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Post-discharge after surgery Virtual Care with Remote Automated Monitoring-1 (PVC-RAM-1) technology versus standard care: randomised controlled trial.
McGillion, Michael H; Parlow, Joel; Borges, Flavia K; Marcucci, Maura; Jacka, Michael; Adili, Anthony; Lalu, Manoj M; Ouellette, Carley; Bird, Marissa; Ofori, Sandra; Roshanov, Pavel S; Patel, Ameen; Yang, Homer; O'Leary, Susan; Tandon, Vikas; Hamilton, Gavin M; Mrkobrada, Marko; Conen, David; Harvey, Valerie; Lounsbury, Jennifer; Mian, Rajibul; Bangdiwala, Shrikant I; Arellano, Ramiro; Scott, Ted; Guyatt, Gordon H; Gao, Peggy; Graham, Michelle; Nenshi, Rahima; Forster, Alan J; Nagappa, Mahesh; Levesque, Kelsea; Marosi, Kristen; Chaudhry, Sultan; Haider, Shariq; Deuchar, Lesly; LeBlanc, Brandi; McCartney, Colin J L; Schemitsch, Emil H; Vincent, Jessica; Pettit, Shirley M; DuMerton, Deborah; Paulin, Angela Djuric; Simunovic, Marko; Williams, David C; Halman, Samantha; Harlock, John; Meyer, Ralph M; Taylor, Dylan A; Shanthanna, Harsha; Schlachta, Christopher M.
  • McGillion MH; School of Nursing, McMaster University, Hamilton, Ontario, Canada.
  • Parlow J; Population Health Research Institute, Hamilton, Ontario, Canada.
  • Borges FK; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada.
  • Marcucci M; Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada.
  • Jacka M; Population Health Research Institute, Hamilton, Ontario, Canada.
  • Adili A; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
  • Lalu MM; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
  • Ouellette C; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
  • Bird M; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
  • Ofori S; Departments of Critical Care and Anesthesiology, University of Alberta, Edmonton, Alberta, Canada.
  • Roshanov PS; Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
  • Patel A; St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
  • Yang H; Department of Anesthesiology and Pain Medicine, The University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.
  • O'Leary S; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
  • Tandon V; School of Nursing, McMaster University, Hamilton, Ontario, Canada.
  • Hamilton GM; School of Nursing, McMaster University, Hamilton, Ontario, Canada.
  • Mrkobrada M; Population Health Research Institute, Hamilton, Ontario, Canada.
  • Conen D; Department of Internal Medicine, University of Port Harcourt, Port Harcourt, Nigeria, West Africa.
  • Harvey V; Department of Medicine, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada.
  • Lounsbury J; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
  • Mian R; Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Ontario, Canada.
  • Bangdiwala SI; Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada.
  • Arellano R; Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre, London, Ontario, Canada.
  • Scott T; Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Ontario, Canada.
  • Guyatt GH; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.
  • Gao P; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
  • Graham M; St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
  • Nenshi R; Department of Anesthesiology and Pain Medicine, The University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.
  • Forster AJ; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
  • Nagappa M; Department of Medicine, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada.
  • Levesque K; Population Health Research Institute, Hamilton, Ontario, Canada.
  • Marosi K; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
  • Chaudhry S; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
  • Haider S; Population Health Research Institute, Hamilton, Ontario, Canada.
  • Deuchar L; School of Nursing, McMaster University, Hamilton, Ontario, Canada.
  • LeBlanc B; Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Ontario, Canada.
  • McCartney CJL; Population Health Research Institute, Hamilton, Ontario, Canada.
  • Schemitsch EH; Population Health Research Institute, Hamilton, Ontario, Canada.
  • Vincent J; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
  • Pettit SM; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada.
  • DuMerton D; Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada.
  • Paulin AD; Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Ontario, Canada.
  • Simunovic M; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
  • Williams DC; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
  • Halman S; Population Health Research Institute, Hamilton, Ontario, Canada.
  • Harlock J; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
  • Meyer RM; Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
  • Taylor DA; St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
  • Shanthanna H; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
  • Schlachta CM; Department of Medicine, The University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.
BMJ ; 374: n2209, 2021 09 30.
Article in English | MEDLINE | ID: covidwho-1448003
ABSTRACT

OBJECTIVE:

To determine if virtual care with remote automated monitoring (RAM) technology versus standard care increases days alive at home among adults discharged after non-elective surgery during the covid-19 pandemic.

DESIGN:

Multicentre randomised controlled trial.

SETTING:

8 acute care hospitals in Canada.

PARTICIPANTS:

905 adults (≥40 years) who resided in areas with mobile phone coverage and were to be discharged from hospital after non-elective surgery were randomised either to virtual care and RAM (n=451) or to standard care (n=454). 903 participants (99.8%) completed the 31 day follow-up. INTERVENTION Participants in the experimental group received a tablet computer and RAM technology that measured blood pressure, heart rate, respiratory rate, oxygen saturation, temperature, and body weight. For 30 days the participants took daily biophysical measurements and photographs of their wound and interacted with nurses virtually. Participants in the standard care group received post-hospital discharge management according to the centre's usual care. Patients, healthcare providers, and data collectors were aware of patients' group allocations. Outcome adjudicators were blinded to group allocation. MAIN OUTCOME

MEASURES:

The primary outcome was days alive at home during 31 days of follow-up. The 12 secondary outcomes included acute hospital care, detection and correction of drug errors, and pain at 7, 15, and 30 days after randomisation.

RESULTS:

All 905 participants (mean age 63.1 years) were analysed in the groups to which they were randomised. Days alive at home during 31 days of follow-up were 29.7 in the virtual care group and 29.5 in the standard care group relative risk 1.01 (95% confidence interval 0.99 to 1.02); absolute difference 0.2% (95% confidence interval -0.5% to 0.9%). 99 participants (22.0%) in the virtual care group and 124 (27.3%) in the standard care group required acute hospital care relative risk 0.80 (0.64 to 1.01); absolute difference 5.3% (-0.3% to 10.9%). More participants in the virtual care group than standard care group had a drug error detected (134 (29.7%) v 25 (5.5%); absolute difference 24.2%, 19.5% to 28.9%) and a drug error corrected (absolute difference 24.4%, 19.9% to 28.9%). Fewer participants in the virtual care group than standard care group reported pain at 7, 15, and 30 days after randomisation absolute differences 13.9% (7.4% to 20.4%), 11.9% (5.1% to 18.7%), and 9.6% (2.9% to 16.3%), respectively. Beneficial effects proved substantially larger in centres with a higher rate of care escalation.

CONCLUSION:

Virtual care with RAM shows promise in improving outcomes important to patients and to optimal health system function. TRIAL REGISTRATION ClinicalTrials.gov NCT04344665.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Surgical Procedures, Operative / Telemedicine / Aftercare / Monitoring, Ambulatory Type of study: Controlled clinical trial / Etiology study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: BMJ Journal subject: Medicine Year: 2021 Document Type: Article Affiliation country: Bmj.n2209

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Surgical Procedures, Operative / Telemedicine / Aftercare / Monitoring, Ambulatory Type of study: Controlled clinical trial / Etiology study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: BMJ Journal subject: Medicine Year: 2021 Document Type: Article Affiliation country: Bmj.n2209