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Name: Literature Review
Description: Current Article Jan 2018 to present 40 points. Original Copy of article
attached(Scanned) 20 points 1 page Summary of Article - 60 points( Grammar/Sentence
Structure - 20 points, Article make connection to course - 20 points, APA citation - 20
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Name:Literature Review
Description:Current Article Jan 2018 to present 40 points. Original Copy of article
attached(Scanned) 20 points 1 page Summary of Article - 60 points( Grammar/Sentence
Structure - 20 points, Article make connection to course - 20 points, APA citation - 20
points.
Exit
Remote patient
monitoring via
smartphone cuts oneweek post-partum
visits by 57%
This case study shows how UPMC MageeWomens Hospital accomplished that
reduction by sending new mothers home
with a free blood pressure cuff and access
to a remote monitoring portal.
By Bill Siwicki (/content/bill-siwicki)
02:19 PM
October 12, 2018
(https://oasc17.247realmedia.com/RealMedia/
x)
Credit: University of Pittsburg
(https://www.shrs.pitt.edu/dpt/clinical-partners)
(https://oasc17.247realmedia.com/RealMedia/
x)
Historically, at the University of Pittsburgh Medical Center
Magee-Womens Hospital in Pittsburgh, when a patient has
been discharged from the hospital and has had a
hypertensive disorder during her pregnancy or postpartum
period, it recommended follow-up within a week to the
primary OB provider for a blood pressure check.
Patients are sometimes sent home on new medications or
continuing to take a medication they were prescribed
during the pregnancy related to hypertension diagnosis.
These patients are given instructions and education
regarding signs and symptoms that would alert them to call
their OB or come back to the emergency department.
It has not been a standard of care to ask this population of
patients to check their blood pressure regularly and report
it back during the weeks following a delivery. Patients
experiencing and needing treatment for a hypertensive
crisis is the most common reason for readmission to UPMC
Magee-Womens Hospital.
These women also are at an increased risk for developing
some type of cardiovascular disease later in life because of
the development during their pregnancy. Therefore, followup with their primary care physician is a goal that the
hospital felt needed to be addressed.
PROPOSAL
Expand remote monitoring from chronic disease patient
populations – notably COPD and congestive heart failure –
to specialized cases such as postpartum hypertension.
"Some of our doctors at UPMC Magee-Women's Hospital
have teamed up since February with our technology partner
Vivify and the UPMC Enterprises team to use smartphones
to monitor women with persistent hypertension
postpartum," said Richard Beigi, MD, the hospital's chief
medical officer. "Hypertensive disorders affect five to 10
percent of pregnancies and are the number one reason for
obstetric readmissions postpartum, according to our docs."
MARKETPLACE
There is a growing market for remote patient monitoring
technology. Vendors include A&D Medical, Abbott, Biotronik,
Boston Scientific, ClairVista, Qualcomm Life and Spacelabs
Healthcare.
MEETING THE CHALLENGE
The University of Pittsburgh Medical Center has been an
innovator in the use of remote patient monitoring
technology. By reaching patients where they are, using
familiar consumer electronics paired with common health
peripherals such as blood pressure cuffs and scales, UPMC
has dramatically improved patient engagement, reduced
emergency department visits, and decreased the number of
hospital readmissions for chronically ill patients.
"Through the use of Vivify's digital portal, we are able to
send and receive information to our patients in a
convenient and familiar manner," Beigi explained. "Patients
are invited to participate and must accept the link once it is
sent to their phone. They then receive daily text messages
with prompts for them to send their blood pressure and
pulse and answer a few questions to give us a snapshot of
any symptoms they may be experiencing, as well as a view
of their overall health."
These responses are checked by the hospital's call center
nurses who respond to any alerts or requests from
patients. The hospital has created a detailed algorithm that
guides the nurses to provide advice, change or discontinue
medications, or guide patients to seek emergency care, if
needed.
"In our pilot, the women – more than 60 so far – go home
after giving birth with a free blood pressure cuff and access
to the Vivify portal," Beigi said. "Through that secure
system, they send blood pressure readings to nurses at a
call center and answer regular text messages about such
symptoms as headaches, visual disturbances and shortness
of breath—which trigger different levels of alerts based on
algorithms created by Magee's maternal fetal medicine
experts."
The order for the remote monitoring is generated from the
hospital's Cerner EHR and sent to the portal, which sends a
text to the patient's phone. Patients can text information to
portal, which sends a weekly PDF summary to the
healthcare organization's outpatient EHR.
"According to the doctors, this 'bring your own device'
method of remote monitoring has allowed them to keep
patients at home whenever possible, rather than
readmitting them to the hospital or seeing them in the
emergency department, a huge benefit to new moms," Beigi
said. "This system also more rapidly identifies women who
do need to be seen again."
And this period of monitoring, typically six weeks, gives
nurses and physicians the chance to educate these
patients about the fact that gestational hypertension puts
them at much greater risk for cardiovascular disease later
in life, so it's especially important to connect them with a
primary care physician if they don't have one, he added.
Now that the program is out of the pilot stage, the hospital
is continuing to increase enrollment of patients by inviting
all providers to use Vivify for their postpartum
hypertension patients. It also is looking at remote
monitoring use-cases for other high-risk populations in
women's health, such as gestational diabetes.
"Remote monitoring through this solution is a useful tool to
engage patients through a device they are already using,
their smartphone," he said. "It allows them to communicate
with our care team at their convenience, and gives us a
view of our patients' continual health journey, as well as a
way to provide interventions while increasing patient
satisfaction."
RESULTS
To date, 57 percent of patients who have been through the
remote patient monitoring program have been able to
avoid the one-week postpartum visit for a blood pressure
check.
"If we have monitored the patient's blood pressures during
the first few days after they have been discharged from the
hospital and they are within normal limits, there is no need
for them to go to the office to have it checked," he
explained. "We will continue to watch them for up to six
weeks after delivery."
If the patient has other concerns or questions, they are
able to return to their OB for that one week follow-up
appointment, which is why the number is only 57 percent,
he added. Many women have loved being able to avoid the
appointment as they are now caring for themselves and a
newborn and don't want to leave their homes, he said.
Further, 88 percent of the patients who have gone through
the program have come back for the six-week postpartum
visit, compared with 30-40 percent nationally, Beigi said.
"We believe these women are engaged in the program and
become educated about their disease through this
journey," he explained. "We educate and encourage them to
continue to seek care due to the increased risks later in
life. Early identification and intervention is key for this."
These women stay engaged by returning to their OB visit
within 4-6 weeks postpartum before they graduate from the
remote monitoring program. The hospital believes many
will continue to use the blood pressure cuff and knowledge
they have obtained through the program.
ADVICE FOR OTHERS
"We suggest having a team of individuals involved –
physicians, nurses, administrators – who really understand
operations in order to roll out such a program," Beigi
concluded. "There are nuances that come up that require
such an understanding in order to work through the
processes to make it functional for all involved."
Twitter: @SiwickiHealthIT
(https://twitter.com/SiwickiHealthIT)
Email the writer: bill.siwicki@himssmedia.com
(mailto:bill.siwicki@himssmedia.com)
Topics: Clinical (/category/resource-topic/clinical),
Telehealth (/category/resource-topic/telehealth)
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