Researchers at STSI share findings from mHealth trial targeting hypertension, diabetes, and cardiac arrhythmia

Chronic diseases, such as hypertension, diabetes, and heart arrhythmia, are the leading causes of death and disability in the United States. According to the Centers for Disease Control and Prevention, the treatment of chronic diseases accounts for 86% of the health care costs in the United States and represent a monumental burden on the health care system.

New technologies, including mobile health devices designed to enable patients to better monitor and manage chronic conditions, are being developed to try to reduce the strain that these diseases exert on health care resources. However, due to their relative novelty, little is known about what the impact of these devices on health care utilization truly is.

To investigate the relationship between mobile health devices and health care resource utilization, Dr. Eric Topol, Director of the Scripps Translational Science Institute (STSI), spearheaded a prospective randomized controlled trial looking for changes in health care costs and utilization among a group of people with chronic health conditions using smartphone-enabled biosensors. The study hypothesized that mobile monitoring may influence health care resource utilization as measured using health insurance claim submissions. The findings were recently published in the open access journal PeerJ.

The study sought to determine whether the use of mobile monitoring would lead to short-term changes in health care resource utilization. For individuals with hypertension, diabetes, or heart arrhythmia, close monitoring of specific vital signs is a key component of disease management. Biomedical sensors in mobile health devices provide patients with meaningful and increasingly precise physiologic metrics, such as blood pressure, blood glucose level, and heart rate. This data can enable patients and physicians to make proactive health care decisions, which ultimately lead to better health outcomes and reduce health care resource utilization. However, some within the health care community have expressed concern that the impact might actually be the reverse.

“I think there is expectation that in the long term, proper health monitoring will lead to better outcomes and those better outcomes will also lead to lower resource utilization. But in the short term, people are worried that if you give patients these devices and this data, it may lead to over-utilization of an already over-burdened health system, since patients may not know how to differentiate normal variation from readings that require medical attention,” explained Dr. Nathan Wineinger, Director of Biostatistics at STSI and co-first author on the recent PeerJ publication. “Based on our trial we really didn’t see any proof of that being the case,” Dr. Wineinger concluded.

In designing the trial, researchers at STSI were eager to create an intervention that would closely simulate a future approach to chronic disease monitoring – one that engages the patient, empowers the physician, and leverages both mobile health technology and more traditional health education and disease management programs.

The trial enrolled 160 individuals who had submitted health insurance claims billed for three study conditions – diabetes, hypertension or arrhythmia. Participants, who took part for a six-month period, were randomized to either the control or intervention group. Individuals assigned to the intervention group were provided with one or more mobile devices that corresponded with their health condition(s). Individuals with hypertension received a Withings blood pressure monitor; those with diabetes were given a Sanofi iGBStar blood glucose meter; and those with arrhythmia received the AliveCor Mobile ECG. In addition to the devices, the participants received an iPhone so that they could link their devices with mobile phone applications, as well as access to HealthCircles™, an online health care coordination and management platform developed by QualcommLife. Participants were provided with instructions on how often they should take readings using the devices they were assigned. The readings were then wirelessly uploaded to the participant’s HealthyCircles™ account and made available to nurses from HealthComp, Scripps Health’s third party administrator, as well as the participants themselves via a study phone or a computer.

All participants, including those in the control group were enrolled in the HealthComp disease management program, which involved educational outreach by nursing staff who distributed information regarding disease prevention and chronic disease management.

By using health insurance claims to measure resource utilization, the researchers were able to determine the economic consequences of the intervention. An increase in claims in the intervention group as compared to the control group would suggest that mobile monitoring was resulting in an increase in cost. Analysis of insurance claims submitted during the study period, however, showed no difference between the control and intervention groups, suggesting that substantial short-term changes in health care utilization as a result of monitoring are unlikely. Based on these findings the study concluded that any apprehension directed at consumer mobile health monitoring with respect to over-utilization of health care resources should be tempered, and focus should be placed on the potential merits of empowering patients through active health monitoring.

“If we take hypertension as an example, traditional monitoring consists of the individual getting their blood pressure measured sparingly, be it at the doctor’s office or elsewhere. As a result, any adjustments to treatment and medications can take months or even longer,” said Dr. Wineinger. “Mobile health devices, such as the ones used by study participants, will allow monitoring at a much more consistent and individualized level, making it possible for individuals and their health care providers to identify the best treatment for that individual quickly, without added pressure on health care resources.”

View the results and read the publication in PeerJ.

Related links –