Researchers find no evidence that smart homes and home health monitoring technologies "help address disability prediction and health-related quality of life, or fall prevention."
Researchers have found no evidence that smart homes and home health monitoring help prevent falls or health-related quality of life for the elderly.
While internet-linked devices and home health monitoring have the potential to improve care for the elderly, a review of existing evidence in the current issue of the International Journal of Medical Informatics found limited evidence of some benefits, but concludes that more research is needed into their efficacy.
The research comes after two disappointing studies that found little change in outcomes with some forms of home monitoring.
Still, hospitals and home health agencies increasingly favor the approach to keep track of chronically ill and recently discharged patients at risk of readmission.
The researchers identified 1,863 relevant studies and analyzed 48 with the strongest quantitative evidence.
They found no evidence that smart homes and home health monitoring technologies "help address disability prediction and health-related quality of life, or fall prevention."
Lead author Lili Liu is with the Department of Occupational Therapy at the University of Alberta in Edmonton, Canada. She says providers should not discount systems that patients favor, but should be aware of the lack of research into how well they work.
"If a family member would come to me and say 'I use the same system on my house for security as I do to monitor a family member who is living on the other side of the country,' I would say use it, if it works for you," Liu said.
Still, the review found little in terms of the type of rigorous, controlled studies needed to link health outcomes to technology, she said.
Liu said the devices and systems are flooding the market and in many cases, have not been properly studied or vetted. In Canada, provincial health agencies conduct assessments of new technologies. She suggested that hospitals do the same.
The simple push-button pendants that emerged in the 1970s to summon help have given way to monitoring devices equipped with global positioning systems and connected to cell phones.
Wi-Fi and Bluetooth technology now allow patients to send health data to providers from wearable heart monitors. Home devices allow providers to monitor glucose levels and blood pressure from afar.
Pill boxes remind patients to take medication and let caregivers know if they don't. Digital home health hubs can collect data in one place.
Still, a March UCLA study concluded that the combination of health coaching telephone calls and telemonitoring did not reduce 180-day readmissions for heart failure patients.
In another recent study, researchers found no cost or utilization benefit for patient who used mobile devices and cell phone systems for tracking for hypertension, diabetes and cardiac arrhythmias.
Joseph Kvedar, head of the Partners Center for Connected Health in Boston finds fault in both studies, pointing out only 60% of the patients in the heart failure study fully participated in the program.
'Does Not Fit Preexisting Notions of Clinical Evidence'
The traditional research model used for most clinical trials fails to include factors like "ongoing provider-patient interaction," he said in an email response to questions from HealthLeaders.
"Remote monitoring requires a different way of evaluating effectiveness, which does not fit cleanly into our preexisting notions of clinical evidence," he wrote.
"For example, if a patient is not engaged with or using the remote monitoring intervention, should that technology be deemed unsuccessful in managing a chronic illness?"
Instead, he wrote, researchers should focus on the design elements of programs and how well they engage and motivate patients to comply with treatment plans.
A report from a 2015 National Academies workshop on the future of home healthcare noted that research into home monitoring technology is increasing, but evidence of efficacy is lacking or contradictory.
And, the research is challenging because "the pace of technological advance is faster than traditional research grant cycles, so that by the time a study has been planned and funding have been acquired, the technology to be studied is outdated."
A recent survey by the Health Information and Management Systems Society (HIMSS) of 227 hospitals found that 52% already use three or more form of connected health technology and 47% plan to expand their programs over the next few years.
Tinker Ready is a contributing writer at HealthLeaders Media.