Telehealth cuts hospital visits and deaths, study suggests
But cost savings modest and might not offset initial outlay for technology
Friday, 22 June 2012
Telehealth can reduce deaths as well as patients’ use of emergency hospital care, but might not save enough money to offset the initial cost of the necessary equipment, report researchers today on bmj.com. Their study also found reductions in admission rates and length of hospital stay in patients who used telehealth.
Nuffield Trust researchers randomised 3230 patients with long-term conditions – diabetes, chronic obstructive pulmonary disease or heart failure – to either usual care or telehealth, and followed them for one year. Those in the telehealth group were taught to use appropriate monitoring equipment, which electronically transmitted their readings to healthcare professionals.
Over the one-year study, 43% of patients in the telehealth group were admitted to hospital, compared with 48% in the control group. Mortality was also significantly lower in the telehealth group than in control patients: 4.6% against 8.3%, which the authors said equates to about 60 lives saved over 12 months.
The rate of emergency hospital admissions was lower in the telehealth group, at 0.54 per head, than in the control group, at 0.68 per head. The authors write: “These changes were significant in the unadjusted comparisons and when we adjusted for a predictive risk score, but not when we adjusted for baseline characteristics.”
Mean length of hospital stay was 4.87 days for people in the telehealth group, significantly lower than the 5.68 days in the control group which the authors said “reflected the reduced admission proportion overall”.
They found a short-term increase in hospital admissions in the control group, for which they suggest several possible explanations. One was increased anxiety in control patients because they felt excluded from support that they perceived as beneficial. Another was previously unmet health needs being recognised by clinicians conducting the initial screening, that they were comfortable being monitored in the community setting for the telehealth group, but not for controls.
The researchers found that the estimated cost savings from the scheme were modest, and said: “We cannot conclude that telehealth reduces secondary care costs over 12 months.”
They conclude that telehealth did reduce mortality and helped patients avoid emergency hospital care, perhaps because it helped them manage their health and avoid worsening symptoms, or because it changed their view of when they need to see additional help. But they stress that the benefits might not be enough to outweigh the cost of the required technology.
The authors of an accompanying editorial say the results mean that full-scale national rollout of telehealth is not warranted, and more research is needed in areas where it shows most promise. They conclude: “There is great potential but also still much to be done.”