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					COCIR                      Referenced studies demonstrating the benefits of telemedicine




Demonstrating the benefits of telemedicine:
Database of referenced studies on telemedicine

1. Introduction

Telemedicine is an emerging field in healthcare with many unknowns.
COCIR has established a dedicated Focus Group on telemedicine to respond to the many questions and doubts remaining
about telemedicine.

COCIR defines telemedicine as the delivery of healthcare services through the use of Information and Communication
Technologies (ICT) in a situation where the actors are not at the same location. The actors can either be two healthcare
professionals (e.g. teleradiology, telesurgery) or a health care professional and a patient (e.g. telemonitoring of chronically
ill such as those with diabetes and heart conditions, telepsychiatry etc).
Telemedicine includes all areas where medical or social data is being sent/exchanged between at least two remote
locations, including both Caregiver-Patient/Citizen as well as Doc-to-Doc communication.


2. Purposes

Although an increasing number of studies and clinical trials demonstrate the effectiveness of telemedicine solutions, many
clinicians, patients and payers, partially question the evidence available and do not trust telemedicine applications to
support and improve the delivery of good quality healthcare. This lack of confidence is also a barrier to the integration of
telemedicine in healthcare infrastructure and to the reimbursement of telemedicine services by health insurance
companies.

This lack of trust is based on the fact that the results of existing studies are only partly known and many of the results are
not directly comparable, because of the size, duration or overall design of the respective studies.

To address this situation, COCIR has started to collect and summarise the peer reviewed evidence of telemedicine projects
and studies to support consistent communication on the quality of care and cost-effectiveness of Telemedicine solutions.


3. Criteria

The references that are listed below are all completed and published relevant studies in well-known scientific publications.


4. Periodicity

This database is a living document and will be updated regularly with new studies.


5. Abbreviations

- BDOC: Bed Days Of Care

- CCQ: Clinical COPD Questionaire (measure of HRQoL)

- CHF: Congestive Heart Failure

- COPD: Chronic Obstructive Pulmonary Disease

- ECG: Electrocardiogram

- ER: Emergency Room

- GP: General Physician

- HF: Heart Failure

- HHA: Home Health Agencies


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COCIR                      Referenced studies demonstrating the benefits of telemedicine




- HRQoL: Health Related Quality of Life

- HTM: Home Telemonitoring

- LVEF: Left Ventricular Ejection Traction

- NYHA: New York Heart Association (NYHA) functional classification (extent of heart failure)

- RCT: Randomised Controlled Trial

- SGRQ: St George’s Respiratory Questionnaire

- TM: Telemonitoring

- UC: Usual Care




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COCIR                                                     Referenced studies demonstrating the benefits of telemedicine                                                                      COPD




        Reference of study       Study type         Patients population           Study duration             Study outcome                Type of intervention                Link

        Koff P et al. (2009):   RCT;            Intervention group: 270         9 months follow-       ·    Significant reduction in    Proactive Integrated Care      http://www.ersnet
        Proactive Integrated    monocentric,    patients; control group: 130    up; study period:      critical care utilizations •     with disease-specific          .org/learning_reso
        Care Reduces Critical   Setting:        patients; Inclusion Criteria:   2006-07;               Reduction in gross costs         education, teaching of self-   urces_player/abstr
        Care and Improves       COPD and        GOLD Class III and IV or FEV1   enrollment 2 pt. per   depending on differing           management techniques,         act_print_09/files/
        Quality of Life in      General         > 50% predicted with a recent   day                    hospital reimbursement           enhanced communication         66.pdf
        COPD, European          Pulmonary       exacerbation; Exclusion                                rates (High Reimbursement        and remote home
        Respiratory Journal     Clinic at the   Criteria: Asthma, Significant                          Rate: -450$ p.p.p.m.,            monitoring with Health
        34 (Suppl. 53):p. 75s   University of   co-morbidities including HIV                           Middle: -210$ p.p.p.m.,          Buddy; monitoring from
                                Colorado        infection, interstitial lung                           Low: -150$ p.p.p.m.); •          Monday to Friday for
                                Hospital        disease, end-stage liver or                            Significant improvements in      changes in symptoms,
                                                renal disease or dementia                              health-related quality of life   SpO², FEV1 and steps in 6
                                                Diseases likely to result in                           (measured with SGRQ), 6          min walk test
                                                death within 2 years,                                  min walk distance, oxygene
                                                Exclusion Criteria: Asthma,                            saturation and shortness of
                                                                                                       breath; • Decreased
                                                                                                       mortality (4 % vs. 1%,
                                                                                                       p=0.046)




