Literature Collection

As Canadian healthcare moves toward integrated care, it lacks "North Star" metrics, relying instead on hospital-centric indicators that miss the patient experience. Building on the integrated care framework by Anne Wojtak and Jodeme Goldhar, this paper argues for shifting from measuring system activity to measuring the burden placed on patients and caregivers. It proposes three new metrics: the System Friction Ratio, the Caregiver Latency Index and the Patient-Reported Burden Score. To achieve true population health, we must stop counting hospital-focused administrative outputs and start measuring the friction patients and families face when navigating the system.

BACKGROUND: Home blood pressure telemonitoring (HBPT) can empower patients to participate in their healthcare and reduce office BP. Evidence that BP control can be sustained following HBPT is scarce. We examined the effects of an HBPT program on BP outcomes. METHODS: We included patients with uncontrolled hypertension enrolled in an HBPT program at an integrated healthcare system between November 2019 and June 2022. Clinicians enrolled patients and provided them with a BP device and a mobile application. We examined clinic BP before and after enrollment in HBPT, and sustained clinic BP control (last clinic BP < 140/90 mmHg) within 12 months following graduation from the program (home BP < 135/85 mmHg). Multivariable robust Poisson regression was used to identify factors associated with sustained clinic BP control. RESULTS: Overall, 3574 patients were enrolled and 59% consented to participation. Among those who consented, 3% did not submit >1 home BP, 37% were actively enrolled, 30% disenrolled without meeting home BP control and 30% graduated by meeting home BP control. Among 527 patients who graduated and had ≥1 follow-up clinic BP, 396 (75%) sustained clinic BP control within 12 months while mean clinic SBP and DBP was reduced by 16.3 (95% CI: -18.3, -14.4) mmHg and 10.0 (95% CI: -11.1, -8.9) mmHg, respectively (P < 0.0001 for both) compared with the last clinic BP prior to HBPT enrollment. CONCLUSIONS: The HBPT program in this healthcare system demonstrates potential; however, effective strategies are needed to facilitate enrollment and consent of patients and to scale the program.