number of quarterly inpatient admissions from baseline to the study period that were 18% greater than those of matched controls during this same time period (-0.035 vs -0.003; difference-in-differences = -0.032, 95% CI = -0.054 to -0.010, P = .005). No relationship was found between the Health Buddy Program and ED use or number of hospital days for participants who were hospitalized. The Health Buddy Program was most strongly associated with fewer admissions for individuals with chronic obstructive pulmonary disease and mortality for those with congestive heart failure. Care management coupled with content-driven telehealth technology has potential to improve health outcomes in high-cost Medicare beneficiaries.

Baker LC ，Macaulay DS ，Sorg RA ，Diener MD ，Johnson SJ ，Birnbaum HG ... -  《-》

Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial.

Steventon A ，Bardsley M ，Billings J ，Dixon J ，Doll H ，Hirani S ，Cartwright M ，Rixon L ，Knapp M ，Henderson C ，Rogers A ，Fitzpatrick R ，Hendy J ，Newman S ，Whole System Demonstrator Evaluation Team ... -  《BMJ-British Medical Journal》

Retrospective observational study of the impact on emergency admission of telehealth at scale delivered in community care in Liverpool, UK.

To assess the effect of a real world, ongoing telehealth service on the use of secondary healthcare. A retrospective observational study with anonymous matched controls. Primary and community healthcare. Patients were recruited over 4 years in 89 general practices in Liverpool, UK and remotely managed by a dedicated clinical team in Liverpool Community Health. 5154 patients with chronic obstructive pulmonary disease, heart failure or diabetes were enrolled in the programme, of whom 3562 satisfied the inclusion criteria of this study. At least 9 weeks of telehealth including vital sign collection, questionnaires, education, support and informal coaching by clinical staff. Reduction in the number of emergency admissions in the 12 months after start, compared with the year before start. Secondary subgroup analysis to improve future targeting and personalisation of the service. The average number of emergency admissions for the intervention group at baseline is 0.35, 95% CI 0.32 to 0.38. The differential decrease in emergency admissions in the intervention group in comparison with the control group, the average treatment effect, is 0.08, 95 CI 0.05 to 0.11, corresponding to an average percentage decrease of 22.7%. In subgroup analysis, a score is calculated that can be used prospectively to predict individual benefit from the intervention. Patients with an above median score (37%) are predicted average reduction in emergency admissions of 0.15, 95% CI 0.09 to 0.2, corresponding to a percentage decrease in admissions of 25.3%. The telehealth intervention has a positive impact across a wide cohort of patients with different diseases. Prospective scoring of patients and allocation to targeted telehealth interventions is likely to improve the effectiveness and efficiency of the service.

van Berkel C ，Almond P ，Hughes C ，Smith M ，Horsfield D ，Duckworth H ... -  《BMJ Open》