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Meta-Analysis Shows Telehealth Reduces Chronic Condition Costs, Mortality

The use of telemedicine to help manage chronic diseases such as congestive heart failure, stroke, and chronic obstructive pulmonary disease can yield clear benefits including fewer and shorter hospital stays, fewer emergency room visits, less severe illness, and even fewer deaths.

That’s the conclusion of a study published in Telemedicine and e-Health. The authors of the multi-institution study said their findings were based on a systematic review of the professional literature published from 2000 to early 2014, selected on the basis of scientific merit. Of the studies that met the minimum criteria for inclusion, 19 dealt with CHF, 21 with stroke, and 17 with COPD. An additional set of 14 studies investigated cost.

Key findings included:

*Among CHF patients, telemonitoring was significantly associated with reductions in mortality ranging from 15 to 56 percent compared with patients undergoing “usual” care. In only one study was mortality higher among the telemonitoring group. However, this exception may be accounted for by the fact that the study population was composed of a very elderly and severely sick patient population and other methodological issues.

*The various modalities of telestroke (except for a telephone-only intervention with poor sensitivity compared with video), have been demonstrated to reduce mortality in the range of 25 percent during the first year after the event.

*The majority of studies of telemonitoring for all three chronic diseases reported lower hospital admissions and re-admissions, length of stay, and emergency department visits. There were notable exceptions, but in those instances the effects of telemonitoring were neutral. One study found telepulmonology to result in cost shifting in the outpatient setting (i.e., a decrease in demand for pulmonologists and an increase in demand for nurses).

*The economic effects of telemonitoring have been measured or examined in two ways: (1) changes in rates or volumes of hospital admissions, re-admissions, length of stay, and/or emergency department visits and (2) cost-benefit analysis and cost-effectiveness analysis of telemonitoring in terms of specified outcomes. In both instances and with few exceptions, the evidence supports the economic benefits of telemonitoring compared with usual care among patients with CHF, stroke, and COPD.

"Despite some inconsistencies in methodologies, the preponderance of the evidence produced by telemonitoring studies points to significant trends in reducing hospitalization and emergency department visits and preventing and/or limiting illness severity and episodes, resulting in improved health outcomes," the authors concluded.

The study is available here.

SEP 22, 2014
7:33am ET