REMOTE monitoring did not increase time spent at home after discharge among patients hospitalized with sepsis or lower respiratory tract infection, according to results from a randomized clinical trial of 1,286 adults.
The trial evaluated whether remote monitoring after serious infection could reduce readmissions by identifying postdischarge deterioration earlier. Participants were randomized to usual care or one of four remote patient monitoring approaches, combining low or high intensity questionnaires with either a standard nurse response team or an enhanced nurse practitioner led response team.
Across all arms, the primary endpoint of days at home within 90 days was similar. Median postdischarge home days were 90 in the usual care arm and 90 in each remote monitoring arm, with overlapping interquartile ranges. Compared with usual care, cumulative odds ratios for postdischarge home days ranged from 0.86 to 1.01 across the four intervention strategies, with probabilities of superiority below 55% for all comparisons.
Readmission Findings Raise Questions for Older Adults
At least one readmission occurred in 37.8% of patients receiving usual care, compared with 39.7% in the low intensity standard response arm, 44.2% in the high intensity standard response arm, 37.3% in the low intensity enhanced response arm, and 36.3% in the high intensity enhanced response arm.
Subgroup findings were particularly notable among adults aged 65 years or older. In this group, both standard and enhanced response remote monitoring arms were associated with fewer home days compared with usual care, with inferiority probabilities of 99.6% and 97.9%, respectively. Readmission rates were also higher among older adults assigned to remote monitoring than among those receiving usual care.
The findings suggest that remote monitoring may trigger more alerts and clinical escalation without necessarily improving recovery after serious infection. This may be especially relevant for older adults and patients discharged to skilled nursing facilities, where postacute care needs are often complex.
Engagement Did Not Explain the Null Result
Among 887 patients assigned to remote monitoring, 529 enrolled in the program. More than 10,000 questionnaires were sent, and nurses responded to more than 94% of alerts. Despite this level of protocol fidelity, the intervention did not improve primary or secondary outcomes.
Qualitative interviews suggested that many patients found remote monitoring easy to use and somewhat reassuring, but some reported frustration with standardized questionnaires and limited personal connection with call center teams.
The results do not suggest that patients recovering from sepsis or lower respiratory tract infection do not need postacute care support. Instead, they indicate that remote monitoring after sepsis may require more personalized design, clearer escalation pathways, and better alignment with patient needs before it can reliably reduce readmissions.
Reference
Yende S et al. Remote Monitoring Approaches to Reduce Readmissions After Infection and Sepsis. JAMA Netw Open. 2026;9(6).
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