Effects of Remote Patient Monitoring Use on Care Outcomes Among Medicare Patients With Hypertension: An Observational Study
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Visual Abstract. Effects of Remote Patient Monitoring Use on Care Outcomes Among Medicare Patients With Hypertension
Remote patient monitoring (RPM) is used with increasing frequency for chronic conditions, particularly hypertension. This study uses Medicare data to emulate a cluster randomized trial on the use of RPM for hypertension care at the practice level, with focus on hypertension medication use, outpatient visit use, testing and imaging use, hypertension-related acute care use, and total hypertension-related spending.
Abstract
Background:
Remote patient monitoring (RPM) is a promising tool for improving chronic disease management. Use of RPM for hypertension monitoring is growing rapidly, raising concerns about increased spending. However, the effects of RPM are still unclear.
Objective:
To estimate RPM’s effect on hypertension care and spending.
Design:
Matched observational study emulating a longitudinal, cluster randomized trial. After matching, effect estimates were derived from a regression analysis comparing changes in outcomes from 2019 to 2021 for patients with hypertension at high-RPM practices versus those at matched control practices with little RPM use.
Setting:
Traditional Medicare.
Patients:
Patients with hypertension.
Intervention:
Receipt of care at a high-RPM practice.
Measurements:
Primary outcomes included hypertension medication use (medication fills, adherence, and unique medications received), outpatient visit use, testing and imaging use, hypertension-related acute care use, and total hypertension-related spending.
Results:
192 high-RPM practices (with 19 978 patients with hypertension) were matched to 942 low-RPM control practices (with 95 029 patients with hypertension). Compared with patients with hypertension at matched low-RPM practices, patients with hypertension at high-RPM practices had a 3.3% (95% CI, 1.9% to 4.8%) relative increase in hypertension medication fills, a 1.6% (CI, 0.7% to 2.5%) increase in days’ supply, and a 1.3% (CI, 0.2% to 2.4%) increase in unique medications received. Patients at high-RPM practices also had fewer hypertension-related acute care encounters (−9.3% [CI, −20.6% to 2.1%]) and reduced testing use (−5.9% [CI, −11.9% to 0.0%]). However, these patients also saw increases in primary care physician outpatient visits (7.2% [CI, −0.1% to 14.6%]) and a $274 [CI, $165 to $384]) increase in total hypertension-related spending.
Limitation:
Lacked blood pressure data; residual confounding.
Conclusion:
Patients in high-RPM practices had improved hypertension care outcomes but increased spending.
Primary Funding Source:
National Institute of Neurological Disorders and Stroke.
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Information & Authors
Information
Published In
Annals of Internal Medicine
Volume 176 • Number 11 • November 2023
Pages: 1465 - 1475
History
Published online: 7 November 2023
Published in issue: November 2023
Keywords
Copyright
© 2023 American College of Physicians.
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Effects of Remote Patient Monitoring Use on Care Outcomes Among Medicare Patients With Hypertension: An Observational Study. Ann Intern Med.2023;176:1465-1475. [Epub 7 November 2023]. doi:10.7326/M23-1182
Effects of Remote Patient Monitoring Use on Care Outcomes Among Medicare Patients With Hypertension: An Observational Study. Ann Intern Med.2023;176:1465-1475. [Epub 7 November 2023]. doi:10.7326/M23-1182
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