5 ways to adapt chronic disease management during Covid-19
Remote patient monitoring (RPM) is a proven and effective modality that can be used to monitor patients avoiding health care facilities and to care for recovering patients at home given the shortages in acute care facility capacity. But successful RPM relies on efficient data collection, which is why wearables and other consumer devices will be vital to caring for patients at home in the aftermath of Covid-19.
RPM is ready to be in the spotlight
RPM is the collection and transmission of clinical data from outside conventional care settings to providers. The continued adoption of virtual visits is only sustainable if coupled with RPM. Virtual visits enable providers to connect with patients, an interaction that has pleasantly surprised both parties. But virtual visits don't provide an opportunity to perform the physical examinations and monitoring that are often essential for diagnoses and treatment. RPM can fill this gap, allowing physicians to collect important information as they normally would during in-person examinations, on an ongoing basis.
Before the epidemic, RPM was primarily used to manage chronic conditions such as diabetes. RPM helped patients manage their chronic conditions at home, preventing unnecessary visits to the hospital. Moving forward, it will be even more important to keep these patients out of the hospital because chronic conditions increase the risk of contracting Covid-19. Even relatively healthy patients will be uncomfortable going to health care facilities because they've been told to stay away for the past few months. In both cases, RPM will ensure that patients receive needed care if they can't or won't show up in person.
The epidemic is already accelerating the use of RPM to treat mild cases of Covid-19. For example, some providers are using blood pressure cuffs, pulse oximeters, and other devices to monitor patients who aren't ill enough to be hospitalized. RPM will continue to play an important role during and after the pandemic, especially given the limited capacity of acute care facilities.
RPM can support at-home discharge as an alternative to SNFs
Traditionally, patients are discharged to post-acute care facilities, most notably skilled nursing facilities (SNFs). Researchers predict that over 700,000 beds are needed to handle the discharge of Covid-19 patients, but only 345,000 beds are available in the post-acute space. The shortage of beds means that patients can't be discharged to open up room for newly ill patients.
Even if there was enough capacity, some SNFs are reluctant to accept Covid-19 patients because of the risk of infection. SNFs tend to have older, chronic care patients and infection is notoriously a problem in these locations. An influx of recovering Covid-19 patients would exacerbate the existing problems.
RPM gives providers the option to discharge patients to their homes, preventing infection spread in overcrowded health care facilities that are already stretched thin. Patients can actually be discharged earlier because follow-up care is conducted virtually. If a patient's condition deteriorates, RPM devices alert clinicians in real-time. Furthermore, RPM has already proved itself to be effective at preventing readmissions.
For example, before Covid-19 Trinity Health successfully used RPM to discharge 80% of their Medicare patients to home. Prior to discharge, a nurse drops off a home health kit and trains the patient to use the devices. The patient is then responsible for logging their data every day for at least two months so nurses can monitor progress and intervene when necessary. The results were encouraging—Trinity reported a 90% compliance rate, a reduction in readmissions from 15% to 8%, and a patient satisfaction score consistently over 90%.
Will RPM widen the digital divide?
Although RPM shows promise, it could exacerbate existing inequities. RPM is only a viable option for patients who have sufficient broadband connectivity and the necessary resources to access RPM devices. According to the Federal Communications Commission, 21 million Americans lack internet access, meaning many won't be able to access care if RPM becomes the norm.
Still, using RPM to discharge patients to home and monitor patients outside of health care facilities opens up capacity for those who need medical care the most. To fully take advantage of RPM, keep health equity and potential barriers to access at the front of all strategic decisions. Starting the implementation process now will yield important evidence to influence the new normal for reimbursement and standards of care.
3 key questions for remote patient monitoring
Remote patient monitoring (RPM) is the collection and transmission of clinical data, often from outside conventional care settings, to a provider.
To succeed with remote patient monitoring, providers need to answer three key questions: Is it technically feasible? Is it clinically relevant? Is it cost effective?