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Holmstrand EC, Sato H, Li J, Mukherjee A, Fitzpatrick NE, Rayl KR, Colangelo FR. Digital hypertension management: clinical and cost outcomes of a pilot implementation of the OMRON hypertension management platform. Front Digit Health 2023; 5:1128553. [PMID: 37800090 PMCID: PMC10548242 DOI: 10.3389/fdgth.2023.1128553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/23/2023] [Indexed: 10/07/2023] Open
Abstract
Importance Home monitoring of blood pressure (BP) in hypertensive patients can improve outcomes, but challenges to both patient compliance and the effective transmission of home BP readings to physicians can limit the extent to which physicians can use this information to improve care. The OMRON Hypertension Management Platform (OMRON HMP) pairs a home BP cuff with a digital product that tracks data, provides reminders to improve patient compliance, and provides a streamlined source of information to physicians. Objective The primary objective of the quality improvement (QI) project was to test the hypothesis that use of the OMRON HMP could reduce the number and cost of hypertension related claims, relative to a retrospectively matched cohort of insured members. A secondary objective was to demonstrate improvement in control of BP among patients. Design Eligible members were recruited to the QI project between December 1, 2018 and December 30, 2020 and data collected for six months following recruitment. All members received the OMRON HMP intervention. Setting Enrollment and data collection were coordinated on-site at selected PCP partner providers in Western Pennsylvania. Eligible members were identified from insurance claims data as those receiving care for primary hypertension from participating primary care physicians and/or cardiologists. Participants Eligible members were between the ages of 35 and 85, with a diagnosis of primary hypertension. The retrospective cohort was selected from electronic medical records of Highmark-insured patients with hypertension who received care at Allegheny Health Network (AHN), a subsidiary of Highmark Health. Members were matched on baseline BP and lipid measures, age, smoking status, diabetes status, race and sex. Intervention Daily home BP readings were recorded by the OMRON HMP app. Patient data was reviewed by clinical staff on a weekly basis and treatment plans could be adjusted in response to this data. Results OMRON HMP users showed a significant increase in the number and cost of hypertension-related claims, contrary to the hypothesis, but did display improvements in control of BP. Conclusions and Relevance The use of a digital platform to facilitate at-home BP monitoring appeared to improve BP control but led to increased hypertension-related costs in the short-term.
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Affiliation(s)
| | - Hironori Sato
- Technology Development HQ, Omron Healthcare Co., Ltd., Kyoto, Japan
| | - Jim Li
- Technology Development HQ, Omron Healthcare Co., Ltd., Kyoto, Japan
| | - Abhishek Mukherjee
- VITAL Innovation Program, Highmark Health, Pittsburgh, PA, United States
| | | | - Kenneth R. Rayl
- VITAL Innovation Program, Highmark Health, Pittsburgh, PA, United States
| | - Francis R. Colangelo
- Premier Medical Associates, Allegheny Health Network, Monroeville, PA, United States
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Fundoiano-Hershcovitz Y, Bacher D, Ritholz MD, Horwitz DL, Manejwala O, Goldstein P. Blood Pressure Monitoring as a Digital Health Tool for Improving Diabetes Clinical Outcomes: Retrospective Real-world Study. J Med Internet Res 2022; 24:e32923. [PMID: 35133284 PMCID: PMC8864523 DOI: 10.2196/32923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/03/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Remote data capture for blood glucose (BG) or blood pressure (BP) monitoring and the use of a supportive digital app are becoming the model in diabetes and hypertension chronic care. One of the goals in chronic condition management is to increase awareness and generate behavioral change in order to improve outcomes in diabetes and related comorbidities, such as hypertension. In addition, there is a lack of understanding of the association between BG and BP levels when using digital health tools. OBJECTIVE By applying a rigorous study framework to digital health data, this study investigated the relationship between BP monitoring and BG and BP levels, as well as a lagged association between BP and BG. We hypothesized that during the first 6 months of BP monitoring, BG and BP levels would decrease. Finally, we suggested a positive association between BP levels and the following month's BG levels. METHODS In this retrospective, real-world case-control study, we extracted the data of 269 people with type 2 diabetes (T2D) who tracked their BG levels using the Dario digital platform for a chronic condition. We analyzed the digital data of the users who, in addition to BG, monitored their BP using the same app (BP-monitoring [BPM] group, n=137) 6 months before and after starting their BP monitoring. Propensity score matching established a control group, no blood pressure monitoring (NBPM, n=132), matched on demographic and baseline clinical measures to the BPM group. A piecewise mixed model was used for analyzing the time trajectories of BG, BP, and their lagged association. RESULTS Analysis revealed a significant difference in BG time trajectories associated with BP monitoring in BPM and NBPM groups (t=-2.12, P=.03). The BPM group demonstrated BG reduction improvement in the monthly average BG levels during the first 6 months (t=-3.57, P<.001), while BG did not change for the NBPM group (t=0.39, P=.70). Both groups showed similarly stable BG time trajectories (B=0.98, t=1.16, P=.25) before starting the use of the BP-monitoring system. In addition, the BPM group showed a significant reduction in systolic (t=-6.42, P<.001) and diastolic (t=-4.80, P<.001) BP during the first 6 months of BP monitoring. Finally, BG levels were positively associated with systolic (B=0.24, t=2.77, P=.001) and diastolic (B=0.30, t=2.41, P=.02) BP. CONCLUSIONS The results of this study shed light on the association between BG and BP levels and on the role of BP self-monitoring in diabetes management. Our findings also underscore the need and provide a basis for a comprehensive approach to understanding the mechanism of BP regulation associated with BG.
