Telemedicine Cuts Costs and Improves Outcomes in Chronic Disease Management

Digital Health is a broad term which encompasses overlapping technology sectors across healthcare—as evidenced by our Venn diagram representing the Digital Health Landscape. In this “Digital Health in Action” series, we’ll focus on specific examples from each domain to show what an impact the digital health movement is making on healthcare across the world.

On the Digital Health Landscape, telemedicine is making a difference in chronic disease management. A meta-analysis of all the research published on the effectiveness of the use of telemedicine in Congestive Heart Failure (CHF), stroke, and Chronic Obstructive Pulmonary Disease (COPD) – three leading causes of death in the United States – reveals that telemedicine can cut costs and improve health outcomes.

Published in Telemedicine and e-Health, the study, “The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management,” was conducted by a team of researchers and clinicians led by Rashid Bashshur, PhD, Gary Shannon, PhD, and Brian Smith, MS and provides a comprehensive and systematic review of the scientific evidence regarding the impact of telemedicine.

Chronic Disease is a Major Issue

Chronic diseases—such as cancer, obesity, diabetes, heart diseases, stroke and arthritis— are the most prevalent and preventable diseases in the United States.  Nearly 50 per cent of adults and more than 7 per cent of children and adolescents suffer from at least one chronic illness in the U.S.

Seven out of the top ten leading causes of death in the U.S. are due to chronic diseases—accounting for approximately 70% of all deaths. Heart disease and cancer together accounted for 48% of the all-death total. With 75% of all healthcare expenditure going toward treating chronic diseases, they also impose a huge burden on the costs associated with healthcare delivery.

Telemedicine Offers Solutions

The telemedicine technologies used in chronic disease management are diverse and include:

• Videoconferencing
• Point-to-point connections
• Dedicated networks
• Wearables and sensors
• Implantable devices
• Various devices with remote diagnostic capabilities

The primary role of telemedicine in this context has been to:

• provide education to consumers to improve self-management
• enable faster, cheaper and instantaneous transfer of health-related information via telemonitoring
• facilitate communications between patients in rural and remote areas with healthcare professionals
• improve electronic health record (EHR) management

The Bashshur study notes that while telemedicine demands investments in technology, human resources, and organizational development, these costs are outweighed by potential benefits accrued by proper implementation of telemedicine applications. Such benefits include:

• Enhanced care coordination
• Improved continuity of care
• Decreased response time
• Reduced costs and time for travel
• Improved on-site triage and promptness of referrals

Telemedicine’s Impact on CHF

Among patients with congestive heart failure, Bashshur, et al, found that telemonitoring was “significantly associated with reductions in mortality ranging from 15% to 56% compared with patients receiving ‘usual care.’” Several of the studies examined revealed that telemonitoring of CHF patients also produced a “noticeable change (improvement) in health outcomes,” “fewer episodes of health worsening,” “improved quality of life,” and “general improvement in clinical, functional, and quality of life status.”

Telemedicine’s Impact on Stroke

We looked a little more closely at a few individual studies regarding the potential for telestroke programs, which have led to a “significant reduction in the number of patients requiring transfer to a tertiary care centre.”

• In a study to assess whether telestroke consults were superior for decision-making purposes than telephone-only consults, the former won out—with researchers determining that telemedicine-based consulting resulted in more accurate decision-making.
• A study to determine the efficacy and safety of thrombolytic therapy to treat ischemic stroke at a distant hospital via telemedicine consult found telemedicine to be a reliable and safe tool.
• Additionally, another study found that the physician-use of smartphones for high-quality videoconferencing to administer the National Institutes of Health Stroke Scale (NIHSS) provided reliability and ease of use for providers in remote hospitals who need to consult with specialists in urban stroke centers.

Bashshur, et al, concluded that “Except for the telephone-only intervention (with poor sensitivity compared with video), the various modalities of telestroke have been demonstrated to reduce mortality in the range of 25% in the first year after the event.”

Telemedicine’s Impact on COPD

Chronic Obstructive Pulmonary Disease (COPD) is a group of respiratory conditions that progressively incapacitate those affected and is a leading cause of death throughout the world. A study to assess “Using Telehealth technology to deliver pulmonary rehabilitation in chronic obstructive pulmonary disease patients” concluded that telehealth pulmonary rehabilitation was an effective tool for increasing access to services, and improved both quality of life and capacity to exercise in comparison with the traditional model.

In addition, Bashshur, et al, noted that although there were a limited number of studies available that measured mortality outcomes, “Likely positive effects of telepulmonology include fewer exacerbations in the disease and improvements in quality of life and exercise capacity.”

Study Conclusions

The Bashshur team concluded that telemedicine has great potential to address problems associated with care access, care quality and the need to reduce costs for CHF, stroke and COPD. “Despite some inconsistencies in methodologies, the preponderance of the evidence produced by telemedicine studies points to significant trends in reducing hospitalization and emergency department visits and preventing and/or limiting illness severity and episodes, resulting in improved health outcomes.”

Noting this great potential, Charles R. Doarn, MBA, Research Professor of Family and Community Medicine, University of Cincinnati, says

"The integration of telemedicine into healthcare adds great value in managing chronic disease both for patient and provider…Dr. Bashshur has presented this work to both the U.S. Congress and the Congressional Budget Office, and with concomitant efforts by the American Telemedicine Association and others, the Congress may finally move telemedicine forward as an important element in healthcare for all Americans.”