How remote patient care helped cut heart failure readmissions

Chronic diseases place a significant burden on the U.S. healthcare system, making effective chronic disease management a priority for healthcare facilities nationwide. However, effective chronic disease management is easier said than done, as it requires widespread care coordination, continuous tracking of patient health metrics and timely interventions.

One health system is addressing these challenges through remote patient monitoring (RPM) -- and seeing results. Last month, UMass Memorial Health -- Harrington announced that its RPM program for heart failure has significantly reduced the hospital readmission rate for this population.

This is significant because heart failure is a prevalent chronic condition, with research showing that nearly 6.7 million Americans over the age of 20 suffer from the disease. The prevalence is expected to rise to 8.5 million Americans by 2030, and approximately one in four will develop heart failure in their lifetime.

It is also a costly condition to treat. One study estimates that an average of $28,950 per year is spent on individuals with heart failure compared with $5,727 on those without the chronic condition.

However, heart failure can be managed well in the home, according to Jess Calcidise, chief nursing officer and chief operating officer at UMass Memorial Health -- Harrington.

"For the most part, heart failure can absolutely be managed at home if it's managed closely," she said in an interview. "Unfortunately, many people that have heart failure have heart failure flares, they wind up in the hospital … and it really impacts their life. But controlled heart failure can be managed really well these days."

Thus, like several other healthcare facilities, the hospital partnered with a third-party RPM provider to achieve its clinical care goals regarding heart failure. While the hospital has made significant progress in improving clinical outcomes for the heart failure patient population, integrating a technology-based program comes with challenges that must be addressed.

Continuous monitoring prompts early interventions

Heart failure, also known as congestive heart failure, is a condition where the heart isn't able to pump enough blood and oxygen to the body's organs. In this condition, fluid often builds up in the lungs and other areas of the patient's body, resulting in breathing difficulties and a rapid heart rate, among other issues, Calcidise explained. Treatment for the condition includes lifestyle changes, surgical procedures and medications; however, the medications can cause side effects, like frequent urination. Among older patients, side effects like these can result in falls and other adverse events.

Thus, the complications of the disease and treatment challenges make hospital readmission common among heart failure patients.

"If you ask any leader in healthcare, we've been chasing heart failure readmissions for years," Calcidise said. "And we have tried everything from giving people [weight] scales to phone calls every day, asking them if they've weighed themselves to programs where people come in for education. I mean, we've been chasing heart failure for years."

UMass Memorial Health -- Harrington decided to partner with RPM technology and services provider Brook, Inc. to tackle rising readmission rates and enhance heart failure outcomes. The vendor provides an RPM platform as well as devices like blood pressure cuffs, weight scales and pulse oximeters, allowing patients to measure their vital signs at home and share the readings with a remote care team.

The hospital first identifies hospitalized patients with a heart failure diagnosis who are going to be discharged to their homes, Calcidise said. A nurse navigator at the hospital meets with those patients and explains the program. The patients decide whether they want to participate.

"The patients can certainly decline, but what we're finding is that most are interested in it because of the success that we're having with keeping people out of the hospital," she said.

Once the patients are discharged with the technology access and devices they need, a Brook nurse coach connects with them. These nurses monitor the data collected by the RPM devices and transmitted via the Brook app and care portal. They also work with the patient's primary care team to ensure timely interventions.

Of the patients that we've onboarded, less than 50% of them have been readmitted to the hospital. Previously, we were at around 75% readmissions from traditional treatments for heart failure.

"The Brook nurse gets the weight [data] on the patient every day," said Calcidise. "They're watching the trends on it. So the Brook nurse will, for instance, see a 3-, 4- or 5-pound weight gain for that patient, be able to contact the primary care physician, get an order … to have the patient increase their medications, or come into the office and see them before they get to a weight gain that requires a visit to the emergency room and admission to the hospital."

Through these early interventions, the hospital has seen improved heart failure outcomes and decreased healthcare service utilization.

"Of the patients that we've onboarded, less than 50% of them have been readmitted to the hospital," Calcidise said. "Previously, we were at around 75% readmissions from traditional treatments for heart failure."

Not only has the program cut the readmissions rate, but the hospital has also reduced emergency department visits among the heart failure population. The decreased readmissions and ED visit rates indicate that heart failure patients within the RPM program are able to remain healthier for longer. This is because clinicians can intervene at the slightest change in the patient's health metrics rather than when the condition has worsened significantly, Calcidise noted.

Challenges to scaling RPM use

Though the RPM program has proved effective in enhancing heart failure care at UMass Memorial Health -- Harrington, the hospital first had to contend with several challenges, including resistance to change.

Change is hard, Calcidise emphasized, especially in the healthcare industry where clinicians are hesitant to trust that the change being asked of them will result in improved patient care. In the partnership with Brook, UMass Memorial Health -- Harrington leaders had to first ensure that their clinicians trusted the RPM technology and the Brook nurses who were monitoring the data and reporting it back to them.

Further, to gain the all-important clinical buy-in, hospital leaders highlighted the fact that UMass Memorial Health -- Harrington clinicians will not be tasked with additional monitoring following program implementation.

"That makes the difference because your organization isn't taking on the burden of doing the monitoring, doing the intervening…. And in the day where everyone's job in healthcare is hard, if you can get that from a vendor and get the quality that we're seeing out of it, I highly recommend it," Calcidise said.

Another significant hurdle is balancing patient privacy with scaling RPM technology utilization, which is a broader challenge to RPM use in the healthcare industry. Calcidise noted that concerns around patient privacy could be holding back progress in the RPM arena. These concerns could prevent people from participating in RPM programs, limiting their benefits like individualizing patient care and driving down costs.

"We should be concerned for patient privacy, but as we talk about population health measures, we're going to have to recognize that RPM plays a big role in how we're going to manage our populations, how we're going to manage our chronic diseases," Calcidise said.

Despite these hurdles, UMass Memorial Health -- Harrington is all in on using RPM to bolster chronic disease management. The hospital plans to launch an RPM program focused on chronic obstructive pulmonary disease (COPD) with Brook. According to Calcidise, the two organizations are working to develop an algorithm for post-acute care for COPD patients.

As the hospital moves forward with its plans to expand RPM utilization, hospital leaders hope that the technology will enhance population health outside and inside the facility's four walls.

"If I can keep five people out of my ER when I've got 15 others waiting, that's a win," Calcidise said. "If we can open up one more primary care visit for a patient that needs to see the primary care [physician] because we can manage this chronic disease remotely, that's a win."

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.