• Mitchell Tang, Carter H Nakamoto, Ariel D Stern, Jose R Zubizarreta, Felippe O Marcondes, Lori Uscher-Pines, Lee H Schwamm, and Ateev Mehrotra.
• Harvard Graduate School of Arts and Sciences, Cambridge; and Harvard Business School, Boston, Massachusetts (M.T.).
• Ann. Intern. Med. 2023 Nov 1; 176 (11): 146514751465-1475.

BackgroundRemote patient monitoring (RPM) is a promising tool for improving chronic disease management. Use of RPM for hypertension monitoring is growing rapidly, raising concerns about increased spending. However, the effects of RPM are still unclear.ObjectiveTo estimate RPM's effect on hypertension care and spending.DesignMatched observational study emulating a longitudinal, cluster randomized trial. After matching, effect estimates were derived from a regression analysis comparing changes in outcomes from 2019 to 2021 for patients with hypertension at high-RPM practices versus those at matched control practices with little RPM use.SettingTraditional Medicare.PatientsPatients with hypertension.InterventionReceipt of care at a high-RPM practice.MeasurementsPrimary outcomes included hypertension medication use (medication fills, adherence, and unique medications received), outpatient visit use, testing and imaging use, hypertension-related acute care use, and total hypertension-related spending.Results192 high-RPM practices (with 19 978 patients with hypertension) were matched to 942 low-RPM control practices (with 95 029 patients with hypertension). Compared with patients with hypertension at matched low-RPM practices, patients with hypertension at high-RPM practices had a 3.3% (95% CI, 1.9% to 4.8%) relative increase in hypertension medication fills, a 1.6% (CI, 0.7% to 2.5%) increase in days' supply, and a 1.3% (CI, 0.2% to 2.4%) increase in unique medications received. Patients at high-RPM practices also had fewer hypertension-related acute care encounters (-9.3% [CI, -20.6% to 2.1%]) and reduced testing use (-5.9% [CI, -11.9% to 0.0%]). However, these patients also saw increases in primary care physician outpatient visits (7.2% [CI, -0.1% to 14.6%]) and a $274 [CI, $165 to $384]) increase in total hypertension-related spending.LimitationLacked blood pressure data; residual confounding.ConclusionPatients in high-RPM practices had improved hypertension care outcomes but increased spending.Primary Funding SourceNational Institute of Neurological Disorders and Stroke.

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