February 2020
Telehealth News:
Research & News Recap
Interest in remote patient monitoring (RPM) and its positive impact continues to grow as providers see the benefits of adding telehealth to their workflow. This has led to increased and extensive research on telehealth as well as changes to government policies. Explore recent research on the efficacy of telehealth in HRS’ February 2020 Research & News Recap.
Part I. Research Findings - Remote Patient Monitoring and Telehealth
In this section, four studies conducted within the last year on various RPM and telehealth topics are analyzed. Real quantitative and qualitative data from telehealth patients were collected, studied, and conclusions were drawn in the studies included below. The results point to the positive impacts of RPM on healthcare and the growth potential of telehealth.
Article 1
Telehealth Interventions to Improve Obstetric and Gynecologic Health Outcomes
What was studied?
This literature review of 47 studies aimed to establish whether telehealth and remote patient monitoring (RPM) improved patient outcomes in obstetrics, family planning, and gynecology. Researchers evaluated whether telehealth and RPM could serve as an alternative or added service to standard care. Specific telehealth services and modalities evaluated included specialty consultations through virtual visits, direct-to-patient virtual visits, wearable devices, educational apps and videos, and mobile health apps.
The studies in the review compared patient health and behavioral outcomes. The studies reviewed explored a variety of outcomes including smoking cessation, pregnancy wellness, breastfeeding, physical activity and healthy eating during pregnancy.
Research Findings
- RPM and text messaging for diabetes reduced outpatient clinic visits while maintaining maternal and neonatal clinical outcomes
- All text messaging for smoking cessation trials demonstrated a reduction in self-reported smoking at 30 days - 9.6% among treatment group vs. 15.3% in the control group
- Educational videos and apps for breastfeeding: 84% participation in telehealth group, compared with 66% of the control group breastfeeding at 3 months
- RPM and automated-messaging for asthma: 82% of telehealth patients had well controlled asthma at six months compared to 58% on patients in the control group
Why do these findings matter?
The United States currently has the highest maternal mortality rate among all developed countries, with over 800 women dying in child birth each year. Though these numbers are shocking, perhaps even more shocking is the drastic increase in maternal and infant mortality in minority and rural communities across the US.
While multiple elements contribute to these staggering statistics, access to healthcare is a primary factor and one that can be addressed through the utilization of telehealth and remote monitoring services. As this literature review shows, education, medication reminders, and symptom and biometric monitoring through telehealth can improve clinical outcomes for mothers and infants while maintaining, or even reducing, costs to patient and providers.
Access the full article, here.
Date Published: February 2020
Denicola, Nathaniel, et al. “Telehealth Interventions to Improve Obstetric and Gynecologic Health Outcomes.” Obstetrics & Gynecology, vol. 135, no. 2, 2 Feb. 2020, pp. 371–382., doi:10.1097/aog.0000000000003646.
Article 2
Enhancing Palliative Care Patient Access to Psychological Counseling Through Outreach Telehealth Services
What was studied?
The goal of the study was to determine whether a telehealth program could improve the care of cancer patients receiving psychological counseling in an outpatient palliative clinic. To determine whether telehealth augmented counseling care delivered, researchers compared the outcomes of patients who received videoconferencing and telephone counseling interventions combined with counseling at the clinic to patients who received only counseling at the outpatient clinic.
Researchers reviewed 2,072 unique patients, who had 4,567 total counseling encounters across outreach and outpatient settings. 452 patients participated in a combination of outpatient and outreach counseling services (outreach group) and 1,620 received counseling services during in-person outpatient clinic visits only (outpatient-only) group. Data collected included patient demographic characteristics, cancer diagnoses, and psychology service characteristics including type of encounter (outpatient vs. outreach), session length, number of sessions, Edmonth Symptom Assessment System (ESAS) associated with the patient’s initial counseling encounter, and psychological intervention provided.
Research Findings
- Outreach telehealth counseling via video conferencing and/or telephone enhanced palliative care access to psychological counseling
- The outreach group had less time between their first and second encounter (median = 14 days) compared with the outpatient-only group (median = 30 days)
Why do these findings matter?
Many patients with advanced cancer diagnoses experience psychological disorders such as anxiety, depression, and/or adjustment disorders. Psychological services for cancer patients are necessary, but are often not accessible due to barriers such as absence of information, shame associated with mental health services, physical location, lack of providers, and costs of care.
For advanced cancer patients these barriers to adequate care can be especially cumbersome. Telehealth can overcome these limitations, by providing counseling via videoconferencing or telephone to patients at home. Outreach telehealth services provide an opportunity for counselors to intervene as situations arise, for example, if a patient is experiencing a depressive or anxious episode.
Access the full article, here.
Date Published: November, 2019
Guzman, D., Ann‐Yi, S., Bruera, E., Wu, J., Williams, J. L., Najera, J., … Carmack, C. L. (2019). Enhancing palliative care patient access to psychological counseling through outreach telehealth services. Psycho-Oncology, 29(1), 132–138. doi: 10.1002/pon.5270
Article 3
Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine: A Nonrandomized Controlled Trial
What was studied?
In a recent clinical trial, researchers at the Medical University of South Carolina (MUSC) investigated the effectiveness of utilizing telemedicine as a treatment option for opioid use disorder (OUD) in pregnant and postpartum women. Their goal was to examine maternal and newborn outcomes for pregnant women with OUD receiving care via telemedicine compared to those receiving care in-person.
The primary outcome for mothers was retention in treatment at 6-8 weeks post partum, and secondary outcomes tested for positive drug screen results. The primary newborn outcome was NAS – neonatal abstinence syndrome – which was retrieved from their electronic health record (EHR). Secondary outcomes examined for newborns included length of newborn hospital stay and birth weight per EHR. By addressing these outcomes, researchers hoped to improve access to addiction treatment for pregnant women with OUD, ultimately reducing maternal mortality rates.
