MaineGeneral Health in Augusta had high, rising readmission rates for congestive heart failure. In January 2020, the organization launched a remote patient monitoring pilot, working with vendor Health Recovery Solutions to monitor CHF patients after discharge from the hospital.
Upon discharge, patients often need support to understand their symptoms and warning signs after returning home. Remote patient monitoring allows patients to monitor their blood pressure, weight, oxygen saturation, symptoms and medication adherence in real time at home with a dedicated registered nurse who actively outreaches to patients as needed.
During the pilot, MaineGeneral Health learned it takes more clinical time to monitor and follow up with patients. Because of this, it hired a full-time employee to monitor the patient panel. As the program grew to more than 100 patients, the organization expanded to allowing referrals for patients with any chronic condition or COVID-19, and hired additional clinical staff.
“When COVID-19 hit, patients avoided coming into the office when possible,” said Laura Mrazik, telehealth coordinator at MaineGeneral Health. “Patients needed a mechanism to connect with their primary care providers for chronic or acute care needs when virtual care was appropriate.
“We shifted priority to identifying a user-friendly solution for our outpatient practices to deploy virtual visits,” she continued. “Patients with COVID-19 symptoms were able to stay out of the office for their routine chronic condition follow-ups without exposing patients or staff.”
MaineGeneral already had selected the RPM vendor prior to COVID-19. However, the pandemic exacerbated the need, especially as patients began delaying care.
“Patients are educated while in the hospital on the opportunity to monitor,” Mrazik explained. “Once discharged, a care team member visits their home and sets up the unit for them – this includes a data-enabled tablet, programmed only for the vendor’s application, as well as Bluetooth-connected heart rate monitor, pulse oximeter and scale.
“In May and June 2022, MaineGeneral has achieved a CMS-CHF readmission rate of 0%, compared with 20% and 26.7% in the same months the prior year. Additionally, the overall CHF readmission rate has hit 0% in four of the last nine months.
Laura Mrazik, MaineGeneral Health
“Units are programmed with disease-specific survey questions to flag high-risk symptoms, and set with daily reminder alerts to take medications and record vital signs,” she added. “Early intervention by RNs on staff have resulted in avoiding readmissions through timely medication adjustments, identifying a pacemaker’s dead battery, discovering a patient’s need to be on hypertension medication, and more.”
In an effort to find a video technology that was easy to use for patients, MaineGeneral ended up with HIPAA-compliant Zoom as the video conferencing component for virtual care in outpatient settings. The organization implemented virtual visits across all primary care, integrated behavioral health and pediatric behavioral health service lines.
“This funding also purchased tablets for patients in the hospital who were unable to visit with their families due to the new no-visitor policies,” Mrazik said. “We deployed Zoom-enabled tablets so patients could connect with family and friends during an inpatient stay.
“In an effort to resolve for the need to limit patient exposure and connect with patients virtually, MaineGeneral planned workflows, purchased equipment, improved processes, and expanded telehealth services in remote patient monitoring and virtual visits in the outpatient setting,” she added.
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