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Remote monitoring helps keep Peninsula heart patients out of hospital

Bon SecoursAffordable Care Act (Obamacare)Hampton RoadsPneumoniaSentara

NEWPORT NEWS — When a disembodied voice in his Newport News home announces it's time to take his vital signs, Ron Day and his wife, Carol, head upstairs from the living room to a bedroom equipped with a remote monitoring device.

Ronald, a 73-year-old retiree from Newport News shipyard, has a weakened heart. He's had an aortic valve replacement and doctors installed a pacemaker last fall. He was hospitalized for weeks in December for fluid build-up in his right lung.

"It was a touchy situation," said Carol, as Ron followed recorded instructions to step on the scale.

Now, each day at 9 a.m., including weekends, Ron's data — weight, heart rate, oxygen saturation level and blood pressure — are transmitted wirelessly to a computer screen monitored by either Anita Dunn or LaTonya Davis-Boone, nurses for Bon Secours Home Care, working miles away in a corner office in Virginia Beach.

Such remote monitoring, known as telehealth, has taken on increased significance since October, when the Affordable Care Act introduced penalties for hospitals for 30-day readmissions of patients with heart failure, pneumonia or heart attack. Almost one in five Medicare patients nationally is readmitted within a month of going home at a cost of $17 billion in avoidable bills, according to ModernHealthcare.com.

The Dartmouth Atlas Project reported this week that nationwide the numbers barely shifted between 2006 and 2010. Peninsula health systems, however, have brought readmissions to a post-surgical low of between 8 and 11 percent and post-medical to between 13 and 15 percent.

By keeping daily tabs on patients, not only to check on their well-being but also to ensure that they comply with medication and diet instructions, remote monitoring has proven effective as one strategy in reducing unnecessary hospitalizations. It also provides patients with a sense of security. "Most patients love it. They like the novelty of knowing someone is watching them," said Vickie Morgan, director of clinical operations for Riverside Home Health department.

A pilot study by Sentara Home Care Services, which pioneered the concept in Hampton Roads more than a decade ago, showed that readmissions for congestive heart failure (CHF) patients decreased by 81 percent in the first six months of its program and that hospital days dropped by 87 percent. From 2010 to 2012 its e-Home Program for CHF patients dropped the 30-day readmission rate to 2 percent. Other studies, both in Europe and the U.S., have reported drops between 60 and 75 percent in readmissions for all patients.

Bon Secours started offering telehealth seven years ago as part of an array of home health services for patients post-hospitalization. The duo of Dunn and Davis-Boone takes turns going out to set up the equipment for patients — a small black box that transmits the data either wirelessly or through the phone lines. It allows them to monitor between 85 and 110 patients daily, from Williamsburg to the oceanfront, along with more in Richmond. They look for any significant changes, such as more than a 2-pound weight gain, indicative of fluid build-up. If anything's out of the ordinary, they call the patient to re-do the measurement; if it's still out of whack, they'll call the doctor.

When Day's oxygen level came up at 84, well below the acceptable 90 to 100 range, Carol said confidently, "I expect Anita will call and have us re-do it." A glitch in the automated system often provides false low readings, which can be corrected by a manual override, she explained. "I think it's fantastic. You can't go to the doctor every day. And then there's the transportation, not everyone has it," Carol added. The whole process, including a follow-up phone call, takes just a few minutes.

Newport News resident Frances Capps, 84, who has been home-monitored for more than a month after multiple strokes also appreciates not having to go back and forth to the doctor. Like Day, though, she needs help with the blood pressure cuff. Otherwise, patients find the system with its step-by-step instructions simple to use. It's programmed to answer follow-up questions geared to individual patients. Day's machine asks him if his ankles have been more swollen and if he has made an emergency room visit in the week prior. He answered by pushing the "No" button on the box.

In conclusion the machine reminded him to take his meds — an array of five prescriptions, down from 13 — and to eat a healthy diet."You can do pretty good if you stick with it," he said

Both Bon Secours and Riverside employ the same 60-day window for monitoring patients. "For those who need to learn how to manage diseases, 60 days is a good time to get a habit going," said Morgan. "The monitor is a point of contact. You can start talking a patient through symptoms, ask if they've taken their meds, or what they ate at the weekend — perhaps they had that country ham dinner they shouldn't have."

Copyright © 2014, The Baltimore Sun
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