Effects of Remote Patient Monitoring in the Ambulatory Care Setting on Chronic Conditions

Remote patient monitoring (RPM) is an opportunity to manage patient care virtually. Although RPM technology is not new, the COVID-19 pandemic provided an opportunity to capitalize on telemedicine, reduce in-person visits, and potentially prevent the transmission of SARS-CoV-2. Biometric data is transmitted by the patient and reviewed in the EMR by the treating provider. The ability to manage chronic conditions in the outpatient setting contributes to reduced costs for patients, improved continuity of care, and prevention of acute exacerbations. In addition to lowering costs and acuity of interventions, Noel et al. (2020) noted that patients enrolled in RPM were more likely to adhere to medication and have accurate medication reconciliation than those that are not enrolled.
At a large academic medical institution, providers enroll patients that are diagnosed with either heart failure (HF) or hypertension (HTN). Patients are mailed a kit with Bluetooth-enabled equipment and a cellular tablet that has their diagnosis specific care plan. Once the kit is received, the RPM nursing team monitors their biometric data daily. The RPM nurses make the initial patient contact to complete the welcome call (WC) and answer program-specific questions. Additionally, the nurses call for any measures that are above or below preset parameters and nonadherence to the program.
Patient success and enrollment is largely dependent on a collaborative relationship between ordering/managing providers and the RPM nursing team. Management of patients by a dedicated RPM nursing team reduces the workload on clinic nurses who are triaging non-RPM patients. The RPM goals for both patient populations align with the health system goals to reduce readmissions, lower ED utilization, and reduce overall cost of care for patients. A multidisciplinary team that includes executive leadership, ambulatory care nursing, health system emerging strategies, telehealth strategies, and operations routinely meets to evaluate progress toward stated goals. Enrollment in RPM for the HF population estimates the 30-day readmission rate of 9.3%, compared to HF patients not enrolled in RPM with a 17% 30-day readmission rate. Emergency department (ED) rates 90 days after inpatient discharge for patients enrolled in RPM are 0% and rates for patients not enrolled in RPM are 42%. Baseline BP for the HTN population was 138/77. As of October 14, the average BP for this group is 121/71.
By implementing innovative technology-driven solutions like the Epic dashboard, outpatient clinics can more effectively manage their nursing resources, improve patient care, and support the overall efficiency of healthcare operations.