Martin J. Schreiber
WASHINGTON — Results of a study presented here showed home remote monitoring of high-risk patients on peritoneal dialysis helped reduce uncontrolled blood pressure, aligned treatment weight closer to target weight and increased positive answers to health questions posed to patients about their care.
Home remote monitoring (HRM), defined by lead author Martin J. Schreiber, MD, and DaVita Inc. colleagues as “virtual health technologies,” captures biometric data along with virtual in-home interactions between patients and the health care team, they wrote.
“It can promote a more proactive approach to care management and may improve outcomes,” they wrote in their study abstract.
For the study, researchers identified high-risk patients on PD at DaVita Kidney Care using a predictive clinical algorithm in conjunction with care team clinical judgement.
“These are patients deemed at high risk for hospitalization or dropout from PD programs, including new starts; patients post-hospitalization; patients with early peritonitis; patients with depression or high social demographic burden characteristics, and patients with new or worsening co morbidities,” Schreiber told Healio Nephrology via email. Patients had to sign a consent and a physician’s order was required to place a patient on the HRM protocol.
Researchers designed algorithms for the biometric values they wanted to track (blood pressure, weight and temperature). Use of an iPad was offered to patients who wanted to participate in daily health sessions, which included questions about their symptoms. Educational content designed to reinforce training concepts was also offered to patients.
The study began in April 2017 and more than 12,000 high-risk patients on PD were identified to use HRM; as of May 2019, 4,700 patients were still actively using the platform.
“More than 1 million data points have been collected to date,” the authors wrote. “Metrics tracked during implementation included: patient enrollment rate, consistency of patient data transmission and speed of alert resolution by the care team. Adoption metrics were assessed by program, along with hospitalization rates and mean time on therapy.”
Researchers plan to continue the remote monitoring of high-risk patients and improve adherence and adoption of HRM into clinic workflow, as well as timely closure of HRM alerts. Schreiber said there was no concern during the study that the number of alerts during the monitoring might cause some patients to eventually become ambivalent to the alarms. “Since one patient could have generated multiple alerts at one sitting and alerts aggregated would signify one encounter which would be addressed, I do not believe it would lead to alert fatigue,” Schreiber told Healio Nephrology. “However, in any surveillance system the goal is to achieve a balance between benefit and burden to the health care team. Mining the alerts will assist in clarifying the extent of work required to manage a high risk/rising risk population.” – by Mark E. Neumann
Schreiber MJ, et al. Abstract TH-OR088. Presented at: ASN Kidney Week; Nov. 7-10, 2019; Washington, D.C.
Disclosures: The study was funded by DaVita Kidney Care. The authors report they are employees of DaVita.