Abstract MP72: Remote Monitoring Reduces Blood Pressure And Crisis Hypertension In Post-acute Transitions Of Care For Medicare Patients

Abstract

Introduction: The major benefits of remote physiologic monitoring (RPM) of blood pressure are usually observed in high-risk patients. Readmissions, return to acute care (RTA), is an undesirable outcome for post-acute care facilities (PACs). Transitions from PACS to ambulatory care have a high risk of RTA. We assessed RPM for hypertension (HTN) patients discharged from PACs. Hypothesis: We hypothesized that PAC discharged patients would benefit from RPM and it would lead to less hypertension during their transition to ambulatory care. Methods: Patients were enrolled in Medicare’s (CMS) RPM program that were being discharged from PACs in Tennessee. HTN RPM began at discharge from PACs. Blood pressure (BP) was measured with cellular-connected devices and a mobile-could application (Alertive, Seattle WA). Data was equally divided into 24-hour windows, classified to JNC8 hypertension classes. Results were reported to PAC and ambulatory clinicians on a monthly basis. Immediate alerts were delivered to physicians for patients with systolic BP > 180 mmHg for timely intervention. Events such as ED visits and hospital readmissions were tracked by the nursing team during their calls per CMS RPM criteria. Patients were telephoned once a month, coached on their BP data, adherence to medications, and upcoming medical visits. Mean comparison of BP data before and after RPM was performed using paired t-test. Results: BP readings from 20 patients (mean age=78.3 ±8.4) were collected between March and May, 2021. A total of 758 readings were analyzed. Twelve hypertensive crises in 6 unique patients were observed. Nine hypotensive instances in 5 patients were observed. Events led to intervention in all unique patients. One patient was hospitalized, and another was referred to the ED for abdominal pain vs 8 patients readmitted in the prior 90 days. Overall, there was a significant decrease in mean systolic BP (144.7 ± 23.1 mmHg at start of RPM vs. 135.2 ± 15.9 mmHg, post RPM; p=0.018) with a mean reduction of 9.5 mmHg at end of the program. Conclusions: After discharge from PAC’s patients monitored by CMS’ RPM achieved a significant reduction in BP. PAC hypotension is an area to evaluate in cardiovascular and renal patients. Future work to demonstrate reduction in RTA is merited.