Remote patient monitoring and resource use in the specialized health service: an overview of systematic reviews (revised edition)
Systematic review
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We conducted an overview of six systematic reviews that studied the effects of remote patient monitoring of adults with noncommunicable diseases on resource use in the specialized health service.
Key message
This is a revised edition of an earlier published report.
Remote patient monitoring includes the use of technological devices that enable the person to be followed up by the healthcare services at home. We conducted an overview of six systematic reviews that studied the effects of remote patient monitoring of adults with noncommunicable diseases on resource use in the specialized health service. The systematic reviews were published between 2016 and 2020. 83 out of the 125 primary studies included in these systematic reviews were relevant for this report (30 003 participants).
The synthesis of the body of evidence in this report shows that, compared with common practice, remote patient monitoring:
- may result in little to no difference in hospitalization and emergency department visits in adults with cardiovascular disease (low certainty).
- probably reduces hospitalization for any cause in adults with asthma (moderate certainty).
- may result in little to no difference in emergency department visits and length of stay in hospital in adults with chronic obstructive pulmonary disease (low certainty).
- We are uncertain whether remote patient monitoring has an effect in hospitalization in adults with cardiovascular disease or in emergency department visits in adults with asthma (very low certainty).
We downgraded our certainty in the evidence mainly due to poor intervention re-porting, methodological biases, and low precision of the effect estimates. There is a need for further primary research on the effects of remote patient monitoring of adults with other noncommunicable diseases, such as diabetes, mental disorders, or cancer.
Remote patient monitoring may result in little to no difference in the resource use in the specialized health services compared with standard of care for adults with cardiovascular disease, chronic obstructive pulmonary disease, or asthma. Further high-quality research will likely change our conclusions. We found no evidence on the effects of remote patient monitoring on outpatient visits and follow-up.
Summary
Introduction
Remote patient monitoring includes the use of technological devices that enable the people with chronic diseases to be followed up by the healthcare services at home. This monitoring can occur through invasive remote monitoring (implantable equipment that transmit data automatically) or non-invasive remote monitoring (portable devices that transmit data either manually or automatically). There is little summarized research on the effects of remote patient monitoring on adults with noncommunicable diseases on resource use in the specialized health service. To date, most systematic reviews in this area have focused on clinical outcomes such as symptom control and quality of life.
Objective
This overview of systematic reviews aimed to answer the following research question: What is the effect of remote patient monitoring of adults with noncommunicable diseases on resource use in the specialized health services?
Method
We conducted a systematic literature search in relevant databases in June of 2021. We included only systematic reviews of high methodological quality. We limited our inclusion criteria to systematic reviews of randomized trials that studied the effect of remote patient monitoring compared to standard care on resource use in the specialized health services (i.e., hospitalization, hospital stay, consultations, outpatient visits and follow-up, and emergency department visits) in adults with noncommunicable diseases living at home.
Two researchers read the titles, abstracts, and full texts of all relevant references. We assessed the methodological quality, extracted, and analyzed data from the included reviews, and evaluated our certainty of each result using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). GRADE helped us to describe our certainty that the results show the true effect of the intervention using standard statements.
Results
We read the titles and abstracts of 933 references, screened 67 of them in full-text and finally included six systematic reviews published between 2016 and 2020. 83 out of the 125 primary studies included in these systematic reviews were relevant for this report (30 003 participants). All systematic reviews compared remote patient monitoring with standard treatment or usual care for patients with either cardiovascular or chronic respiratory diseases (i.e., asthma and chronic obstructive pulmonary disease).
Among the systematic reviews that addressed the effect of remote patient monitoring for adults with cardiovascular disease, two systematic reviews compared the effect of invasive remote patient monitoring (implantable equipment that transmitted data automatically) with standard care. The results indicate that invasive remote patient monitoring may result in little to no difference in hospitalization, either for any cause or due to heart failure. The remaining two systematic reviews studied the effect of non-invasive remote patient monitoring (portable devices that transmitted data either manually or automatically) of adults with cardiovascular disease. The results indicate that this intervention may result in little to no difference in hospitalization for any cause and emergency department visits and may reduce hospitalization due to heart failure.
