Study highlights strengths and barriers of remote heart failure care

Interviews with patients hospitalized for heart failure, caregivers, providers, and organizational leaders highlighted several strengths of Mighty Heart (a major clinical trial examining the effectiveness of in home and telehealth-enabled visits from paramedics) that may support its adoption and implementation across health systems, a Columbia Nursing-led study finds. However, financial and regulatory challenges must be addressed to maximize the reach and sustainability of mobile integrated health (MIH), the researchers note. 

The study, "Mobile Integrated Health and Post–Hospital Discharge Heart Failure Care," was published in the Journal of the American Medical Association (JAMA) Network Open on August 21, 2026. 

It follows a prior publication in JAMA Internal Medicine last year, "Mobile Integrated Health vs a Transitions of Care Coordinator for Patients Discharged After Heart Failure: The Mighty-Heart Randomized Clinical Trial," reporting the trial's main effectiveness results. 

When the research team conducted interviews, they learned adoption was higher when patients had a desire for closer monitoring and care in the home, clinicians were interested in providing better remote care, there was a presence of key partners to support initial pilot testing, and there was more flexibility in care modalities (as a result of the COVID-19 pandemic). 

Interviewees also noted how the MIH intervention was great at reaching diverse populations and supporting post-discharge needs, further demonstrating its value. 

While feedback was mostly positive and promising, some responses highlighted the operational, financial, and regulatory barriers that hinder further scalability. Current payment mechanisms and regulatory frameworks do not fully support this type of care, limiting the ability of hospitals to fund the program through current reimbursement models. The logistical nature of operating the MIH program, which requires managing clinicians' time and effectively allocating personnel and resources, is also a challenge. 

"Our findings suggest that selecting desired outcomes that align with institutional financial priorities, securing robust institutional investment and operational infrastructure before launch, anticipating regulatory and scope-of-practice constraints, and building interdisciplinary relationships proactively between emergency medicine and subspeciality clinicians are key drivers of MIH program success," the researchers explain. 

"MIH programs frequently reduce ED transports, but their financial viability is fundamentally constrained by Medicare's transport-based EMS reimbursement structure, which limits staffing levels and clinical scope, ultimately shaping program effectiveness and sustainability. Our findings suggest that durable scale will require explicit reimbursement mechanisms for mobile integrated health." 

The study was led by assistant professor Meghan Reading Turchioe, PhD, and Mary Crawford Professor Ruth Masterson Creber, PhD, both from Columbia Nursing. 

Other study authors include Yihong Zhao, PhD, Stacey Dai, MPH, Columbia Nursing; Parag Goyal, MD, Melani Ellison, MPH, Leah Shafran Topaz, PhD, Brock Daniels, MD, Jacky Choi, MPH, Weill Cornell Medicine; Rohit Mukherjee, MD, Christina McGinnis, BS, Rutgers Robert Wood Johnson Medical School; and Roland C. Merchan, MD, the Icahn School of Medicine at Mount Sinai.

This study was funded by the Patient-Centered Outcomes Research Institute (PCORI).