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.
The "HepB event" had impacted on the participants' confidence in the safety of Hepatitis B vaccine. For such event, relevant authority departments need effectively communicate with the media and the public, and promptly issue positive information and the investigation result, thereby reducing the negative impact of the event, and improve the vaccine confidence among the public.
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 on HF patients at NorthShore University HealthSystem (NSUHS). METHODS This study is a feasibility study and will use a wearable biosensor to continuously, remotely monitor HF patients for 30 days post discharge. Eligible patients admitted with a HF exacerbation at NSUHS will be recruited and the wearable biosensor will be placed prior to discharge. The biosensor will collect physiological ambulatory data, which will be analyzed for signs of patient deterioration. Participants will also complete a daily survey through a dedicated study phone. If prespecified criteria from the physiological data and survey results are met a notification will be triggered and a predetermined EHR-based pathway of telephonic management will be completed. In phase I, which has already been completed, five patients were enrolled and monitored for 30 days post-discharge. The results of phase I were analyzed and modifications to the program were made to optimize it. Following analysis of the results from phase I, 15 patients are being enrolled for phase II, which is a calibration and testing period to enable further adjustments to be made. Following phase II, 45 patients will be enrolled for phase III. These results will be analyzed to determine the feasibility of a CRPM program in HF patients. Semi-structured interviews will also be conducted with key stakeholders, including patients, and these results will be analyzed using the Affective Adaptation of the Technology Acceptance Model (A/TAM). RESULTS Phase I has been completed and results have been published. Phase II and phase III results will be available by the end of 2022. CONCLUSIONS A CRPM program may offer a low-risk solution to improve care of HF patients post hospital discharge and may help decrease readmission of HF patients to the hospital. This protocol may also lay the groundwork for the use of CRPM solutions in other high risk patient groups. CLINICALTRIAL NCT04738279
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