Mobile Integrated Health and Post–Hospital Discharge Heart Failure Care
Key result
Mobile integrated health fails to improve 30-day KCCQ scores over a transitions coordinator.
- mean difference, 1.83
- 95% CI -0.75 to 4.40
- P=.16
- n=2,003
Figures
Structured PICO
P
Population
2,003 adults hospitalized with heart failure, excluding those with NYHA class IV, enrolled in a trial comparing mobile integrated health to a transitions of care coordinator, with 45 participants interviewed for qualitative analysis.
I
Intervention
Mobile integrated health (MIH) intervention including home visits from community paramedics, ongoing nurse care coordination, and facilitated telehealth consultations.
C
Comparator
Transitions of care coordinator (TOCC) control group (from the parent trial).
O
Outcome
Five RE-AIM domains (Reach, Effectiveness, Adoption, Implementation, Maintenance) assessed using directed content analysis of interview data.
Main Result
Mean Difference: 1.83 (95% CI -0.75–4.4)
p-value: p=.16
Limitations
- Data originated from participants enrolled in a randomized clinical trial conducted in a single city
- Interviews represent the views of those who agreed to be interviewed, introducing potential selection bias
- Patient interviews may be subject to social desirability bias
- Only 2 caregivers participated, limiting insight into caregiver perspectives
- Reflects a single MIH program design that excluded patients with advanced heart failure
- Potential selection bias toward those with more favorable views of MIH
- Patient interviews may be subject to social desirability bias, with participants underreporting negative experiences
- Reflects a single MIH program design that excluded patients with advanced HF
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“MIH programs frequently reduce ED transports, but their financial viability is fundamentally constrained by Medicare's transport-based EMS reimbursement structure, which limits staffing levels and clinical scope, ultimately shaping program effectiveness and sustainability. Our findings suggest that durable scale will require explicit reimbursement mechanisms for mobile integrated health.”
Implication
While a mobile integrated health program for heart failure patients did not significantly reduce 30-day readmissions, it was highly valued by patients and clinicians, though its sustainability requires supportive reimbursement models and policy reforms.
Abstract
Importance Mobile integrated health (MIH) is a promising model for improving transitions of care for patients with heart failure (HF). National implementation remains limited due to insufficient understanding of barriers and facilitators to adoption and sustainability. Objective To identify factors associated with the implementation of an MIH program for patients with HF in an urban setting, using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Design, Setting, and Participants This qualitative study was embedded in the Using Mobile Integrated Health and Telehealth to Support Transitions of Care Among Heart Failure Patients (MIGHTy-Heart) randomized clinical trial conducted from January 2021 to September 2024 at 2 large urban health systems in New York, New York. Qualitative data were generated through semistructured interviews with patients and stakeholders (clinicians, paramedics, caregivers, and program leaders). Data were analyzed from January 2022 through August 2023. Exposure The MIH intervention included home visits from community paramedics, ongoing nurse care coordination, and facilitated telehealth consultations. Main Outcomes and Measures Five RE-AIM domains were assessed using directed content analysis of interview data. Quantitative reach was measured by comparing adults with HF offered access to MIH to all adults with HF receiving care at the health systems during the study period, and effectiveness data were summarized descriptively from the parent MIGHTy-Heart trial. Adoption was measured by comparing facilitators and barriers to adoption. Implementation was assessed through service utilization and thematic analysis. Maintenance included willingness to recommend MIH and institutional continuation plans. Results A total of 73 343 patients (51 420 [70%] aged ≥65 years; 39 979 [55%] male) were treated for HF across both health systems during the trial period, including 1005 who were enrolled in the trial and randomized to MIH, among whom 414 received at least 1 MIH visit; 20 patients and 25 stakeholders were interviewed for qualitative results. Regarding reach, MIH participants vs all patients with HF were similar with respect to age and sex, but had greater racial and ethnic diversity (MIH group: 50% Black or African American, 27% Hispanic or Latino, and 25% White; all HF patients: 9% Black or African American, 4% Hispanic or Latino, and 42% White). Regarding effectiveness, there was no statistically significant decrease in 30-day all-cause readmissions or Kansas City Cardiomyopathy Questionnaire scores among MIH participants vs the comparator group (mean difference, 1.83; 95% CI, −0.75 to 4.40; P = .16). Adoption was promoted by institutional alignment, and implementation was supported by leadership engagement, interdisciplinary coordination, and patient trust. Barriers included misaligned reimbursement and regulatory constraints. Sustainability plans reflected MIH’s perceived value to patients and staff. Conclusions and Relevance Despite the primary trial showing no difference in 30-day readmissions or Kansas City Cardiomyopathy Questionnaire scores between MIH and the transitions of care coordinator control group, this qualitative study found that MIH was well received and aligned with institutional goals. Sustaining and scaling MIH may require supportive reimbursement models and policy reforms.
Discussion
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Cite This Study
Turchioe et al. (2026) studied Heart failure (n=2,003). Mobile integrated health (MIH) vs. Transitions of care coordinator was evaluated on Kansas City Cardiomyopathy Questionnaire scores at 30 days (mean difference, 1.83, 95% CI -0.75 to 4.40, p=.16). Mobile integrated health did not significantly improve 30-day Kansas City Cardiomyopathy Questionnaire scores compared to a transitions of care coordinator (mean difference 1.83, P=0.16), but qualitative analysis showed it was well received and aligned with institutional goals.