We write frequently about telemedicine and remote patient monitoring (RPM). RPM platforms typically enable healthcare professionals to interact with patients in their own homes and track clinical data from wearables or other connected devices. People cite many advantages for remote doctor-patient engagement, such as patient comfort, convenience, and savings for both patients and healthcare systems. Researchers from Penn Medicine reported superior results from RPM compared to standard in-person care, published in a study in JAMA Network Open.
The Penn Medicine study found that hospital readmissions following total hip or knee replacements declined by 75% from conventional post-surgical care when patients were enrolled in an RPM rehab program. A total of 242 post-op knee and hip replacement patients were randomly assigned to either standard after-surgery care group or the study group. The study group subjects were issued wearable step counters and participated in bidirectional text messaging with physicians. Study group participants began the RPM program prior to surgery and continued for 45 days after discharge.
The primary purpose of the study was to measure the joint replacement patients’ rate of discharge to home (versus a skilled nursing facility or inpatient rehabilitation) and clinical outcomes. The messaging included postoperative goals and milestones, pain score tracking, and as-needed connection to clinicians. Observed metrics included average daily step count and rehospitalizations.
The researchers found no significant difference in most of the study measures; rate of discharge to home and step count averages were about the same. However, the study group had significantly reduced rehospitalization rates. Overall, 12.2% of the control group that received standard care were readmitted to the hospital, compared with just 3.4% for the test group.
The authors of the study suggested the reduction in rehospitalizations in the study group may have been due to goal setting and patient connections to the care team. Penn Medicine medical personnel have implemented conversational text messaging, goal setting, and connection to clinicians in their patient care, according to a Penn Medicine news release. The researchers also expressed an interest following patient activity levels beyond the 45-day post discharge period. Hopefully further studies will replicate the Penn Medicine findings.
The ramifications of the Penn Medicine study are striking. Cost and convenience savings in post-discharge care via RPM with no degradation in patient outcomes are big wins. Rehospitalization is costly to all parties and reducing readmission rates by a factor of 4 is an even larger score.
