Remote Patient Monitoring Program Components and Short-Term Hypertension Control: Retrospective Cohort Study.
Remote patient monitoring (RPM) is recommended for hypertension control. However, less is known about short-term responses of hypertension to RPM and which program components are most important for hypertension control.
This study aimed to evaluate the association between frequency of blood pressure monitoring, nurse monitoring, and their combination and hypertension control within 3 months.
This retrospective cohort study was conducted among a convenience sample of 1464 patients with hypertension enrolled in the Brook Remote Care RPM program who sought care at any of the 68 participating primary care clinics in New York or Massachusetts, United States, between 2021 and 2023. Patients with at least 3 blood pressure measures for 70% of the weeks they were in the program were defined as having adequate readings. Brook nurses monitored patients from certain clinics, whereas clinic nurses monitored other patients. Hypertension control was defined as a weekly average blood pressure of less than 140/90 mm Hg. Generalized linear models with a binomial specification and log link were used to estimate the prevalence ratio (PR) and 95% CI of the mutually adjusted associations between adequate blood pressure readings and Brook nurse monitoring, as well as their combination with hypertension control, at 4, 8, and 12 weeks, adjusted for patient age and sex.
At weeks 4, 8, and 12, patients with adequate readings had 10% (PR=1.10, 95% CI 1.02-1.20), 12% (PR=1.12, 95% CI 1.04-1.20), and 15% (PR=1.15, 95% CI 1.07-1.24) higher prevalence of hypertension control than patients with lower frequencies of readings, respectively. Brook nurse monitoring was associated with 16% (PR=1.16, 95% CI 1.07-1.27), 6% (PR=1.06, 95% CI 0.99-1.15), and 8% (PR=1.08, 95% CI 1.00-1.16) higher prevalence of hypertension control at weeks 4, 8, and 12, respectively, compared to clinical staff monitoring. The combination of adequate readings plus Brook nurse monitoring was associated with 26% (PR=1.26, 95% CI 1.11-1.44), 17% (PR=1.17, 95% CI 1.05-1.31), and 27% (PR=1.27, 95% CI 1.12-1.43) higher prevalence of hypertension control at weeks 4, 8, and 12, respectively, compared to an inadequate number of blood pressure readings and not receiving Brook nurse monitoring.
This is the first study to compare outcomes for RPM patients using clinical nurse monitoring and independent staff monitoring. This study represents a contribution to the literature on clinical outcomes for RPM patients with a focus on short-term, rather than longer-term, hypertension control, evaluation of nurse monitoring conducted by Brook Health compared to clinical staff, and the joint association of monitoring frequency and Brook nurse monitoring on hypertension control. Our study findings suggest that both frequency of monitoring and specialized nurse monitoring improve hypertension control within 3 months of program enrollment. The combination of higher monitoring frequency and Brook nurse monitoring may serve as a cost-effective approach to hypertension control in high-risk populations that overcomes the limitations of clinical care staff.
This study aimed to evaluate the association between frequency of blood pressure monitoring, nurse monitoring, and their combination and hypertension control within 3 months.
This retrospective cohort study was conducted among a convenience sample of 1464 patients with hypertension enrolled in the Brook Remote Care RPM program who sought care at any of the 68 participating primary care clinics in New York or Massachusetts, United States, between 2021 and 2023. Patients with at least 3 blood pressure measures for 70% of the weeks they were in the program were defined as having adequate readings. Brook nurses monitored patients from certain clinics, whereas clinic nurses monitored other patients. Hypertension control was defined as a weekly average blood pressure of less than 140/90 mm Hg. Generalized linear models with a binomial specification and log link were used to estimate the prevalence ratio (PR) and 95% CI of the mutually adjusted associations between adequate blood pressure readings and Brook nurse monitoring, as well as their combination with hypertension control, at 4, 8, and 12 weeks, adjusted for patient age and sex.
At weeks 4, 8, and 12, patients with adequate readings had 10% (PR=1.10, 95% CI 1.02-1.20), 12% (PR=1.12, 95% CI 1.04-1.20), and 15% (PR=1.15, 95% CI 1.07-1.24) higher prevalence of hypertension control than patients with lower frequencies of readings, respectively. Brook nurse monitoring was associated with 16% (PR=1.16, 95% CI 1.07-1.27), 6% (PR=1.06, 95% CI 0.99-1.15), and 8% (PR=1.08, 95% CI 1.00-1.16) higher prevalence of hypertension control at weeks 4, 8, and 12, respectively, compared to clinical staff monitoring. The combination of adequate readings plus Brook nurse monitoring was associated with 26% (PR=1.26, 95% CI 1.11-1.44), 17% (PR=1.17, 95% CI 1.05-1.31), and 27% (PR=1.27, 95% CI 1.12-1.43) higher prevalence of hypertension control at weeks 4, 8, and 12, respectively, compared to an inadequate number of blood pressure readings and not receiving Brook nurse monitoring.
This is the first study to compare outcomes for RPM patients using clinical nurse monitoring and independent staff monitoring. This study represents a contribution to the literature on clinical outcomes for RPM patients with a focus on short-term, rather than longer-term, hypertension control, evaluation of nurse monitoring conducted by Brook Health compared to clinical staff, and the joint association of monitoring frequency and Brook nurse monitoring on hypertension control. Our study findings suggest that both frequency of monitoring and specialized nurse monitoring improve hypertension control within 3 months of program enrollment. The combination of higher monitoring frequency and Brook nurse monitoring may serve as a cost-effective approach to hypertension control in high-risk populations that overcomes the limitations of clinical care staff.