Integrating Mobile Integrated Health Into Emergency Care for Heart Failure: A RE-AIM–Based Evaluation

Mobile Integrated Health (MIH) programs have the potential to improve care transitions and reduce avoidable emergency department utilization among patients with heart failure (HF). Despite growing interest, widespread adoption remains limited due to gaps in understanding real-world implementation, adoption, and sustainability.

We conducted a mixed-methods implementation analysis embedded within the MIGHTy-Heart pragmatic randomized clinical trial (January 2021–September 2024) across two large urban health systems in New York City. Quantitative data were derived from 1,005 adults randomized to MIH access, of whom 414 received at least one MIH visit. Qualitative data were obtained through semi-structured interviews with 20 patients and 25 stakeholders, including clinicians, community paramedics, caregivers, and program leaders. The MIH intervention consisted of home visits by community paramedics, nurse-led care coordination, and facilitated telehealth consultations. Outcomes were evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Effectiveness outcomes included 30-day all-cause readmissions and Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary scores.

Patients receiving MIH were similar in age and sex to the overall HF population but demonstrated greater racial and ethnic diversity (50% Black or African American; 27% Hispanic or Latino). There were no statistically significant differences in 30-day readmissions (20.3% vs 20.4%; odds ratio 0.99; 95% CI 0.83–1.19) or KCCQ scores (mean difference 1.83; 95% CI −0.75 to 4.40) compared with usual care. Adoption and implementation were facilitated by institutional alignment, leadership engagement, interdisciplinary coordination, and patient trust. Barriers included misaligned reimbursement structures and regulatory constraints. Maintenance planning was perceived as having substantial value to patients and staff.

MIH implementation in an urban setting was feasible and well-aligned with institutional priorities. Sustained adoption and scale-up may require policy reform and reimbursement models that support community-based acute care delivery.