Remote monitoring technologies are increasingly being deployed to enable health professionals to monitor patients more closely and intervene more quickly when patients’ health deteriorates. Remote monitoring and structured telephone support have been found to improve health outcomes for chronic obstructive pulmonary disease, congestive heart failure, hypertension, and hyperlipidemia. The most common model is for registered nurses (RNs) or other health professionals to review reported data and contact patients if it appears that the patient’s treatment plan needs to be adjusted.
- What models of remote monitoring are being implemented in the United States?
- How are different types of health professionals involved in remote monitoring?
- How do health professionals who provide remote monitoring interact with health care workers who provide care in patients’ homes?
- Is remote monitoring being substituted for home visits by RNs, and to what extent do personal care aides collaborate with clinicians to ensure that critical findings from remote monitoring are communicated and acted upon?
For questions, contact: Joanne Spetz, PhD, FAAN, Director, UCSF Health Workforce Research Center on Long-Term Care, [email protected]
There is a widely accepted observation that the current health care delivery model in the U.S was not developed to manage care needs associated with extended life expectancy and growing rates of chronic conditions. Remote monitoring programs aim to anticipate/identify illness exacerbations and avoid unnecessary treatment, including emergency room visits, re-hospitalizations, and excess costs to the health care system. Combining a literature reivew and key informant interviews, the study presents findings as to how remote monitoring programs are preparing and leveraging the health care workforce to manage patients with chronic illness and long-term care needs who are living at home, with a specific focus on four chronic conditions – CHF, DM, COPD, and CKD.
The authors found that multidisciplinary team approaches were associated with more positive biometric and health care system outcomes. RNs form the core of most programs, as their training and experience allow them the independence to perform assessments while simultaneously communicating and acting upon data.
The report concludes that patient-centered monitoring technologies have the potential to improve the efficiency, cost, and accountability of chronic health care delivery but will require appropriate medical professional support and robust investment in training.
Ko, M, Wagner, L, Spetz, J. Nursing Home Implementation of Health Information Technology: Review of the Literature Finds Inadequate Investment in Preparation, Infrastructure, and Training. Inquiry, 2018, 55: 1-10.
Health information technology (HIT) is increasingly adopted by nursing homes to improve safety, quality of care, and staff productivity. We examined processes of HIT implementation in nursing homes, impact on the nursing home workforce, and related evidence on quality of care. We conducted a literature review that yielded 46 research articles on nursing homes’ implementation of HIT. To provide additional contemporary context to our findings from the literature review, we also conducted semistructured interviews and small focus groups of nursing home staff (n = 15) in the United States. We found that nursing homes often do not employ a systematic process for HIT implementation, lack necessary technology support and infrastructure such as wireless connectivity, and underinvest in staff training, both for current and new hires. We found mixed evidence on whether HIT affects staff productivity and no evidence that HIT increases staff turnover. We found modest evidence that HIT may foster teamwork and communication. We found no evidence that the impact of HIT on staff or workflows improves quality of care or resident health outcomes. Without initial investment in implementation and training of their workforce, nursing homes are unlikely to realize potential HIT-related gains in productivity and quality of care. Policy makers should consider creating greater incentives for preparation, infrastructure, and training, with greater engagement of nursing home staff in design and implementation.