A Randomized Controlled Trial of a Post-ICU Telehealth Care Model (WFIT)
Rita N. Bakhru, Lori Flores, Joanna M. Cain, Valesha M. Province, Jason Fanning, Himanshu Rawal, Richa Bundy, Corey Obermiller, Adam Moses, Ajay Dharod, Lindsey Abdelfattah, Amresh Hanchate, D. Clark Files
Abstract
Abstract Rationale Survivors of critical illness are at high risk for poor long-term outcomes, including readmissions, reduced quality of life, and mortality. A post-ICU telehealth care model may improve outcomes. Objectives We sought to evaluate the cost-effectiveness and clinical efficacy of a post-ICU telehealth care model. Methods We performed a single-center randomized controlled trial of 400 ICU patients with sepsis and/or acute respiratory failure, who had two or fewer hospital admissions in the past year, and who were not admitted from or discharged to hospice, a skilled nursing facility, or a long-term acute care hospital. The intervention group had scheduled telehealth visits at 1 and 2 weeks after ICU discharge and as needed for 6 months with a clinician trained in post-ICU recovery. The primary outcome is the cost-effectiveness of the intervention. Measurements and Main Results Overall healthcare spending on emergency room (ER) visits and hospitalizations were a mean (SD, in U.S. dollars) $7,801.10 ($15,461.03) in the attention control group versus $8,086.50 ($17,464.87) in the intervention group, with a calculated incremental net benefit of $1,958.29 (−$5,779.56 to $9,696.14). ER visits to our healthcare system were the same between groups, but patient-reported ER visits to outside hospitals were different (0.97 per 100 patients per month in the attention control group vs. 2.43 in the intervention group; P = 0.03). Readmissions, mortality, quality-of-life scores, and overall patient satisfaction scores were similar between groups. Conclusions This randomized controlled trial of a post-ICU telehealth intervention demonstrated wide variation but no clear incremental net benefit compared with standard care. Clinical trial registered with www.clinicaltrials.gov (NCT 04576065).