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1.
Value in Health ; 26(6 Supplement):S302-S303, 2023.
Article in English | EMBASE | ID: covidwho-20239589

ABSTRACT

Objectives: To provide an overview of trends in the current evidence landscape of products and services in development that support remote patient monitoring (RPM) and remote therapeutic monitoring (RTM), given the release of new billing codes for RPM and RTM by Centers for Medicare and Medicaid Services (CMS) in 2019. Method(s): A focused literature review was conducted in PubMed. Articles published between January 1, 2013 and January 1, 2023 were eligible for inclusion if reported technologies were classified as RPM (defined as the collection and interpretation of physiologic data digitally stored and/or transmitted by patients and/or caregivers to qualified health care professionals) or RTM (defined as the use of medical devices to monitor a patient's health or response to treatment using non-physiological data), following CMS definitions. RPM and RTM technologies included hardware, software, telehealth, and blockchain applications. Articles were then categorized using a semi-automated software platform (AutoLit, Nested Knowledge, St. Paul, MN) based on disease area, study design, intervention, and outcomes studied. Result(s): Of the 673 records screened, 245 articles were included. Observational studies (19.6%) were the most common study design, followed by systematic or focused literature reviews (11.0%) and narrative reviews (10.6%). The most common disease areas included cardiology (25.7%), coronavirus disease of 2019 (COVID-19;13.9%), and diabetes (9.4%). The most frequent clinical, non-clinical, and patient-reported outcomes were symptom monitoring (20.8%), all cause readmission and hospitalization rates (both 7.3%), and patient experience (7.8%), respectively. Conclusion(s): CMS policy and coding practices for RPM and RTM are evolving, and this trend is likely to continue into the future. This review provides details on the current evidence trends associated with RPM/RTM technologies. Evidence development of RPM and RTM should be assessed as evidence needs for coverage and reimbursement may receive increased payer management.Copyright © 2023

2.
BJU International ; 129:107-108, 2022.
Article in English | EMBASE | ID: covidwho-1956725

ABSTRACT

Introduction & Objectives: Residential aged care facility (RACF) patients require complex care, with many needing urinary catheters. As part of Aged Care Quality Standards, facilities are expected to provide appropriate catheter management. Hospital transfers for simple catheter management burdens both Patients and health care systems. Additionally, during the COVID 19 pandemic, transfers to ED for simple catheter issues unnecessarily stresses an already strained healthcare system. Visiting geriatric services provide an alternative for RACF patients. We assessed the trends of ED presentations and referrals to visiting geriatric services for catheter related concerns before and during 2020. Methods: We assessed the electronic medical records of a tertiary teaching hospital for RACF patients with catheter related issues who were transferred to ED and those who were referred to the visiting geriatric services from 2018 to 2020. Exclusion criteria included patients who received a urinary catheter for indications other than a primary urinary tract pathology or where further assessment was required. Flushing, repositioning, or changing of a catheter was deemed suitable as management by nursing staff at RACF. Non-urgent medical assessment was deemed suitable for visiting geriatric services. Results: A total of 399 catheter related issues were managed over the included timeframe, with 129 in 2018, 126 in 2019 and 144 in 2020. Presentations to the ED accounted for 70 (54.3%), 61 (48.4%), and 56 (38.9%) of all presentations in 2018, 2019, and 2020 respectively. The remainder were managed by visiting geriatric services. Out of all catheters related issues, visiting geriatric services managed proportionately more presentations over each sequential year. Subgroup analysis of patients presenting to the ED (total 188) showed that, 115 (61.2%) were suitable for management by RACF staff. A further 34 (18.1%) were deemed suitable for visiting geriatric services. Across all three years, 79.3% of presentations were deemed safe to manage outside of the ED. Furthermore, a total of 211 were patients referred to visiting geriatric services. Of these, 25 (11.8%) were ultimate referred to hospital. Conclusions: During the COVID-19 pandemic in 2020, ED presentations for simple catheter issues reduced with subsequent increase in referrals to visiting geriatric services. This reduces not only financial costs or risks of delirium and falls, but also use of ED resources. However, given 79.3% of ED presentations were deemed safe to manage in the community with or without visiting geriatric services, and only 11.8% of those managed by visiting geriatric services were referred to the ED, there is ongoing unnecessary expenditure for these cases. Further collaboration between ED, urology and geriatric medicine can further streamline this process to identify appropriate residents to be managed in RACF.

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