Remote patient monitoring (RPM), a strategy that hospitals increasingly use to track patients after discharge, did not improve recovery outcomes for patients hospitalized with sepsis or other serious infections, according to a large randomized clinical trial published in JAMA Network Open.1 Researchers found that RPM neither increased postdischarge survival nor reduced hospital readmissions within 90 days of discharge. Among adults aged 65 years and older, RPM outcomes were worse than with standard follow-up care.
The study, led by Sachin Yende, MD, MS, Professor of Critical Care Medicine and Clinical and Translational Science and Chief Medical Officer, Integrated Veteran Care, Veterans Health Administration University of Pittsburgh and UPMC, sought to determine whether different RPM approaches could improve recovery after hospitalization for sepsis or lower respiratory tract infections.
The study team’s findings challenge the assumption that RPM alone improves postdischarge outcomes, especially as RPM programs continue to expand across US health systems and receive reimbursement through the Centers for Medicare and Medicaid Services (CMS).
“We think this should prompt a real second look,” Dr. Yende said. “In one of the largest [randomized controlled trials] of RPM after sepsis or lower respiratory tract infection to date, none of our four RPM configurations reduced 90-day readmissions or increased days at home versus usual care; and in patients 65 and older, RPM was linked to worse outcomes on both measures.”
At the same time, the results should not be interpreted as evidence that remote monitoring technology is inherently ineffective, he said.
“We’d caution against reading this as ‘RPM doesn’t work’—our usual-care arm already included strong structured follow-up, so hospitals should audit who they’re enrolling and why rather than assume the technology is a substitute for good care coordination,” he said.
The multicenter trial enrolled 1,286 adults discharged from 19 hospitals between March 2021 and December 2024 after treatment for sepsis or lower respiratory tract infections. Participants were randomly assigned to one of four RPM models or to a usual-care group. The monitoring programs varied in intensity and staffing, combining symptom questionnaires with either nurse-led or nurse practitioner-led response teams. Patients in the control group received standard discharge care, including telephone-based support.
Researchers measured the primary outcome as the number of days patients survived at home during the 90-day period following discharge. Secondary measures included mortality, readmissions, emergency department visits, quality of life, and functional status.
Across all intervention groups, RPM failed to improve the primary outcome. Patients in both the remote monitoring and usual-care groups spent a median of 90 days alive and at home, and statistical analyses showed no meaningful differences between the approaches. Readmission rates were also similar, ranging from 36.3% to 44.2% in the RPM group compared with 37.8% in the usual-care group.
The research team identified several possible reasons for the disappointing results.
“We see a few contributing factors,” Dr. Yende said. “Our usual-care comparator was already strong, narrowing the room for RPM to add benefit; our monitoring was symptom-based rather than physiologic, which may have missed early deterioration; and patients told us in interviews that they found the standardized, call-center-style response reassuring but limited in solving their actual problems.”
Patient engagement did not appear to explain the findings. Although only about 60% of patients assigned to RPM ultimately enrolled in the program, researchers observed similar outcomes regardless of participation levels.
“Engagement was moderate (~60% enrolled), but we saw similar effects regardless of engagement level, so that alone doesn’t explain the null result,” Dr. Yende noted. “For older adults, we suspect alerts may have prompted more reflexive hospital referrals rather than resolving issues in place.”
The most concerning findings involved older patients. Adults aged 65 years and older who received RPM survived fewer days at home postdischarge and had higher readmission rates than those receiving standard care. These results suggest that patient selection and implementation strategies may be as important as the technology itself.
“We read this as mainly an implementation and targeting problem, not a verdict on the technology,” Dr. Yende said. “The fact that we saw a benefit signal in younger patients and a harm signal in older patients and those discharged to skilled nursing facilities argues against a uniform ‘RPM doesn’t work’ conclusion.”
The study also raises important questions for policymakers and payers as RPM adoption continues to grow.
“We’d note that RPM is reimbursed by CMS and use has grown despite limited high-quality evidence of benefit. This trial is one of the first large [randomized clinical trials] to test that assumption,” Dr. Yende said. “We think it argues for more outcome-based reimbursement rather than covering RPM broadly regardless of population or program design.”
References
1. Yende S, Talisa VB, Mayes K, et al. Remote monitoring approaches to reduce readmissions after infection and sepsis: a randomized clinical trial. JAMA Netw Open. 2026;9(6):e2616641. doi:10.1001/jamanetworkopen.2026.16641
