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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Clinical and economic effectiveness of telehealth in home mechanical ventilation
Paula Johanna Filser1,2, Pauline Sarah Münchenberg1, Elke Berger2
1Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Background:
The number of patients requiring home mechanical ventilation is rising, while in-person follow-up is increasingly burdensome for patients and health systems. Telehealth may maintain clinical stability and improve care efficiency. This systematic review examined the clinical and economic effectiveness of telehealth in the management of home mechanical ventilation.
Methods:
The study protocol was registered a priori in PROSPERO. A systematic search was conducted in MEDLINE, Embase and Web of Science. The reporting of the systematic review was aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. We included quantitative studies comparing telehealth-supported home ventilation with standard care, reporting clinical or economic outcomes.
Results:
From 356 identified studies, 11 met the inclusion criteria: nine randomised controlled trials, one cohort study and one retrospective analysis, mostly conducted in Europe, with a total of 1458 participants. The study populations included patients with, e.g. COPD, amyotrophic lateral sclerosis and obesity hypoventilation syndrome. Interventions involved telehealth-supported home ventilation management. Across studies, telehealth-supported care achieved clinical outcomes comparable to those of standard care. Arterial carbon dioxide tension (P aCO2 ) control and health-related quality of life were similar between groups, with one study reporting greater P aCO2 reduction with telemonitoring. Evidence on the number of hospitalisations and exacerbations was mixed. Mortality and survival rates showed nonsignificant trends towards benefit; one cohort study reported improved first-year survival. Economic outcomes varied: home initiation reduced costs, while long-term follow-up results were heterogeneous.
Conclusions:
elehealth-supported home ventilation appears to be a comparable alternative to in-hospital management and often provides economic advantages. Future research should focus on standardised outcome measures, longer follow-up and health-system-specific cost-effectiveness analyses to guide sustainable implementation.
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