Abstract
BACKGROUND: Every year in France, 40% of people aged ≥80 years are hospitalized, with an average length of hospital stay of 25 days and a readmission rate of 14% to 30% within the month following discharge. This situation is putting pressure on the health care system, encouraging the reinforcement of home care to reduce avoidable hospitalization. The EPOCA remote patient monitoring (RPM) system is a medical and social telehealth solution specialized in RPM, teleconsultation, tele-expertise, and care coordination in emergency medicine and geriatrics. The platform provides long-term medical support at home (MSAH) with 24-7 telemonitoring of older adults with polypathology. We hypothesized that receiving long-term MSAH via the EPOCA RPM system would be associated with a reduction in the rates and durations of hospitalizations or emergency department (ED) visits in older adults with polypathology. OBJECTIVE: We aimed to compare the hospitalization and ED visit rates, as well as the cumulative hospital stay duration, before and after enrollment in the EPOCA RPM system for older adults with polypathology. METHODS: This retrospective observational study included older adults (aged ≥70 years) with polypathology (>2 affected systems) followed throughout 2 different types of long-term MSAH between February 2022 and October 2023. We compared the number of hospital admissions, including ED visits; the cumulative duration of hospital stays during the follow-up; and the average length of hospital stays during the period corresponding to the MSAH program (Y) compared to the year before entering the program (Y - 1). Subgroup analyses were conducted according to the severity of the participants' disability. RESULTS: A total of 120 participants were included in the MSAH program, with a mean age of 86.8 (SD 7.9) years. Hospitalization and ED visit rates decreased (-48%) between the Y - 1 and Y periods, as did the total duration of hospital stays (-63%). A significant reduction in number of hospitalizations (median decreased from 1.0 to 0.0 per patient per year; P<.001) and ED visits (median decreased from 1.0 to 0.0 per patient per year; P<.001) was observed between the Y - 1 and Y periods. This corresponded to a significant median reduction of 14 days spent at the hospital per patient per year (P<.001). The decrease in hospitalization and ED visit rates and numbers was greater in participants with severe disabilities than in those with no or moderate disabilities. CONCLUSIONS: Among older adults with polypathology, the EPOCA RPM system is associated with reduction in number of hospitalizations, ED visits, and duration of hospital stays. Facing the challenge of population aging, home telemonitoring embedded in the health care system offers potential benefits.