Use Cases of RPM Defined (1): Chronic conditions that are prone to exacerbations
One of the most frequently proposed use cases for remote patient monitoring is biometric monitoring as part of home care for individuals with chronic conditions prone to frequent exacerbations. Chronic conditions included within this use case include asthma, COPD, heart failure, hypertension, diabetes, renal failure, inflammatory bowel disease, sleep disorders, transplant, and claudication. Over time, long Covid may join this group.
We discuss two examples of this use case: heart failure and asthma.
Heart failure is a chronic condition that requires rigorous management of many aspects for optimal outcomes. Frequent and consistent biometrics monitoring outside of the home is thought to offer significant promise. In particular, weight and blood pressure should be monitored regularly. Depending on the severity and associated comorbidities, oxygen saturation, blood glucose, heart rate, and respiratory rate may also be of import. For more advanced heart failure, monitoring of pulmonary artery pressures is even possible remotely and may be helpful. Of equal importance is the management of medication adherence, which is to be included with the Medicare conception of remote patient monitoring in 2022.
A patient may be gaining 2 pounds a day of fluid. For a given day, this change may not seem significant, but over time the cumulative effect could have harmful consequences. If this weight gain can be caught and addressed before the patient reaches a critical trigger point for decompensation, quality of life can be improved and potential urgent care, ER, or hospital admissions avoided.
In asthma, one may note subtle and seemingly undetected changes in heart rate, respiratory rate, oxygen saturation, or even airflow that may be indicative of trends toward a critical threshold. If caught early, outcomes can be improved and/or complications averted.
Countless scenarios exist. The key will be to design the optimal monitoring regimen for the patient’s condition in a way that will be executed by the patient/clinician team consistently and safely.
The potential to improve the quality of daily life, reduce ER and hospital admissions, and improve long-term outcomes with RPM is promising but has been a daunting task. The maturation of devices and the technology that is used to monitor these devices has brought this daunting task within reach. Identifying and executing best practices will make this task a reality.
Kimberly Gandy, Jos Domen, Mary Topping
Kimberly Gandy, MD, PhD is a Northwestern/Stanford/Duke-trained physician-scientist with over 25 years of experience at the intersection of science, medicine, and technology.
Jos Domen, PhD is a University of Amsterdam and Stanford-trained cell biologist and immunologist that has run laboratories at Duke and elsewhere, and published extensively in the scientific literature.
Mary Topping, MBA has 15 years of operational and strategic experience in payer and provider settings, including Kaiser Permanente. She’s designed and implemented Medicare insurance products, improved revenue cycle processes, built business cases, and facilitated team innovation in care delivery.
*This is the second in our series of articles on the Use Cases of RPM. Please take a look and join in the discussion around this emerging field. hashtag#RPM hashtag#Remotepatientmonitoring hashtag#virtualcare hashtag#homecareservices hashtag#homecare