Metro Health/University of Michigan Health is an osteopathic teaching hospital serving more than 250,000 patients per year throughout western Michigan.

THE PROBLEM

Metro Health had been exploring telehealth and remote patient monitoring (RPM) vendors for almost two years before the COVID-19 pandemic hit the U.S. The team believed that telehealth and RPM would be the future of healthcare delivery, but were spending time outlining current challenges, program goals and the features its telehealth/RPM platform would need to meet these challenges and goals.

The initial telehealth/RPM program was set to focus on congestive heart failure patients – high-risk patients recently discharged from the hospital who were at risk for adverse outcomes such as a hospital readmission or an emergency department visit. This was the intended goal for the program at first – reduce 30-day hospitalizations.

"It was important to us that the implementation of a telehealth/RPM program would provide the best patient experience," said Dr. Lance M. Owens, chief medical information officer and family medicine section chief at Metro Health. 

"As an organization, we are focused on the patient and provider experience, so a user-friendly platform was a necessity. We needed to be able to go to providers and staff and explain how this will ease their daily workload while enhancing patient care."

Specific to COVID-19, the state of Michigan began to see the first large surge of cases in November 2020.

"We quickly were averaging around 7,000 new cases a day across the state, and due to this rapid increase, we faced similar challenges that many hospitals confronted throughout the pandemic," Owens recalled. "With the rise in cases, we also saw a rise in hospitalizations, impacting our hospital's bed capacity.

"Not only is an increase in hospitalizations going to stretch your bed capacity, but it's also going to impact the nursing ratio, requiring a nurse to care for more patients at a time than normal," he continued. 

"In addition, this pandemic has drawn attention to isolation and the role that can play on a patient's mental and physical health. Patients under isolation in the hospital were experiencing the negative impacts of that, which was another driver for providing in-home care to COVID-19 patients."

PROPOSAL

Metro Health had a few challenges that it needed to address: limited bed capacity, cancelled elective surgeries, patient isolation, staffing ratio and staff safety.

"We were fortunate that this surge came in the latter half of 2020, where we had a better grasp of treatment of COVID-19, but we knew we needed to move these patients out of the hospital in order to relieve some of the strain on bed capacity and staffing," Owens said. "That's when we settled on the need for a COVID-19 outpatient program.

"Once we came to the decision that we needed to provide at-home care for COVID-19 patients, the question then became: What tools do we need to monitor patients through recovery from their homes?" he continued. "We were fortunate that our affiliate, Michigan Medicine, had already partnered with Health Recovery Solutions and was using their telehealth and RPM platform to discharge COVID-19 patients and monitor them at home."

Metro Health knew Health Recovery Solutions would have the technology and the tools it required for this type of program, he added.

MARKETPLACE

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MEETING THE CHALLENGE

There are a few key features of the telehealth and RPM platform that Metro Health has used for monitoring COVID-19 patients: biometric and symptom monitoring, medication and monitoring reminders, patient communication through voice calling and virtual visits, and a COVID-19 care plan.

The COVID-19 care plan has allowed staff to customize reminders, symptom surveys and educational videos that they send to patients to ensure all the patient data needed was being collected.

"We enrolled about 20-25% of Metro Health's COVID-19 patients in the telehealth and RPM program," Owens said. "Patients were evaluated for eligibility by hospitalists, intensivists or the care management team, making sure they met specific eligibility criteria. For example, one criteria that had to be met for patients to enroll was a support system or caregiver at home.

"Once these patients were evaluated for eligibility and enrolled in the program, they were trained on the platform – how to record their vital signs, answer symptom surveys, answer voice and video calls, etc. – before being discharged from the hospital," he continued. "Specifically, we had patients recover their temperature, blood pressure and blood oxygen levels every day."

On days 1, 2, 4, 7 and 10 of enrollment, patients participated in a virtual visit. On days that patients did not have a virtual visit, they received a voice call from the team. Staff also encouraged patients to call or text the team through the tablet if they had any questions or concerns. This has had a significant impact on patient adherence.

RESULTS

Beginning with patient satisfaction, Metro Health recorded a 95% patient satisfaction rate among COVID-19 patients enrolled in the telehealth and RPM program. This is a key metric for Metro Health because its mission statement places patient experience as a priority.

Included within the telehealth platform, patients complete a patient satisfaction survey prior to discharge from the program. The survey includes a few questions that staff use to help evaluate success of the telehealth program, aside from simply asking, "Are you satisfied with the telehealth program?"

Staff members ask patients, "Do you feel more involved in your care due to the telehealth program?" and "Would you recommend the telehealth program to a family member or friend?" and "Is the equipment easy to use?" These all are important to evaluating the patient experience for Metro Health.

"For hospital days saved, there are numerous metrics that you could use to analyze this number," Owens said. "From a basic level, we wanted to compare the length of stay among hospitalized COVID-19 patients and length of stay on the telehealth program for our at-home COVID-19 patients. Essentially, for each patient you're able to treat on telehealth at home, the hospital avoids a hospital stay."

Finally, patient adherence. Metro Health required patients to record their blood pressure, blood oxygen level and temperature each day. The organization achieved a 90% adherence rate across these biometrics, meaning that, while enrolled, 90% of patients were recording their biometrics daily. That recording is critical to the success of the program.

"These biometric readings largely inform your knowledge of the patient's recovery and enable the program to send risk alerts if a patient's vitals are out of the predetermined ranges that our team set," Owens concluded. "These readings help us assess a patient's progress and identify exacerbations to prevent hospitalizations or ED visits before they occur."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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