Post-Hospitalization Follow-up of two Noncommunicable Diseases using eHealth Solutions: A Restricted, Systematic Review (Preprint)

BACKGROUND Heart failure (HF) and colorectal cancer (CRC) are non-communicable diseases (NCD) with high incidence rates, substantial treatment burden, and significant risk of readmission within 30 days following hospitalization. During the transition between hospital and home, electronic health (eHealth) can be one way to improve follow-up on HF and CRC patients’ care needs to support self-care, increase quality of life (QoL), and reduce readmission rates. OBJECTIVE The objectives of this review are to summarize research on the content and delivery modes of HF and CRC post-hospitalization eHealth interventions, explore patient adherence to the interventions, and examine the effects on patient outcomes of self-care, QoL, and readmissions. METHODS A restricted, systematic review study design was employed. Literature searches and reviews followed the PRISMA-S checklist. Literature searches were performed in CINAHL, Medline, EMBASE, and Cochrane Library for studies published between 2015 and 2020. The review process involved three groups of researchers working in pairs. The Mixed Method Assessment Tool was used to assess included studies’ methodological quality. A thematic analysis method was employed to analyze data extracted from the studies. RESULTS Twenty-two studies were examined in this review, including 18 interventions provided to HF populations and four delivered to CRC patients. The studies were published between 2015 and 2019, 11 of them in the USA. The majority were randomized, controlled trials (N=19), and 14 of the studies recruited patients upon hospital discharge to eHealth interventions lasting for 14 days to 12 months. The studies involved structured telephone calls, video chat, interactive voice response, a web-based mobile platform, and telemonitoring, and included elements of patient education, counseling, social and emotional support, and self-monitoring of symptoms and vitals. Half of the studies provided information on patient adherence, which was reported as ranging from satisfactory to high. When used to follow up on HF patients post-hospitalization, eHealth can positively affect QoL, while its impact is less evident for self-care and readmissions. Among CRC patients, QoL was improved by eHealth follow-up, but the small number of eligible studies complicated the ability to draw conclusions. CONCLUSIONS This review suggests that NCD patients with HF and CRC should receive prompt follow-up after hospitalization, and eHealth holds the potential to improve these patients’ QoL. Patient adherence in eHealth follow-up trials shows promise for successful future interventions and adherence research. Further research is warranted to examine the effects of eHealth on self-care and readmissions, especially within relatively understudied NCD populations.