        Vitacca et al. (2009    RCT,            101 patients (57:44)            12 months              43% reduction of hospital
        Tele-assistance in      monocentric                                                            admissions (0,17 vs 0,3 per
        chronic respiratory                                                                            patient per month) ;
        failure patients: a     Setting:                                                               reduction of costs 52%
        randomized clinical     Italy                                                                  (UC: 24743 Euro/Year vs.
        trial. European                                                                                TM: 9886 + 2000 Euro
        Respiratory Journal;                                                                           (service/ devices) )
        33: 411-418




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COCIR                                                     Referenced studies demonstrating the benefits of telemedicine                                                                  COPD




        Reference of study       Study type         Patients population            Study duration          Study outcome              Type of intervention                Link

        Koff P et al. (2009):   RCT;            Intervention group: 19 (mean     First patient        • Quality of life (SGRQ):     Proactive Integrated Care      http://erj.ersjourn
        Proactive Integrated    monocentric     age 67y), control group: 19      enrolled: Nov        intervention) 10.3 points     with disease-specific          als.com/cgi/conten
        Care Improves                           (age 65y); GOLD stage III and    2004; last patient   improved (19%), control)      education, teaching of self-   t/short/09031936.
        Quality of Life in      Setting:        IV; no statistical significant   enrolled: June       0.6 points improved (1%),     management techniques,         00063108v1
        Patients with COPD.     COPD and        baseline characteristics         2005; follow-up 12   p=0.018;                      enhanced communication
        European                General                                          weeks; outcomes      • Costs: no stat. signif.     and remote home
        Respiratory Journal,    Pulmonary                                        compared to prior    differences; exacerbations    monitoring with Health
        33(5), 1031-8.          Clinic at the                                    12 weeks             and hospital admissions not   Buddy; monitoring from
                                University of                                                         analyzed; detection of        Monday to Friday for
                                Colorado                                                              exacerbations (9 vs. 2        changes in symptoms,
                                Hospital                                                              patients)                     SpO², FEV1 and steps in 6
                                                                                                                                    min walk test




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COCIR                                                     Referenced studies demonstrating the benefits of telemedicine                                                               COPD




        Reference of study        Study type       Patients population             Study duration           Study outcome             Type of intervention             Link

        Trappenburg J.C.A.       Non-          Intervention group: 68 (mean      First patient        • Rate of exacerbation:      Health Buddy intervention     http://www.liebert
        et al. (2008): Effects   randomized    age 69y), control group: 56       enrolled: May        intervention group 1.0 ->    with daily questions to       online.com/doi/ab
        of Telemonitoring in     controlled    (age 70y); GOLD stage III and     2004; last patient   0.65 (-35 %), control        patients that both monitor    s/10.1089/tmj.200
        Patients with Chronic    comparison;   IV; history of at least 1 COPD    enrolled: August     group 0.69 -> 1.01 (+46      their disease symptoms,       7.0037
        Obstructive              multicenter   exacerbation in the preceding     2005; follow-up 6    %), p=0.004;                 medication compliance,
        Pulmonary Disease.                     6 months; more                    months; outcomes     • Rate of hospitalization:   and knowledge; and
        Telemedicine and e-                    exacerbations, outpatient         compared to          intervention 0.76 -> 0.65 (- provide education about
        Health, 14(2), p.                      visits and hospital admissions    previous 6 months    15 %), control 0.48 ->       their condition; answers
        138-146.                               in intervention than in control                        0.75 (+ 56 %), p=0.02;       reviewed from Monday to
                                               at baseline                                            quality of life (CCQ): no    Friday by respiratory
                                                                                                      statistical significant      nurse; usual access to
                                                                                                      differences                  physician, GP or clinic; no
                                                                                                                                   additional case
                                                                                                                                   management or education




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COCIR                                                      Referenced studies demonstrating the benefits of telemedicine                                                       Diabetes




        Reference of study     Study type           Patients population         Study duration            Study outcome            Type of intervention               Link