Two systematic reviews addressed the effect of non-invasive remote patient monitoring of adults with chronic respiratory disease. We found that the intervention probably reduces hospitalization for any cause in adults with asthma, whereas it is uncertain whether this intervention has the same effect in adults with chronic obstructive pulmonary disease. Non-invasive remote patient monitoring may result in little to no difference in length of stay in hospital and emergency department visits in adults with chronic obstructive pulmonary disease. We are uncertain whether this intervention has the same effect in adults with asthma. The following table summarizes the review findings and the assessment of the certainty of the evidence. For a complete description of certainty of the evidence, see the evidence profiles in Appendix 6.
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Table 2: Summary of findings |
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Remote patient monitoring compared to standard care for adults with chronic diseases |
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Outcome |
Anticipated absolute effects |
Relative effect |
Number of participants (studies) |
Certainty |
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Standard care |
Non-invasive remote patient monitoring |
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Cardiovascular disease |
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Hospitalization – any cause |
Unable to calculate based on available data |
RR 0.91 (0.77 to 1.06) |
696 (1 SR, 8 RCT) a |
⨁⨁◯◯ |
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|
Hospitalization – heart failure |
Unable to calculate based on available data |
RR 0.85 (0.70 to 1.02) |
2 051 (1 SR, 5 RCT) a |
⨁⨁⨁◯ |
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Emergency department visits – heart failure |
Unable to calculate based on available data |
RR 0.38 (0.21 to 0.69) |
128 (1 SR, 2 RCT) a |
⨁⨁◯◯ |
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Chronic respiratory disease |
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Hospitalization for any cause – asthma |
83 per 1 000 |
21 per 1 000 (5 to 79) |
OR 0.24 (0.06 to 0.94) |
621 (1 SR, 6 RCT) b |
⨁⨁⨁◯ |
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Hospitalization for any cause - COPD |
Unable to calculate based on available data |
Mean difference 0.13 lower (from 0.58 lower to 0.32 higher) |
MD -0,13 (-0.58 to 0.32) |
517 (1 SR, 5 RCT) c |
⨁◯◯◯ |
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Length of stay in hospital - COPD |
Unable to calculate based on available data |
Mean difference 0.18 higher (from 1.66 lower to 2.02 higher) |
MD 0.18 (-1.66 to 2.02) |
920 (1 SR, 6 RCT) c |
⨁⨁⨁◯ LOW 1,5 |
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Emergency department visits |
150 per 1 000 |
99 per 1 000 (34 to 286) |
OR 0.66 (0.23 to 1.91) |
817 (1 SR, 6 RCT) b |
⨁◯◯◯ |
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COPD: chronic obstructive pulmonary disease; CI: confidence interval; HR: hazard ratio; MD: mean difference; OR: odds ratio; RCT: randomized controlled trial; RR: risk ratio; SR: systematic review |
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*Anticipated absolute effect is the probability of an event (1). For example, an absolute effect of 100 per 1000 means that every tenth person (100 individuals in a group of 1000 people) will experience an event. The risk for an individual in this group is 1 in 10 or 10%. §Relative effect (risk ratio, RR) is the ratio of probabilities of an event in each of the groups (1). For example, a relative effect of 0.50 means that the probability of an event in the test group is half that of the probability of an event in the control group. The risk for an individual in the control group is double relative to a person in the test group.
References: a. Yun et al. 2018; b. Kew et al. 2016; c. Sul et al. 2020 |
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Legend 1 Downgraded one level for methodological bias: most primary studies had weaknesses with randomization and allocation of participants, and did not report attrition 2 Downgraded one level for inconsistency: high heterogeneity 3 Downgraded one level for methodological bias: unclear which studies reported outcome data 4 Downgraded one level for imprecision: small trials with few participants 5 Downgraded one level for imprecision: wide confidence intervals |
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Discussion
The evidence base we found partially answers the scope of the commission. Participants were mainly older patients with chronic cardiovascular or respiratory diseases of varying severity. The interventions were primarily non-invasive forms of remote patient monitoring. The protocols and methods used for data transfer and assessment were poorly described. Our findings show a need for further primary research on the effects of remote patient monitoring of adults with other noncommunicable diseases, such as diabetes, mental disorders, or cancer. Such studies may elucidate the effect of this intervention on other outcomes, such as outpatient visits and follow-up.
Conclusion
Remote patient monitoring may result in little to no difference in the resource use in the specialized health services compared with standard of care for adults with cardiovascular disease, chronic obstructive pulmonary disease, or asthma. There is a lack of summarized evidence on the effect of remote patient monitoring on outpatient visits and follow-up. Further high-quality research will likely change our conclusions.
