Challenge intuitive assumptions: Example of telemonitoring study
Proponents of telemonitoring suggest that it has the potential to improve patient outcomes, but recent studies suggest such optimism may be premature. Paul Y. Takahashi, MD, MPH, an former associate professor of medicine at the Mayo Clinic in Rochester, Minn, and colleagues found that tracking older patients at home through telemonitoring did not lead to fewer hospitalizations or emergency department visits. The findings are based on a study of 205 individuals with an average age of about 80 years and multiple chronic conditions who were randomly assigned to receive telemonitoring or usual care at 4 Mayo Clinic sites in Minnesota
A telemonitoring device in the home that can measure and transmit information about indicators of health such as blood pressure and oxygen saturation coupled with videoconferencing can allow a health care team to assess a patient’s condition remotely and discuss ongoing treatment plans with the patient.
Background from Dr. Takahashi:“It’s really important to try to change our care models offered to older and sicker patients. Taking care of older people to help keep them out of the hospital is important because every time they go, they usually lose a little more of their health. We looked at this population and thought using a monitoring system and taking measurements every day would help these patients avoid the hospital. Unfortunately, we did not find that. We still have to figure this out.“Telemonitoring is designed to provide access and help people living in rural areas where they can’t easily just get up and go visit their doctor or a specialist. Maybe telemonitoring is not as important in Rochester [Minnesota, where the study took place] or other urban areas, where patients have easy access to their doctors. So maybe we need to look at different populations than the one we studied. Maybe the sickest population is not the right population. Maybe it’s those not quite as ill for whom you can make changes in treatments that will make a real difference.“Telemonitoring will become a bigger part of medicine because the technology continues to grow, but the question is when is the appropriate time to use it. You want to make sure the time you’re investing in something is really helping. We do a lot in medicine because we think it is the right thing to do, but it might not be.”
A Kaiser Permanente study found this:Providers and health system leaders most frequently associated value with “traditional” metrics of clinical structure, process, and health outcomes.Patients identified aspects of the care experience, such as convenience, respectful providers, and trusting relationships with their clinicians, as most critical for them in terms of engagement and as meaningful attributes of valuePayers, including public payers, private health plans, and major employers, identified financial metrics - especially affordability plus return on their health-associated investments - as their leading indicators of value. No payer suggestedreducing costs by relaxing clinical quality standards. Rather, cost impact was generally identified as attainable through improved efficiency and reduction of waste. Each stakeholder’s perspective recognized and granted importance to the elements valued by other stakeholder perspectives, albeit with lower priority.Each stakeholder assigned prime “value” to substantially different metrics. Each stakeholder perspective did “get quality,” but in its own manner.
What’s missing in health care research and innovation?Collaboration across the health care ecosystemAvailability of high quality, high volume data sourcesOpportunity to prototype and test new findingsVehicles for widespread adoption of new knowledgeOptum Labs: A seat at the tableAn open, collaborative center for research and innovation for healthcare stakeholders interested in improving patient care.Established by Optum and Mayo Clinic,January 2013, in Cambridge MA.All projects must be primarily to improve patient care, lower the cost of improved care, and be transparent to the entire collaborative.
