JMIR Publications

ABSTRACT

Background:

Long-term remote patient monitoring, particularly of weight, pulse, and blood pressure, has been shown to significantly reduce mortality and hospitalization rates due to cardiovascular issues in heart failure patients. Despite its proven effectiveness, maintaining patient engagement in remote monitoring programs remains a challenge.

Objective:

This study aims to evaluate the impact of two-way mobile text-based communication in prompting patients to record key vital signs, and how it compares to traditional, unprompted patient reporting through electronic medical records in terms of engagement and clinical outcomes.

Methods:

We analyzed data from patients participating in the University of Michigan Advanced Heart Failure Program. Participants were required to submit daily reports of their weight, blood pressure, and pulse via one of two methods: the MiChart Patient Outreach Texting Application (MPOTA) or the Patient Enrolled Flowsheets (PEF). The study's primary metric was the consistency of patient-reported vital signs, with secondary metrics including variations in hospitalization and emergency room visits pre- and post-enrollment in the programs.

Results:

The study included a total of 890 patients, with 301 in the MPOTA group and 589 in the PEF group, after applying exclusion criteria. The MPOTA group had a higher proportion of Black patients (20% vs 10%). The engagement rate for the PEF group had a median of 2.29%, with a range from 0 to 99.76%. In contrast, the MPOTA group showed a significantly higher median engagement rate of 66.67%, with rates spanning from 0% to 100%. There were no significant differences in hospitalization or emergency room visit rates across engagement categories (none, low, medium, high) in either program. Mean hospitalizations declined by 21% in the MPOTA group (0.53 to 0.42, p=0.06) and 18% in the PEF group (0.50 to 0.41, p=0.03) after initiation of each program. Emergency room visits did not significantly change in either group. Regression analyses similarly showed no significant association between engagement level and hospital or emergency room use in either group, though medium engagement was associated with a non-significant trend toward fewer events. Despite improved engagement with MPOTA, this did not translate into significant reductions in hospitalizations or emergency room visits.

Conclusions:

While the adoption of the MPOTA system did not lead to significant reductions in hospitalizations or emergency room visits, it was associated with substantially higher patient engagement levels compared to unprompted patient reporting. These findings from this study suggest that mobile text-based communication may be a useful tool for improving engagement in remote monitoring programs for patients with advanced heart failure, though further research is needed to assess its impact on clinical outcomes.