Participants were divided into two groups: those who received in-person treatment for OUD (n = 54) and those who received telemedicine for the treatment of their OUD (n = 44). In total, these 98 women (mean age = 30.2 years) were seen weekly for 4 weeks, then every 2 weeks for another 4 weeks before moving to monthly treatment thereafter. At the time of publication, this is still the only clinical study to describe a telemedicine program for the treatment of OUD in pregnant women compared to traditional in-person care.
Research Findings
- Retention: after 6–8 weeks postpartum, 35 of 41 participants (85.4%) in the telemedicine group, and 44 of 48 (91.7%) in the in-person group were retained in treatment
- NAS: for those treated by telemedicine, 17 of 39 children (43.6%) were born with neonatal abstinence syndrome, compared to 28 of 45 (62.2%) in the in-person group
Why do these findings matter?
The number of pregnant women with OUD in the US has more than quadrupled over the last two decades, causing massive public health ramifications. In this nonrandomized controlled trial, researchers found that virtual care was more cost effective and produced similar outcomes for both mothers and newborns, offering a potentially scalable solution for treating this chronic disease. These results also have a significant impact for rural and impoverished communities, who already face geographic and financial barriers to accessing this valuable treatment program in person.
If telemedicine can be utilized as a part of an integrated care delivery to reduce the maternal morbidity associated with opioid use, the potential to scale this treatment may lead to important improvements in overall maternal and child health. The public health implications go beyond just pregnant mothers with OUD and their newborns, these results also pose a potential solution for future treatment for combating the opioid crisis overall.
Date Published: January 31, 2020
Guille C, Simpson AN, Douglas E, et al. Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine: A Nonrandomized Controlled Trial. JAMA Netw Open. 2020;3(1):e1920177. doi:10.1001/jamanetworkopen.2019.20177
Article 4
Telehealth Delivery of Memory Rehabilitation Following Stroke
What was studied?
A study by Cambridge University examined the efficacy and feasibility of providing memory care services to post-stroke patients via telehealth. The two-arm, non-randomized study assigned patient to either the telehealth intervention group or face-to-face control group based on self-selection, geographic location, and availability. Outcomes were measured at pre-intervention, a six-week follow-up, and at post intervention.
Participants were selected via community outreach, Stoke Foundation newsletters, previous clinical trials, and through other avenues. Study participants were at least 18 years of age, had a confirmed stroke three or more months prior, and had since experienced post-stroke memory difficulties.
Telehealth interventions were delivered by psychologists under the supervision of neuropsychologists for two hours a week over six weeks. Face-to-face interventions were delivered by trained therapists in local university clinics or in participants' homes. 46 stroke survivors satisfied inclusion criteria, with 18 allocated to the face-to-face condition and 28 to the telehealth condition.
Finally, a blinded, randomized intervention was added to measure the effectiveness of a six-week booster session with outcomes measured at 12 weeks.
- Goal Attainment (GAS) scores for telehealth patients saw a significant increase post-intervention (57.33 baseline; 37.46 post-intervention), compared with both the standard group model and the face-to-face intervention group
- Everyday memory scores among telehealth patients were not only the best post-intervention (24.36 baseline, 16.94 post-intervention), but continued to improve at follow-up (13.91) unlike with the group model and face-to-face group
- GAS T scores additional established telehealth delivery of services as non-inferior to the standard group model of treatment
- Booster patient reported significantly higher greater improvement in memory function at the week 12 follow-up compared to those patient who did not receive a six-week booster session
Why do these findings matter?
30% of stroke survivors experience cognitive impairment and memory loss within their first year post-stroke. Cognitive impairments including difficulty with attention, memory, language, and/or orientation can severely diminishing a survivor's quality of life.
To date, most therapies for cognitive impairment require specialized rehabilitation, most often performed in group settings at health clinics. These requirements for care present significant barriers to stroke survivors and their caregivers living in rural regions. In addition to proving the efficacy of telehealth treatment to augment in-person treatment, but the Cambridge study provided evidence that telehealth virtual visits can improve memory rehabilitation in stroke patients over the long-term.
Access the full article, here.
Date Published: January 27, 2020
Lawson, D., Stolwyk, R., Ponsford, J., McKenzie, D., Downing, M., & Wong, D. (2020). Telehealth Delivery of Memory Rehabilitation Following Stroke. Journal of the International Neuropsychological Society, 26(1), 58-71. doi:10.1017/S1355617719000651
Part II. Reimbursement Updates
Throughout 2019 and continuing into 2020, the Centers for Medicare and Medicaid Services (CMS) have made changes to their policies in order to make telehealth more accessible across the country. A summary of changes released in February 2020 is provided below.
Article 5
In early February, the Center for Medicare and Medicaid Services (CMS) proposed a rule that would expand telehealth coverage for ESRD patients and specialty care under Medicare Advantage (MA) plans.
Roughly 30 million Americans, or 15% of the adult population, are affected by chronic kidney disease. Of that 15%, more than 660,000 have kidney failure, and almost 470,000 are on dialysis. Due to CMS guidelines, the bulk of patient treated for kidney disease and ESRD are covered by CMS through Medicare, Medicaid, or a combination of both.
Telehealth offers patients the opportunity to improve their quality of life through at-home dialysis treatments. Through telehealth and RPM services, clinicians can observe patient vitals in between and during treatments, share educational resources, and monitor medication and dietary adherence.
In addition, nephrologists administering dialysis to kidney patients can better coordinate care with patients’ primary care providers and provide care on-demand through via telehealth.
Date Published: February 07, 2020
Access the full article, here.