Virtual Care For Recovering Cardiac Patients

Objectives

• Improve access to specialized cardiac care using technology as patients transition from hospital to community
• Reduce hospital readmissions
• Improve patient quality of life and health status
• Provide care closer to home
• Leverage new digital technology to increase support to patients

Model

The Cardiac Virtual Care Program (CVC) is designed to provide virtual care to cardiac patients. The program is comprised of two modalities, including remote patient monitoring and automated calling.

This program is only eligible for the following patients:

• Heart failure (HF) patients with one readmission/one month or two readmissions/in six months (NYHA III/IV)
• Patients with new HF diagnosis
• Patients recovering from cardiac surgery
• Patients requiring vital sign/ arrhythmia monitoring
• Any cardiac patient requiring frequent monitoring or trending of information to facilitate optimal clinical management

A fundamental part of this program is to ensure that the right technology is assigned to the right patient.

Heart Failure Virtual Care Program: Telehome Monitoring (first 3 to 4 months)
The Telehome Monitoring Program for Heart Failure, is one of the specifically designed programs for patients who require daily monitoring. This acute-intervention model is based on a transitional care model and provides care after discharge and between medical visits when patients are at risk. All UOHI health care providers can refer patients to this program. An MD order/referral is required for community hospitals. This model does not require any home visits, or any OHIP fees. Enrollment takes 5 to 10 minutes in the hospital, where patients are taught to install and use the equipment before going home. Patients sign an agreement with a nurse that they will transmit their vitals daily at a specific time.

The Telehome Monitoring Program uses devices which have recorded voice prompts and provides simple instructions to ensure vital signs and other information are captured properly. Vital-sign information is then transmitted automatically to a central station at UOHI, where it is reviewed by expert cardiac nurses. Nurses call patients for further assessment and intervention, as required. Patients are also asked several clinical questions; responses are priority coded as red, yellow and green priority and they receive interventions based on need.

For patients identified in community hospitals, a local contact nurse provides them with the equipment and training. An UOHI expert nurse follows the patient and communicates with their physician through information shared on the referral form. UOHI also trains hospital staff and provides ongoing educational support and equipment support, as needed.

Automated Calling / Interactive Voice Response Model (IVR) (1 to 12 months)
This model uses a TelAsk system that automatically calls or texts patients every two weeks to ensure ongoing educational support. Questions are posed in a “yes” or “no” format and captured either through voice-to-text or key pads on the phone. Depending on responses, a clinician will be flagged to follow up with a call, as needed.

Patients who have had cardiac surgery at UOHI are automatically enrolled into the program. The IVR model runs during regular work hours. However, patients can contact a nursing coordinator at any time during the call. If a patient needs immediate assistance, UOHI has a nursing coordinator available 24/7 (not specific to the model).

Technology Type:
Patient Remote Monitoring
Uses Resideo’s Genesis Touch on a Samsung Galaxy Tablet monitor with additional devices as necessary including Bluetooth enabled; blood pressure cuff, weigh scale, pulse oximeter, and ECG Cards.

Clinician Remote Monitoring
Clinicians use a dashboard to view patient data gathered from the aforementioned devices. Through this dashboard they can: receive alerts and review responses to questions, see trending reports and clinicians can select questions for patients to answer from a base of 150 questions.

Automated Calling / IVR
With the Automated Calling system, the patient receives a call, email or text. Yes/No responses to questions are triaged via an algorithm and generate alerts for the clinical team to contact the patient.

Outcomes

Telehome Monitoring

• Improved quality of life and functional status in both HF and angina patients
• Patients found technology easy to use and expressed high levels of satisfaction with this approach to care
• Patients preferred to speak to the nurse by phone instead of via videoconference

Automated Calling / IVR

• 51 per cent reduction in hospital readmissions at three months
• 45 per cent reduction in hospital readmissions at one year

Source: Woodend, A. K., Sherrard, H., Fraser, M., Stuewe, L., Cheung, T., & Struthers, C. (2008). Telehome monitoring in patients with cardiac disease who are at high risk of readmission. Heart & Lung, 37(1), 36-45.

Change Required to Support the Model

The UOHI Cardiac model requires dedicated staffing to support the operational model:

• 1 Advance Practice Nurse
• 2 Registered Nurses
• 1 Part Time Registered Nurse
• 1 F/T clerk
• 1 Medical Lead

2.5 full-time equivalents (FTEs) were trained to monitor patients either via remote patient monitoring program or via IVR responses and to interact with them virtually.

One registered nurse can monitor and manage 75 patients a day.

The UOHI Cardiac Telehealth Program was initially funded through an innovation Grant (The Richard Ivey Foundation). Additional funding was received through the Aging at Home initiative, which enabled expansion to other hospitals within the LHIN.

When using automated calling you need to minimize the number of algorithm questions to keep patients engaged.

Integrating remote-monitoring data into an EMR is key to ensuring that physicians are on board and have access to real-time patient data.

Adoption Rate

More than 3,000 patients have been followed to date.
In October 2019:

• 104 patients are on home monitoring
• 1,924 patients are being followed by IVR

UOHI’s Telehealth Monitoring Model:

• 300 sites across North America have adopted a model similar to UOHI’s automated calling systems
• Similar home monitoring and automated-calling models have been implemented in 10 provinces

Disclaimer

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