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Research Cover - July 2020
 
 
 
 
 
 
 
July 2020
Telehealth News:
Research & News Recap

Interest in remote patient monitoring (RPM) and its positive impact continues to grow as providers see the benefits of adding telehealth to their workflow. This has led to increased and extensive research on telehealth as well as changes to government policies. Explore recent research on the efficacy of telehealth and understand new rulings from the Center of Medicare and Medicaid Services (CMS) in HRS’ July 2020 Research & News Recap.

Part I. Research Findings - Remote Patient Monitoring and Telehealth

In this section three studies conducted within the last year on various RPM and telehealth topics are analyzed. Real quantitative and qualitative data from telehealth patients was collected, studied, and conclusions were drawn in the studies included below. The results point to the positive impacts of RPM in healthcare and the growth potential of telehealth.

Article 1

Implementation of an Intensive Telehealth Intervention for Rural Patients with Uncontrolled Diabetes

What was studied?

Over two years, the Veterans Affairs Office of Rural Health conducted a study with 125 rural diabetes patients with poor glycemic control. Selected patients were enrolled in an Advanced Comprehensive Diabetes Care (ACDC) intervention program for sixth months. The ACDC intervention provided three key offerings to unengaged diabetes patients: telemonitoring, self-management support, and clinician-guided medication management.

Every two weeks, nurses conducted 30-minute phone calls with ACDC patients. During calls, nurses reviewed blood glucose reporting, medication adherence, and provided self-management guidance to patients. Guidance included education modules focuses on diet, exercise, and medication management among others a self-management education module on such topics as diabetes medication management, diet, and exercise. Following every 2-week call, a medication manager reviewed reports from nurses on patient progress. Medication managers adjusted treatment, but did not communicate directly with patients.

Research findings 

  • Mean HbA1c improved from 9.25% at baseline to 7.89% at six months
  • Improvements in glycemic control persisted at 12 months (-1.22%, 95% CI -1.48 to -0.97) and 18 months (-1.07%, 95% CI -1.40 to -0.73) for patients that opted to remain in the ACDC program
  • Patient engagement was considered successful with the average patient completely 10 of 12 intervention calls.
  • ACDC enhanced patient engagement and awareness of glycemic control with many patients requesting to continue ACDC telemonitoring after the initial six month intervention
  • Workload for nurses was considered to increase moderately but at an acceptable rate given the intensive care required by diabetes patients

Why do these findings matter?

According to the Health Resources & Services Administration (HSRA) and Center for Disease Control (CDC), diabetes prevalence is approximately 15 to 17 percent higher in rural communities than in urban communities. Further impacting these rural communities is a lack of diabetes self-management programs. 62 percent of nonmetropolitan counties do not have disease self-management programs, significantly increasing mortality in these communities.

The above study proves the efficacy of providing advanced care for diabetes through telehealth to expand access to specialty care and establish self-management skills in previously unengaged diabetes patients. In addition, the study outlines how an Advanced Comprehensive Diabetes Care (ACDC) intervention program can significantly impact a community without straining existing staffing resources, a critical point in rural communities.

Access the full article, here

Date Published: June 2020

Kobe, Elizabeth A., et al. “21-OR: Implementation of an Intensive Telehealth Intervention for Rural Patients with Uncontrolled Diabetes.” Diabetes, American Diabetes Association, 1 June 2020, diabetes.diabetesjournals.org/content/69/Supplement_1/21-OR.

Article 2

Managing Patients with Chronic Pain During the COVID-19 Outbreak: Considerations for the Rapid Introduction of Remotely Supported (eHealth) Pain Management Services

What was studied?

The American Pediatric Surgical Association (APSA) sponsored this literature review outlining the current and future uses of telehealth and remote patient monitoring in pediatric surgery. The review highlights implementation strategies for adding pediatric telehealth to your practice and highlights previous studies that demonstrate the efficacy of utilizing highly specialized technology to monitor and treat pediatric patients.

Current & future uses of telehealth

  • During preoperative and postoperative periods, virtual visits can assist in patient evaluation. During the preoperative period, physicians can utilize virtual visits to evaluate possible candidates for surgery who are in rural or remote locations. Virtual visits can then assist physician in performing follow-up care in the postoperative period.
  • Remote monitoring supports the collection of specific patient data such as daily surgical drain output, spirometry results, symptoms, blood pressure and medication adherence
  • Specialty consultation in emergency departments and ICUs through virtual visits
  • Remote surgery via the ZEUS system consisting of a “patient side” and a “surgeon side” connected through asynchronous transfer mode technology

Why do these findings matter?

