scholarly journals Factors influencing the effectiveness of remote patient monitoring interventions: a realist review

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e051844
Author(s):  
Emma E Thomas ◽  
Monica L Taylor ◽  
Annie Banbury ◽  
Centaine L Snoswell ◽  
Helen M Haydon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Care ◽  
Patient Monitoring ◽  
Realist Review ◽  
Secondary Outcome ◽  
Remote Patient Monitoring ◽  
Coordinated Care ◽  
Biometric Data ◽  
Remote Patient ◽  
The Impact

ObjectivesOur recent systematic review determined that remote patient monitoring (RPM) interventions can reduce acute care use. However, effectiveness varied within and between populations. Clinicians, researchers, and policymakers require more than evidence of effect; they need guidance on how best to design and implement RPM interventions. Therefore, this study aimed to explore these results further to (1) identify factors of RPM interventions that relate to increased and decreased acute care use and (2) develop recommendations for future RPM interventions.DesignRealist review—a qualitative systematic review method which aims to identify and explain why intervention results vary in different situations. We analysed secondarily 91 studies included in our previous systematic review that reported on RPM interventions and the impact on acute care use. Online databases PubMed, EMBASE and CINAHL were searched in October 2020. Included studies were published in English during 2015–2020 and used RPM to monitor an individual’s biometric data (eg, heart rate, blood pressure) from a distance.Primary and secondary outcome measuresContextual factors and potential mechanisms that led to variation in acute care use (hospitalisations, length of stay or emergency department presentations).ResultsAcross a range of RPM interventions 31 factors emerged that impact the effectiveness of RPM innovations on acute care use. These were synthesised into six theories of intervention success: (1) targeting populations at high risk; (2) accurately detecting a decline in health; (3) providing responsive and timely care; (4) personalising care; (5) enhancing self-management, and (6) ensuring collaborative and coordinated care.ConclusionWhile RPM interventions are complex, if they are designed with patients, providers and the implementation setting in mind and incorporate the key variables identified within this review, it is more likely that they will be effective at reducing acute hospital events.PROSPERO registration numberCRD42020142523.

scholarly journals How to use remote patient monitoring successfully in cardiac and pulmonary patients: a realist review

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
E Thomas ◽  
M Taylor ◽  
A Smith ◽  
L Caffery
Keyword(s):  
Acute Care ◽  
Patient Monitoring ◽  
Realist Review ◽  
Work Outcomes ◽  
Self Management ◽  
Remote Patient Monitoring ◽  
Coordinated Care ◽  
Eligibility Criteria ◽  
Funding Sources ◽  
Remote Patient

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Queensland Health Background Remote patient monitoring (RPM) is an underutilised telehealth intervention that can enhance self-management of cardiovascular and pulmonary disease and reduce acute care use. However, studies of effectiveness of RPM interventions vary widely. This study aimed to explain the variation in outcomes related to RPM interventions within cardiac and pulmonary populations. Specifically, we aimed to answer why some RPM interventions are more successful than others in reducing demand on acute care services. Methods In brief, search terms for remote monitoring and acute care utilisation were used across three electronic databases: PubMed, EMBASE and CINAHL. The search, conducted in October 2020, included articles published in the last five years (2015-2020). Articles were included if they used RPM to monitor an individual’s biometrics (e.g. heart rate, blood pressure) from a distance while they are not in hospital. Realist review methodology was used to enable exploration of how, why and for whom interventions do and do not work.  Outcomes were evaluated to determine contextual factors and potential mechanisms that led to variation in cardiac and pulmonary intervention outcomes. Results After screening, 91 articles met the eligibility criteria and were included. We found that across a broad range of RPM interventions 31 factors emerged that are likely to impact the effectiveness of cardiac and pulmonary RPM innovations. These were synthesised into six theories of intervention success: 1) targeting populations at high risk; 2) accurately detecting a decline in health; 3) providing responsive and timely care; 4) personalising care; 5) enhancing self-management and, 6) ensuring collaborative and coordinated care. Conclusion  While RPM interventions are complex, if they are designed with patients, providers and the implementation setting in mind and with the key variables identified within this review  incorporated, it is more likely that they will be effective at reducing acute hospital events.

scholarly journals Association of a Remote Patient Monitoring (RPM) Program With Reduced Hospitalizations in Cancer Patients With COVID-19

2021 ◽  
pp. OP.21.00307
Author(s):  
Joshua C. Pritchett ◽  
Bijan J. Borah ◽  
Aakash P. Desai ◽  
Zhuoer Xie ◽  
Antoine N. Saliba ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Cancer Patients ◽  
Acute Care ◽  
Patient Monitoring ◽  
Statistical Significance ◽  
Admission Rate ◽  
Remote Patient Monitoring ◽  
Hospital Admission Rate ◽  
Remote Patient ◽  
The Impact

