The Study of Effectiveness of a Remote Patient Monitoring Program for Heart Failure Patients

摘要

This research uses a Markov chain model to study Remote Patient Monitoring (RPM) program integrated into the heart failure disease care process. The model presents eight health states of a heart failure patient in the disease management process. These states are home/Post-Acute Care (PAC), doctor visit, Urgent Care (UC) visits, transfer from other health facility, Emergency Room (ER) visit, hospitalization, 30-day readmission, and death. The transition probabilities are obtained through a review of retrospective data for Massachusetts General Hospital (MGH) patients enrolled in the Connected Cardiac Care Program (CCCP) and their matched control patients. During the first month of the intervention, RPM decreased patient's transition probability to all states except for doctor visit and home/PAC compared to a control patient. During the four months of intervention and post intervention, an RPM patient had lower probability to be in the home/PAC and death states compared to that of a control patient, yet an RPM patient had an increased probability of visiting the doctor office, being hospitalized, and readmitted within a 30-day of a previous hospitalization event. This research indicates an RPM program's positive impact on managing the heart failure disease. However, further research is required to reach the optimal RPM process design.