Telemedicine Based Remote Home Monitoring After Liver Transplantation: Results of a Randomized Prospective Trial
Shimul A. Shah*, Tiffany Kaiser*, Tiffany C. Lee*, Rita Alloway*, E. Steve Woodle, Michael J. Edwards
University of Cincinnati, Cincinnati, OH
OBJECTIVE(S): We aimed to optimize postoperative care of patients after orthotopic liver transplantation (OLT) with the use of information technology. To quantify the impact of this practice change, we conducted the first randomized controlled trial (RCT) of telemedicine with continuous, dynamic, remote home monitoring compared to the current standard of care (SOC).
METHODS: 106 consecutive OLT recipients were randomized (1:1) to one of two post-transplant care strategies: traditional (SOC) or telemedicine. Telemedicine remote home monitoring used an electronic tablet and bluetooth devices to support daily text messages, education videos, and video FaceTimeŽ capability; data was cyber-delivered into our electronic medical record daily. Endpoints were participation and adherence, 90-day readmission rate, and perception of QOL. RESULTS: 100 patients completed the study with 50 in each arm. Participation and adherence with telemedicine was 86% for basic health sessions (vital sign recording) but only 45% for using messaging or FaceTime. There was a profound reduction in 90-day readmission rates with telemedicine compared to SOC (28% vs 58%; p=0.004). The biggest impact occurred between days 31-90 with only 4% readmissions with telemedicine compared to 22% with SOC. The telemedicine cohort also showed improved QOL in regards to physical function (p=0.02) and general health (p=0.05) at 90 days.
CONCLUSIONS: To our knowledge, this is the first RCT demonstrating the impact of telemedicine based remote home monitoring after major surgery. The magnitude of effect on OLT outcomes, readmissions, QOL and health care utilization suggests that the adoption of telemedicine has great potential for other major operations.
* By Invitation
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