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Affiliation(s)
| | | | - Marilyn D Ritholz
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
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Abstract
PURPOSE OF REVIEW Hypertension (HTN) is the most common chronic disease impacting over half the US adult population. Our current office-based model of care is failing in its ability to control blood pressure (BP) as only 44% of adult US hypertensives are achieving minimal levels of BP control (< 140/90 mmHg), leading to high rates of preventable cardiovascular events and death. RECENT FINDINGS Reengineering care delivery using a fully digital platform combined with a dedicated team-based approach to HTN management has demonstrated superior BP control rates, very high levels patient acceptance, and the ability to better diagnose and treat masked and white coat HTN. SUMMARY A digital medicine program in the clinical care setting can be an effective and convenient mechanism of delivering HTN management, outperforming traditional office-based care, and is well accepted by patients.
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Affiliation(s)
- Richard V Milani
- Center for Healthcare Innovation
- Department of Cardiology, Ochsner Health and Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Carl J Lavie
- Department of Cardiology, Ochsner Health and Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Hector O Ventura
- Department of Cardiology, Ochsner Health and Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, Louisiana, USA
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Ionov MV, Zhukova OV, Yudina YS, Avdonina NG, Emelyanov IV, Kurapeev DI, Zvartau NE, Konradi AO. Value-based approach to blood pressure telemonitoring and remote counseling in hypertensive patients. Blood Press 2020; 30:20-30. [PMID: 32954832 DOI: 10.1080/08037051.2020.1813015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Blood pressure telemonitoring and remote counselling (BPTM) improves blood pressure (BP) control in patients with hypertension (HTN). Studies assessing the efficacy of BPTM from a value-based perspective are lacking. We investigated whether BPTM fits all principles of the value-based approach (clinical and economic effectiveness, improvement in patient-reported outcome/experience measures (PROM/PREM)). MATERIALS AND METHODS Two hundred and forty ambulatory patients with uncontrolled HTN were randomised in a 2: 1 manner to BPTM (n = 160, mean age 47 y.o.) and usual care (UC, n = 80; 49 y.o.) with baseline and 3-month follow-up clinic visits. BPTM employed a mobile application (for patients) and a desktop version (for clinician), which allowed communication and exchange of medical data. The main outcomes were changes in office and ambulatory systolic (S) BPs, rate of BP control. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were evaluated in economic analysis. The MOS SF-36 score was taken as a PROM, and the PEQ score was used as a PREM. RESULTS Larger decreases in office and ambulatory SBPs (-16.8 and -8.9 mm Hg, respectively; p < .05) was achieved in BPTM group while the treatment intensity was equal (2.4 drugs). The ICER 11.1 EUR/-1 mm Hg 24-hour SBP/1 year was 75% effective as per willingness-to-pay threshold. BPTM improved PROM (+2.1 in mean MOS SF-36; p = .04), reduced long-term mortality (+0.11 life years gained), leading to +0.49 quality-adjusted life years (QALYs) gained as compared with UC. The ICUR was 4 169.4 EUR/QALY gained. Patient-reported experience was higher in the BPTM (+10 PEQ, p = .01). The UC group showed minor changes in MOS SF-36 and PEQ (+1.3; +6, respectively; p n.s.). CONCLUSIONS Being cost-effective, BPTM incorporates both clinical benefits and patient-perceived value. Larger randomised studies are needed to confirm our findings.
