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July 28, 2015Telemedicine Journal and e-Health

Impact of a Telehealth and Care Management Program on All-Cause Mortality and Healthcare Utilization in Patients with Heart Failure

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Why the study?

Does a content-driven telehealth system coupled with care management reduce all-cause mortality and healthcare utilization in Medicare beneficiaries with heart failure?

Population

1,246 Medicare beneficiaries with heart failure, mean age 78.8, 56.7% male, US-based.

Comparison

Health Buddy Program, a content-driven… vs Propensity score-matched control group of…

Design

Cohort

Follow-up

3 years

Key result

Availability of the Health Buddy Program was associated with a 24.9% lower risk-adjusted all-cause mortality over 3 years of follow-up compared to matched controls (HR 0.75).

Authors

DKDavid KaoJLJoAnn LindenfeldDMDendy Macaulay

Discussion

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Member takes

Overview

Should not yet change HF telehealth practice; leaves open whether RCTs will confirm mortality benefit.

Study Design

Type

Cohort (n=1,246)

Multicenter

Yes

Structured PICO

Does a content-driven telehealth system coupled with care management reduce all-cause mortality and healthcare utilization in Medicare beneficiaries with heart failure?

P
Population
1,246 Medicare beneficiaries with heart failure, matched by propensity score, followed for 3 years to evaluate the impact of a telehealth and care management program.
E
Exposure
Health Buddy Program (HBP), a content-driven telehealth system coupled with care management, which asks patients daily for vital signs and health-related information, provides feedback/education, and transmits data to care managers for risk stratification and triage.
C
Comparator
Propensity score-matched control group of Medicare beneficiaries with heart failure from the Medicare 5% sample receiving usual care.
O
Outcome
Time to all-cause mortality over 3 years after being offered HBP enrollmenthard clinical

Main Result

Hazard Ratio: 0.75 (95% CI 0.63–0.89)

Absolute Event Rate: 39% vs 46.4%

p-value: p=0.001

A content-driven telehealth system coupled with care management was associated with significantly better survival and reduced hospitalizations in Medicare beneficiaries with heart failure.

Limitations

  • Retrospective study design requiring prospective validation.
  • Unobserved differences between intervention and control cohorts may have affected outcomes despite propensity matching.
  • Control patients received care from different clinical sites than intervention patients.
  • Restricted to heart failure patients in the Pacific Northwest, limiting generalizability.
  • Lack of Medicare Part D data to assess medication adherence or quality of heart failure therapy.
  • Retrospective study design
  • Unobserved differences between the intervention and control cohorts may have affected outcomes despite propensity matching
  • Predictors of patient engagement were unavailable
  • Control patients received care from different clinical sites than intervention patients
  • Restricted to HF patients in the Pacific Northwest, limiting generalizability
  • Temporal granularity in Medicare data was limited to quarters
  • Lack of Medicare Part D data to assess medication compliance or quality of HF therapy

Cite This Study

Kao et al. (2015) conducted a cohort in Heart Failure (n=1,246). Health Buddy Program (telehealth and care management) vs. Propensity score-matched routine care was evaluated on All-cause mortality (HR 0.75, 95% CI 0.63-0.89, p=0.001). Availability of the Health Buddy Program was associated with a 24.9% lower risk-adjusted all-cause mortality over 3 years of follow-up compared to matched controls (HR 0.75).

synapsesocial.com/papers/6a859137b451cea71dae6bd3https://doi.org/10.1089/tmj.2015.0007
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