4 Chronic Care Use Cases for Remote Patient Monitoring

May 27, 2022 - Amid the rapid expansion of virtual care, remote patient monitoring (RPM) has emerged as a reliable tool for treating both acute and chronic conditions.

RPM involves leveraging connected digital tools to record personal health data in one location that a provider reviews at a different location, either in real time or later, according to the Department of Health and Human Services' Health Resources and Services Administration.

RPM programs employ different devices, like weight scales, pulse oximeters, blood glucose meters, blood pressure monitors, and heart monitors. These enable providers to keep track of patient health metrics between clinic visits and adjust treatment plans as needed, making RPM a beneficial tool for long-term chronic disease management. Further, hospital-at-home programs have proved to be a viable alternative to in-hospital stays for patients with chronic diseases.

Here are some of the chronic conditions that could benefit from RPM services:

DIABETES

There is strong evidence showing that RPM can improve diabetes care, and as a result, providers are increasingly incorporating the care modality into their diabetes services.

A study published in 2019 showed that patients with more frequent and regular participation in remote monitoring had lower hemoglobin A1c levels — which measures average blood sugar — at the end of the program.

Even during the COVID-19 pandemic, RPM helped providers manage type 2 diabetes patients. A study conducted at St. Joseph's/Candler health system in Savannah, Georgia, showed that an RPM platform managed by a pharmacist helped reduce A1c levels by 2.2 percent over a six-month period in 2020.

In addition to type 2 diabetes patients, RPM tools can be used to improve care for young children with type 1 diabetes. Stanford Children's Health in Palo Alto, California, conducted a study that showed 53 percent of children provided with continuous glucose monitors reached the standard of care goal of having an A1c below 7 percent.

"There has been debate in the medical community about when is too early to start diabetes technology," Priya Prahalad, MD, Stanford Children's Health pediatric endocrinologist and member of the Maternal and Child Health Research Institute at Stanford Medicine, previously told mHealthIntelligence. "And I think what we are able to show is that starting diabetes technology early does not have any adverse effects on patients and families. It does not decrease their quality of life."

Among providers, RPM strategies are increasingly being applied to diabetes care. In April, UBMD Pediatrics, a medical group in New York State, announced a collaboration with Cecelia Health to enhance care for children with type 1 diabetes by providing RPM.

Last year, the University of Mississippi Medical Center partnered with a federally qualified health center to increase access to diabetes care through RPM.

HYPERTENSION

Several studies have found that RPM can help maintain and decrease hypertension or high blood pressure (BP).

One published in 2018 showed that 81 percent of hypertension patients who enrolled in a home-based BP monitoring program achieved their BP goal in about seven weeks. Another study showed an RPM program that combined home BP monitoring with virtual nursing support helped maintain and even reduce BP during the pandemic.

Not only that but home-based BP measurements were found to be more reliable and accurate than those taken in clinics or kiosks.

Based on this clinical evidence, several providers have incorporated RPM into their hypertension treatment programs.

Last year, Northwestern Medicine piloted OMRON Healthcare's VitalSight RPM service for its high-risk hypertensive patients. The service provides patients with the necessary devices to measure and share BP readings with their care team.  

And it's not just the major health systems — smaller facilities with fewer resources are also turning to RPM to manage hypertension. In January, North Carolina-based federally qualified health center Robeson Health Care Corporation announced a partnership with HealthSnap that would enable it to offer RPM to more than 2,500 patients living with hypertension.

CANCER

Research showing that RPM can be used to enhance cancer treatments was available long before the pandemic.

In a study published in 2016, some patients receiving routine outpatient chemotherapy at Memorial Sloan Kettering Cancer Center were asked to report 12 common symptoms via tablet devices. Health-related quality of life improved for patients who reported their symptoms via the tablet than those who received usual care, which did not include remote self-reporting of symptoms. Further, patients receiving the intervention were less frequently admitted to the emergency room or hospitalized.

More recently, researchers at Huntsman Cancer Institute at the University of Utah found that the patients who participated in its adult oncology hospital-at-home program were 58 percent less likely to be admitted for an unplanned hospital stay than those not in the program.

Amid the recent disruptions in cancer care, RPM has helped ensure continued care access for cancer patients in their own homes, including those who contracted COVID-19.

A study published last September showed most COVID-19-positive cancer patients enrolled in an RPM program agreed that the program was worthwhile, enabled better management of their COVID-19 symptoms, and made them feel more connected to their care team.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems.

Studies show that RPM can be used to improve care for COPD patients, including one where researchers concluded that "remote monitoring of COPD patients holds promise for detection of exacerbation events."

Another study published in 2021 revealed that RPM could help make COPD diagnoses and treatment more efficient.

In addition, research indicates that patients are ready to use a telemonitoring system for at-home pulmonary rehabilitation. The study published in 2018 shows that 98 percent of the participants agreed the system was easy to use and said they would be willing to use it throughout the pulmonary rehabilitation period.

As the initial COVID-19 surges slowed, providers and payers began adding COPD care to their home monitoring programs.

In 2021, West Tennessee Health modified its RPM platform to monitor patients with congestive heart failure and COPD, and Deaconess Health made a similar move.

Humana also launched a home healthcare service last year that included RPM. The payer announced plans to develop care pathways for members with various chronic conditions, including COPD.

As RPM becomes further integrated into care delivery, the physical boundaries of the healthcare system will shift, opening up possibilities for more comprehensive chronic care management.