Use Of Home Monitoring Research Articles

Experiences with home monitoring technology in older adults with traumatic brain injury: a qualitative study

BackgroundHome monitoring systems utilising artificial intelligence hold promise for digitally enhanced healthcare in older adults. Their real-world use will depend on acceptability to the end user i.e. older adults and caregivers. We explored the experiences of adults over the age of 60 and their social and care networks with a home monitoring system installed on hospital discharge after sustaining a moderate/severe Traumatic Brain Injury (TBI), a growing public health concern.MethodsA qualitative descriptive approach was taken to explore experiential data from older adults and their caregivers as part of a feasibility study. Semi-structured interviews were conducted with 6 patients and 6 caregivers (N = 12) at 6-month study exit. Data were analysed using Framework analysis. Potential factors affecting acceptability and barriers and facilitators to the use of home monitoring in clinical care and research were examined.ResultsHome monitoring was acceptable to older adults with TBI and their caregivers. Facilitators to the use of home monitoring were perceived need for greater support after hospital discharge, the absence of sound and video recording, and the peace of mind provided to care providers. Potential barriers to adoption were reliability, lack of confidence in technology and uncertainty at how data would be acted upon to improve safety at home.ConclusionsRemote monitoring approaches are likely to be acceptable, especially if patients and caregivers see direct benefit to their care. We identified key barriers and facilitators to the use of home monitoring in older adults who had sustained TBI, which can inform the development of home monitoring for research and clinical use. For sustained use in this demographic the technology should be developed in conjunction with older adults and their social and care networks.

Current diagnosis and treatment practice for pulmonary hypertension in bronchopulmonary dysplasia-A survey study in Germany (PUsH BPD).

Pulmonary hypertension (PH) is the most severe complication in preterm infants with bronchopulmonary dysplasia (BPD) and associated with significant mortality. Diagnostic and treatment strategies, however, still lack standardization. By the use of a survey study (PH in BPD), we assessed clinical practice (diagnosis, treatment, follow-up) in preterm infants with early postnatal persistent pulmonary hypertension of the newborn(PPHN) as well as at risk for or with established BPD-associated PH between 06/2018 and 10/2020 in two-thirds of all German perinatal centers with >70 very low birthweight infants/year including their cardiology departments and outpatient units. Data wereanalyzed descriptively by measures of locations and distributional shares. In routine postnatal care, clinical presentation and echocardiography were reported as the main diagnostic modalities to screen for PPHN in preterm infants, whereas biomarkers brain natriuretic peptide/N-terminal pro b-type natriuretic peptide were infrequently used. For PPHN treatment, inhaled nitric oxidewas used in varying frequency. The majority of participants agreed to prescribe diuretics and steroids (systemic/inhaled) for infants at risk for or with established BPD-associated PH and strongly agreed on recommending respiratory syncytial virus immunization and the use of home monitoring upon discharge. Reported oxygen saturation targets, however, varied in these patients in in- and outpatient care. The survey reveals shared practices in diagnostic and therapeutic strategies for preterms with PPHN and BPD-associated PH in Germany. Future studies are needed to agree on detailed echo parameters and biomarkers to diagnose and monitor disease next to a much-needed agreement on the use of pulmonary vasodilators, steroids, and diuretics as well as target oxygen saturation levels.

P196 Use of nose clips for routine spirometry helps maximise forced expiratory outcome measures in cystic fibrosis clinics

Spirometry is used in CF patients to monitor progression of lung disease. Whilst nose clips (NC) are recommended by some guidelines there is no current consensus on their use during spirometry testing (Chavasse et al., 2003 European Respiratory Journal). The COVID-19 pandemic saw an escalation in the use of home monitoring including portable spirometers often resulting in reduced compliance with spirometry guidance. We examined the effect of NC on spirometry measurements in patients attending the CF clinic at Southampton Children’s Hospital.

Remote Patient Monitoring During COVID-19

This Viewpoint explains how some hospitals used home monitoring of pulse oximetry during the COVID-19 pandemic to avoid patient overcrowding and control high patient to staff ratios and how increased use of home monitoring for other vital signs could potentially improve patient safety and decrease costs.

Impact of COVID-19 restrictions on diabetes health checks and prescribing for people with type 2 diabetes: a UK-wide cohort study involving 618 161 people in primary care

ObjectiveTo compare rates of performing National Institute for Health and Care Excellence-recommended health checks and prescribing in people with type 2 diabetes (T2D), before and after the first COVID-19 peak...

Home monitoring of physiology and symptoms to detect interstitial lung disease exacerbations and progression: a systematic review.