PURPOSE: The goal of this study was to assess the impact of an interdisciplinary remote patient monitoring (RPM) program on clinical outcomes and acute care utilization in cancer patients with COVID-19. METHODS: This is a cross-sectional analysis following a prospective observational study performed at Mayo Clinic Cancer Center. Adult patients receiving cancer-directed therapy or in recent remission on active surveillance with polymerase chain reaction–confirmed SARS-CoV-2 infection between March 18 and July 31, 2020, were included. RPM was composed of in-home technology to assess symptoms and physiologic data with centralized nursing and physician oversight. RESULTS: During the study timeframe, 224 patients with cancer were diagnosed with COVID-19. Of the 187 patients (83%) initially managed in the outpatient setting, those who did not receive RPM were significantly more likely to experience hospitalization than those receiving RPM. Following balancing of patient characteristics by inverse propensity score weighting, rates of hospitalization for RPM and non-RPM patients were 2.8% and 13%, respectively, implying that the use of RPM was associated with a 78% relative risk reduction in hospital admission rate (95% CI, 54 to 102; P = .002). Furthermore, when hospitalized, these patients experienced a shorter length of stay and fewer prolonged hospitalizations, intensive care unit admissions, and deaths, although these trends did not reach statistical significance. CONCLUSION: The use of RPM and a centralized virtual care team was associated with a reduction in hospital admission rate and lower overall acute care resource utilization among cancer patients with COVID-19.

scholarly journals A flexible protocol for a systematic review of remote patient monitoring

2020 ◽  
Vol 21 ◽  
Author(s):  
Ashley Elizabeth Muller ◽  
Rigmor C. Berg
Keyword(s):  
Systematic Review ◽  
Patient Monitoring ◽  
Remote Patient Monitoring ◽  
Assessment Development ◽  
Primary Health ◽  
Health Authorities ◽  
Literature Searches ◽  
Primary Health Services ◽  
Remote Patient

Abstract Background: Norway is interested in implementing remote patient monitoring (RPM) within primary health services. This systematic review will first identify the types of RPM that are of interest to Norwegian health authorities, then synthesize the effects of RPM on clinical health and health service utilization outcomes among adults with chronic diseases. Methods: We will perform systematic literature searches in multiple databases, using RPM-related searches, such as telemedicine, telemonitoring, and eHealth. Based on what research exists, the review will be selected from a cascading menu of review types. Methodological quality will be assessed through appropriate checklists, while the quality of the evidence will be assessed through Grading of Recommendations Assessment, Development, and Evaluation. Discussion: This flexible protocol specifies the production of different possible types of reviews of RPM. It is anticipated that the results of the review will inform the development of effective RPM programs to the most appropriate chronic disease groups.

Association of use of remote patient monitoring (RPM) with reduced hospitalizations in cancer patients with COVID-19.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1503-1503
Author(s):  
Joshua Pritchett ◽  
Aakash Desai ◽  
Bijan J Borah ◽  
Zhuoer Xie ◽  
Antoine N Saliba ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Patient Monitoring ◽  
Severe Illness ◽  
Remote Patient Monitoring ◽  
Hospital Admission Rate ◽  
Icu Admission ◽  
Remote Patient ◽  
The Impact

1503 Background: Patients with cancer and COVID-19 are at risk for poor clinical outcomes. An established multi-site remote patient monitoring (RPM) service was rapidly adapted to support a novel, interdisciplinary COVID-19 program for outpatient management of patients at high-risk for severe illness. The goal of this study was to assess the impact of the RPM program on clinical outcomes and acute care utilization in cancer patients diagnosed with COVID-19. Methods: This is a cross-sectional analysis following a multi-site prospective observational study performed at Mayo Clinic Cancer Center (MCCC). All adult patients with active cancer – defined as currently receiving cancer-directed therapy or in recent remission on active surveillance – and PCR-confirmed SARS-CoV-2 infection between March 18 and July 31, 2020 were included. RPM was comprised of in-home technology to assess symptoms and physiologic data with centralized nurse and physician oversight. Results: During the study timeframe 224 cancer patients were diagnosed with COVID-19 at MCCC. Initial management included urgent hospitalization (within 48 hours of diagnosis) in 34 patients (15%). Of the remaining 190 patients (85%) initially managed in the outpatient setting, those who did not receive RPM were significantly more likely to experience hospitalization than those receiving RPM (OR 3.6, 95% CI 1.036 to 12.01, P = 0.044). Following balancing of patient characteristics by inverse propensity weighting, rates of hospital admission for RPM and non-RPM patients were 3.1% and 11% respectively, implying that RPM was associated with an 8% reduction in hospital admission rate (-0.077; 95% CI: -0.315 to -0.019, P = 0.009). Use of RPM was also associated with lower rates of prolonged hospitalization, ICU admission, and mortality, though these trends did not reach statistical significance. Conclusions: In the midst of a global pandemic associated with inpatient bed, ventilator, and PPE shortages, the RPM program provided an effective strategy for outpatient clinical management and was associated with decreased rates of hospitalization, ICU admission, and mortality in cancer patients with COVID-19. This care model enabled simultaneous opportunity to mitigate the increased risks of exposure, transmission, and resource utilization associated with conventional care.

