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CC BY-NC-ND 4.0 · Appl Clin Inform 2023; 14(03): 428-438
DOI: 10.1055/a-2057-7277
Research Article

Prospective Cohort Study of Remote Patient Monitoring with and without Care Coordination for Hypertension in Primary Care

Stephen D. Persell
1   Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
2   Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
,
Lucia C. Petito
3   Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
,
Lauren Anthony
4   Department of Quality and Patient Safety, Northwestern Medical Group, Northwestern Memorial Healthcare, Chicago, Illinois, United States
,
Yaw Peprah
1   Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
,
Ji Young Lee
1   Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
,
Tara Campanella
5   Department of Ambulatory Care Coordination, Northwestern Memorial Healthcare, Chicago, Illinois, United States
,
Jill Campbell
5   Department of Ambulatory Care Coordination, Northwestern Memorial Healthcare, Chicago, Illinois, United States
,
Kelly Pigott
5   Department of Ambulatory Care Coordination, Northwestern Memorial Healthcare, Chicago, Illinois, United States
,
Jasmina Kadric
5   Department of Ambulatory Care Coordination, Northwestern Memorial Healthcare, Chicago, Illinois, United States
,
Charles J. Duax
6   Downshift Consulting, Chicago, Illinois, United States
,
Jim Li
7   Department of Global Medical Affairs, Omron Healthcare Co. Ltd, Kyoto, Japan
,
Hironori Sato
8   Product Innovation Department, Technology Development HQ, Omron Healthcare Co. Ltd, Kyoto, Japan
› Author Affiliations Funding This work was funded by the Omron Healthcare Co. Ltd paid to the Northwestern University. REDCap is supported at the Feinberg School of Medicine by the Northwestern University Clinical and Translational Science (NUCATS) Institute. Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422.
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Abstract

Background Out-of-office blood pressure (BP) measurements contribute valuable information for guiding clinical management of hypertension. Measurements from home devices can be directly transmitted to patients' electronic health record for use in remote monitoring programs.

Objective This study aimed to compare in primary care practice care coordinator-assisted implementation of remote patient monitoring (RPM) for hypertension to RPM implementation alone and to usual care.

Methods This was a pragmatic observational cohort study. Patients aged 65 to 85 years with Medicare insurance from two populations were included: those with uncontrolled hypertension and a general hypertension group seeing primary care physicians (PCPs) within one health system. Exposures were clinic-level availability of RPM plus care coordination, RPM alone, or usual care. At two clinics (13 PCPs), nurse care coordinators with PCP approval offered RPM to patients with uncontrolled office BP and assisted with initiation. At two clinics (39 PCPs), RPM was at PCPs' discretion. Twenty clinics continued usual care. Main measures were controlling high BP (<140/90 mm Hg), last office systolic blood pressure (SBP), and proportion with antihypertensive medication intensification.

Results Among the Medicare cohorts with uncontrolled hypertension, 16.7% (39/234) of patients from the care coordination clinics were prescribed RPM versus <1% (4/600) at noncare coordination sites. RPM-enrolled care coordination group patients had higher baseline SBP than the noncare coordination group (148.8 vs. 140.0 mm Hg). After 6 months, in the uncontrolled hypertension cohorts the prevalences of controlling high BP were 32.5% (RPM with care coordination), 30.7 % (RPM alone), and 27.1% (usual care); multivariable adjusted odds ratios (95% confidence interval) were 1.63 (1.12–2.39; p = 0.011) and 1.29 (0.98–1.69; p = 0.068) compared with usual care, respectively.

Conclusion Care coordination facilitated RPM enrollment among poorly controlled hypertension patients and may improve hypertension control in primary care among Medicare patients.

Keywords

remote physiological monitoring - remote patient monitoring - primary care - hypertension - telemedicine

Note

These findings of this stdy were presented in part and in abstract form at the American College of Cardiology (ACC.22) National Meeting in Washington, DC, on April 2, 2022,


Protection of Human and Animal Subjects

This study was approved by the Northwestern University Institutional Review Board. All data used were obtained in the course of routine medical care with a waiver of informed consent.


Registration

This study is registered with ClinicalTrials.gov (identifier: NCT04764318).


Role of the Funder

The Northwestern University investigators were solely responsible for the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation and approval of the manuscript; and decision to submit the manuscript for publication. All analyses were conducted by the Northwestern University employees. Employees from Omron Healthcare Co. Ltd participated and provided input into study meetings and reviewed the manuscript. The Northwestern University investigators retained the right to publish and what content to publish independent of the funder.


Supplementary Material



Publication History

Received: 12 November 2022

Accepted: 11 February 2023

Accepted Manuscript online:
18 March 2023

Article published online:
31 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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