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National randomized controlled trial of virtual house calls for Parkinson disease
Christopher A Beck1, Denise B Beran1, Kevin M Biglan1
1From the Department of Biostatistics and Computational Biology (C.A.B.), University of Rochester, NY; National Parkinson Foundation (D.B.B., P.N.S.), Miami, FL; Department of Neurology (K.M.B., E.R.D., I.H.R., H.S.) and The Center for Human Experimental Therapeutics (E.R.D., M.A.A., M.J.E., S.G., H.T.K., R.K., S.S., E.A.S., W.Z.), University of Rochester Medical Center, NY; Division of Geriatric Medicine and Gerontology, Department of Medicine (C.M.B., Z.M., B.D.), Johns Hopkins University School of Medicine, Baltimore, MD; Simone Consulting (R.S.), Sunnyvale, CA; Departments of Neurology and Biostatistics and Epidemiology (A.W.W., M.S., S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia; University of California San Francisco (N.B.G., M.K., C.M.T., K.D.); Northwest Neurological, PLLC (J. Aldred), Spokane, WA; Oregon Health and Science University (J.C., A. Fraser), Portland; Baylor College of Medicine (J.J.-S., C.H.), Houston, TX; Augusta University (J.C.M., D.M.), GA; Duke Medical Center (P.H., L.G.), Durham, NC; Massachusetts General Hospital (N.I.M., G.B.), Boston; Struthers Parkinson's Center (M.N.), Minneapolis, MN; Beth Israel Deaconess Medical Center (L.C.S.), Boston, MA; University of Miami (C.S., S.V.-P.), FL; Northwestern University (C.Z., N.O.), Evanston, IL; The Feinstein Institute for Medical Research (A. Feigin, J. Ayan), Northwell Health, Manhasset, NY; Medical University of South Carolina (C.V.), Charleston; University of Kansas Medical Center (R.P.), Kansas City; Parkinson's Institute (R.D.), Sunnyvale, CA; Mayo Clinic (A.H.), Rochester, MN; Center for Information Technology Research in the Interest of Society (CITRIS) (S.D.), University of California, Berkeley; Health Informatics Centre (S.S.R.), Karolinska Institute, Stockholm, Sweden; and PatientsLikeMe (P.W.), Derby, UK.
Objective:
To determine whether providing remote neurologic care into the homes of people with Parkinson disease (PD) is feasible, beneficial, and valuable.
Methods:
In a 1-year randomized controlled trial, we compared usual care to usual care supplemented by 4 virtual visits via video conferencing from a remote specialist into patients' homes. Primary outcome measures were feasibility, as measured by the proportion who completed at least one virtual visit and the proportion of virtual visits completed on time; and efficacy, as measured by the change in the Parkinson's Disease Questionnaire-39, a quality of life scale. Secondary outcomes included quality of care, caregiver burden, and time and travel savings.
Results:
A total of 927 individuals indicated interest, 210 were enrolled, and 195 were randomized. Participants had recently seen a specialist (73%) and were largely college-educated (73%) and white (96%). Ninety-five (98% of the intervention group) completed at least one virtual visit, and 91% of 388 virtual visits were completed. Quality of life did not improve in those receiving virtual house calls (0.3 points worse on a 100-point scale; 95% confidence interval [CI] -2.0 to 2.7 points; p = 0.78) nor did quality of care or caregiver burden. Each virtual house call saved patients a median of 88 minutes (95% CI 70-120; p < 0.0001) and 38 miles per visit (95% CI 36-56; p < 0.0001).
Conclusions:
Providing remote neurologic care directly into the homes of people with PD was feasible and was neither more nor less efficacious than usual in-person care. Virtual house calls generated great interest and provided substantial convenience.
Clinicaltrialsgov Identifier:
NCT02038959.
Classification Of Evidence:
This study provides Class III evidence that for patients with PD, virtual house calls from a neurologist are feasible and do not significantly change quality of life compared to in-person visits. The study is rated Class III because it was not possible to mask patients to visit type.
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