Abstract P156: Improvement In Blood Pressure Using Remote Patient Monitoring During COVID19

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Nadia A Liyanage-Don ◽  
Joseph E Schwartz ◽  
Nathalie Moise ◽  
Kelsey B Bryant ◽  
Adina Bono ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Patient Monitoring ◽  
Healthcare Access ◽  
Vital Signs ◽  
Primary Care Doctor ◽  
Remote Patient Monitoring ◽  
Nursing Support ◽  
Before And After ◽  
Remote Patient ◽  
The Impact

Introduction: The coronavirus disease 2019 (COVID19) pandemic required strict social distancing to curb transmission. Unfortunately, these measures severely limited healthcare access and chronic disease management. In response, many health organizations rapidly developed or expanded telemedicine to provide care directly to patients at home. Little has been reported about the impact of such interventions on clinical outcomes during COVID19. We examined whether enrollment in a remote patient monitoring (RPM) program for hypertension (HTN) prior to COVID19 was associated with improved blood pressure during the pandemic. Methods: We developed an RPM program that tracked vital signs, medication side effects, and treatment adherence patterns outside of the clinic. Patients were referred by their primary care doctor for uncontrolled HTN or suspected white coat HTN. Patients received a two-way tablet, blood pressure cuff, and virtual nursing support via scheduled video visits. Those referred for uncontrolled HTN who had at least two weeks of data both before and after the onset of COVID19 (defined as the first two weeks of March 2020) were included in the study. A mixed-models analysis that adjusted for serial autocorrelation was used to compare mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) in the pre-/post-COVID19 periods. Results: Of 94 patients enrolled in the RPM program to date, 46 had at least two weeks of data both pre-COVID19 and post-COVID19. Mean age was 69.0 ± 10.9 years, 69.6% (32 of 46) were women, 78.3% (36 of 46) were Hispanic, and 63.0% (29 of 46) were Spanish-speaking. Pre-COVID, mean SBP was 132.31 ± 13.99 mmHg, mean DBP was 77.10 ± 9.87 mmHg, and 70% (32 of 46) of patients had uncontrolled BP (>130/80 mmHg per AHA guidelines). Post-COVID, mean SBP was 129.57 ± 13.29 mmHg, mean DBP was 76.00 ± 9.16 mmHg, and 57% (26 of 46) of patients had uncontrolled BP. There was a significant reduction in both mean SBP (β = –2.74, 95% CI –5.21, –0.26, p = 0.03) and mean DBP (β = –1.10, 95% CI –2.22, 0.02, p = 0.05) post-COVID vs. pre-COVID. Discussion: Despite the stress and social isolation associated with COVID19, participation in an RPM program that combines home BP monitoring with virtual nursing support can help maintain and even mildly decrease BP.

The Impact of Remote Patient Monitoring (Telehealth) upon Medicare Beneficiaries with Heart Failure

2012 ◽  
Vol 18 (2) ◽  
pp. 101-108 ◽  
Author(s):  
Renée Pekmezaris ◽  
Irina Mitzner ◽  
Kathleen R. Pecinka ◽  
Christian N. Nouryan ◽  
Martin L. Lesser ◽  
...  
Keyword(s):  
Heart Failure ◽  
Patient Monitoring ◽  
Medicare Beneficiaries ◽  
Remote Patient Monitoring ◽  
Remote Patient ◽  
The Impact

scholarly journals Maximizing VA Remote Patient Monitoring During the COVID-19 Response

2021 ◽  
Author(s):  
Catherine Buck ◽  
Rita Kobb ◽  
Ron Sandreth ◽  
Lisa Alexander ◽  
Sherron Olliff ◽  
...  
Keyword(s):  
Disease Management ◽  
Large Scale ◽  
Patient Monitoring ◽  
The United States ◽  
Health Administration ◽  
Remote Patient Monitoring ◽  
Management Protocol ◽  
Remote Patient ◽  
The Impact ◽  
At Home

