The document discusses a study on remote monitoring of patients with rheumatoid arthritis (RA) in London, UK, conducted across six hospitals. The study evaluated a remote monitoring service capturing monthly Rheumatoid Arthritis Impact of Disease scores and patient-generated text messages for RA patients in remission or with low disease activity.
The document discusses a study on remote monitoring of patients with rheumatoid arthritis (RA) in London, UK, conducted across six hospitals. The study evaluated a remote monitoring service capturing monthly Rheumatoid Arthritis Impact of Disease scores and patient-generated text messages for RA patients in remission or with low disease activity. The study used a mixed methods approach with active patient involvement, exploring patient and staff experiences and implementation outcomes. Results showed high patient engagement with the service, with patients finding it easy to use and improving access to care. Staff views were more mixed, highlighting implementation barriers specific to some sites. There was some concern over technical abilities of patients and clinical staff to use the technology. Similar to the first article, there were issues identified by clinical staff surrounding the project management and leadership of the role out of this.The study emphasises the importance of equal levels of patient and staff engagement for sustainability of remote monitoring interventions for patients with RA in routine care settings. The study aims to address implementation challenges in scaling remote monitoring technologies for RA patients and improving clinical management. The study does have some limitations including deviations from the early protocol, less exploration of service outcomes, and feasibility analysis. It was not a controlled evaluation, so definitive conclusions about the relationship between observed outcomes and the remote monitoring service could not be drawn. Engaging with staff at roll-out hospitals proved challenging, limiting detailed understanding beyond the pilot hospital. The study was also conducted during a time significantly impacted by COVID-19, which may have affected the transferability of the findings to a non-COVID-19 context.
The paper discusses various studies and reviews related to Hospital at Home (HaH) services, focusing on patient and caregiver perceptions, experiences, and satisfaction with receiving acute hospital-level care at home.
The paper discusses various studies and reviews related to Hospital at Home (HaH) services, focusing on patient and caregiver perceptions, experiences, and satisfaction with receiving acute hospital-level care at home. The findings highlight the positive experiences of patients and caregivers with HaH services, as well as the barriers and concerns they face in adopting these services. The importance of patient-centred care, communication, and system factors in shaping perceptions of HaH services is emphasised, along with recommendations for improving quality and implementation. Hospital at Home (HaH) services have been positively perceived by patients and caregivers. Patients appreciate the comfort, convenience, and safety of receiving care at home, along with the maintenance of usual activities and shorter recovery times. Caregivers value their involvement in the care process. While there are concerns about privacy and having strangers in the home, overall, HaH programs have been found to reduce hospital length of stay, readmissions, and costs without adverse outcomes for patients. Patients and caregivers prefer HaH services and feel safe and satisfied with the care received. To improve HaH services, it is recommended to focus on patient-centred care, continuity of care, multidisciplinary teams, and effective communication. The inclusion of various studies and the focus on patient and caregiver experiences with HaH services add depth to the discussion. Whilst the paper touches on barriers and concerns related to HaH services, such as privacy issues and caregiver stress, a more in-depth exploration of these challenges and potential solutions could enhance the practical implications of the findings. Additionally, the paper could provide more specific recommendations for clinicians and healthcare organisations looking to implement or improve HaH services based on the identified barriers and enablers.
This article focuses on the hospital at home scheme in the US.
This article focuses on the hospital at home scheme in the US. Whilst this is a step further than the virtual ward, it provides an interesting perspective of a hospital setting up a hospital at home service and deciding that they needed to use an outside contractor to provide the remote monitoring element. As seen in other articles, there was an initial concern and distrust amongst clinical staff in about this change. The article gives a superficial overview of the challenges that they faced and how they met them. Nevertheless, it provides a good summary of how a hospital at home was introduced into a hospital that had never used this concept before. For a further discussion of a hospital at home service being implemented in the US and the legislation they have to meet - see Cole MD, Patil NT, Tribout JA, Fitzpatrick JJ. A hospital-at-home care model innovation: An exploratory study. Nurs Manage. 2024 Feb 1;55(2):16-24. For an in depth UK perspective, see Chen H, Ignatowicz A, Skrybant M, Lasserson D. An integrated understanding of the impact of hospital at home: a mixed-methods study to articulate and test a programme theory. BMC Health Serv Res. 2024 Feb 2;24(1):163.
