August 2020

Interest in remote patient monitoring (RPM) and its positive impact continues to grow as providers see the benefits of adding telehealth to their workflow. This has led to increased and extensive research on telehealth as well as changes to government policies. Explore recent research on the efficacy of telehealth and understand new rulings from the Center of Medicare and Medicaid Services (CMS) in HRS’ August 2020 Research & News Recap.

Part I. Research Findings - Remote Patient Monitoring and Telehealth

Uptake of Virtual Visits in A Geriatric Primary Care Clinic During the COVID-19 Pandemic

What was studied?

As states across the US experience a resurgence of COVID-19 cases, providers are continuing to shift in-person visits to virtual services. Published by the American Geriatric Society, this study from the University of Michigan Medical center outlines how their multi-site geriatric clinic, providing over 300 in-person visits per week prior to COVID-19, shifted to video and telephonic visits at the onset of the pandemic. Over a five-week period, the geriatric program transitioned from delivery 0% of visits virtually to 91% of visits through phone and video platforms.

Best practices for adaptation 

• Patient and caregiver Involvement: Prior to virtual and telephonic visits, patient and/or their caregivers were asked to measure blood pressure (BP), pulse, body weight, temperature, and glucose (if necessary). Due to the importance of accurate BP readings, the health system adapted to a provide “drive-through” BP visits
• Pre-visit medication review: Prior to virtual and telephonic visits, pharmacy technologists or medical assistant performed medication reconciliation with patients and/or their caregivers
• Pre-visit collection of patient information: Patients were asked to complete the following forms to provide a more complete picture of their health status: PHQ9, fall screening, social history, and physical and cognitive functional assessment
• Detailed patient medical history

Additional benefits

• During the first five weeks, over 1,135 travel miles were saved through virtual visits for an average of 24 miles saved per visit.
• Clinician skepticism over virtual care within the health system was dramatically reduced
• Virtual visit provided patients with an additional touch point during an especially isolating and lonely period of time, helping improve their mental and emotional health and well being

Access the full article, here.

Date Published: May 2020

Dewar, S., Lee, P., Suh, T., & Min, L. (2020, May 15). Uptake of Virtual Visits in A Geriatric Primary Care Clinic During the COVID‐19 Pandemic. Retrieved August 07, 2020, from https://onlinelibrary.wiley.com/doi/10.1111/jgs.16534

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

What was studied?

The George Washington University Hospital conducted an observational study over six months to evaluate the feasibility of monitoring prenatal risk factors via a mobile health solution. Participants (age 18-40) used Bluetooth devices to record their weight and blood pressure everyday throughout the first trimester of their pregnancy. The patients vital were recorded in their mobile application and daily readings, as well as weekly and monthly trends were available to the patient’s OBGYN at The George Washington University Hospital. In addition, educational material was available to participants via the mobile application including information regarding pregnancy progression, smoking, drug abuse and alcohol consumption risks, pregnancy warning signs, proper nutrition and appropriate weight gain.

Patients had access to the application through their mobile devices and were provided Bluetooth connected devices with which to record their daily vital signs. The application and devices were available to participants at no cost.

To examine the feasibility of remote patient monitoring for prenatal care, four key categories were evaluated: patient engagement, patient satisfaction, data accuracy, and efficacy of the alert system.

• Weight collected an average of 1.5x per week, collected an average of 46 times per patient throughout the study (4.6x that of in-office only)
• Blood pressure collected an average of 1.1x per week, collected an average of 34 times per patient throughout the study (3.4x that of in-office only)

Data Accuracy

• No significant differences between weight and blood pressure recorded in office vs. through the mobile application indicating accurate data recorded

Risk Alert Efficacy

• During the study, no inappropriate alerts were received by the team. Two alerts were received through the study, both being relevant to the patient’s status and progress

Patient Satisfaction

• All study participants felt comfortable with the technology and monitoring concept and felt the resources (education) was beneficial. Most participants 83% felt the app helped them develop healthy behaviors and improve communication with their provider

Why do these findings matter?

Preeclampsia is the most common pregnancy complication, affecting 1 in 20 pregnancies. For preeclampsia (as well as gestational diabetes and premature birth) extreme weight gain and high blood pressure are significant risk factors. Early identification of these risk factors proves incredibly beneficial to pregnant women and their babies. The ability to consistently monitor blood pressure and weight gain throughout a pregnancy via a mobile application can enhance patients’ knowledge of their risk and better comply with their care as it has in similar studies with diabetes management, HIV medication adherence, and sickle cell anemia adherence.

Date Published: 2019

Marko KI, Krapf JM, Meltzer AC, et al. Testing the Feasibility of Remote Patient Monitoring in Prenatal Care Using a Mobile App and Connected Devices: A Prospective Observational Trial. JMIR Res Protoc. 2016;5(4):e200. Published 2016 Nov 18. doi:10.2196/resprot.6167