There may also be watches or rings that can measure blood pressure and heart rate. For example, companies are developing wearable wireless devices that can combine an accelerometer, stethoscope, electrocardiogram, and other functions to collect data from continuous monitoring. In addition, there will likely be even smaller devices used for physiological monitoring. In the future there will likely be more laptop-based and tablet-based devices used in the home. However, more and higher-quality studies are needed. Studies of home monitoring programs have shown specific improvements in the management of hypertension, congestive heart failure, and diabetes. Use of technologies for chronic disease care management has been associated with reductions in hospitalizations, readmissions, lengths of stay, and costs improvement in some physiologic measures high rates of satisfaction and better adherence to medication. More than a decade ago, the VA developed a care management program that offered personalized education, monitoring, and feedback at home from a remote disease management support team. Traditionally, chronic disease has been managed through an episodic office-based model rather than a care management model, which uses frequent patient contact and regular physiologic measurement. The 100 million Americans with chronic disease account for about 75 percent of health care expenditures. The biggest need in home- and community-based care relates to chronic disease. NASA further developed this technology with a pilot with the Papago Indians, the Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC) project. Home monitoring developed more fully in the Mercury space program when the National Aeronautics and Space Administration (NASA) began performing physiologic monitoring over a distance. In 1925, a cover of Science and Invention magazine showed a doctor diagnosing a patient by radio, and within envisioned a device that would allow for the video examination of a patient over distance. For example, an 1879 article in the Lancet talked about using the telephone to reduce unnecessary office visits. Health care in the home-based setting has a long history.
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