Abstract  Objective: The Veterans Health Administration has one of the largest remote patient monitoring programs in the United States and is supported by an enterprise-wide infrastructure for providers, clinicians, staff, Veterans, and caregivers. The COVID-19 pandemic, however, presented new challenges: a sudden need to provide large-scale remote monitoring for a new disease that did not yet have a disease management protocol. VHA needed to be ready within weeks to provide this daily monitoring for hundreds — even thousands — of Veterans.  Methods: The U.S. Department of Veterans Affairs Office of Connected Care already had a comprehensive infrastructure in place for its Remote Patient Monitoring – Home Telehealth (RPM – HT) program. Connected Care activated and built on this infrastructure to support providers, clinicians, and staff in their efforts to rapidly bring RPM – HT to Veterans across the nation when they had COVID-19 symptoms or exposure. To do this, Connected Care activated an emergency management plan, rapidly developed a new COVID-19-specific disease management protocol, added weekend monitoring, and procured critically needed monitoring supplies, such as thermometers and pulse oximeters. Connected Care’s strong foundation allowed for innovation and flexibility, such as the training of non-RPM – HT staff in RPM – HT processes, RPM – HT enrollment within acute care settings, and new strategic partnerships. Outcomes: More than 23,500 Veterans were enrolled for COVID-19-related monitoring from March 2020 to May 2021. At points in December 2020 and January 2021, the number of Veterans being monitored in a single day topped 2,000. Even with this rapid buildup, patient satisfaction levels remained at about 90% in numerous categories. In addition, the percentage of Veterans admitted to VA facilities while on COVID-19-related home monitoring has been extremely low, at 4%, a potential indicator that the monitoring system has been helpful in enabling Veterans who did have the virus to convalesce at home. Further study is needed to determine the impact RPM – HT enrollment for COVID-19 care had on the need for inpatient care. Conclusion: The Office of Connected Care’s established, enterprise-wide RPM – HT business, clinical, and technical infrastructure enabled VHA to enter the COVID-19 public health emergency well-positioned for the rapid deployment and growth of at-home and mobile monitoring. As the COVID-19 emergency made at-home management of Veterans increasingly important, the national RPM – HT program successfully adapted its practices to meet Veteran, caregiver, and staff needs.

scholarly journals Water Removal Cycle-By-Cycle During Automated Peritoneal Dialysis: Assessment by Remote Patient Monitoring and Modelling of Peritoneal Tissue Hydration

2021 ◽  
Author(s):  
Joanna Stachowska-Pietka ◽  
Beata Naumnik ◽  
Ewa Suchowierska ◽  
Rafael Gomez ◽  
Jacek Waniewski ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Monitoring ◽  
Water Removal ◽  
Remote Patient Monitoring ◽  
Automated Peritoneal Dialysis ◽  
Fluid Exchange ◽  
Tissue Hydration ◽  
Peritoneal Tissue ◽  
Remote Patient ◽  
The Impact

Abstract Water removal which is a key treatment goal of automated peritoneal dialysis (APD) can be assessed cycle-by-cycle using remote patient monitoring (RPM). We analysed ultrafiltration patterns during night APD following a dry day (APDDD; no daytime fluid exchange) or wet day (APDWD; daytime exchange). Ultrafiltration for each APD exchange were recorded for 16 days using RPM in 14 patients. The distributed model of fluid and solute transport was applied to simulate APD and to explore the impact of changes in peritoneal tissue hydration on ultrafiltration. We found lower ultrafiltration (mL, median [first quartile-third quartile]) during first and second vs. consecutive exchanges in APDDD (-61 [-148—27], 170 [78—228] vs. 213 [126—275] mL; p<0.001), but not in APDWD (81 [-8—176], 81 [-4—192] and 115 [4—219] mL; NS). Simulations in a virtual patient showed that lower ultrafiltration (by 114 mL) was related to increased peritoneal tissue hydration caused by inflow of 187 mL of water during the first APDDD exchange. The observed phenomenon of lower ultrafiltration during initial exchanges of dialysis fluid in patients undergoing APDDD appears to be due to water inflow into the peritoneal tissue, re-establishing a state of increased hydration typical for peritoneal dialysis.

Economic Evaluations of Remote Patient Monitoring for Chronic Disease: A Systematic Review

2022 ◽  
Author(s):  
Keshia R. De Guzman ◽  
Centaine L. Snoswell ◽  
Monica L. Taylor ◽  
Leonard C. Gray ◽  
Liam J. Caffery
Keyword(s):  
Systematic Review ◽  
Chronic Disease ◽  
Patient Monitoring ◽  
Economic Evaluations ◽  
Remote Patient Monitoring ◽  
Remote Patient
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