        Chumbler et al.       Retroperspectiv   774 patients (387 for each    4 years               • Reduction of 4-year all-   Veterans Health               http://jtt.rsmjourn
        (2009): Mortality     ely matched       group), mean age 68 y,                              cause mortality: hazard      Administration (VHA) care     als.com/cgi/conten
        risk for diabetes     controlled        slightly higher comorbidity                         ratio 0.69, 95% CI           coordination/ home-           t/abstract/15/2/98
        patients in a care    comparison        score and pre-enrollment                            0.50–0.92, p=0.013           telehealth (CC/HT)
        coordination, home-   using             outpatient visits in                                • Mean survival time:        program using Health
        telehealth            propensity        intervention group                                  intervention 1348 days       Buddy as communication
        programme. Journal    scores                                                                versus control 1278 days,    device for education and
        of Telemedicine and                                                                         p=0.015                      monitoring of symptoms
        Telecare, 15(2),                                                                                                         and health status; Care
        98–101                                                                                                                   coordinators (registered
                                                                                                                                 nurses and nurse
                                                                                                                                 practitioners) monitored
                                                                                                                                 the answers from the
                                                                                                                                 devices daily so that early
                                                                                                                                 interventions could be
                                                                                                                                 made




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COCIR                                                        Referenced studies demonstrating the benefits of telemedicine                                                   Diabetes




        Reference of study       Study type            Patients population            Study duration        Study outcome           Type of intervention            Link

        Chumbler et al.         Uncontrolled,     445 patients, 2 or more            12 months         • Hospitalizations: -50%   Veterans Health             http://ehp.sagepu
        (2005): Evaluation      pre-post          hospitalizations or ED visits in                     • ER visits: -11%          Administration (VHA) care   b.com/cgi/content/
        of a care               evaluation        the 12 months preceding                              • BDOC: -3days,            coordination/ home-         abstract/28/4/464
        coordination/home-                        enrollment,                                          improvement of HrQoL       telehealth (CC/HT)
        telehealth program      Setting:                                                                                          program using Health
        for veterans with       VA sites in the                                                                                   Buddy as communication
        diabetes: health        Florida,                                                                                          device for education and
        services utilization    Southern                                                                                          monitoring of symptoms
        and health-related      Georgia, and                                                                                      and health status
        quality of life. Eval   Portsmouth
        Health Prof, 28(4),     region (USA)
        464-78.




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COCIR                                                  Referenced studies demonstrating the benefits of telemedicine                                 Multiple Chronic Diseases




        Reference of study     Study type        Patients population         Study duration        Study outcome             Type of intervention           Link

        Darkins et al.        Non-controlled 17025 patients, veterans, with 12 months         • 25% reduction in          Different telemonitoring    http://www.liebert
        (2008): The           pre-post       diabetes, hypertension, CHF,                     numbers of bed days of care systems                     online.com/doi/ab
        Systematic            evaluation     COPD, depression,                                • 19% reduction in                                      s/10.1089/tmj.200
        Implementation of                    postraumatic stress disorder                     numbers of hospital                                     8.0021
        Health Informatics,   Setting:       or other mental health                           admissions
        Home Telehealth,      Care                                                            • 86% mean satisfaction
        and Disease           Coordination/                                                   score rating
        Management to         Home
        Support the Care of   Telehealth as
        Veterans with         a routine non
        Chronic Conditions.   institutional
        Telemedicine & e-     care services
        Health, 14(10),
        1118-1126.




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COCIR                                             Referenced studies demonstrating the benefits of telemedicine                                            Congestive Heart Failure




    Reference of study Study type       Patients population            Study duration        Study outcome                  Type of intervention            Link



