Passive remote monitoring technologies’ influence on home care clients’ ability to stay home: A multi-provincial randomized control trial
ABSTRACT
Background:
This inter-provincial study examined how passive remote monitoring (PRM) technologies in the home supported older adults’ safe aging in place and avoidance or delay of higher levels of care.
Objective:
Researchers in Nova Scotia (NS) and Ontario (ON), Canada implemented a PRM model of homecare unique to their health system contexts. Each PRM model integrated tailored PRM devices (e.g. motion sensors, cameras, door alarms) into homecare patients’ residences with the aim of linking patients, family/friend caregivers, and healthcare providers to support older adults’ aging in place.
Methods:
A pragmatic randomized control trial examined how passive remote monitoring (PRM) technologies support older adults to safely remain in their home and avoid/delay admission to higher levels of care. Pairs of homecare patients and their family/friend caregivers were recruited in ON and NS. Participant pairs were randomly assigned to one of two conditions: 1) standard home care (control) or 2) standard home care plus study-provided PRM (intervention). Participants provided their provincial health insurance numbers to link with provincial health administrative databases and identify if patients were admitted to higher levels of care after 1 year. Cox proportional hazards models were used to evaluate the primary outcome in each province.
Results:
313 patient-caregiver pairs were recruited: 174 pairs in ON (60= intervention; 114= control) and 139 pairs in NS (45= intervention; 94= control). Results indicate PRM was associated with a non-significant 30% reduction in risk of patients being admitted to higher levels of care in ON (hazard ratio= 0.7, 95% CI [0.3, 1.4]) and no reduction in risk in NS (hazard ratio= 1.1, 95% CI [0.3, 3.7]). Adjusting for patient sex had no impact on model estimates for either province.
Conclusions:
Limitations related, in part, to the impact of COVID-19 may have contributed to the effectiveness of the intervention. However, results demonstrate a trend in favor of PRM to support patients’ aging in place. Further study is required to understand if longer follow-up time allows more effects of PRM on patients’ avoidance of higher levels of care to be detected. Clinical Trial: This PRCT is registered with the International Standard Randomised Controlled Trial; number (ISRCTN) 79884651
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