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Remote Vital Sign Monitoring in Admission Avoidance Hospital at Home: A Systematic Review
Rajan Patel1, Tabitha D Thornton-Swan2, Laura C Armitage1
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
Journal of the American Medical Directors Association
|June 22, 2024
Summary
This systematic review found limited evidence on vital sign monitoring in hospital at home (HAH) for acute illness. Automated monitoring in HAH reduced hospital readmissions, but more research is needed.
Area of Science:
- Health Services Research
- Digital Health
- Geriatric Medicine
Background:
- Hospital at home (HAH) offers an alternative to hospital admission for acute physical illness.
- Effective vital sign monitoring is crucial for HAH safety and clinical decision-making.
- Current vital sign monitoring systems range from manual checks to automated continuous remote monitoring.
Approach:
- Systematic review of randomized controlled trials (RCTs) published between March 2016 and February 2023.
- Searches included databases, trial registries, and existing systematic reviews.
- Risk of bias assessed using Cochrane risk of bias 2 tool; meta-analyses and narrative summaries performed.
Key Points:
- Twenty-one RCTs involving 3459 participants were analyzed, categorizing monitoring as manual or automated.
- Overall, HAH showed no significant difference in mortality or readmission compared to hospital care.
- Automated monitoring in HAH was associated with a significant reduction in hospital readmissions (RR 0.30).
Conclusions:
- Gaps exist in reporting and evidence for remote vital sign monitoring in HAH, despite its growing use.
- Continuous monitoring with wearable devices shows potential but is underutilized in current RCTs.
- Recommendations are proposed for implementing and evaluating remote monitoring in future HAH clinical trials.
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