MedEd Bytes: Out-of-hospital remote patient monitoring

MedEd Bytes

MedEd Bytes is a video series that offers a quick and digestible learning format that can help solidify your understanding of different therapies leveraged in patient monitoring and respiratory interventions. In this series, we’ll cover topics such as capnography waveforms, the technology behind pulse oximetry, modes of ventilation, and more. To stay up to date with the series, please subscribe to our YouTube channel or start watching the series below.

MedEd Bytes series:

Out-of-hospital remote patient monitoring

Out-of-hospital remote patient monitoring is the electronic collection of patient physiological measurements (such as blood pressure, weight, heart rate, temperature, respiratory rate, or blood glucose levels) outside of traditional health care settings.1 The primary objective of remote patient monitoring is often earlier recognition of deterioration, mostly in patients with chronic diseases.2

Byte 1: Pitfalls of transitioning from hospital to home

Elderly patients and patients suffering from chronic conditions frequently have trouble transitioning from the hospital to home.3

 

Byte 2: Hospital-to-home transitional care strategies

While several studies have shown that hospital-to-home transitional care strategies can decrease readmissions or improve quality of life, a recent systematic review found significant heterogeneity in implementation and inconsistent effectiveness.4

Byte 3: Hospital-to-home digital health technologies

Spurred by both recent technological innovations and the COVID-19 pandemic, investigators have recently accelerated the rate of research into the use of technology to facilitate the transition from hospital to home.5,6

Byte 4: Out-of-hospital remote patient monitoring

The primary objective of remote patient monitoring is typically earlier recognition of deterioration, primarily in patients with chronic diseases.2

Byte 5: Wearable at-home remote patient monitoring

A recent systematic review evaluating the utility of intermittent and continuous wearable remote patient monitoring found that vital signs needed to be collected at least daily to influence mortality and/or hospital admission rates.1 Continuous, or near continuous, acquisition of vital sign data is a key feature of wearables.7

Byte 6: Background on heart failure

Twenty-seven percent of heart failure (HF) hospitalizations require readmission within 30 days.8

 

 

Byte 7: Remote patient monitoring in heart failure patients

More recently, wearables have gained attention as an alternative to intermittent remote monitoring in heart failure patients, as real time monitoring and intelligent alerts may more rapidly detect deterioration.9

Byte 8: Background on chronic obstructive pulmonary disease

Acute exacerbations of chronic obstructive pulmonary disease contribute to 1.2 million admissions in the United States annually with a mean cost of $9545 per admission and total costs of $11.9 billion.10

Byte 9: Remote patient monitoring in COPD patients

One trial found that among patients who suffered an acute exacerbation of COPD (AECOPD), continuous monitoring of heart rate and physical activity was predictive of AECOPD severity.11

Byte 10: Connected care

For healthcare facilities looking to improve the management of chronic disease through the data generated by wearable devices, a recent review article, proposes the implementation of an augmented continuous connected care pyramid to address some of the challenges associated with managing RPM patients.12

Byte 11: Using wearables for hospital and home monitoring

The ability of wearables to automatically detect deterioration can help clinicians detect and treat issues quickly.13,14

1

Hamza M, Alsma J, Kellett J, et al. Can vital signs recorded in patients' homes aid decision making in emergency care? A scoping review. Resusc Plus. Jun 2021;6:100116. doi:10.1016/j.resplu.2021.100116.

2

Whitelaw S, Pellegrini DM, Mamas MA, Cowie M, Van Spall HGC. Barriers and facilitators of the uptake of digital health technology in cardiovascular care: a systematic scoping review. Eur Heart J Digit Health. Mar 2021;2(1):62–74. doi: 10.1093/ehjdh/ztab005.

3

Krumholz HM. Post-hospital syndrome — an acquired, transient condition of generalized risk. N Engl J Med. 2013;368(2):100–2. doi:10.1056/NEJMp1212324.

4

Liebzeit D, Rutkowski R, Arbaje AI, Fields B, Werner NE. A scoping review of interventions for older adults transitioning from hospital to home. J Am Geriatr Soc. 2021;69(10):2950–2962. doi:10.1111/jgs.17323.

5

Ilowite J, Lisker G, Greenberg H. Digital health technology and telemedicine-based hospital and home programs in pulmonary medicine during the COVID-19 pandemic. Am J Ther. 2021;28(2):e217–e223. doi:10.1097/mjt.0000000000001342.

6

Joyce D, De Brún A, Symmons SM, Fox R, McAuliffe E. Remote patient monitoring for COVID-19 patients: comparisons and framework for reporting. BMC Health Serv Res. 2023;23(1):826. doi:10.1186/s12913-023-09526-0.

7

Majumder S, Mondal T, Deen MJ. Wearable sensors for remote health monitoring. Sensors (Basel). 2017;17(1):130. doi:10.3390/s17010130.

8

Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360(14):1418–28. doi:10.1056/NEJMsa0803563.

9

Stehlik J, Schmalfuss C, Bozkurt B, et al. Continuous wearable monitoring analytics predict heart failure hospitalization: The LINK-HF Multicenter Study. Circ Heart Fail. 2020;13(3):e006513. doi:10.1161/circheartfailure.119.006513.

10

Perera PN, Armstrong EP, Sherrill DL, Skrepnek GH. Acute exacerbations of COPD in the United States: inpatient burden and predictors of costs and mortality. Copd. 2012;9(2):131–41. doi:10.3109/15412555.2011.650239.

11

Hawthorne G, Richardson M, Greening NJ, et al. A proof of concept for continuous, non-invasive, free-living vital signs monitoring to predict readmission following an acute exacerbation of COPD: a prospective cohort study. Respir Res. 2022;23(1):102. doi:10.1186/s12931-022-02018-5.

12

Mann DM, Lawrence K. Reimagining connected care in the era of digital medicine. JMIR Mhealth Uhealth. 2022;10(4):e34483. doi:10.2196/34483.

13

Han WH, Sohn DK, Hwangbo Y, et al. Effect of a wireless vital sign monitoring system on the rapid response system in the general ward. J Med Syst. 2022;46(10):64.  

14

Downey C, Randell R, Brown J, Jayne DG. Continuous versus intermittent vital signs monitoring using a wearable, wireless patch in patients admitted to surgical wards: Pilot Cluster Randomized Controlled Trial. J Med Internet Res. 2018;20(12):e10802.