Continuous Remote Patient Monitoring for Post-Discharge Heart Failure Management: Workflow Modeling Using Discrete Event Simulation.

The Cascade-HF protocol is a Continuous Remote Patient Monitoring (CRPM) study at a major health system in the United States to reduce Heart Failure (HF)-related hospitalizations and readmissions using wearable biosensors to collect physiological data over a 30-day period to determine decompensation risk among HF patients. The alerts produced, coupled with electronic patient-reported outcomes, are utilized daily by the home health team, and escalated to the heart failure team as needed, for proactive actions. Limited research has examined anticipating the implementation and workflow challenges of such complex CRPM studies such as resource planning and staffing decisions that leverage the recorded data to drive clinical preparedness and operational efficiency. This preliminary analysis applies discrete event simulation modeling to the Cascade-HF protocol using pilot data from a soft launch to assess workload of the clinical team, evaluate escalation patterns and provide decision support recommendations to enable scale-up for all post-discharge patients.

Evaluating an Advanced Practice Provider-Managed Coronavirus Disease 2019 Deterioration Program.

Background: COVID-19 changed how healthcare systems could provide quality healthcare to patients, safely. An urban healthcare system created an advanced practice provider (APP)-managed continuous remote patient monitoring (cRPM) program. Methods: A mixed-method study design focusing on the usable and feasible nature of the cRPM program. Both APP-guided interviews and online questionnaires were analyzed. Results: There was overwhelmingly positive APP feedback utilizing the remote monitoring solution including providing quality healthcare, detecting early clinical deterioration, and desiring to adapt the solution to other acute or chronic diseases. Implications: Understanding the clinical users' feedback on usability and feasibility of cRPM highlights the significance of rapid clinical assessment, urgent care escalation and provider accessibility.

Continuous Remote Patient Monitoring in Patients With Heart Failure (Cascade Study): Protocol for a Mixed Methods Feasibility Study.

BACKGROUND: Heart failure (HF) is a prevalent chronic disease and is associated with increases in mortality and morbidity. HF is a leading cause of hospitalizations and readmissions in the United States. A potentially promising area for preventing HF readmissions is continuous remote patient monitoring (CRPM). OBJECTIVE: The primary aim of this study is to determine the feasibility and preliminary efficacy of a CRPM solution in patients with HF at NorthShore University HealthSystem. METHODS: This study is a feasibility study and uses a wearable biosensor to continuously remotely monitor patients with HF for 30 days after discharge. Eligible patients admitted with an HF exacerbation at NorthShore University HealthSystem are being recruited, and the wearable biosensor is placed before discharge. The biosensor collects physiological ambulatory data, which are analyzed for signs of patient deterioration. Participants are also completing a daily survey through a dedicated study smartphone. If prespecified criteria from the physiological data and survey results are met, a notification is triggered, and a predetermined electronic health record-based pathway of telephonic management is completed. In phase 1, which has already been completed, 5 patients were enrolled and monitored for 30 days after discharge. The results of phase 1 were analyzed, and modifications to the program were made to optimize it. After analysis of the phase 1 results, 15 patients are being enrolled for phase 2, which is a calibration and testing period to enable further adjustments to be made. After phase 2, we will enroll 45 patients for phase 3. The combined results of phases 1, 2, and 3 will be analyzed to determine the feasibility of a CRPM program in patients with HF. Semistructured interviews are being conducted with key stakeholders, including patients, and these results will be analyzed using the affective adaptation of the technology acceptance model. RESULTS: During phase 1, of the 5 patients, 2 (40%) were readmitted during the study period. The study completion rate for phase 1 was 80% (4/5), and the study attrition rate was 20% (1/5). There were 57 protocol deviations out of 150 patient days in phase 1 of the study. The results of phase 1 were analyzed, and the study protocol was adjusted to optimize it for phases 2 and 3. Phase 2 and phase 3 results will be available by the end of 2022. CONCLUSIONS: A CRPM program may offer a low-risk solution to improve care of patients with HF after hospital discharge and may help to decrease readmission of patients with HF to the hospital. This protocol may also lay the groundwork for the use of CRPM solutions in other groups of patients considered to be at high risk. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/36741.