A Post-Discharge Remote Monitoring System to Enhance Adverse Event Surveillance in Patients with Multiple Chronic Conditions: Design and Field Testing

Background: Adverse events (AEs) after hospitalization are common and disproportionately affect adults with multiple chronic conditions (MCC). Capturing patient-reported symptoms and self-assessed health may enable earlier detection of post-discharge AEs. Objective: To identify and test user requirements for an automated remote monitoring system to enhance AE surveillance during the transition home following discharge. Methods: We conducted a mixed-methods study using an iterative, user-centered design approach. Semi-structured interviews with patients and clinicians informed system requirements, followed by real-world field testing in 20 patients who used the system for up to 7 days after discharge. The prototype leveraged interoperable electronic health record data services, delivered automated post-discharge check-ins using a combined questionnaire assessing new or worsening symptoms and patient-reported outcomes (PROs), provided risk-stratified health advice (when and with whom to initiate contact), and escalated high-risk symptoms to clinicians in real-time. Descriptive statistics assessed feasibility and utilization; conventional content analysis identified user needs and implementation considerations. Results: Thirty-seven patients with MCC and 23 clinicians participated. Key requirements for patients included clear communication of personalized risk based on red-flag symptoms, and actionable guidance aligned with discharge instructions. Key requirements for clinicians included explicit delineation of responsibility across inpatient and outpatient setting, and selective escalation to minimize burden. Field testing patients completed 60% of the combined questionnaires. Seven patients received Level 2 or Level 3 health advice after reporting new or worsening symptoms. Three patients triggered Level 3 alerts, resulting in one-time, secure escalation emails to clinicians. Four of the 7 patients who received Level 2 or 3 health advice had chart-confirmed emergency department visits within 1 week of discharge. Patients found the system understandable and helpful, while clinicians noted challenges interpreting PRO trends. Conclusions: These observations support the feasibility and acceptability among patients and clinicians of collecting patient-reported symptoms and PROs during the early post-discharge period. Future iterations should prioritize clear risk communication, role clarity, and interpretable patient-reported data. Formal validation is required to assess predictive performance and clinical utility of symptom-based escalation for post-discharge AE surveillance.