A Randomized Controlled Trial of a Post-ICU Telehealth Care Model (WFIT)

Survivors of critical illness are at high risk for poor long-term outcomes including readmissions, reduced quality of life, and mortality. A post-ICU telehealth care model may improve outcomes. We sought to evaluate the cost-effectiveness and clinical efficacy of a post-ICU telehealth care model. We performed a single center randomized controlled trial of 400 ICU patients with sepsis and/or acute respiratory failure, who had ≤2 hospital admissions in the past year, and who were not admitted from or discharged to hospice, a skilled nursing facility or a long-term acute care hospital. The intervention group had scheduled telehealth visits at 1- and 2- weeks post-ICU discharge and as needed for six months with a clinician trained in post-ICU recovery. The primary outcome is cost-effectiveness of the intervention. Overall healthcare spending on ER visits and hospitalizations were a mean (SD, in USD) $7,801.10 (15,461.03) in the attention control group vs 8,086.50 (17,464.87) in the intervention group, with a calculated incremental net benefit of $1,958.29 (-$5,779.56, $9,696.14). ER visits to our health care system were the same between groups, but patient-reported ER visits to outside hospitals were different (0.97 per 100 patients per month in the attention control group vs 2.43 in the intervention group, p=0.03). Readmissions, mortality, quality of life scores and overall patient satisfaction scores were similar between groups. This randomized controlled trial of a post-ICU telehealth intervention demonstrated wide variation, but no clear incremental net benefit compared to standard care.