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Reamer C, Chi WN, Gordon R, Sarswat N, Gupta C, Gaznabi S, White VanGompel E, Szum I, Morton-Jost M, Vaughn J, Larimer K, Victorson D, Erwin J, Halasyamani L, Solomonides A, Padman R, Shah NS. Continuous remote patient monitoring in heart failure patients (CASCADE study): mixed methods feasibility protocol (Preprint). JMIR Res Protoc 2022; 11:e36741. [PMID: 36006689 PMCID: PMC9459840 DOI: 10.2196/36741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/24/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022] Open
Abstract
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
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Affiliation(s)
- Courtney Reamer
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Wei Ning Chi
- Outcomes Research Network, NorthShore University HealthSystem, Evanston, IL, United States
| | - Robert Gordon
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Nitasha Sarswat
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Charu Gupta
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Safwan Gaznabi
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Emily White VanGompel
- Department of Family Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Izabella Szum
- Home and Hospice Services, NorthShore University HealthSystem, Evanston, IL, United States
| | - Melissa Morton-Jost
- Home and Hospice Services, NorthShore University HealthSystem, Evanston, IL, United States
| | | | | | - David Victorson
- Department of Medical Social Sciences, Northwestern University, Evanston, IL, United States
| | - John Erwin
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Lakshmi Halasyamani
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Anthony Solomonides
- Outcomes Research Network, NorthShore University HealthSystem, Evanston, IL, United States
| | - Rema Padman
- Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Nirav S Shah
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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Chi WN, Reamer C, Gordon R, Sarswat N, Gupta C, White VanGompel E, Dayiantis J, Morton-Jost M, Ravichandran U, Larimer K, Victorson D, Erwin J, Halasyamani L, Solomonides A, Padman R, Shah NS. Continuous Remote Patient Monitoring: Evaluation of the Heart Failure Cascade Soft Launch. Appl Clin Inform 2021; 12:1161-1173. [PMID: 34965606 PMCID: PMC8716190 DOI: 10.1055/s-0041-1740480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE We report on our experience of deploying a continuous remote patient monitoring (CRPM) study soft launch with structured cascading and escalation pathways on heart failure (HF) patients post-discharge. The lessons learned from the soft launch are used to modify and fine-tune the workflow process and study protocol. METHODS This soft launch was conducted at NorthShore University HealthSystem's Evanston Hospital from December 2020 to March 2021. Patients were provided with non-invasive wearable biosensors that continuously collect ambulatory physiological data, and a study phone that collects patient-reported outcomes. The physiological data are analyzed by machine learning algorithms, potentially identifying physiological perturbation in HF patients. Alerts from this algorithm may be cascaded with other patient status data to inform home health nurses' (HHNs') management via a structured protocol. HHNs review the monitoring platform daily. If the patient's status meets specific criteria, HHNs perform assessments and escalate patient cases to the HF team for further guidance on early intervention. RESULTS We enrolled five patients into the soft launch. Four participants adhered to study activities. Two out of five patients were readmitted, one due to HF, one due to infection. Observed miscommunication and protocol gaps were noted for protocol amendment. The study team adopted an organizational development method from change management theory to reconfigure the study protocol. CONCLUSION We sought to automate the monitoring aspects of post-discharge care by aligning a new technology that generates streaming data from a wearable device with a complex, multi-provider workflow into a novel protocol using iterative design, implementation, and evaluation methods to monitor post-discharge HF patients. CRPM with structured escalation and telemonitoring protocol shows potential to maintain patients in their home environment and reduce HF-related readmissions. Our results suggest that further education to engage and empower frontline workers using advanced technology is essential to scale up the approach.
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Affiliation(s)
- Wei Ning Chi
- Outcomes Research Network, NorthShore University HealthSystem, Evanston, Illinois, United States,Address for correspondence Wei Ning Chi, MBBS, MPH Research Institute, 1001 University PlEvanston, IL 60201United States
| | - Courtney Reamer
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - Robert Gordon
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - Nitasha Sarswat
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States,Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
| | - Charu Gupta
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - Emily White VanGompel
- Department of Family Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States,Department of Family Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
| | - Julie Dayiantis
- Home and Hospice Services, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - Melissa Morton-Jost
- Home and Hospice Services, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - Urmila Ravichandran
- Health Information Technology, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - Karen Larimer
- Clinical Department, physIQ, Inc., Chicago, Illinois, United States
| | - David Victorson
- Northwestern University Feinberg School of Medicine, Evanston, Illinois, United States
| | - John Erwin
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States,Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
| | - Lakshmi Halasyamani
- Department of Family Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States,Department of Family Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
| | - Anthony Solomonides
- Outcomes Research Network, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - Rema Padman
- The Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
| | - Nirav S. Shah
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States,Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
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