Reliable outpatient monitoring has been a topic of interest among healthcare providers for many yearsCitation1. Although the widespread integration of this technology into medical practice has been limited, recent technological advances have led to an explosion of the monitoring device industry and concurrently the routine use of outpatient monitoring has become increasingly feasible. The goal of monitoring is to measure any number of different variables pertaining to an individual’s internal physiologic state and the surrounding environment. Although tech-savvy and fitness-minded individuals currently dominate the market for such devices, there is increasing interest in expanding the use of outpatient monitoring as a strategy to improve healthcare deliveryCitation1. This prospect of monitoring clinically relevant variables as a patient candidly interacts with his/her environment has tremendous implications for virtually every medical discipline. Yet despite significant progress within the monitoring device industryCitation2,Citation3, widespread integration of this technology into medical practice remains limited.
Three general approaches to outpatient monitoring have been utilized – patient reported outcomes, tele-monitoring, and quantifying self hybrid models. There is considerable overlap between these three approaches, yet each is characterized by unique advantages and disadvantages that must be considered in the context of patient- and disease-specific variables. Here, we seek to clarify the difference between these various models of outpatient monitoring, and also to delineate the advantages and disadvantages of each strategy. Patient reported outcomes (PRO) involve self-reporting of subjective data by the patient. This can be accomplished with a simple diary, or alternatively via a mobile- or web-based application that automatically transmits data to a healthcare provider. Although the details of a PRO plan may vary, the distinguishing feature is that the patient actively provides data.
Tele-monitoring utilizes monitoring equipment in order to measure physiologic variables. In essence, this approach may be viewed as an outpatient extension of continuous monitoring that has traditionally only been practical in dedicated hospital wards. The distinguishing feature of tele-monitoring is that data collection occurs passively, although patients may be involved in varying capacities. For instance, data may be collected using an external patient-controlled monitor, or instead via an invasive device that operates wholly independently of the patient. Furthermore, a tele-monitoring system may be calibrated to provide a reflexive intervention based on passively collected data, or instead may alert the patient that some intervention is necessary.
The primary benefit of PRO is that it encourages active patient participation in disease management. The inherent downside, however, is that patient-reported data may be inconsistent and unreliable. Tele-monitoring provides objective and reliable data; however, its utility is limited to quantifiable variables. Furthermore, due to its automated nature, tele-monitoring allows the patient to assume a passive role in disease management.
Quantifying self hybrid models (QSHMs) combine features of PRO and tele-monitoring into a system that integrates passive data collection and active patient reporting. In this way, QSHMs circumvent the unreliable subjectivity of PRO and the inflexible objectivity of tele-monitoring. Additionally, by allowing for correlation of subjective symptoms with objective physiologic data in real-time, QSHMs enable patients to understand their disease and modify their behavior in unprecedented ways. Initial studies evaluating the impact of QSHMs in chronic disease management have been promisingCitation4–6.
Finally, it is important to recognize that the widespread use of outpatient monitoring may be a double-edged sword: ideally, monitoring data will serve to detect subtle but clinically significant changes in physiologic parameters that short-term inpatient monitoring is unable to identify. If not applied correctly, however, outpatient monitoring may serve only to augment patient anxiety and to increase the number of emergency department or office visits without a substantial improvement in clinical care.
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Declaration of funding
This editorial was not funded.
All authors have contributed to the conception, design and drafting the work. The authors have been involved in the final approval of the version to be published and therefore agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Declaration of financial/other relationships
G.A. is a consultant/adviser to Folup, Inc. E.S.S., P.R., Y.J., J.-Y.R., and E.S.C. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.
References
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- Swan M. Emerging patient-driven health care models: an examination of health social networks, consumer personalized medicine and quantified self-tracking. Int J Environ Res Publ Health 2009;6:492-525
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- Juillière Y, Jourdain P, Suty-Selton C, et al. Therapeutic patient education and all-cause mortality in patients with chronic heart failure: a propensity analysis. Int J Cardiol 2013;168:388-95
- Chan DS, Callahan CW, Hatch-Pigott VB, et al. Internet-based home monitoring and education of children with asthma is comparable to ideal office-based care: results of a 1-year asthma in-home monitoring trial. Pediatrics 2007;119:569-78
- Logan AG, Irvine MJ, McIsaac WJ, et al. Effect of home blood pressure telemonitoring with self-care support on uncontrolled systolic hypertension in diabetics. Hypertension 2012;60:51-7