Impact of a home-based remote patient monitoring system: a multicenter retrospective observational study in older adults with polypathology (Preprint)

Abstract

BACKGROUND Every year, in France, 40% of people aged 80 and older are hospitalized, with an average length of hospital stay of 25 days and a readmission rate of 14 to 30% within the month following discharge. This situation is putting pressure on the healthcare system, encouraging the reinforcement of home care to reduce avoidable hospitalization. EPOCA remote patient monitoring (RPM) system is a medical and social telehealth solution, specialized in remote patient monitoring, teleconsultation, tele-expertise and care coordination in emergency medicine and geriatrics. The platform provides long-term medical support at home (MSAH) with 24/7 telemonitoring of polypathological older adults. We hypothesized that entering the EPOCA RPM system long-term MSAH would be associated with a reduction of the rates and durations of hospitalizations or emergency department (ED) visits in older polypathological adults. OBJECTIVE We aimed to compare the hospitalization and ED visits rates as well as the cumulated hospital stay duration before and after entering the EPOCA RPM system long-term MSAH globally and per participant. Then two subgroups of participants according to the severity of their disability were analyzed. METHODS This retrospective observational study included polypathological (>2 affected systems) older (≥ 70 years) adults followed into two different types of long-term MSAH between February 2022 and October 2023. We compared the number of hospital admissions, including ED visits, the cumulated duration of hospital stays during the follow-up, and the average length of hospital stays between the period corresponding to the MSAH program (Y) compared to the year before entering the program (Y-1). Subgroup analysis were performed according to the severity of participant’s disability. RESULTS One hundred and twenty participants were included in MSAH, with a mean age of 86.8 years. Hospitalization and ED visits rate decreased (-48%) between Y-1 and Y periods as well as the total duration of hospital stays (-63%). A significant reduction of hospitalization number (from 1.3 to 0.7 per patient per year, P<.001) and ED visits (from 1.4 to 0.7 per patient per year, P<.001) was observed between Y-1 and Y follow-up periods. It corresponds to a significant reduction of 17 days spent at hospital per patient per year (P<.001). The decrease in hospitalization and ED visit rates and numbers was greater in participants with severe disabilities compared to those with no or moderate disabilities. CONCLUSIONS Among polypathological older adults, EPOCA RPM system is associated with reduction of hospitalization number, ED visits and duration of hospital stays. Facing the challenge of population aging, home telemonitoring embedded in the healthcare system offers potential benefits.