Effects of Remote Patient Monitoring on Healthcare Utilization in Patients with Non-Communicable Diseases: A Systematic Review (Preprint)

Abstract

BACKGROUND Management of non-communicable diseases (NCDs) is an increasing challenge for healthcare systems. Remote patient monitoring presents a promising solution by utilizing technology to monitor patients outside clinical settings. There is a lack of knowledge about the effect on resource utilization. OBJECTIVE This systematic review aimed to review the effects of remote patient monitoring on healthcare resource utilization in patients with NCDs. METHODS Eligible randomized controlled trials (RCTs) involved a digital transmission of health data from patients to healthcare personnel. Outcomes included hospitalizations, length of stay, outpatient visits, and emergency service use. A systematic literature search was performed in Medline, Embase and Cochrane Central Register of Controlled Trials, June 2024. Titles and abstract and full texts were screened individually by two authors. Risk of bias was assessed and predetermined data was extracted, analysed, and pooled in meta-analysis when possible. Confidence in the estimates was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. RESULTS We included 40 RCTs published between 2017 and 2024. The largest group of NCDs was cardiovascular disease (16 studies). We found low certainty evidence for a lower proportion of hospitalizations among patients with remote patient monitoring (RR: 0.86, 95% confidence interval (CI): 0.77 to 0.95) compared to usual care. Compared to usual care, remote patient monitoring had 0.13 fewer hospitalizations (95% CI: 0.29 fewer to 0.03 more, low certainty). Hospital length of stay is possibly shorter among patients with remote patient monitoring compared to usual care (MD: -0.81 days, 95% CI: -1.58 to -0.05 days, low certainty). The proportion of outpatient visits was probably close to equal between remote patient monitoring and usual care (RR: 0.94, 95% CI: 0.87 to 1.02; moderate certainty). Compared to usual care, remote patient monitoring had 0.41 more outpatient visits, but the CI was wide (95% CI: -0.22 to 1.03, low certainty). The results indicate a small or zero difference between remote patient monitoring and usual care on proportion of emergency visits (RR: 0.91, 95% CI: 0.79 to 1.05; low certainty). We have very low certainty in the evidence for number of emergency visits. CONCLUSIONS This systematic review showed that remote patient monitoring possibly led to lower proportions of patients being hospitalized, fewer hospitalizations, and shorter hospital length of stay compared to usual care. Remote patient monitoring had possibly more outpatient visits compared to usual care. The proportion of patients with outpatient visits was probably similar, and the proportion with emergency visits was also possibly similar. Finally, we had very low certainty in the number of emergency visits. The results should be considered with caution as the confidence of evidence was of moderate to very low certainty. We did not find results about institutional stay. CLINICALTRIAL PROSPERO (CRD42023431366). https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=431366