Both frequency of monitoring and specialized nurse monitoring improve hypertension control within 3 months of RPM program enrollment, with their combination associated with 26%, 17%, and 27% higher prevalence of hypertension control at weeks 4, 8, and 12, respectively.
Key Findings
Results
Adequate blood pressure readings were associated with progressively higher prevalence of hypertension control at each time point through 12 weeks.
Patients with adequate readings had 10% higher prevalence of hypertension control at week 4 (PR=1.10, 95% CI 1.02-1.20)
At week 8, patients with adequate readings had 12% higher prevalence of hypertension control (PR=1.12, 95% CI 1.04-1.20)
At week 12, patients with adequate readings had 15% higher prevalence of hypertension control (PR=1.15, 95% CI 1.07-1.24)
Adequate readings were defined as having at least 3 blood pressure measures for 70% of the weeks enrolled in the program
Associations were mutually adjusted for Brook nurse monitoring, patient age, and sex
Results
Brook nurse monitoring was associated with higher prevalence of hypertension control compared to clinical staff monitoring, with the strongest association observed at week 4.
Brook nurse monitoring was associated with 16% higher prevalence of hypertension control at week 4 (PR=1.16, 95% CI 1.07-1.27)
At week 8, the association was 6% higher prevalence (PR=1.06, 95% CI 0.99-1.15), with the confidence interval crossing 1
At week 12, Brook nurse monitoring was associated with 8% higher prevalence of hypertension control (PR=1.08, 95% CI 1.00-1.16)
Brook nurses monitored patients from certain clinics while clinic nurses monitored patients from other clinics
This is described as the first study to compare RPM outcomes between clinical nurse monitoring and independent staff monitoring
Results
The combination of adequate blood pressure readings and Brook nurse monitoring was associated with substantially higher prevalence of hypertension control compared to inadequate readings without Brook nurse monitoring.
The combination was associated with 26% higher prevalence of hypertension control at week 4 (PR=1.26, 95% CI 1.11-1.44)
At week 8, the combination was associated with 17% higher prevalence of hypertension control (PR=1.17, 95% CI 1.05-1.31)
At week 12, the combination was associated with 27% higher prevalence of hypertension control (PR=1.27, 95% CI 1.12-1.43)
The reference group was patients with an inadequate number of blood pressure readings who did not receive Brook nurse monitoring
These combined associations were larger than either component alone at all three time points
Methods
The study population consisted of 1464 patients with hypertension enrolled in the Brook Remote Care RPM program across 68 primary care clinics.
Patients were drawn from 68 participating primary care clinics in New York or Massachusetts, United States
The study period spanned 2021 to 2023
The sample was described as a convenience sample
Hypertension control was defined as a weekly average blood pressure of less than 140/90 mm Hg
The study design was a retrospective cohort study
Methods
Generalized linear models with a binomial specification and log link were used to estimate prevalence ratios for hypertension control at 4, 8, and 12 weeks.
Models estimated prevalence ratios (PR) and 95% CIs for the mutually adjusted associations between adequate blood pressure readings, Brook nurse monitoring, and hypertension control
Models were adjusted for patient age and sex
Outcomes were assessed at three time points: 4, 8, and 12 weeks
Associations between adequate readings and nurse monitoring type were estimated mutually adjusted for one another
The combination variable compared patients with both adequate readings and Brook nurse monitoring to those with neither