Abstract
Background
NCDs are the leading cause of premature mortality, hitting hardest in middle-income countries with fragmented health systems. Long-term real-world evidence from Latin America remains scarce, and most available studies rely on short follow-up or inadequate statistical control, limiting interpretability. This study evaluates longitudinal clinical and behavioral trajectories under a structured hybrid care model in a high-risk multimorbid population.
Methods
Retrospective pre-post observational study using electronic health records linked to a telemonitoring platform at a tertiary centre in Medellín, Colombia (n = 319; ≥3 years follow-up). Participants had hypertension, type 2 diabetes, and/or dyslipidemia. Within-patient changes were assessed using paired tests, McNemar/Bowker tests, and mixed-effects models. Multiple testing was controlled using false discovery rate (q-FDR). All findings were interpreted as longitudinal associations.
Results
Median age 63 years, 73.7% women, 96.9% multimorbidity. Therapeutic target achievement rose from 21.9% to 52.7% (95% CI 47.1–58.3). Weight decreased 4 kg, systolic BP 6 mmHg, diastolic BP 5 mmHg (all q-FDR<0.05). High cardiovascular risk declined 8.8 percentage points, with 29.2% reclassified to lower-risk strata. Adherence improved ∼34 percentage points. Reductions observed in diabetic ketoacidosis and myocardial infarction. Three-year mortality was 2.5%.
Conclusions
Sustained hybrid care was associated with meaningful improvements in cardiometabolic control, adherence, and risk redistribution in a real-world high-risk population. Findings support: expanding hybrid models for chronic disease management; integrating digital and in-person care pathways into policy; and strengthening surveillance through longitudinal real-world data. This study also offers a replicable methodological framework for rigorous digital health evaluation in middle-income settings.
Key messages
• A hybrid care model at Latin America’s first digital hospital achieved therapeutic target doubling and cardiovascular risk reclassification in 29% of high-risk multimorbid adults over three years.
• A scalable hybrid telehealth model improved adherence by 40 percent and shifted nearly one third of patients to lower cardiovascular risk categories.