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McGillion MH, Parlow J, Borges FK, Marcucci M, Jacka M, Adili A, Lalu MM, Ouellette C, Bird M, Ofori S, Roshanov PS, Patel A, Yang H, O'Leary S, Tandon V, Hamilton GM, Mrkobrada M, Conen D, Harvey V, Lounsbury J, Mian R, Bangdiwala SI, Arellano R, Scott T, Guyatt GH, Gao P, Graham M, Nenshi R, Forster AJ, Nagappa M, Levesque K, Marosi K, Chaudhry S, Haider S, Deuchar L, LeBlanc B, McCartney CJL, Schemitsch EH, Vincent J, Pettit SM, DuMerton D, Paulin AD, Simunovic M, Williams DC, Halman S, Harlock J, Meyer RM, Taylor DA, Shanthanna H, Schlachta CM, Parry N, Pichora DR, Yousuf H, Peter E, Lamy A, Petch J, Moloo H, Sehmbi H, Waggott M, Shelley J, Belley-Cote EP, Devereaux PJ. Post-discharge after surgery Virtual Care with Remote Automated Monitoring-1 (PVC-RAM-1) technology versus standard care: randomised controlled trial. BMJ 2021; 374:n2209. [PMID: 34593374 PMCID: PMC8477638 DOI: 10.1136/bmj.n2209] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 01/08/2023]
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.
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Affiliation(s)
- Michael H McGillion
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Joel Parlow
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Flavia K Borges
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maura Marcucci
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Michael Jacka
- Departments of Critical Care and Anesthesiology, University of Alberta, Edmonton, Alberta, Canada
| | - Anthony Adili
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Manoj M Lalu
- Department of Anesthesiology and Pain Medicine, The University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Carley Ouellette
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Marissa Bird
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Sandra Ofori
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Internal Medicine, University of Port Harcourt, Port Harcourt, Nigeria, West Africa
| | - Pavel S Roshanov
- Department of Medicine, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Ameen Patel
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Homer Yang
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Susan O'Leary
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Vikas Tandon
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Gavin M Hamilton
- Department of Anesthesiology and Pain Medicine, The University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marko Mrkobrada
- Department of Medicine, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada
| | - David Conen
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Valerie Harvey
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jennifer Lounsbury
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Rajibul Mian
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Shrikant I Bangdiwala
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ramiro Arellano
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Ted Scott
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Gordon H Guyatt
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Peggy Gao
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Michelle Graham
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Rahima Nenshi
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Alan J Forster
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Mahesh Nagappa
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Kelsea Levesque
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Kristen Marosi
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sultan Chaudhry
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shariq Haider
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Brandi LeBlanc
- St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Colin J L McCartney
- Department of Anesthesiology and Pain Medicine, The University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Emil H Schemitsch
- Department of Surgery, University of Western Ontario and London Health Sciences Centre, London, Ontario, Canada
| | - Jessica Vincent
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Shirley M Pettit
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Deborah DuMerton
- Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Angela Djuric Paulin
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Marko Simunovic
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - David C Williams
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Samantha Halman
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - John Harlock
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ralph M Meyer
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Dylan A Taylor
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Harsha Shanthanna
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Christopher M Schlachta
- Department of Surgery, University of Western Ontario and London Health Sciences Centre, London, Ontario, Canada
| | - Neil Parry
- Department of Surgery, University of Western Ontario and London Health Sciences Centre, London, Ontario, Canada
| | - David R Pichora
- Department of Surgery, Queen's University and Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Haroon Yousuf
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth Peter
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Andre Lamy
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jeremy Petch
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Husein Moloo
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Herman Sehmbi
- Department of Medicine, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada
| | | | - Jessica Shelley
- Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Emilie P Belley-Cote
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - P J Devereaux
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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