A Quality Improvement-based Approach to Implementing a Remote Monitoring-Based Bundle in Transitional Care Patients...

Area of Science:

• Health Services Research
• Quality Improvement Science
• Health Equity

Background:

• Congestive heart failure (HF) is a major cause of hospitalizations, disproportionately affecting minority populations and widening mortality gaps.
• Remote patient monitoring (RPM) offers potential for post-discharge care but may exacerbate health inequities due to technological barriers.

Purpose of the Study:

• To implement and evaluate a quality improvement initiative for heart failure (HF) management using remote patient monitoring (RPM) with an equity lens.
• To assess the impact of an integrated HF care bundle on hospital readmission rates and enrollment equity.

Main Methods:

• A prospective, observational quality improvement (QI) initiative used five Plan-Do-Study-Act (PDSA) cycles at a single site.
• The intervention involved a heart failure (HF) bundle including RPM, clinical telepharmacy, remote therapeutic monitoring, and community paramedicine.
• Mid-program adjustments were made to improve equitable enrollment, shifting from cellular-based to hub-based devices.

Main Results:

• The complete HF bundle (RPM + other services) resulted in a 2.6% readmission rate, compared to 14.3% for a partial bundle and 20.0% for RPM alone.
• Community paramedicine was identified as a key component for program success.
• Equitable patient enrollment improved after program adjustments to accommodate diverse technological access.

Conclusions:

• An HF-based RPM program integrated with clinical telepharmacy and community paramedicine effectively decreased hospital readmissions.
• The initiative successfully identified and addressed disparities in service distribution, improving equity.
• Quality improvement strategies, including mid-program adjustments, are crucial for optimizing RPM effectiveness and equity in HF care.