Wei Ning Chi1, Courtney Reamer2, Robert Gordon2, Nitasha Sarswat2,3, Charu Gupta2, Emily White VanGompel4,5, Julie Dayiantis6, Melissa Morton-Jost6, Urmila Ravichandran7, Karen Larimer8, David Victorson9, John Erwin2,3, Lakshmi Halasyamani4,5, Anthony Solomonides1, Rema Padman10, Nirav S Shah2,3. 1. Outcomes Research Network, NorthShore University HealthSystem, Evanston, Illinois, United States. 2. Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States. 3. Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States. 4. Department of Family Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States. 5. Department of Family Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States. 6. Home and Hospice Services, NorthShore University HealthSystem, Evanston, Illinois, United States. 7. Health Information Technology, NorthShore University HealthSystem, Evanston, Illinois, United States. 8. Clinical Department, physIQ, Inc., Chicago, Illinois, United States. 9. Northwestern University Feinberg School of Medicine, Evanston, Illinois, United States. 10. The Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States.
Abstract
OBJECTIVE: We report on our experience of deploying a continuous remote patient monitoring (CRPM) study soft launch with structured cascading and escalation pathways on heart failure (HF) patients post-discharge. The lessons learned from the soft launch are used to modify and fine-tune the workflow process and study protocol. METHODS: This soft launch was conducted at NorthShore University HealthSystem's Evanston Hospital from December 2020 to March 2021. Patients were provided with non-invasive wearable biosensors that continuously collect ambulatory physiological data, and a study phone that collects patient-reported outcomes. The physiological data are analyzed by machine learning algorithms, potentially identifying physiological perturbation in HF patients. Alerts from this algorithm may be cascaded with other patient status data to inform home health nurses' (HHNs') management via a structured protocol. HHNs review the monitoring platform daily. If the patient's status meets specific criteria, HHNs perform assessments and escalate patient cases to the HF team for further guidance on early intervention. RESULTS: We enrolled five patients into the soft launch. Four participants adhered to study activities. Two out of five patients were readmitted, one due to HF, one due to infection. Observed miscommunication and protocol gaps were noted for protocol amendment. The study team adopted an organizational development method from change management theory to reconfigure the study protocol. CONCLUSION: We sought to automate the monitoring aspects of post-discharge care by aligning a new technology that generates streaming data from a wearable device with a complex, multi-provider workflow into a novel protocol using iterative design, implementation, and evaluation methods to monitor post-discharge HF patients. CRPM with structured escalation and telemonitoring protocol shows potential to maintain patients in their home environment and reduce HF-related readmissions. Our results suggest that further education to engage and empower frontline workers using advanced technology is essential to scale up the approach. Thieme. All rights reserved.
OBJECTIVE: We report on our experience of deploying a continuous remote patient monitoring (CRPM) study soft launch with structured cascading and escalation pathways on heart failure (HF) patients post-discharge. The lessons learned from the soft launch are used to modify and fine-tune the workflow process and study protocol. METHODS: This soft launch was conducted at NorthShore University HealthSystem's Evanston Hospital from December 2020 to March 2021. Patients were provided with non-invasive wearable biosensors that continuously collect ambulatory physiological data, and a study phone that collects patient-reported outcomes. The physiological data are analyzed by machine learning algorithms, potentially identifying physiological perturbation in HF patients. Alerts from this algorithm may be cascaded with other patient status data to inform home health nurses' (HHNs') management via a structured protocol. HHNs review the monitoring platform daily. If the patient's status meets specific criteria, HHNs perform assessments and escalate patient cases to the HF team for further guidance on early intervention. RESULTS: We enrolled five patients into the soft launch. Four participants adhered to study activities. Two out of five patients were readmitted, one due to HF, one due to infection. Observed miscommunication and protocol gaps were noted for protocol amendment. The study team adopted an organizational development method from change management theory to reconfigure the study protocol. CONCLUSION: We sought to automate the monitoring aspects of post-discharge care by aligning a new technology that generates streaming data from a wearable device with a complex, multi-provider workflow into a novel protocol using iterative design, implementation, and evaluation methods to monitor post-discharge HF patients. CRPM with structured escalation and telemonitoring protocol shows potential to maintain patients in their home environment and reduce HF-related readmissions. Our results suggest that further education to engage and empower frontline workers using advanced technology is essential to scale up the approach. Thieme. All rights reserved.
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Authors: Courtney Reamer; Wei Ning Chi; Robert Gordon; Nitasha Sarswat; Charu Gupta; Safwan Gaznabi; Emily White VanGompel; Izabella Szum; Melissa Morton-Jost; Jorma Vaughn; Karen Larimer; David Victorson; John Erwin; Lakshmi Halasyamani; Anthony Solomonides; Rema Padman; Nirav S Shah Journal: JMIR Res Protoc Date: 2022-08-25