Home Monitoring Devices May Ease World Health Burden

Many people believe devices that allow doctors to monitor patients' vital signs in their homes offer a potential way to save health costs and allow older people to stay out of nursing homes.

The trick is proving it, according to a RAND Corp survey commissioned by home medical equipment maker Royal Philips Electronics and released on Tuesday.

The survey of policymakers, providers, patient advocacy groups and others in six countries found most believe home healthcare technology has the potential to relieve pressure on healthcare systems that will soon be clogged by elderly patients living with chronic diseases.

But the evidence is still not strong enough to show the devices are cost-effective and ready for widespread adoption.

"These new ideas are potentially very appealing. They move care out of costly institutions and into patients' homes," said Soeren Mattke, senior scientist at Rand who led the study.
"But given that these are so new, they don't have a place in our traditional healthcare system," Mattke said in a telephone interview.

The report's release coincided with an appeal to Health and Human Services Secretary Kathleen Sebelius and Centers for Medicare and Medicaid Services Administrator Donald Berwick to pay for a large-scale study of home monitoring equipment among people in the Medicare insurance program for the elderly.

The survey drew from more than 100 interviews with researchers, providers, regulators and others in China, France, Germany, Singapore, the United Kingdom and the United States, as well as a review of studies on the effectiveness of home healthcare technologies.

These range from widely used technologies such as glucose monitors for diabetics to advanced telemonitoring equipment that allow doctors to gather daily information on a patient's weight, blood pressure, heart rate and other health measures.

NOT ENOUGH EVIDENCE

The report found experts largely agreed that home healthcare technologies could help meet the swelling demand for care from aging populations around the world, many of whom are living with chronic diseases such as diabetes.

"In the United States, for example, the elderly (age 65 years or older) account for only 12 percent of the total population yet incur 34 percent of total healthcare spending," according to the report, which notes that health spending is growing faster than gross domestic product in most countries.

"This is a global problem," Mattke said. "The world is literally running out of doctors and nurses."
He said by 2014, China will have more people living with chronic disease than the entire U.S. population.

And while there is not yet enough evidence to prove that these technologies will actually help or be cost effective, pockets of evidence suggest they might.

The best evidence so far comes from the U.S. Veterans Health Administration, which uses remote monitoring equipment to help veterans manage diabetes, hypertension and chronic heart failure.

A 2008 VA study of 17,025 home telehealth patients showed the devices cut the average number of days hospitalized by 25 percent and produced a 19 percent reduction in hospital admissions.

"The trends are clear," said Walter van Kuijen, general manager of Home Monitoring for Philips Healthcare, which paid for the study. "We have to get moving on the topic."

The Dutch conglomerate makes lighting products and consumer electronics in addition to hospital equipment for sleep therapy, respiratory care and CT scans.

The company said last week it hopes the new U.S. health reform law — which focuses on improving patient care while controlling health costs — will drive demand for the company's home monitoring devices.