    Giordano et al.       multicenter   460 patients randomized 1:1     one year follow up   • Primary Outcome:             All patients: education
    (2009) Multicenter    (n=5) RCT     to UC (n=230) or TM (n=230)                          significantly lower risk of    about HF, advice on daily
    randomised trial on                 Diagnosis of CHF, left                               heart failure related          weight, self-measurement
    home-based                          ventricular ejection fraction                        readmission - 50%              of blood pressure, rate of
    telemanagement to                   (LVEF) <40%, at least one                            (TM:n=43, UC:n= 73,            carrying out blood
    prevent hospital                    hospitalization for acute HF in                      p=0,0001),                     examinations, dietry
    readmission of                      the previous year, clinically                                                       restricitions, signs and
    patients with chronic               stable: symptomatically                              • Secondary Outcome:-          symptoms of a heart
    heart failure. Int J                improved, without intravenous                        55% reduction in               failure decompoensation.
    Cardiol;131:192-9                   therapie for at least 7 days,                        cardiovascular mortality (
                                        stable oral therapy (                                p= 0,06), 31 % decrease in                         UC:
                                        maximally tolerated doses of                         episodes of hemodynamic        referation to their primary
                                        angiotensinrenin inhibitor and                       anstability (TM: 101           care physician
                                        beta-blocker, no dose change                         episodes, UC: 147                             TM: portable
                                        for 5 days)and stable weight(                        episodes, p< 0,001), mean      advice (Card-Guard 2206)
                                        no change >1Kg).                                     cost of hospital readmisison   transferring from a fixed
                                                                                             35% lower in TM-group          or mobile phone, one-lead-
                                                                                             (TM: €843+/-1733, UC:          trace to a receiving station
                                                                                             €1298+/-2322, p=0,01)          with a doctor or nurse
                                                                                                                            available 24 h, 7
                                                                                                                            days/week. scheduled
                                                                                                                            appoinments every week
                                                                                                                            or every 15 days
                                                                                                                                          Nerve Center:
                                                                                                                            4 Hewlett Packard server,
                                                                                                                            WEB server, firewall ,
                                                                                                                            computerized call center
                                                                                                                            15 lAN workstations.
                                                                                                                            Technological and
                                                                                                                            organistaional support.

                                                                                                                                                     5
                                                                                                                            Centers: Terminals linked
                                                                                                                            with the call center,
                                                                                                                            configured to share the
                                                                                                                            application programme
                                                                                                                            interface of the Central
                                                                                                                            Station with On line




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COCIR                                                   Referenced studies demonstrating the benefits of telemedicine                                              Congestive Heart Failure




    Reference of study Study type             Patients population             Study duration       Study outcome                    Type of intervention            Link



    Mortara et al. (2009)   Multinational,    416 patients, randomized        12 month follow up   • Feasibility: 92 % practical    3 strategies in the TM
    Home telemonitoring     multicentre,      (1:2) to usual care (n=160)or                        recordings (of 1630/2078),       group;
    in heart failure        randomized        TM(n=301); 18<age<85;                                compliance unrelated to
    patients: the HHH       controlled        NYHA II-IV                                           NYHA (p = 0.1) or older age      strategie 1 (n = 106):
    study (Home or          clinical trial,   aetiology:ischaemic,                                 (p = 0,25)                       answering machine +
    Hospital in Heart       additional post   idiopathic, hypertensive, or                                                          nurse telephone contact,
    Failure). Eur J Heart   hoc test          valvular <40%; abnormal                              • Efficacy: (p= 0,5) no
    Fail; 11(3):312-8                         diastolic echocardiographic                          siginificant effect in
                            Setting:          pattern from E/A<1;hospital                          reducing bed days
                            UK, Poland,       admission in the previous 12                         occupancy, cardiac death         strategie 2 (n = 94) :
                            Italy             month;optimized medical                              plus hospitalization or          answering machine +
                                              therapy                                              number of re-                    nurse telephone contact +
                                                                                                   hospitalizations                 weekly vital signs,

                                                                                                   • Post hoc: heterogenous                        strategie 3
                                                                                                   effect in the countries in the   (n= 101): answering
                                                                                                   number of hospitalizations       machine + nurse
                                                                                                   and cardiac death +              telephone contact +
                                                                                                   hospitalization. Italy has a     weekly vital + NICRAM ;
                                                                                                   52% reduction of the
                                                                                                   combined endpoint death                            TM-groups
                                                                                                   and CHF related hospital         : portable device to report
                                                                                                   admission. Only about 10%        ECG, respiration and
                                                                                                   cardiac mortality rate in        physical acticity over 24 h,
                                                                                                   both intervention and            additional reported
                                                                                                   controll group.                  symptoms, weight, heart
                                                                                                                                    rate, systolic blood




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COCIR                                                Referenced studies demonstrating the benefits of telemedicine                                     Congestive Heart Failure




    Reference of study Study type          Patients population         Study duration       Study outcome                   Type of intervention        Link



