scholarly journals Mobile app-based Remote Patient Monitoring in Acute Medical Conditions: A Prospective Feasibility Study Exploring Digital Health Solutions on Clinical Workload during the COVID Crisis. (Preprint)

2020 ◽  
Author(s):  
Sachin Shailendra Shah ◽  
Andrew Gvozdanovic ◽  
Matthew Knight ◽  
Julien Gagnon
Keyword(s):  
Feasibility Study ◽  
Patient Monitoring ◽  
Mobile App ◽  
Full Time ◽  
Remote Patient Monitoring ◽  
Phone Calls ◽  
Clinical Scenarios ◽  
Remote Patient ◽  
The Impact ◽  
Clinical Workload

BACKGROUND Digital remote patient monitoring (RPM) can add value to virtual wards; this has become more apparent in the context of the COVID-19 pandemic. Healthcare providers are overwhelmed resulting in clinical teams spread more thinly. We aim to assess the impact of the introduction of an app-based RPM (Huma Therapeutics) on a clinician's workload in the context of a COVID-19 specific virtual ward. OBJECTIVE This prospective feasibility study aims to evaluate the health economic effect (in terms of clinical workload) a mobile app has on a telephone based virtual ward in the monitoring of COVID-19 patients clinically ready for discharge from hospital. METHODS A prospective feasibility study was carried out over one month where clinician workload was monitored, and full time equivalents (FTE) savings equated. An NHS hospital repurposed a telephone-based respiratory virtual ward for COVID-19. Amber status (NHS definition) COVID-19 patients were monitored for 14 days post-discharge to help identify deteriorating patients earlier. A smartphone-based app was introduced to monitor data points submitted by the patients with telephone calls used for communication. A comparison of clinical workload between those monitored by telephone only (Cohort 1) with those monitored via mobile app and telephone (Cohort 2) was undertaken. RESULTS 56 patients were enrolled in the app-based virtual ward (Cohort 2). Digital RPM reduced the number of phone calls from a mean total of 9 to 4 over monitoring period. There was no change in the mean duration of phone calls (8.5minutes), and no reports of readmissions or mortality. This equates to a mean saving of 47.60 working hours. This translates to 3.30 fewer FTEs (raw phone call data), resulting in 1.1 fewer FTEs required to monitor 100 patients when adjusted for time spent reviewing app data. Individual clinicians were averaging 10.9 minutes per day. CONCLUSIONS Smartphone-based RPM technologies may offer tangible reductions in clinician workload at a time of severe service strain. In this small pilot, we demonstrate the economic and operational impact digital RPM technology can have in improving working efficiency and reducing operational costs. Whilst this particular RPM solution was deployed for the COVID-19 pandemic, it may set a precedent for wider utilisation of digital RPM solutions in other clinical scenarios where increased care delivery efficiency is sought. CLINICALTRIAL

The role of app-based remote patient monitoring in reducing primary care clinician workload during the COVID pandemic: A prospective observational real world feasibility study.

2021 ◽  
Author(s):  
Sachin Shailendra Shah ◽  
Afsana Safa ◽  
Kuldhir Johal ◽  
Dillon Obika ◽  
Sophie Valenine
Keyword(s):  
Primary Care ◽  
Patient Monitoring ◽  
Healthcare Providers ◽  
Routine Care ◽  
Full Time ◽  
Remote Patient Monitoring ◽  
Full Time Equivalent ◽  
Phone Calls ◽  
Medium Risk ◽  
Remote Patient

Abstract Background COVID-19 has placed unprecedented strain on healthcare providers, in particular, primary care services. GP practices have to effectively manage patients remotely preserving social distancing. We aim to assess an app-based remote patient monitoring solution in reducing the workload of a clinician. Primary care COVID patients in West London deemed medium risk where recruited into the virtual ward. Patients were monitored for 14 days by telephone or by both the Huma app and telephone. Information on number of phone calls, duration of phone calls and duration of time spent reviewing the app data recorded.Results The amount of time spent reviewing one patient on the telephone only arm of the study was 490 minutes, compared with 280 minutes spent reviewing one patient who was monitored via both the Huma app and telephone. Based on employed clinicians monitoring patients, this equates to a 0.04 reduction of full-time equivalent staffing I.e. for every 100 patients, it would require 4 less personal to remotely monitor them. There was no difference in mortality or adverse events between the two groups.Conclusion App-based remote patient monitoring clearly holds large economic benefit to COVID-19 patients. In wake of further waves or future pandemics, and even in routine care, app-based remote monitoring patients could free up vital resources in terms of clinical team’s time, allowing a better reallocation of services.

scholarly journals A prospective observational real world feasibility study assessing the role of app-based remote patient monitoring in reducing primary care clinician workload during the COVID pandemic

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sachin Shailendra Shah ◽  
Afsana Safa ◽  
Kuldhir Johal ◽  
Dillon Obika ◽  
Sophie Valentine
Keyword(s):  
Primary Care ◽  
Patient Monitoring ◽  
Healthcare Providers ◽  
Routine Care ◽  
Full Time ◽  
Remote Patient Monitoring ◽  
Full Time Equivalent ◽  
Phone Calls ◽  
Novel Coronavirus ◽  
Remote Patient

Abstract Background The novel coronavirus disease in 2019 (COVID-19) has placed unprecedented strain on healthcare providers, in particular, primary care services. General practitioners (GP) have to effectively manage patients remotely preserving social distancing. We aim to assess an app-based remote patient monitoring solution in reducing the workload of a clinician and reflect this as time-saved in an economic context. Primary care COVID patients in West London deemed medium risk were recruited into the virtual ward. Patients were monitored for 14 days by telephone or by both the Huma app and telephone. Information on number of phone calls, duration of phone calls and duration of time spent reviewing the app data was recorded. Results The amount of time spent reviewing one patient in the telephone only arm of the study was 490 min, compared with 280 min spent reviewing one patient who was monitored via both the Huma app and telephone. Based on employed clinicians monitoring patients, this equates to a 0.04 reduction of full-time equivalent staffing I.e. for every 100 patients, it would require 4 less personnel to remotely monitor them. There was no difference in mortality or adverse events between the two groups. Conclusion App-based remote patient monitoring potentially holds large economic benefit to COVID-19 patients. In wake of further waves or future pandemics, and even in routine care, app-based remote monitoring patients could free up vital resources in terms of clinical team’s time, allowing a better reallocation of services.

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 Testing the Feasibility of Remote Patient Monitoring in Prenatal Care Using a Mobile App and Connected Devices: A Prospective Observational Trial

2016 ◽  
Vol 5 (4) ◽  
pp. e200 ◽  
Author(s):  
Kathryn I Marko ◽  
Jill M Krapf ◽  
Andrew C Meltzer ◽  
Julia Oh ◽  
Nihar Ganju ◽  
...  
Keyword(s):  
Prenatal Care ◽  
Patient Monitoring ◽  
Mobile App ◽  
Remote Patient Monitoring ◽  
Observational Trial ◽  
Remote Patient

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.

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