5/6/2014. Physiologic Monitoring Tools & Use with Patients with Chronic Health Conditions. Objectives. The Issue at Hand

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1 Physiologic Monitoring Tools & Use with Patients with Chronic Health Conditions Kelly Brittain, PhD, RN Assistant Professor MCRH-Nursing Grand Rounds May 8, 2014 Objectives 1. Summarize previous research on chronic disease management and the use of remote health monitoring. 2. Summarize remote health monitoring interventions that have had positive effects on chronic disease management. 3. Summarize new strategies in remote health monitoring interventions for chronic disease management. 4. Identify gaps where future nursing research is needed The Issue at Hand Chronic diseases: common, costly, and preventable 7 out of 10 deaths caused by chronic diseases(cdc, 2014) 5 million Americans have CHF, 500,000 new cases each year Cost $25 billion 60% associated with hospital stays and exceed Medicare reimbursement Annual cost of remote health monitoring/telehealth approximately $2,820 Use of remote patient monitoring technology in conjunction with electronic health records could save the health care industry $700 billion over 15 to 20 years. 1

2 Telehealth/Telemedicine vs. Remote Health Monitoring Telehealth/Telemedicine/Remote health monitoring: Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications. (HRSA, 2014) However, operationally, these are TWO different methods of monitoring patients Telehealth/Telemedicine vs Remote Health Monitoring Telemedicine (Medicaid)/Telehealth (Medicare Part B): Two-way, real time interactive communication (real-time audio and video) between the patient, and health care provider or clinician-to-clinician at the distant site. Viewed as a cost effective alternative to face-to-face consultations or examinations. One of the two parties must be at a health care facility. Remote Health Monitoring: Uses digital technologies to collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to health care providers in a different location for assessment and recommendations. Not currently reimbursable. New to the Game : mhealth Mobile health or mhealth: the provision of health care services and personal health data via mobile devices. Uses devices such as smart phones and portable monitoring sensors that transmit information to providers, as well as dedicated application software (apps), which are downloaded onto devices 2

3 Does Telehealth Work? Many studies & many systematic reviews: Pediatrics Geriatrics Native Americans Home care Mental health Radiology Renal dialysis Rural health Rehabilitation And the answer is Results: inconclusive Why are the results inconclusive? Let s take a closer look. 3

4 Congestive Heart Failure and Telehealth Within 3-6 months, 25%-50% of patients are readmitted with CHF. Reasons: Adherence to meds Knowledge of decompensation/early signs of CHF Lack of follow-up care Lack of prescribed therapy Many of these issues could be addressed via telehealth Telehealth and CHF Signs and symptoms can be monitored remotely BP Weight O 2 saturation Medication adherence Assessment related to measurements Common Elements of a Telehealth CHF Intervention Physiologic measures Lab Telemonitoring nurse/staff Phone Quality of Life measure (Nursing) 4

5 CHF Management in Clinics Setting: 33 cardiology practices; home of the patient Patients: Hospitalized in the previous 30 days Outcomes: Primary-Readmission within 180 days; Secondary-Death, hospitalization, days in the hospital Chaudry, S. I., Mattera, J.A., et al (2010). Telemonitoring in patients with heart failure. N Engl J Med 363(24) Usual care: CHF Management in Clinics Educational materials, daily weight CHF Management in Clinics Intervention: Educational materials, daily weight, toll-free calls to system, series of questions, keypad for responses, information reviewed daily, abnormal responses documented and clinicians notified. Patients were told to contact their physician for any urgent concerns. 5

6 Results: CHF Management in Clinics Telemonitoring and usual care groups did not differ CHF Management in Home Health Setting: Home care agency; home of the patient Patients: Admitted to home care, over 64, class III or IV, no cognitive deficit, phone, Medicare B Outcomes: Home visit frequency, rehospitalization rate, ER use, health care costs, and quality of life Myers, S., Grant, R. W., Lugn, N. E., Holbert, B., Kvedar, J.C. (2006). Impact of home-based monitoring on the care of patients with congestive heart failure. Home Health Care Management & Practice 18 (6) CHF Management in Home Health Usual care: Historic data, date of admission, Medicare B 6

7 CHF Management in Home Health Intervention: Daily weight, blood pressure, O 2 saturation, vital signs transmitted to nurse, nurse made follow-up call, scripted assessment, abnormal symptoms addressed, weekly home visit (Medicare requirement), quality of life assessment CHF Management in Home Health Results: Telemonitoring group had fewer home visits (5.8 to 8.2 per month; p <.0001) Telemonitoring group were enrolled in home care longer (39.8 to 38.2 days; p =.006) No differences in other outcomes Quality of life was only measured in telemonitoring group. Generally low scores What Happened? CHF is complex Attrition Perception of technology Ability to learn new things Value of telemonitoring 7

8 The Future: Remote Health Monitoring Wireless Real-time Wearable devices Constant vs limited time Access to information anywhere Nursing Implications: Practice Telemonitoring is not for everyone Assess barriers and facilitators to use Additional time on the front end Potential for user burnout How can telemonitoring improve the patient s outcomes, patient s quality of life, social support, caregiver, patient/provider communication? Nursing Implications: Research More studies (classification, home care, clinic) Process evaluation Patient/caregiver satisfaction Nursing satisfaction Peer support More or less contact with patient Different strategies 8

9 Summary Landscape of healthcare is changing Health care costs need to be contained Technology is available Not clear if it works Is less or more better? Wearable devices? Summary Nursing had an integral role in practice, research of technology and healthcare Thank you for this opportunity 9

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