    Ramaekers et al.      RCT;             101 patients                3 months follow-up   • Disease specific              Health Buddy CHF            http://www.liebert
    (2009): Adherance     multicentric                                                      knowledge improved              programme w/o additional    online.com/doi/ab
    among                                                                                   significantly in two of the     peripherals                 s/10.1089/tmj.200
    telemonitored         Setting:                                                          three hospitals                                             8.0160
    patients with heart   Telemonitoring                                                    (p < 0.001 and p = 0.040).
    failure to            via University                                                    • Adherence in terms of
    pharmacological and   of Maastricht                                                     fluid restrictions (p =
    nonpharmacological    (NL); Patients                                                    0.012), daily weighing
    recommendations.      recruited from                                                    (p<0.001), physical
    Telemedicine & e-     3 Dutch                                                           exercising (p =0.034), and
    Health;15: 517-24     hospitals and                                                     alcohol restrictions (p =
                          provided with                                                     0.040) improved
                          usual care                                                        significantly in the
                                                                                            telemonitoring group;
                                                                                            • Substantial but
                                                                                            statistically not significant
                                                                                            decrease in depression.




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COCIR                                         Referenced studies demonstrating the benefits of telemedicine                                         Congestive Heart Failure




    Reference of study Study type   Patients population             Study duration       Study outcome                Type of intervention           Link



    Goernig et al. (2009) RCT       95 patients, 5 with suspected   12 months            • No drop outs               TM: mobile 12 channel EC
    Ambulatory Disease              paroxysmale tachycardia, 90                          • Good compliance            (Viapac TM from SHL)G,
    Management in                   with chronic heart                                   • Significant fewer          NYHA III patients
    Cardiac Patients: 12            failure;randomized to UC (n                          hospitalizations -43% (UC:   additionally received a
    month follow-up of              =90) and TM (n=90); at least                         n=143, TM: n=62, p=          wage, pulse- and bloode
    Home Care                       one hospitalization for HF in                        0,001)                       pressure measurement
    Telemedicine in                 the previous 6 month,                                • 68% reduction of bed       and transmitted vital
    Thuringia by the                members of one statutory                             days of hospital care        parameters weight, blood
    Management                      health insurance                                     (UC:1328, TM:424, p=         pressure and pulse on
    Program Zertiva®.                                                                    0,001)                       adaily base; Information
    Phys Rehab Kur                                                                       • costs reduction -77%       meaterial about
    Med; 19: 9-13                                                                        (UC:1371408€ TM:             phatophysiologie, nutrition
                                                                                         317033€, p=0,001) in the     and animation; electronic
                                                                                         TM-group.                    patient record viewable for
                                                                                                                      patients and physicians




    Soran et al. (2008) A RCT       315 patients (1:1)              6 months follow up   • Reduction of combined
    Randomized Clinical                                                                  endpoint cardiac mortality
    Trial of the Clinical                                                                and CHF related hospital
    Effects of Enhanced                                                                  admission by 34%
    Heart Failure                                                                        (p=0,083)
    Monitoring Using a
    Computer-Based
    Telephonic
    Monitoring System in
    Older Minorities and
    Women. J Cardiac
    Fail;14:711-7




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COCIR                                         Referenced studies demonstrating the benefits of telemedicine                                       Congestive Heart Failure




    Reference of study Study type   Patients population             Study duration    Study outcome                 Type of intervention           Link



    Morguet et al.       RCT        128 patients (1:3), TM:n=32,    300 days mean     • All cause hospitalization   All patients: medical
    (2008) Impact of                UC: n=96, Ejection fraction >   follow up         duration ( UC: 317, TM:       instruction about HF,
    telemedical care and            60%,NYHA class II or III                          693 days/100 patients         pathophysiology basics,
    monitoring on                                                                     years, -54%, p=<0,0001)       diet and physical exercise;
    morbidity in mild to                                                              and rate (UC:38, TM:77        biweekly scheduled
    moderate chronic                                                                  days/100 patients years, -    telephone calls about
    heart failure.                                                                    51%, p=0,034) as well as      symptoms, medication and
    Cardiology;111:134-                                                               cardiac hospital              quality of life
    9.                                                                                • Admissions -69% and bed                TM: transmittion
                                                                                      days of care -87%,( UC:379    of weight, blood pressure ,
                                                                                      TM :49 days/100 patients      pulse rate and when
                                                                                      years, p<0,0001) were         required a 12-lead ECG
                                                                                      significantly lower




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COCIR                                             Referenced studies demonstrating the benefits of telemedicine                                     Congestive Heart Failure




    Reference of study Study type        Patients population         Study duration     Study outcome                  Type of intervention          Link