This study evaluates the impact of a digital respiratory ward in Leicester, Leicestershire, and Rutland, England, on patients with COVID-19, economic evaluation of the impact on acute capacity, and wider NHS resource use.
This study evaluates the impact of a digital respiratory ward in Leicester, Leicestershire, and Rutland, England, on patients with COVID-19, economic evaluation of the impact on acute capacity, and wider NHS resource use. The study aims to assess if the digital ward achieves its primary goal of freeing up beds and reducing overall NHS resource use. The digital ward provides early patient discharge, with respiratory specialists supporting them remotely using digital patient monitoring systems. Patients were either discharged home early and supported digitally (10% of patients) or required additional support to recover (90% of patients). The study includes all 310 patients enrolled in the service from November 2020 to November 2021. The results show that the digital ward achieved increased capacity and substantial financial savings in both patients on oxygen and patients not on oxygen, with savings of US $504,197 in net financial savings. The mean gross and net savings per patient were US $1850 and US $1626, respectively. The study concludes that the digital ward delivered significant benefits, with high confidence, at a very low absolute and relative cost. The findings indicate that digital respiratory wards could have implications for future pandemics and how health systems allocate resources more efficiently to recover from the pandemic.
The lack of data on ethnicity, comorbidities, and socioeconomic status of the patients makes it difficult to generalise the results to wider settings. The study also acknowledged some degree of uncertainty around the savings estimated, which may affect the reliability of the findings.
This study examined the effectiveness and economic sustainability of virtual ward care in a medium-sized hospital in the UK.
This study examined the effectiveness and economic sustainability of virtual ward care in a medium-sized hospital in the UK. It is the largest study of virtual wards in terms of patient numbers in the UK, providing valuable insights into their effectiveness and cost implications. The research compared the length of stay, survival outcomes, readmission rates, and costs between hospital patients and virtual ward patients. The findings indicate that virtual ward patients had a shorter stay in the hospital before being transferred to the virtual ward. Factors such as chronic kidney disease and frailty were associated with longer hospital stays. The study also highlighted the cost implications, with the cost of a day saved by a virtual ward being higher than the cost of a single-day hospital bed. Virtual wards were found to be clinically effective in terms of patient survival, but careful management and policies are required to ensure their economic sustainability and cost-effectiveness in the healthcare system. Virtual ward care requires patients to have some self-care ability, and compromised self-care ability may impact the effectiveness of virtual ward care. Clinicians should consider patient characteristics, including comorbidities like chronic kidney disease and frailty, when determining the suitability of virtual ward care for patients. It found that to be cost-effective, the virtual ward would need to double its throughput without altering the standard of care or type of patients cared for. At that level, the service would be cost-effective but would still not provide a saving on traditional inpatient care. Virtual ward care has more readmissions and looks after patients with fewer comorbidities. To save on traditional care, it would need to aspire to triple throughput. Without further efficiency in the virtual ward provision, it remains a clinically effective way to care for patients but not a cost-effective or efficient way to care for patients. The study has several limitations that should be considered. These include a relatively small sample size and potential selection bias due to manual matching. The accuracy of cost estimates and generalizability of cost findings may also be limited due to variations in staffing levels and assumptions in cost calculations.
The document discusses the paradoxes of telehealth platforms and the lessons learned from their use during the COVID-19 pandemic.
