Background
See our clinicaltrials.gov and PCORI® descriptions for more details.
Healthcare Challenge
Nationally, hospital readmissions after sepsis and pneumonia are more common and more costly than readmissions due to heart failure, chronic obstructive pulmonary disease (COPD), or myocardial infarction. Research suggests that if identified early enough, the cause of many of these readmissions could be treated on an outpatient basis potentially allowing patients to stay out of the hospital and spend more time at home.
Goals
- Maximize UPMC Health Plan member days spent at home by identifying the remote-patient monitoring (RPM) strategy that best identifies and treats post-discharge health issues before they cause a hospital readmission among patients with sepsis and lower respiratory tract infections.
- Learn the facilitators, barriers, and contextual factors associated with RPM engagement, satisfaction, and effectiveness.
Implementation Approach
Population
UPMC Health Plan and traditional Medicare Fee-for-Service patients hospitalized with sepsis or lower respiratory tract infection (LRTI) and at medium- to high-risk of readmission who own a phone which they can use to participate in RPM.
Methodology
This randomized controlled trial, also known as the ACCOMPLISH Study, uses an adaptive randomization approach in which, every three months, the study team determines which of the four RPM strategies is best helping patients stay out of the hospital and then gives future patients the highest probability of being enrolled in the best performing RPM strategy. The study will compare the usual post-hospital discharge phone call from a nurse with four different RPM strategies that vary based on the health questions asked of participants and the credentials of the health care response team.
Participants must have access to a smart phone to be eligible for the study.
- Structured Telephone Support: A nurse will call the patient once within seven days after discharge to check in, help them understand their medicines, and make sure they get the care they need.
- RPM Low: Questions focused on worsening infection.
- RPM High: Questions focused on worsening infection and worsening underlying heart and lung conditions.
- Standard Team: RPM alerts are screened by a nurse-staffed call center. Nurses determine whether emergency care is needed. If not, nurses contact the patient and/or the patient's PCP or specialist to coordinate care and ensure timely follow-up.
- Enhanced Team: RPM alerts are screened by a nurse-staffed call center. Nurses determine whether emergency care is needed. If not, the call center alerts a multidisciplinary care team that is led by a certified registered nurse practitioner (CRNP). CRNPs, who operate in a palliative care role, have prescribing authority and can modify care plans. In addition to reacting to RPM triggers, team members (e.g., CRNP, social workers, nurses) meet with the patient in-person or virtually in the week after discharge and at least twice more in the next 90 days, conduct assessments and a pharmacy review, develop care plans, and complete a POLST (physician orders for life-sustaining treatment) or an PA Advance Care Directive.
Participants are asked to complete two surveys for the project - one immediately after they are discharged home from the hospital and one at 90 days. Participants report on their physical function and quality of life with these surveys.
Both the intervention teams, participant PCPs, and participants completed qualitative interviews. Participants were asked to share about their satisfaction, value of the study, and if the study improved quality of life. The care team (intervention teams and PCPs) were invited to share about challenges and benefits to engaging and implementing the ACCOMPLISH Project.
The study design implementation is advised by patient-partners, a patient-partner study co-investigator, and an advisory board comprising health providers, patients, researchers, payers, policy makers, and community organizers/organizations.
Outcomes of Interest
The number of days patients spent at home during the 90 days after hospital discharge to home, and the effectiveness of each monitoring strategy considering additional patient factors such as comorbidities, living arrangements, age, gender, and socioeconomic status.
This project was funded through the Patient-Centered Outcomes Research Institute® (PCORI®) Award IHS-2019C1-16055. The views, statements, and opinions presented in this webpage are solely the responsibility of the author(s) and do not necessarily represent the views of PCORI®.