BackgroundAcute exacerbations (AEs) and disease progression in interstitial lung disease (ILD) pose important challenges to clinicians and patients. AEs of ILD are variable in presentation but may result in rapid progression of ILD, respiratory failure and death. However, in many cases AEs of ILD may go unrecognised so that their true impact and response to therapy is unknown. The potential for home monitoring to facilitate early, and accurate, identification of AE and/or ILD progression has gained interest. With increasing evidence available, there is a need for a systematic review on home monitoring of patients with ILD to summarise the existing data. The aim of this review was to systematically evaluate the evidence for use of home monitoring for early detection of exacerbations and/or progression of ILD.MethodWe searched Ovid-EMBASE, MEDLINE and CINAHL using Medical Subject Headings (MeSH) terms in accordance with the PRISMA guidelines (PROSPERO registration number CRD42020215166).Results13 studies involving 968 patients have demonstrated that home monitoring is feasible and of potential benefit in patients with ILD. Nine studies reported that mean adherence to home monitoring was >75%, and where spirometry was performed there was a significant correlation (r=0.72–0.98, p<0.001) between home and hospital-based readings. Two studies suggested that home monitoring of forced vital capacity might facilitate detection of progression in idiopathic pulmonary fibrosis.ConclusionDespite the fact that individual studies in this systematic review provide supportive evidence suggesting the feasibility and utility of home monitoring in ILD, further studies are necessary to quantify the potential of home monitoring to detect disease progression and/or AEs.

Ethics of Home Monitoring During the Corona Crisis: Promoting Patient Empowerment? Lessons from the Pandemic

"The development and use of home monitoring or remote patient monitoring has rapidly evolved due to scaling down of face-to-face patient care during the corona pandemic. Home monitoring systems for Covid-19 as well as for other conditions are proliferating. One of the stated goals of home monitoring systems is to promote patient empowerment. However, this concept is hardly well defined and often used in a rhetorical way. In this presentation, we will discuss the findings of our empirical study into the views of patients, healthcare professionals and policy makers regarding patient empowerment. We report on the results of two case studies of home monitoring systems in the Netherlands implemented during the corona crisis, in which we study, first, what patients, healthcare professionals and policy makers understand patient empowerment to be, and second, whether they think patient empowerment is actually promoted in these contexts. Finally, we will describe different interpretations or degrees of patient empowerment – compliant, concordant, and collaborative - and normatively argue for home monitoring systems that promote optimal patient empowerment. "

Home monitoring for patients with ILD and the COVID-19 pandemic

Home monitoring for patients with ILD and the COVID-19 pandemic

Clinically significant cardiopulmonary events and the effect of definition standardization on apnea of prematurity management.

To define the impact of care standardization on caffeine and cardiorespiratory monitoring at neonatal intensive care unit (NICU) discharge. Electronic records were abstracted for infants aged 24-36 weeks gestation with birth weights appropriate for gestational age. Infants who died, transferred prior to discharge, had major pulmonary anomalies, required a home monitor for mechanical ventilation or had a family history of sudden infant death syndrome were excluded. Data and records were used to indicate when the new definition of clinically significant cardiopulmonary events (CSCPEs) and concurrent education was implemented. Preimplementation and postimplementation cohorts were compared. Incidence fell from 74% diagnosed with apnea of prematurity at baseline to 49% diagnosed with CSCPE postimplementation (P<0.001). Infants discharged on caffeine reduced from 17% to 5% (P<0.001), and home monitor use also fell from 54% to 16% (P<0.001). Standardizing definitions and treatments reduced the use of caffeine and cardiorespiratory monitors upon NICU dismissal.

Use of Home Monitoring to Improve Blood Pressure Control

Studies have demonstrated that home blood pressure monitoring (HBPM) can produce a small but clinically significant reduction in blood pressure. In this report we describe a quality improvement initiative conducted to determine whether adding HBPM to existing interventions would result in both an increased incidence of patients monitoring their blood pressure at home as well as improved blood pressure control. The outcome was an increase in patients reporting HBPM from 35% to 47.1%. A decrease in blood pressure was not observed. The program resulted in an enhanced HBPM rate, but improved data are necessary to detect an overall decrease in blood pressure.

Diagnostic Evaluation and Home Monitor Use in Late Preterm to Term Infants With Apnea, Bradycardia, and Desaturations

Apnea, bradycardia, and oxygen desaturation events are a common in neonatal intensive care units, with relevant literature to date largely focusing on very low birth weight and extremely low birth weight infants. We conducted a retrospective review of infants born at ≥34 weeks gestational age at 2 tertiary neonatal intensive care units in Boston, MA, between January 2009 and December 2013. Our objectives included (1) describing the diagnostic evaluations performed in late preterm to term infants with discharge-delaying apnea, bradycardia, or oxygen desaturation events and (2) identifying variables associated with home monitor use. Of the 741 eligible infants identified, diagnostic evaluations were variable and infrequent with blood culture, blood glucose, and head ultrasound performed most commonly. The likelihood of home monitor use was greater in infants with either a prolonged inpatient stay or greater gestational age at birth.

Impact of the Hospital to Home Initiative on Readmissions in the VA Health Care System.

