A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors.
A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors.
复制标题
作者：
Bloss CS;Wineinger NE;Peters M;Boeldt DL;Ariniello L;Kim JY;Sheard J;Komatireddy R;Barrett P;Topol EJ
背景移动的健康和数字医疗技术正越来越多地被患有常见慢性疾病的个人用于监测他们的健康状况。许多设备、传感器和应用程序可供患者和消费者使用，其中一些已被证明可以改善健康管理和健康结果。然而，没有进行随机对照试验来检查医疗保健费用，大多数未能为研究参与者提供真正全面的监测系统。方法.我们对2012年提交了与高血压、糖尿病和/或心律失常相关的健康保险索赔的成年人进行了一项前瞻性随机对照试验。干预包括接受一个或多个与其病情相对应的移动的设备（高血压：Withings血压监测仪;糖尿病：Sanofi iBGStar血糖仪;心律失常：AliveCor移动的ECG）和带有链接跟踪应用程序的iPhone，为期6个月;对照组接受标准疾病管理程序。此外，干预研究参与者可以访问在线健康管理系统，该系统在研究过程中为参与者提供详细的设备跟踪信息。这是一个监控系统，通过与设备制造商、互联健康领导者、医疗保健提供者和员工健康计划的合作而设计，使其既独特又包容。我们假设，健康保险索赔方面的卫生资源利用可能会受到监测干预的影响。我们还研究了健康自我管理。结果和结论。几乎没有证据表明干预措施导致医疗保健费用或利用率的差异。此外，我们发现有证据表明，对照组和干预组在大多数卫生保健利用结果方面是等同的。这一结果表明，使用移动的健康或数字医学技术监测慢性健康状况不会导致医疗保健成本或利用率的短期大幅增加或减少。在次要结果中，有一些证据表明健康自我管理得到了改善，其特征是干预组中将健康状况视为偶然因素的倾向减少。
Background. Mobile health and digital medicine technologies are becoming increasingly used by individuals with common, chronic diseases to monitor their health. Numerous devices, sensors, and apps are available to patients and consumers–some of which have been shown to lead to improved health management and health outcomes. However, no randomized controlled trials have been conducted which examine health care costs, and most have failed to provide study participants with a truly comprehensive monitoring system. Methods. We conducted a prospective randomized controlled trial of adults who had submitted a 2012 health insurance claim associated with hypertension, diabetes, and/or cardiac arrhythmia. The intervention involved receipt of one or more mobile devices that corresponded to their condition(s) (hypertension: Withings Blood Pressure Monitor; diabetes: Sanofi iBGStar Blood Glucose Meter; arrhythmia: AliveCor Mobile ECG) and an iPhone with linked tracking applications for a period of 6 months; the control group received a standard disease management program. Moreover, intervention study participants received access to an online health management system which provided participants detailed device tracking information over the course of the study. This was a monitoring system designed by leveraging collaborations with device manufacturers, a connected health leader, health care provider, and employee wellness program–making it both unique and inclusive. We hypothesized that health resource utilization with respect to health insurance claims may be influenced by the monitoring intervention. We also examined health-self management. Results & Conclusions. There was little evidence of differences in health care costs or utilization as a result of the intervention. Furthermore, we found evidence that the control and intervention groups were equivalent with respect to most health care utilization outcomes. This result suggests there are not large short-term increases or decreases in health care costs or utilization associated with monitoring chronic health conditions using mobile health or digital medicine technologies. Among secondary outcomes there was some evidence of improvement in health self-management which was characterized by a decrease in the propensity to view health status as due to chance factors in the intervention group.