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Affiliation(s)
- Mikhail V Ionov
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Institute of Translational Medicine, ITMO University, Saint-Petersburg, Russian Federation
| | - Olga V Zhukova
- Ministry of Health of the Russian Federation, Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation
| | - Yulia S Yudina
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Natalya G Avdonina
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Igor V Emelyanov
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Dmitri I Kurapeev
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Institute of Translational Medicine, ITMO University, Saint-Petersburg, Russian Federation
| | - Nadezhda E Zvartau
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Institute of Translational Medicine, ITMO University, Saint-Petersburg, Russian Federation
| | - Alexandra O Konradi
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Institute of Translational Medicine, ITMO University, Saint-Petersburg, Russian Federation
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Milani RV, Wilt JK, Milani AR, Bober RM, Malamud E, Entwisle J, Lavie CJ. Digital Management of Hypertension Improves Systolic Blood Pressure Variability. Am J Med 2020; 133:e355-e359. [PMID: 31870666 DOI: 10.1016/j.amjmed.2019.10.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Higher systolic blood pressure variability has been shown to be a better predictor of all-cause and cardiovascular disease mortality, stroke, and cardiac disease compared with average systolic blood pressure. METHODS We evaluated the impact of a digital hypertension program on systolic blood pressure variability in 803 consecutive patients with long-standing hypertension who had been under the care of a primary care physician for a minimum of 12 months prior to enrollment (mean 4.7 years). Blood pressure readings were transmitted directly from home using a digitally connected blood pressure unit. Medication adjustments and lifestyle coaching was performed virtually via a dedicated team of pharmacists and health coaches. Systolic blood pressure variability was grouped by quartile and measured using the standard deviation (SD) of all systolic blood pressure values per individual. RESULTS The mean age was 67 ± 12 years, 41% were male, submitting 3.3 ± 3.7 blood pressures per week. Under usual care, only 30% of patients were in the lowest-risk quartile, and 21% of patients were in the highest risk. After 24 months, the mean systolic blood pressure variability progressively fell from 12.8 ± 4.3 mm Hg to 9.9 ± 5.1 mm Hg (P <0.0001) with 57% of patients achieving the lowest-risk quartile. CONCLUSIONS The majority of patients with hypertension under usual care have elevated systolic blood pressure variability exposing them to higher risk of cardiovascular disease events. Digital management of hypertension that includes weekly submission of home readings leads to improvement in average systolic blood pressure as well as systolic blood pressure variability over time, which should improve cardiovascular prognosis.
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Affiliation(s)
- Richard V Milani
- Center for Healthcare Innovation, Ochsner Health System, New Orleans, La; Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, La.
| | - Jonathan K Wilt
- Center for Healthcare Innovation, Ochsner Health System, New Orleans, La
| | | | - Robert M Bober
- Center for Healthcare Innovation, Ochsner Health System, New Orleans, La; Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, La
| | - Eric Malamud
- Center for Healthcare Innovation, Ochsner Health System, New Orleans, La
| | - Jonathan Entwisle
- Center for Healthcare Innovation, Ochsner Health System, New Orleans, La
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, La
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Pallarés-Carratalá V, Bonig-Trigueros I, Palazón-Bru A, Esteban-Giner MJ, Gil-Guillén VF, Giner-Galvañ V. Clinical inertia in hypertension: a new holistic and practical concept within the cardiovascular continuum and clinical care process. Blood Press 2019; 28:217-228. [PMID: 31023106 DOI: 10.1080/08037051.2019.1608134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose: Recognition of clinical inertia is essential to improve the control of chronic diseases. Although it is very intuitive, a better interpretation of the concept of clinical inertia is lacking, likely due to its high complexity. Materials and Methods: After a review of the published articles, we propose a practical vision of inertia, contextualized within the clinical process of hypertension care. Results: This new vision enables the integration of previous terms and definitions of clinical inertia, as well as proposing specific strategies for its reduction. Conclusion: Although some concepts should be considered as 'justified inertia' or 'investigator inertia', the idea that inertia may be present throughout the continuum of care gives physicians a holistic view of the problem that is easily applicable to their clinical practice. Measures to overcome inertia are complicated because of the intrinsic complexity of the concept.
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Affiliation(s)
- Vicente Pallarés-Carratalá
- a Health Surveillance Unit , Castellón Mutual Insurance Union , Castellón de la Plana , Spain.,b Department of Medicine , Jaume I University , Castellón de la Plana , Spain
| | - Irene Bonig-Trigueros
- c Department of Internal Medicine (Cardiovascular Prevention Unit) , La Plana Hospital , Vila-Real , Spain
| | - Antonio Palazón-Bru
- d Department of Clinical Medicine , Miguel Hernández University , San Juan de Alicante , Spain
| | - María José Esteban-Giner
- e Department of Internal Medicine (Hypertension and Cardiometabolic Risk Unit) , Mare de Déu dels Lliris Hospital , Alcoy , Spain
| | - Vicente Francisco Gil-Guillén
- d Department of Clinical Medicine , Miguel Hernández University , San Juan de Alicante , Spain.,f Research Unit General University Hospital of Elda , Elda , Spain
| | - Vicente Giner-Galvañ
- e Department of Internal Medicine (Hypertension and Cardiometabolic Risk Unit) , Mare de Déu dels Lliris Hospital , Alcoy , Spain
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