Mobile Integrated Health Valuable in Heart Failure, but Payment Lags

Mobile integrated health (MIH) was well received by patients and clinicians caring for people recently discharged after heart failure (HF) hospitalization, despite the intervention failing to significantly reduce 30-day all-cause readmissions or improve overall health status compared with a transitions of care coordinator (TOCC) model, a qualitative study within the MIGHTy-Heart (NCT04662541) randomized clinical trial found.¹

The study, published in JAMA Network Open, used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to examine factors that could facilitate or impede implementation as health systems consider broader use of MIH.

“Although MIH did not reduce 30-day readmissions or improve overall health status compared with TOCC in the primary trial, participants consistently described meaningful benefits related to high patient, clinician, and caregiver satisfaction,” wrote the researchers of the study. “These differences highlight a divergence between traditional clinical metrics and the dimensions of value experienced by patients and clinicians.”

Researchers analyzed qualitative interviews with patients and stakeholders involved in the MIH intervention, including clinicians and MIH program personnel. The interviews were nested within the MIH arm of the MIGHTy-Heart trial, conducted across 11 hospitals affiliated with 2 New York City health systems between January 2021 and September 2024.

Across both health systems, 73,343 patients were treated for HF during the trial period. Of these, 1005 patients were enrolled in the randomized trial and assigned to MIH; 414 received at least 1 MIH visit. The broader HF population was 70% aged 65 years or older and 55% male.

Among patients assigned to MIH, 50% were Black or African American, 27% were Hispanic or Latino, and 25% were White. In comparison, among all patients treated for HF across the 2 health systems, 9% were Black or African American, 4% were Hispanic or Latino, and 42% were White.

The MIH intervention incorporated the TOCC nurse follow-up model along with ongoing nurse care coordination, home visits from community paramedics, and facilitated synchronous telehealth visits with emergency medicine physicians.²

High Satisfaction, Limited Clinical Effect

The qualitative findings complement the trial's previously published primary results, which found no significant difference between MIH and TOCC in 30-day all-cause readmissions or overall health status. Thirty-day readmission occurred in 20.3% of patients assigned to MIH and 20.4% of those assigned to TOCC (OR, 0.99; 95% CI, 0.83-1.19; P = .95). The between-group difference in Kansas City Cardiomyopathy Questionnaire Overall Summary scores also was not statistically significant.

An exploratory analysis found greater improvement in health status among participants younger than 70 years who received MIH, although the investigators characterized these subgroup findings as preliminary and requiring further study.

The findings highlight a distinction between clinical trial end points and the broader value that patients and clinicians may perceive from home-based, interdisciplinary care. Stakeholders described MIH as providing reassurance and facilitating closer monitoring after discharge, while clinicians valued the ability to assess and manage patients in their homes.

Facilitations and Barriers

Stakeholders identified institutional leadership engagement, interdisciplinary coordination, and patient trust in community paramedics as important facilitators of implementation. Patients described feeling reassured by close monitoring after discharge, while clinicians valued the ability to assess patients remotely and coordinate care across disciplines.¹

Financial and regulatory constraints were persistent barriers. MIH program leaders described challenges demonstrating a sufficient return on investment to institutional leadership. Traditional emergency medical services reimbursement has historically been closely linked to ambulance transportation, creating a payment mismatch for community paramedicine and other MIH services delivered without transporting a patient to an emergency department.

State-level differences in paramedic scope of practice also can restrict which services community paramedics may provide in patients' homes, potentially limiting program design and financial viability.

The researchers acknowledged limitations, including the study’s small qualitative sample of 20 patients and 25 stakeholders and its inclusion of only 2 New York City health systems, which may limit generalizability. Because the qualitative analysis assessed perceptions and experiences, it cannot establish clinical effectiveness, particularly given the trial's null primary outcomes.

“Despite the primary trial showing no difference in 30-day readmissions or Kansas City Cardiomyopathy Questionnaire scores between MIH and the transitions of care coordinator control group, this qualitative study found that MIH was well received and aligned with institutional goals,” wrote the researchers. “Sustaining and scaling MIH may require supportive reimbursement models and policy reforms.”

References

1. Reading Turchioe M, Ellison M, Shafran Topaz L, et al. Mobile integrated health and post–hospital discharge heart failure care. JAMA Netw Open. 2026;9(8). doi:10.1001/jamanetworkopen.2026.30229
2. Masterson Creber R, Daniels B, Reading Turchioe M, et al. Comparative effectiveness of mobile integrated health versus a transitions of care coordinator: results from the MIGHTy-Heart randomized clinical trial. JAMA Intern Med. 2025;185(11):1341-1348. doi:10.1001/jamainternmed.2025.4483