    Kielblock et al.        Non-         502 patients randomized (1:1) 12 month mean    • Primary outcome:             Heart failure service
    (2007) [Impact of       randomized   to usual care (UC, n=251) or    follow up      Reduction of days in           nurses and for special
    telemetric              controlled   TM (n=251); ICD-Diagnoses:                     hospital: UC:49,1 - TM:25,3    problems doctors, 20
    management on           comparison   150.1,150.11-19,150.9;                         (-48 %, p=0,01) Reduction      learning lessons,
    overall treatment                    hospital admission because of                  of hospital cases: UC: 3,4 -   construction of a medical
    costs and mortality     Setting:     Heart Failure in the previous 6                TM: 2 (-41%, p=0,01)           "data warehouse",
    rate among patients     Disease      month;; ability to                             • Secondary outcome : Cost
    with chronic heart      Management   communicate and read in                        reduction of 39,5%: UC:
    failure] Einfluss       Provider     German                                         17446€ - TM:10563€                        TM-equipment:
    einer telemedizinisch                                                               (p=0,05), Return on            telemetrical weight scale,
    unterstützten                                                                       investment: 3:1; Mortality     weighing every day,
    Betreung auf                                                                        in UC: 27,1%(n=69) -           autometed transfer of
    Gesamtbehandlungsk                                                                  TM:14,7% (n=37)                theses data to the medical
    osten und Mortalität                                                                (p=0,001); statistical         datawarehouse.
    bei chronischer                                                                     significant difference
    Herzinsuffizienz.                                                                   between men and female in
    Dtsch Med                                                                           hospitalizations(F: 1,9 -                Reporting to
    Wochenschr;132:417                                                                  M:N=2,1; p=0,03)and            patients and their
    -422                                                                                costs(F: 9854€ -               physicians: every three
                                                                                        M:11090€; p=0,02);             month
                                                                                        medication in TM-Group
                                                                                        increased: 10,2% total




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COCIR                                                    Referenced studies demonstrating the benefits of telemedicine                                         Congestive Heart Failure




    Reference of study Study type              Patients population          Study duration        Study outcome                  Type of intervention           Link



    Dansky et al. (2007)      Prospective      284 patients randomized (3:2) Follow up 4 months   • Outcome measurement:         All patients: information
    Impact of telehealth      randomized       to UC or TM, primary or                            Omaha System Problem           on heart failure, providing
    on clinical outcomes      field            secondary diagnoses of heart                       rating Scale for Outcomes      basis facts on the desease,
    in patients with          experiment       failure, ability to communicate                    (PRSO)      number of home     guidelines on self-
    heart failure. Clinical   multicentre      in English                                         care was significantly         management        UC:
    Nursing Research;                                                                             correlated with several        routine home visits
    17:182-99                 Setting:                                                            outcomes
                              10 home                                                             • Hospitalization:
                              health                                                              statistically significant            nurses and
                              agencies (HHA)                                                      fewer hospitalizations at 60   supervisors: training
                                                                                                  days; No statistically
                                                                                                  significancy within group                     TM: One-
                                                                                                  comparisons;                   way telemonitoring
                                                                                                  • Emergency visits: fewer      system: own
                                                                                                  ED visits (60 days,TM:         measurements of blood
                                                                                                  24%, TM+Video: 18%,            pressure, pulse and weight
                                                                                                  UC:30%; 120days,               through peripheral
                                                                                                  TM:30%, TM+Video: 31%,         devices, transmitting to
                                                                                                  UC:36%, p=0,09)                the HHA , every day at a
                                                                                                                                 predetermined time
                                                                                                                                 Two-way telemonitoring
                                                                                                                                 system: additional
                                                                                                                                 videocamera and digital
                                                                                                                                 stetoscope for interaction
                                                                                                                                 between nurse and
                                                                                                                                 patient, sessions
                                                                                                                                 scheduled by the home
                                                                                                                                 care nurse (2-3 times a
                                                                                                                                 week)




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COCIR                                                   Referenced studies demonstrating the benefits of telemedicine                                             Congestive Heart Failure




    Reference of study Study type            Patients population                Study duration       Study outcome                   Type of intervention          Link



