A Remote Patient Management Care Model for Pediatric Home Care Ventilator Patients Conserves Resources: A Quality...

Children's Hospital of Philadelphia's Home Care respiratory therapy patient population becomes more acute and resource-intense each year. The organization's trach/vent patients have numerous clinical and equipment needs requiring complex home respiratory management. To conserve respiratory therapy resources, a remote patient management (RPM) program was integrated into the current respiratory services care model by introducing innovative technology to monitor patient data remotely. The authors expected this to reduce the number of home visits defined in the established program while maintaining safe, high-quality care. The goal was a reduction of 20%.

Biweekly, respiratory therapists (RTs) reviewed electronic health records and equipment downloads for specific patients and contacted them to assess their clinical status. RTs documented findings, planned interventions, communicated with interdisciplinary teams, and determined follow-up. Home and video contacts remained options for concerns. At minimum, RTs assessed patients in homes every three months. Chart reviews and safety rounds supported quality assessment.

Results revealed a 38.7% reduction in home visits compared to the prior year and 59.6% reduction in home visits from pre-COVID-19 baseline data, with several instances of special cause variation observed on statistical process control analysis (p < 0.05). The authors found a 21.01% reduction in on-call volume for ventilator-related issues (p = 0.2) and a 5.8% increase in patient's status changing to lower acuity (p = 0.2); neither was statistically significant due to low sample size. Results showed time and mileage savings, improved communication with interdisciplinary teams and families, improved RT quality of life, active ventilator weaning for relevant patients, and potential prevention of hospital admissions.

The program delivered innovation to an established care model, providing resource conservation, financial savings, and patient and staff satisfaction, and exceeded its goal.