The document discusses the paradoxes of telehealth platforms and the lessons learned from their use during the COVID-19 pandemic. The authors conducted an evaluative study on a program called "Techno-Covid Partnership" implemented at the University of Montreal Hospital Center in Canada. Three telehealth platforms were developed, implemented, and evaluated in real-time within the framework of this program. The study highlights seven paradoxes related to the use of telehealth platforms, such as balancing the delivery of care with the quality of care, promoting accessibility while maintaining human contact, and enhancing or diminishing patient-centred care. The study also emphasises the importance of patient engagement, accessibility, proximity, safety, and quality in the continuum of care provided via telehealth platforms. While most users reported positive experiences with telehealth, some challenges related to communication quality, technological barriers, and the virtual nature of interactions were also identified. Some users have said the virtual nature can feel cold, but younger patients felt that it gave them more autonomy and freedom. The study concludes with a critical reflection on these paradoxes and calls for further consideration of their implications in healthcare delivery. Overall, the research offers valuable insights for clinicians on the complexities and challenges associated with telehealth platforms, advocating for a multidisciplinary approach to maximise the benefits of these technologies while addressing potential limitations and ethical considerations.
The article explores the problems and opportunities of a Smartphone-Based Care Management Platform in healthcare, specifically focusing on patients' perceptions in a pilot centre.
The article explores the problems and opportunities of a Smartphone-Based Care Management Platform in healthcare, specifically focusing on patients' perceptions in a pilot centre. The study aims to provide personalised surgical experiences to qualified patients undergoing robotic knee arthroplasty, analysing the outcomes and functionalities of the platform. The research highlights the potential impact of such platforms on surgical experiences by increasing patient engagement, facilitating remote monitoring, and providing personalised care. Key findings include patient appreciation for the app's features but also limitations in its use and perception. Strategies to improve patient recruitment, enhance adherence, and create a comprehensive patient journey for optimised surgical experiences are discussed. The use of mobile apps, wearables, and advanced artificial intelligence systems, such as WalkAI in myMobility, is emphasised for improving postoperative patient management. Overall, the document underscores the importance of technology in enhancing orthopaedic surgery outcomes and post-operative rehabilitation, emphasising the need for continuous monitoring and support during the healing journey. There are some limitations to the paper, but none that hampers its reliability.
This systematic review discusses the impact of remote monitoring on heart failure patients, focusing on reducing mortality, hospitalisations, and improving quality of life.
This systematic review discusses the impact of remote monitoring on heart failure patients, focusing on reducing mortality, hospitalisations, and improving quality of life. Various studies and trials are referenced, showing that telemonitoring strategies can effectively reduce all-cause mortality and rehospitalisations in heart failure patients. However, there is significant heterogeneity in the results, indicating a need for further research to standardise telemonitoring strategies. The findings consistently showed that telemonitoring interventions were effective in reducing mortality, hospital readmissions, and improving outcomes in heart failure patients. The studies highlighted the benefits of telemonitoring in enhancing patient support, improving prognosis, and reducing healthcare utilisation. While there was some variability in the results, overall, telemonitoring was found to be beneficial in improving patient outcomes and reducing healthcare costs in individuals with heart failure. Further research is recommended to standardise telemonitoring strategies for optimal effectiveness. Furthermore, while the article emphasises the positive impact of telemonitoring on heart failure patients, it does not address potential challenges or barriers to implementing telemonitoring interventions in clinical practice. Understanding the practical implications and feasibility of telemonitoring in real-world settings is crucial for clinicians considering adopting these interventions. Overall, while the article provides valuable insights into the effectiveness of telemonitoring in heart failure patients, a more detailed discussion on methodology, limitations, and practical considerations would enhance the review.
This article provides a practical guide on remote management in patients with heart failure, covering new onset to advanced stages. It discusses the benefits, limitations, and evidence gaps of remote monitoring technologies.
This article provides a practical guide on remote management in patients with heart failure, covering new onset to advanced stages. It discusses the benefits, limitations, and evidence gaps of remote monitoring technologies. Recommendations are outlined for using remote monitoring in various heart failure situations, including discovery, acute decompensation, stable periods, and advanced stages. Key aspects include monitoring essential variables like weight, symptoms, and blood chemistry, as well as the importance of compliance with remote monitoring devices. The article emphasises the potential benefits of remote monitoring in optimising medical therapy, preventing hospitalisations, improving outcomes, and enhancing patient education. It also highlights the need for further research to support the use of remote monitoring in heart failure management. The recommendations are supported by evidence from studies on remote monitoring, exercise-based rehabilitation, and patient education programs.
