July 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’ July 2020 Research & News Recap.

Part I. Research Findings - Remote Patient Monitoring and Telehealth

Implementation of an Intensive Telehealth Intervention for Rural Patients with Uncontrolled Diabetes

What was studied?

Over two years, the Veterans Affairs Office of Rural Health conducted a study with 125 rural diabetes patients with poor glycemic control. Selected patients were enrolled in an Advanced Comprehensive Diabetes Care (ACDC) intervention program for sixth months. The ACDC intervention provided three key offerings to unengaged diabetes patients: telemonitoring, self-management support, and clinician-guided medication management.

Every two weeks, nurses conducted 30-minute phone calls with ACDC patients. During calls, nurses reviewed blood glucose reporting, medication adherence, and provided self-management guidance to patients. Guidance included education modules focuses on diet, exercise, and medication management among others a self-management education module on such topics as diabetes medication management, diet, and exercise. Following every 2-week call, a medication manager reviewed reports from nurses on patient progress. Medication managers adjusted treatment, but did not communicate directly with patients.

Research findings 

• Mean HbA1c improved from 9.25% at baseline to 7.89% at six months
• Improvements in glycemic control persisted at 12 months (-1.22%, 95% CI -1.48 to -0.97) and 18 months (-1.07%, 95% CI -1.40 to -0.73) for patients that opted to remain in the ACDC program
• Patient engagement was considered successful with the average patient completely 10 of 12 intervention calls.
• ACDC enhanced patient engagement and awareness of glycemic control with many patients requesting to continue ACDC telemonitoring after the initial six month intervention
• Workload for nurses was considered to increase moderately but at an acceptable rate given the intensive care required by diabetes patients

Why do these findings matter?

According to the Health Resources & Services Administration (HSRA) and Center for Disease Control (CDC), diabetes prevalence is approximately 15 to 17 percent higher in rural communities than in urban communities. Further impacting these rural communities is a lack of diabetes self-management programs. 62 percent of nonmetropolitan counties do not have disease self-management programs, significantly increasing mortality in these communities.

The above study proves the efficacy of providing advanced care for diabetes through telehealth to expand access to specialty care and establish self-management skills in previously unengaged diabetes patients. In addition, the study outlines how an Advanced Comprehensive Diabetes Care (ACDC) intervention program can significantly impact a community without straining existing staffing resources, a critical point in rural communities.

Access the full article, here. 

Date Published: June 2020

Kobe, Elizabeth A., et al. “21-OR: Implementation of an Intensive Telehealth Intervention for Rural Patients with Uncontrolled Diabetes.” Diabetes, American Diabetes Association, 1 June 2020, diabetes.diabetesjournals.org/content/69/Supplement_1/21-OR.

Telemedicine in Pediatric Surgery

What was studied?

The American Pediatric Surgical Association (APSA) sponsored this literature review outlining the current and future uses of telehealth and remote patient monitoring in pediatric surgery. The review highlights implementation strategies for adding pediatric telehealth to your practice and highlights previous studies that demonstrate the efficacy of utilizing highly specialized technology to monitor and treat pediatric patients.

Current & future uses of telehealth

• During preoperative and postoperative periods, virtual visits can assist in patient evaluation. During the preoperative period, physicians can utilize virtual visits to evaluate possible candidates for surgery who are in rural or remote locations. Virtual visits can then assist physician in performing follow-up care in the postoperative period.
• Remote monitoring supports the collection of specific patient data such as daily surgical drain output, spirometry results, symptoms, blood pressure and medication adherence
• Specialty consultation in emergency departments and ICUs through virtual visits
• Remote surgery via the ZEUS system consisting of a “patient side” and a “surgeon side” connected through asynchronous transfer mode technology

Why do these findings matter?

Pediatric surgery is a field in which highly-specialized care is delivered to vulnerable patients by an extremely limited number of providers. Due to provider limitations, patients and their families often travel incredibly long distances. Highlighted studies in this literature review show comparable outcomes to in-person follow-up with a majority of studies reporting significant time, travel, and resource savings to patients and their families. For these vulnerable patient populations, a reduction in time, travel, or stress, along with cost savings can have a substantial impact on their mental and emotional health as well.

Date Published: 2019

Harding, Matthew T, et al. “Telemedicine in Pediatric Surgery.” Journal of Pediatric Surgery, Journal of Pediatric Surgery, 2019, www.jpedsurg.org/article/S0022-3468(18)30312-9/fulltext.