Post-Implementation Outcomes of a Remote Patient Monitoring Program After Emergency Department Discharge.

To better communicate and improve post-visit outcomes, a remote patient monitoring (RPM) program was implemented for patients discharged from emergency departments (ED) across 10 hospitals. The solution was offered to patients at the time of ED discharge and staffed by a group of care coordinators to respond to questions/urgent needs. Of 107,477 consecutive patients offered RPM, 28,425 patients (26.4%) engaged with the program. Activated patients with RPM were less likely to return to the ED within 90 days of their index visit [19.8% compared to 23.6%, p<.001]. While activation rates were modest, we observed fewer return visits to the ED in patients using RPM, with a 16.2% lower hazard of returning in the next year. Future research is needed to understand methods to improve RPM activation, any causal effects of RPM activation on return ED visits, and external validation of these findings.

Early detection of hospitalized patients with previously diagnosed obstructive sleep apnea using computer decision support alerts.

Obstructive sleep apnea (OSA) is a worldwide problem affecting 2-14% of the general population and most patients remain undiagnosed. OSA patients are at elevated risk for hypoxemia, cardiac arrhythmias, cardiorespiratory arrest, hypoxic encephalopathy, stroke and death during hospitalization. Clinical screening questionnaires are used to identify hospitalized patients with OSA; especially before surgery. However, current screening questionnaires miss a significant number of patients and require more definitive testing before specific therapy can be started. Moreover, many patients are admitted to the hospital with a previous diagnosis of OSA that is not reported. Thus, many patients with OSA do not receive appropriate therapy during hospitalization due to the lack of information from previous inpatient and outpatient encounters. Large enterprise data warehouses provide the ability to monitor patient encounters over wide geographical areas. This study found that previously diagnosed OSA is highly prevalent and undertreated in hospitalized patients and the use of early computer alerts by respiratory therapists resulted in significantly more OSA patients receiving appropriate medical care (P < 0.002) which resulted in significantly fewer experiencing hypoxemia (P < 0.006). The impact was greater for non-surgery patients compared to surgery patients.