This paper discusses the use of machine learning algorithms
This paper discusses the use of machine learning algorithms and digital health technologies for blood glucose prediction and management in gestational diabetes. It highlights the various models and approaches used, such as deep learning frameworks and convolutional neural networks, as well as the challenges and future directions in this field. It emphasises the potential benefits of AI in improving clinical outcomes for women with gestational diabetes. The study also emphasises the importance of affordable and clinically interpretable machine learning methods for effective glucose monitoring in pregnant women. This is an in depth study of what technology is out there, including a review of what has been licenced by NICE and is in use in 47% of NHS Trusts. Its strength is in looking at the development of technology and how this can affect future monitoring of diseases.
The study analyzes the Health Call app in 118 UK care homes (2018-2021), showing it reduced emergency visits by 11%, admissions by 25%, and stay length by 11%, saving £57 to £113 per resident. Despite lacking data on resident movements and excluding comorbidities and home characteristics, the findings underscore digital technology's potential to cut costs and enhance care by minimizing unplanned hospital usage.
The study explores the impact of digital technology, specifically the Health Call app, in care homes on reducing unplanned secondary care usage and associated costs.
A retrospective analysis was conducted on data from 118 care homes in the North East of the UK from 2018 to 2021, linking Health Call data with NHS secondary care data. The study found that Health Call reduced emergency attendances by 11%, emergency admissions by 25%, and length of stay by 11%. This reduction led to a cost saving of £57 per resident in 2018, increasing to £113 in 2021.
The study highlights the potential benefits of digital technology in providing timely access to clinical advice, reducing hospital visits and costs, and improving care for residents in care homes. The analysis employed statistical modelling to assess the impact of Health Call, with results showing significant reductions in unplanned secondary care usage and associated costs.
A major strength of the study is that they found significant reductions in emergency attendances, emergency admissions, and length of stay due to Health Call, leading to substantial cost savings per resident.Weaknesses of the paper include limitations such as the lack of timestamp data for resident movements into long-term care, leading to changing cohort sizes and class imbalances between Health Call and non-Health Call residents.
Additionally, the model did not include resident comorbidities, home characteristics, or other potential confounding variables, which could have provided a more comprehensive analysis.
The study investigates the BP@home initiative in London, highlighting primary care's challenges like inadequate IT and resources, and facilitators like integration into health records and person-centred care. It emphasizes the need for more support and training for healthcare professionals to implement remote hypertension management effectively, based on interviews with 20 professionals. The document suggests further research on broader perspectives and patient experiences with remote monitoring.
The document focuses on investigating barriers and facilitators for the successful implementation of the BP@home initiative in London from primary care perspectives. The study highlights the challenges faced by healthcare professionals in terms of inadequate IT, human resources, and financial support, leading to equity concerns among respondents.
However, several facilitators were identified, such as integrating the initiative into electronic health records, providing blood pressure monitors on prescription, and adopting a person-centred care approach. The BP@home program aimed to address the impact of the COVID-19 pandemic on healthcare services, specifically in managing hypertension remotely.
The document emphasises the importance of additional resources, training, and capacity building to support healthcare professionals in successfully implementing such programs. Future studies are recommended to explore perspectives from different regions of the UK and patient experiences with remote monitoring of blood pressure.
Overall, the findings support evidence-based recommendations to streamline the implementation of remote monitoring initiatives in primary care settings. The document appears to be well-researched based on the methodology described. The study involved conducting semi-structured focus groups and interviews with 20 healthcare professionals from various levels in the BP@home initiative in London. The respondents included GPs, nurses, clinical leads, and pharmacists from different Integrated Care Systems, providing a diverse range of perspectives.
