Remote Patient Monitoring Effectively Assures Continuity of Care in Asthma Patients During the COVID-19 Pandemic

Authors

  • Christopher March, BS Three Village Allergy and Immunology, South Setauket, New York, USA https://orcid.org/0000-0002-3344-5749
  • Kimberly Gandy, MD, PhD University of Missouri, Kansas City, Missouri, USA; Play-it Health, Inc. Overland Park, Kansas, USA
  • Jos Domen, PhD Play-it Health, Overland Park, Kansas, USA https://orcid.org/0000-0002-7665-9253
  • Sayyed Hamidi, MD, MBA, MPH University of Illinois at Chicago, US Department of Veterans Affairs, Chicago, Illinois, USA
  • Ryan Chen, BS Stony Brook University, Stony Brook, New York, USA
  • Paul Barach, MD, MPH Jefferson College of Population Health, Philadephia, Pennsylvana, USA; University of Queensland, Brisbane, Australia https://orcid.org/0000-0002-7906-698X
  • Anthony Szema, MD Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, USA; College of Engineering and Applied Sciences, Stony Brook University, Stony Brook, New York, USA; Three Village Allergy and Immunology, South Setauket, New York, USA https://orcid.org/0000-0001-5992-5479

DOI:

https://doi.org/10.30953/thmt.v7.374

Keywords:

asthma, COVID-19, patient safety, quality, telehealth

Abstract

Background: Digital health tools to bridge gaps in managing infectious pandemics was a proposition grounded until recently more in the hypothetical than in reality. The last two years have exposed the extraordinary global need for robust digital solutions.

Objective: The objective of this study was to determine the ability of remote patient monitoring (RPM) during the COVID-19 pandemic to improve clinical outcomes and assure continuity of care in patients with asthma.

Methods and Findings:

Design: The intervention combined health coaching telephone calls and remote telemonitoring.

Participants: 102 patients with asthma were enrolled in a telemonitoring protocol at the beginning of the COVID-19 pandemic in the United States.

Setting: A private, university affiliated, outpatient clinical adult and pediatric allergy/immunology and pulmonary practice.

Intervention: Patients were enrolled with the primary rationale of maintaining continuity of care in the face of uncertain clinical care options. Enrollment and data collection proceeded in a fashion to allow detailed retrospective analysis. Telemonitoring included a pulse oximeter linked to a smart phone using the software platform Plan-it Med (PIM)®. A healthcare professional monitored data daily, and patients were contacted by providers due to vital sign abnormalities and treatment plan alterations.  Patients were encouraged to remain on the platform daily during the first three months of the pandemic. After respiratory and or clinical stability was achieved and clinic visit opportunities were resumed, patients were encouraged to maintain engagement with the platform but were not expected to use the platform daily.

Main Outcome measures: Asthma Control Test (ACT) scores were recorded before and after 6 months. Paired Wilcoxon signed-rank tests (dependent groups, before vs. after) and Wilcoxon rank-sum (Mann-Whitney) tests were performed for unpaired results (independent groups, RPM vs. Control). 

Results: 19 of 102 patients had physiological abnormalities detected (18.6%). Eight of these 19 patients had actionable changes in prescription regimens based on RPM findings (42.1%). In patients utilizing RPM, there was a reported decrease in shortness of breath episodes and a decreased need for rescue inhalers/nebulizer medications (P=0.005). Daily engagement in the first three months of the protocol was 61%. In a subset analysis, 48 study participants (47.1%) chose to continue to actively use the program for at least 14 months. 54 RPM patients were 99.1% compliant with RPM after 110 patient months. Of the patients that chose to discontinue the RPM program the reasons included: (1) symptom alleviation (41.7%); (2) out-of-pocket costs to patients (38.9%), and (3) difficulty using the RPM program (16.7%).

Conclusions:  A novel RPM technology positively impacted continuity of care, asthma outcomes, quality of life, and self-care.

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Author Biographies

Christopher March, BS, Three Village Allergy and Immunology, South Setauket, New York, USA

0000-0002-3344-5749

Kimberly Gandy, MD, PhD, University of Missouri, Kansas City, Missouri, USA; Play-it Health, Inc. Overland Park, Kansas, USA

0000-0001-9797-0705

Jos Domen, PhD, Play-it Health, Overland Park, Kansas, USA

0000-0002-7665-9253

Paul Barach, MD, MPH, Jefferson College of Population Health, Philadephia, Pennsylvana, USA; University of Queensland, Brisbane, Australia

Paul Barach, MD, MPH, is a passionate believer in smart health information technology to improve the safety and quality of healthcare. He is double boarded practicing anesthesiologist and critical care physician-scientist. He trained at the Massachusetts General Hospital affiliated with Harvard Medical School. He is Lecturer and senior advisor to Dean, Jefferson College of Population Health, Visiting Professor Milan Polytechnic, Italy; Honorary Professor, University of Queensland, Australia; Visiting Professor and Honorary Professor at the National Cancer Center in Seoul, Korea, and Visiting Professor, Riphah University, Pakistan. Paul is an elected member of the lead honorary society, Association of University Anesthesiologists. He is former distinguished member of the Uniersities of Chicago, Miami, South Florida and Wayne State University and former member of ASA and WFSA Patient Safety and Quality committees, and Chair of the Patient Safety commission for the World Society of Intravenous Anesthesia. He advises several digital health start-ups and has been a judge in several hackathons and tech challenge events.

Paul has more than 25 years of experience as a practicing physician and physician executive ( Chief Medical Officer, Chief Quality Officer) in the military and in academic medical centers and integrated delivery systems. Paul has a long history of intersecting clinical, information technology and operational responsibilities with executive management, business and entrepreneurial roles including as senior hospital executive in academic medical centers and integrated delivery systems. He is highly adept in identifying gaps and/or risk exposure in operations as well as developing and implementing strong digital and safety management systems of corporate checks-and-balances.  He is a formally trained health services researcher, with advanced post graduate training in advanced medical education and assessment methods from the Harvard Medical School Josiah Macy Program medical education, lean six sigma, quality improvement and lean techniques at Intermountain Healthcare. He has had additional training in epidemiology and statistics including both methodological as well as applied HTA research. Prior to that he spent 5 years in the military and was involved in team training, leadership and simulation work.

Theories and ideas he has helped shape and provided research findings for, are now in common use as a result of his work: TeamSTEPPS, surgical team training, human factors tools, multi-method, triangulated approaches to research, governance of health systems, and interprofessional learning and culture change to achieve safe and reliable outcomes.  His work has led to over $16,000,000 in federal competitive grant funding from the US NIH/AHRQ, EC FP-7, Australian NHMRC, UK NIHR and Norwegian Federal Agencies and he requliary is asked to review federal grants.

Paul served on numerous lead peer review journal boards and was  Editor of the lead British Medical Journal Safety and Quality, and has published more than 300 scientific papers and 5 books.

 

Anthony Szema, MD, Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, USA; College of Engineering and Applied Sciences, Stony Brook University, Stony Brook, New York, USA; Three Village Allergy and Immunology, South Setauket, New York, USA

0000-0001-5992-5479

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Published

2022-11-23

How to Cite

March, BS, C. ., Gandy, MD, PhD, K. ., Domen, PhD, J. ., Hamidi, MD, MBA, MPH, S. ., Chen, BS, R. ., Barach, MD, MPH, P., & Szema, MD, A. . (2022). Remote Patient Monitoring Effectively Assures Continuity of Care in Asthma Patients During the COVID-19 Pandemic . Telehealth and Medicine Today, 7(5). https://doi.org/10.30953/thmt.v7.374

Issue

Section

Original Clinical Research