    John G. F. Cleland et   Randomized        Enrollment criteria:              First patient        • Significant mortality         Twice-daily patient
    al. Noninvasive         controlled trial. Intervention group: 462,          enrolled: August     reduction - 30%                 measurement of weight,
    Home                                      control group: 168. 48% were      2000. Last patient   • Reduction in hospital         blood pressure, heart rate
    Telemonitoring for      Setting:          aged > 70yrs old. History of at   enrolled: March      length of stay – 25%.           and rythm with automated
    Patients with Heart     Patients were     least 1 hospital admission due    2002. Follow up                                      devices linked to a
    Failure at High Risk    recruited from to worsening heart failure           450 days.                                            cardiology center. The
    of Recurrent            twelve main       lasting > 48hrs within the last                                                        objective was to identify
    Admission and           and four          6 weeks, persisting symptoms                                                           whether home
    Death. The Trans-       satellite         of heart failure, LV ejection                                                          telemonitoring (HTM)
    European Network-       hospitals that    fraction <40%, .... In addition                                                        improves outcomes
    Home-Care               did not have a history of at least 1                                                                     compared with nurses
    Management System       comprehensive unplanned cardiovascular                                                                   telephone support and
    (TEN-HMS) Study -       heart failure     admission lasting >48h within                                                          usual care.
    Journal of American     management        previous 2 years, and LV
    College of Cardiology   organisation in ejection fraction< 25%, or
    2005;45:1654-64         place in          treatment with furosemide at
                            Germany, the a dose>100mg/day or
                            Netherlands       equivalent.
                            and UK.




    Schofield et al.        Non-             73 patients, veterans with new 6 months                 • Vital signs: significant      Care-coordinated, nurse-      http://www.liebert
    (2005): Early           randomized       onset systolic CHF (NYHA II-                            improvements in blood           directed home telehealth      online.com/doi/ab
    Outcomes of a Care      non-controlled   IV), mean LVEF 23%, mean                                pressure (129m to 119/69        management program            s/10.1089%2Ftmj.
    Coordination-           pre-post         age 67ys                                                mm Hg, p < 0.05), weight        with disease-specific         2005.11.20
    Enhanced Telehome       evaluations                                                              (196 to 192 pounds, p <         education via the nurse
    Care Program for                                                                                 0.01), and shortness of         coordinator and/or
    Elderly Veterans with   Setting:                                                                 breath rate (0-10 scale, 4.0    the Health Buddy and
    Chronic Heart           primary care                                                             to 2.7, P = 0.02);              monitoring of symptoms,
    Failure. Telemedicine   providers of                                                             • Resource utilization:         weight, blood pressure,
    and eHealth, 11(1),     the Veterans                                                             significant reduction for bed   heart rate.
    20-27.                  Health                                                                   days of care 1.65 (+/- 5.4)
                            Administration                                                           per patient during the
                            (USA)                                                                    program versus 8.63 (+/-
                                                                                                     9.6) during prior year, p <
                                                                                                     0.001




                                                                                       6/30/2010                                                                                  16 on 17
COCIR                                                  Referenced studies demonstrating the benefits of telemedicine                                         Congestive Heart Failure




    Reference of study Study type            Patients population            Study duration        Study outcome                  Type of intervention         Link



    Vaccaro et al.          Non-             52 patients with moderate or   Enrollment period     • Inpatient hospitalizations   Monitoring of symptoms       http://www.liebert
    (2001): Utilization     randomized,      severe CHF in intervention     from 8/99 through     for all causes: reduction by   via Health Buddy plus        online.com/doi/ab
    Reduction Cost          matched          group, 1 inpatient admission   10/99, follow-up of   1.29 to 0.65 per patient per   written educational          s/10.1089/109350
    Savings, and Return     cohort           or 3 ER visits for CHF in      6 months              year (-49.6 %), p<0.001;       material and monthly         70152596052
    on Investment for       controlled       the prior year, 56 % male,                           • ER visits for all causes:    phone calls for education
    the PacifiCare          comparison       median age above 75 years;                           reduction by 0.63 to 0.17
    Chronic Heart Failure                    matched cohort control group                         per patient per year (-
    Program, “Taking        Setting:         with 638 patients                                    73%), p<0.001;
    Charge of Your Heart    Primary care                                                          • Estimated costs savings
    Health.” Disease        providers of                                                          for hospitalizations and ER
    Management, 4(3),       the Veterans                                                          visits: $5,271 per patient
    131-141.                Health                                                                per year (-50.6%)
                            Administration
                            (USA)




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