The merits of telemedicine programs in addressing acute emergencies, such as stroke, have been well documented. In a post-pandemic world, however, one of the most important uses of telehealth technology might be in preventative care, particularly for patients that health systems and hospitals deem “high-risk.” This article will review various definitions of high-risk patients, highlight research that connects telehealth implementation with positive outcomes, and explain how health organizations are incorporating telehealth services to achieve those benefits.
Who is a “high-risk” patient?
In the literature, there is no one definition of a high-risk patient. The phrase typically refers to people whose chronic conditions increase their likelihood of seeking hospital care. “We defined patients as high-risk if the probability of a 90-day hospitalization was 10% or greater,” wrote a group of authors in a 2019 American Journal of Managed Care article. Another group writing for The Hospitalist in 2015 defined “high-risk” as those patients who are “admitted to the hospital five or more times within one year.” Whatever the exact number, explained two physicians in a 2009 Western Journal of Emergency Medicine article, these “patients provide a challenge to emergency physicians.”
“Recent work on managing frequent users on a more individual basis through consistent outpatient services has been shown to both reduce ED [emergency department] use and improve symptoms of chronic conditions that bring the patient to the ED,” the authors suggest.
Evidence-based research shows telehealth can improve outcomes for high-risk patients
Implementing telehealth solutions is an attractive way hospitals and health systems can provide the “consistent outpatient services” the Western Journal authors recommend. In the last decade, researchers worldwide have studied the outcomes of varied telehealth programs, particularly for patients with one or more chronic conditions. These studies’ results suggest that telehealth programs can make a positive impact on the health and well-being of participants:
Telemedicine use helps reduce hospital admissions and readmissions
In 2014, nearly two dozen academic medical professionals and practitioners published research in Telemedicine and E-Health that reviewed telemedicine’s impact on the management of congestive heart failure, stroke, and chronic obstructive pulmonary disease (COPD). The authors concluded that the “preponderance of evidence” showed that telemedicine use produced several benefits, but chief among them were “reductions in service: hospital admissions/re-admissions, length of hospital stay, and emergency visits typically declined.
Telemonitoring programs support improved health indicators
A 2017 article in the Journal of Medical Internet Research evaluated the impact of a telemonitoring program in Spain’s Valencia region. The study focused on patients suffering from one or more chronic conditions, particularly diabetes, hypertension, heart failure, and COPD. The authors found that patients with one or more of these conditions had better weight, heart rate, blood pressure, and glycemic control after a year of program participation when compared with the previous year. “In addition,” they wrote, “primary care emergency and hospital emergency visits were decreased, despite the participants being a year older and a year further along in their disease evolution.”
CDC recognizes telehealth as a valuable tool to manage chronic conditions
The CDC, citing research by the Community Preventive Services Task Force (CPSTF), states that “telehealth interventions can help improve chronic disease, including … “high blood pressure, cardiovascular disease, diabetes, HIV infection, end-stage renal disease, asthma, and obesity.” In numerous studies, the CPSTF found that the implementation of various technology – including text messaging and email reminders, internet-based consultations and pre-recorded videos, and phone calls – can lead to better medication adherence, clinical outcomes, and dietary outcomes.
Telehealth in action for “high-risk” patients
What do some of these telehealth interventions look like? The Spanish telemedicine program highlighted in the study above, called ValCrònic, was implemented jointly by primary care practices and hospitals. Patients “received health education and awareness interventions tailored to their conditions through informative videos” available in a study-provided tablet, through which they also independently measured and entered their vital signs. Medical personnel then determined, based on the entries, whether to “call participants to check the values, ask them to come to the health center, go to their home, or consult a doctor.”
Here in the United States, a small but growing number of mobile integrated health and community paramedic programs have been developed to help patients with complex medication regimens – a descriptor that can be applied to many sufferers of chronic conditions. “Addressing medication complexity requires a holistic approach, which should include deploying providers, such as community paramedics, in new or expanded roles,” wrote the authors of this 2019 Health Affairs article. “Community paramedics are able to go where clinicians typically do not – into the patient’s home – where they may discover unexpected barriers and underlying factors that affect health outcomes.” The authors say the next step in enhancing these kinds of programs is integrating technology to benefit these patients, such as using videoconferencing to allow “pharmacists to video chat with patients and care team members about medications during home visits.”
“We’re redefining the house call for a whole generation that doesn’t know what a house call is,” said Carl Marci, chief medical officer for Ready, a mobile health care provider, in a 2020 MHealth Intelligence article.
Learn more about how telehealth can help you reach your high-risk patients
To reap the benefits these kinds of preventive-care programs can provide, medical practices need a technology partner they can trust. Caregility offers a variety of solutions for virtual consults to virtual observation and monitoring to help boost your “high-risk” patient services. Please contact us today for more information.