JMIR Publications

ABSTRACT

Background:

Use of telehealth programs and wearable sensors which allow patients to monitor their own vital signs have been expanded in response to the COVID-19 pandemic. The electronic national early warning system (E-NEWS) is a tool for both identifying and responding to acute illness.

Objective:

This study design aimed to establish a comprehensive telehealth system to monitor vital signs through the employment of national early warning scores in those patients receiving medical home care.

Methods:

The study was performed at a medical center and its hospital-affiliated home health care agency in central Taiwan, running from November 1, 2022, to October 31, 2023. Throughout this period, patients eligible for integrated home-based medical care (iHBMC) were consistently enrolled. Sensor data received from devices such as blood pressure monitors, thermometers and pulse oximeters were transmitted at least twice per day for 2 weeks to a cloud-based medical server using wi-fi or general packet radio service modules, with the E-NEWS then making the necessary calculations.

Results:

Initially, a system was established using a cloud-based electronic health platform before a novel health process done through home vital signs monitoring was then introduced in order to calculate and display E-NEWS. To test its clinical use, we enrolled 28 participants having a median age of 84.5 years who had received iHBMC (interquartile range (IQR):79.3-90.8), and were 32.1% male. One participant had a tracheostomy tube, 15 participants had nasogastric tubes, and 14 had urinary catheters. Additionally, the age-adjusted Charlson comorbidity index was 6.5 (IQR: 5.25-9), while the Barthel index for activities of daily living was 0.0 (IQR: 0.0-18.8). During the telemonitoring period, 27 participants recorded their data throughout the entire study period, with only one participant recording for less than 14 days. After converting vital signs to E-NEWS scores, the overall mean score was found to be 4.0 (IQR: 3.0-6.0), with abnormal E-NEWS values being noted 283 times. Regarding the feedback provided for the telemonitoring system, 85.7% of participants reported satisfaction, 10.7% were neutral, and 3.6% felt it to be unsatisfactory.

Conclusions:

The study demonstrated the feasibility of setting up a comprehensive monitoring system integrated with the early warning score in an iHBMC setting. Whether the system may help to recognize abnormal vital signs early, and make the appropriate responses in medical home care patients under deterioration, still requires further research.