Remote monitoring does not beat usual care for sepsis patients
· News-MedicalRemote monitoring isn't a panacea for reducing readmissions across all conditions - and for some patients, clinicians should proceed with caution, clinical trial results published today in JAMA Network Open suggest. The findings were simultaneously presented at the Critical Care Reviews annual meeting in Belfast by physicians and scientists from the University of Pittsburgh and UPMC Health Plan.
Sepsis and lower respiratory tract infections are a leading cause of hospital readmissions. The trial – the largest of its kind – tested four remote monitoring approaches against UPMC's usual post-discharge care and found that none of them outperformed usual care in reducing readmissions in these patients. The findings indicate that health systems should reevaluate implementation of remote monitoring for these patients and encourage technology companies to develop and test systems better tailored to complex care needs.
Remote monitoring - from smartphone-based questionnaires to internet-connected scales and blood pressure monitors - allows patients to leave the hospital while clinicians track their health from a distance and intervene to act on alerts and deliver timely care. The ACCOMPLISH (Comparative Effectiveness of Readmission Reduction Interventions for Individuals with Sepsis or Pneumonia) trial tested four care models, and the results highlight the importance of studying care models implemented in real-world conditions to optimize outcomes.
Sachin Yende, M.D., M.S., lead author, professor of critical care medicine, Pitt's School of MedicineHealth systems, insurers and policymakers all want to reduce hospital readmissions, and most patients prefer to recover safely at home. Remote monitoring has been held up as a solution, is reimbursed by the Centers of Medicare & Medicaid and its use has grown. But, aside from a few conditions, there's a dearth of high-quality data to show it reduces readmissions."
Sepsis occurs when the body has an extreme response to an infection that can damage organs. Lower respiratory tract infections can cause severe breathing difficulties. Both tend to require hospitalization with intensive treatment. If the patient survives and is discharged from the hospital, they may still have lingering complications for several months, making them particularly vulnerable to hospital readmission.
Yende partnered with Kristin Mayes, M.S., program administrator at UPMC Health Plan's Center for High-Value Health Care, to explore the effectiveness of remote monitoring in patients discharged home after serious infection.
Between March 2021 and December 2024, the trial enrolled 1,286 adults who had been discharged after hospitalization with sepsis or lower respiratory tract infection. They were randomized to one of four remote monitoring interventions or usual care. Usual care typically involved a post-discharge phone call from a nurse and continued management with a primary care physician. Younger patients appeared to benefit slightly from remote monitoring, but readmissions were paradoxically higher among older patients, a surprising finding that Yende said warrants further investigation.
The four interventions combined short or long health questionnaires with standard or enhanced clinical response, each of which followed federal Centers for Medicare & Medicaid Services guidelines. The standard response team consisted of nurses who responded to alerts flagged by the questionnaires and then coordinated care with the patients' primary and specialty clinicians. The enhanced response team added certified registered nurse practitioners with palliative care expertise who could coordinate many aspects of care response themselves and had access to social workers.
The goal was to safely keep patients out of the hospital in the 90 days after discharge. While the rate of readmissions ranged from 36.3% among the patients who received the long questionnaire with enhanced clinical response to 44.2% in those who received the long questionnaire with standard clinical response, the difference did not reach statistical significance. The control arm that received usual care had a 37.8% readmission rate.
"This complex trial was possible because UPMC is both a health care provider and insurer. This allows us – with patient and member permission – to deploy interventions even after the patient is discharged from the hospital and seamlessly learn from their experiences over time to see if those interventions worked," Mayes said. "And, while the trial didn't tell us that one remote monitoring approach was superior, it did yield valuable information to better use our resources and make future programs and technology more responsive to patient preferences."
Dr. Yende was particularly struck by UPMC's evidence-based usual care post-discharge follow-up support and the quality of care delivered by UPMC's primary care physicians. Their personalized approach, he noted, could serve as a valuable blueprint for other health systems looking to design care models that reduce readmissions - and may help explain why, as currently designed, remote monitoring offered little incremental benefit over usual care alone.
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