Farrukh N. Jafri MD, MS-HPEd, FACEP (is Medical Director, WPH Cares, White Plains Hospital, White Plains, New York, and Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York.), Kenay Johnson MA, CPHQ (is Senior Manager, Network Performance Group, Montefiore Medical Center, Bronx, New York.), Michelle Elsener MBA, BSN, RN-BC, CPHQ (is Clinical Quality Nurse, White Plains Hospital.), Michael Latchmansingh RN, JD, MBA (is Senior Director, Department of Innovation, White Plains Hospital.), Jonathan Sege MS (is Senior Director, Data Management and Analytics, White Plains Hospital.), Melanie Plotke PharmD (formerly Clinical Data Pharmacist, Cureatr, New York, is Manager, Science and Clinical Practice Guidelines, American Academy of Dermatology, Chicago.), Tina Jing MD (is Resident, Department of Anesthesiology, NewYork Presbyterian /Columbia University.), Adeel Arif (is Research Associate, White Plains Hospital, and Applied Analytics Master's Student, Columbia University.), Fran Ganz-Lord MD, FACP (is Senior Director, Network Performance Group, Montefiore Medical Center, and Associate Professor of Medicine, Division of Internal Medicine, Albert Einstein College of Medicine. Please address correspondence to Farrukh N Jafri)
{"title":"A Quality Improvement-based Approach to Implementing a Remote Monitoring–Based Bundle in Transitional Care Patients for Heart Failure","authors":"Farrukh N. Jafri MD, MS-HPEd, FACEP (is Medical Director, WPH Cares, White Plains Hospital, White Plains, New York, and Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York.), Kenay Johnson MA, CPHQ (is Senior Manager, Network Performance Group, Montefiore Medical Center, Bronx, New York.), Michelle Elsener MBA, BSN, RN-BC, CPHQ (is Clinical Quality Nurse, White Plains Hospital.), Michael Latchmansingh RN, JD, MBA (is Senior Director, Department of Innovation, White Plains Hospital.), Jonathan Sege MS (is Senior Director, Data Management and Analytics, White Plains Hospital.), Melanie Plotke PharmD (formerly Clinical Data Pharmacist, Cureatr, New York, is Manager, Science and Clinical Practice Guidelines, American Academy of Dermatology, Chicago.), Tina Jing MD (is Resident, Department of Anesthesiology, NewYork Presbyterian /Columbia University.), Adeel Arif (is Research Associate, White Plains Hospital, and Applied Analytics Master's Student, Columbia University.), Fran Ganz-Lord MD, FACP (is Senior Director, Network Performance Group, Montefiore Medical Center, and Associate Professor of Medicine, Division of Internal Medicine, Albert Einstein College of Medicine. Please address correspondence to Farrukh N Jafri)","doi":"10.1016/j.jcjq.2024.07.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Congestive heart failure (HF) is a leading cause of hospitalization and readmission, leading to increased health care utilization and cost. This is complicated by high incidence, prevalence, and hospitalization rates among racial and ethnic minorities, with a widening in the mortality disparity gap. Remote patient monitoring (RPM) has the potential to proactively engage patients after discharge to optimize medication management and intervene to avoid rehospitalization. However, it also may widen the equity gap due to technological barriers and bias.</div></div><div><h3>Methods</h3><div>A prospective, observational quality improvement (QI) initiative leveraging an amended tool from the Institute for Healthcare Improvement Model for Improvement was incorporated with an equity lens and five Plan-Do-Study-Act (PDSA) cycles at a single site. The intervention used an HF bundle that included RPM, clinical telepharmacy, remote therapeutic monitoring, and community paramedicine.</div></div><div><h3>Results</h3><div>Between May 2022 and March 2023, five PDSA cycles were run involving 90 enrolled patients. In total, 38 (42.2%) patients received the complete HF bundle, 42 (46.7%) a partial bundle, and 10 (11.1%) only RPM. The patients with the complete bundle had a readmission rate of 2.6% compared to 14.3% in the partial bundle and 20.0% in RPM alone. The biggest impact of this program was the incorporation of community paramedicine. The program also noted an improvement in equitable enrollment after adjusting mid-program by avoiding cellular phone–enabled devices and transitioning to a hub-based model.</div></div><div><h3>Conclusion</h3><div>This single-site QI–based initiative implemented an HF–based RPM program that leveraged clinical telepharmacy and community paramedicine. This program identified a disparity of care gap regarding the equitable distribution of services and made mid-study adjustments to improve the disparity gap. The program found that use of the HF bundle resulted in a decreased hospital readmission rate.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Commission journal on quality and patient safety","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553725024002241","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
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Abstract
Background
Congestive heart failure (HF) is a leading cause of hospitalization and readmission, leading to increased health care utilization and cost. This is complicated by high incidence, prevalence, and hospitalization rates among racial and ethnic minorities, with a widening in the mortality disparity gap. Remote patient monitoring (RPM) has the potential to proactively engage patients after discharge to optimize medication management and intervene to avoid rehospitalization. However, it also may widen the equity gap due to technological barriers and bias.
Methods
A prospective, observational quality improvement (QI) initiative leveraging an amended tool from the Institute for Healthcare Improvement Model for Improvement was incorporated with an equity lens and five Plan-Do-Study-Act (PDSA) cycles at a single site. The intervention used an HF bundle that included RPM, clinical telepharmacy, remote therapeutic monitoring, and community paramedicine.
Results
Between May 2022 and March 2023, five PDSA cycles were run involving 90 enrolled patients. In total, 38 (42.2%) patients received the complete HF bundle, 42 (46.7%) a partial bundle, and 10 (11.1%) only RPM. The patients with the complete bundle had a readmission rate of 2.6% compared to 14.3% in the partial bundle and 20.0% in RPM alone. The biggest impact of this program was the incorporation of community paramedicine. The program also noted an improvement in equitable enrollment after adjusting mid-program by avoiding cellular phone–enabled devices and transitioning to a hub-based model.
Conclusion
This single-site QI–based initiative implemented an HF–based RPM program that leveraged clinical telepharmacy and community paramedicine. This program identified a disparity of care gap regarding the equitable distribution of services and made mid-study adjustments to improve the disparity gap. The program found that use of the HF bundle resulted in a decreased hospital readmission rate.
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