Pediatric surgery is a field in which highly-specialized care is delivered to vulnerable patients by an extremely limited number of providers. Due to provider limitations, patients and their families often travel incredibly long distances. Highlighted studies in this literature review show comparable outcomes to in-person follow-up with a majority of studies reporting significant time, travel, and resource savings to patients and their families. For these vulnerable patient populations, a reduction in time, travel, or stress, along with cost savings can have a substantial impact on their mental and emotional health as well.

Access the full article, here.

Date Published: 2019

Harding, Matthew T, et al. “Telemedicine in Pediatric Surgery.” Journal of Pediatric Surgery, Journal of Pediatric Surgery, 2019, www.jpedsurg.org/article/S0022-3468(18)30312-9/fulltext.

Article 3

Can Remote Patient Management Improve Outcomes in Peritoneal Dialysis?

What was studied?

Existing research on the impact of RPM is limited and often scattered. This literature review from Keenan Research Center aims to compile the results of existing studies and evaluate the role of Remote Patient Monitoring (RPM) in Peritoneal Dialysis (PD) treatment. RPM could increase the use of PD by offering at-home guidance and educational materials to patients, and providing treatment feedback and important clinical data to clinicians. In addition, with the recent wave of state legislation aimed at expanding at-home dialysis treatment, both to provide comfort and reduce costs, this review evaluates the role of RPM in increasing utilization of at-home solutions for End-Stage Renal Disease (ESRD).

Similarly to the more commonly used hemodialysis, PD removes waste from a patient’s blood when their kidneys no longer remove the waste adequately. Unlike hemodialysis, PD utilizes a cleansing fluid, injected into the abdomen via a catheter, and the lining of the patient’s abdomen to filter and remove waste.

Research findings

  • Majority of literature reviewed supported the reduction of hospitalizations due to increased availability of patient information and the identification on non-adherence via RPM
  • Across evaluated studies, RPM showed potential to increase utilization of PD both by patients at home and by long-term care clinics
  • Literature supported the use of RPM for the prevention of PD-related infections, a key contributor to hospitalizations and a frequently used argument against at-home dialysis
  • Numerous studies proved the efficacy of RPM in identifying non-adherence among PR patients and in enhancing physician-patient communication to then increase adherence
  • Patients receiving PD report higher levels of satisfaction and rated their quality of care higher than patients receiving hemodialysis – across over 300 surveys, more than 80% of respondents reported being “satisfied” or “very satisfied” with their care. Studies largely attributed this increase in patient satisfaction to the promotion of self-efficacy, motivation, and knowledge from RPM.

Why do these findings matter?

RPM for peritoneal dialysis is critical to patient quality of life. PD is often recommended over hemodialysis for more active patients, those who want to and are able to continue working or traveling and aim to reduce daily disruptions. The ability to perform PD at home combined with the support, instruction, and reduced burden from RPM has resulted in decreased hospitalizations, improved patient satisfaction, and increased utilization.

Access the full article, here.

Date Published: 2019

Ronco C, Crepaldi C, Rosner MH (eds): Remote Patient Management in Peritoneal Dialysis. Contrib Nephrol. Basel, Karger, 2019, vol 197, pp 113–123 (DOI: 10.1159/000496306). doi: 10.1159/000496306

Part II. Reimbursement Updates

Throughout the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) have made changes to their policies in order to make telehealth more accessible across the country. As we continue to move forward, new federal policies and state laws have been proposed to continue expanding reimbursement for telehealth and RPM services. Below, you can review recent reimbursement changes as well as insights from our reimbursement team.

Reimbursement Updates

Michigan Governor Signs New Telehealth Coverage Guidelines into Law

At the end of June, Michigan Governor Gretchen Whitmer signed into law five bills that will expand telehealth services and reimbursement, loosening current regulations for telehealth services specifically for Medicaid providers. The bill was first introduced in January and following an executive order from Whitmer in May to expand telehealth coverage in the wake of COVID-19, the bill quickly pass the state legislature and senate in June. Included in the package is House Bill 5416 which will allow for remote patient monitoring services and incorporates in-home and in-school settings as originating sites beginning in October 2020.

Access the full article, here.

Date Published: June 26, 2020

Wicklund, Eric. “Michigan Governor Signs New Telehealth Coverage Guidelines Into Law.” MHealthIntelligence, MHealthIntelligence, 26 Jun. 2020, https://mhealthintelligence.com/news/michigan-governor-signs-new-telehealth-coverage-guidelines-into-law.

 

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