Hospital to Home (H2H) is a national quality improvement initiative sponsored by the Institute for Healthcare Improvement and the American College of Cardiology, with the goal of reducing readmission for patients hospitalized with heart disease. We sought to determine the impact of H2H within the Veterans Affairs (VA) health care system. Using a controlled interrupted time series, we determined the association of VA hospital enrollment in H2H with the primary outcome of 30-day all-cause readmission following a heart failure hospitalization. VA heart failure providers were surveyed to determine quality improvement projects initiated in response to H2H. Secondary outcomes included initiation of recommended H2H projects, follow-up within 7 days, and total hospital days at 30 days and 1 year. Sixty-five of 104 VA hospitals (66%) enrolled in the national H2H initiative. Hospital characteristic associated with H2H enrollment included provision of tertiary care, academic affiliation, and greater use of home monitoring. There was no significant difference in mean 30-day readmission rates (20.0% ± 5.0% for H2H vs 19.3% ± 5.9% for non-H2H hospitals; P = .48) The mean fraction of patients with a cardiology visit within 7 days was slightly higher for H2H hospitals (3.0% ± 2.4% for H2H vs 2.0% ± 1.9% for non-H2H hospitals; P = .05). Patients discharged from H2H hospitals had fewer mean hospitals days during the following year (7.6% ± 2.6% for H2H vs 9.2% ± 3.0 for non-H2H; P = .01) early after launch of H2H, but the effect did not persist. VA hospitals enrolling in H2H had slightly more early follow-up in cardiology clinic but no difference in 30-day readmission rates compared with hospitals not enrolling in H2H.

Electronic monitoring of symptoms and lung function to assess asthma control in children

BackgroundAsthma remains poorly controlled in children. Home monitoring of asthma control may help to improve the level of asthma control. ObjectivesTo compare 2 methods to assess asthma control: (1) prospective home monitoring, based on daily assessment of forced expiratory volume in 1 second (FEV1) and electronic symptom score, and (2) Asthma Control Questionnaire (ACQ) with retrospective assessment of symptoms and FEV1. MethodsNinety-six children with asthma were prospectively followed up during 1 year. Asthma control was assessed by home monitoring, including an electronic symptom score based on Global Initiative for Asthma (GINA) criteria and FEV1 measurements. In the hospital, the ACQ was completed and FEV1 was measured. Kappa analysis was performed to assess levels of agreement between the 2 methods. ResultsAgreement between the 2 methods was low (κ coefficient of 0.393). In 29 children (37%), prospective home monitoring was less optimistic than the retrospective assessment of asthma control by the ACQ. ConclusionThis study found low agreement between asthma control based on GINA criteria by means of prospective home monitoring and the hospital ACQ. The prospective home monitor detected more cases of less well-controlled asthma than the ACQ. However, optimization of adherence to home monitor use is necessary. Trial Registrationclinicaltrials.gov Identifier: NCT01239238.

A systematic review of the cost and cost-effectiveness of telehealth for patients suffering from chronic obstructive pulmonary disease

We conducted a systematic review of the evidence on the costs and cost-effectiveness of telehealth for patients with chronic obstructive pulmonary disease (COPD). A literature search identified six relevant economic evaluations that were assessed according to the Consensus Health Economic Criteria list (CHEC list). Three studies were from North America and three studies were from Europe. All studies reported the use of home monitoring devices that measured and transmitted different physical indicators to nurses who provided personalised feedback to patients during weekdays. The six studies involved a total of 559 COPD patients of whom 281 were randomised to telehealth. The review demonstrated a potential for cost savings. All six studies reported a lower average cost per patient with telehealth plus usual care compared with usual care alone. However, the quality of the economic evidence was poor. Five studies were evaluated as low quality and one study was evaluated as moderate quality, with CHEC list scores of 21–68%. Caution is advised for healthcare decision-makers seeking large-scale implementation of telehealth in routine clinical practice. The clinical effectiveness of such implementations with follow-up exceeding 12 months has not yet been demonstrated.

Editorial introductions

Editorial introductions

Home blood pressure monitoring may make office measurements obsolete

he conventional measurement of blood pressure(BP) in the office or clinic has been the cornerstonefor hypertension management for decades. How-ever, because of the white-coat and the masked hyper-tension phenomena, out-of-office BP monitoring withambulatory or home measurements is often required [1].ExtensiveresearchonambulatoryBPmonitoringhasestab-lished its role as the most accurate tool for hypertensiondiagnosis [1–3].Onthecontrary,despitetheincreasinguseof home BP monitoring by hypertensive patients in thedaily management of their high BP condition, research inthisfield,inparticularwhenconsideringoutcometrials,hasbeen delayed as compared to ambulatory BP monitoring[4,5].

Update on sudden infant death syndrome.

With the introduction of the Back to Sleep campaign by the American Academy of Pediatrics in 1992, the incidence of Sudden infant death syndrome has decreased by almost 50%. Despite this success, SIDS continues to be the most common cause of unexplained infant death in Western countries. This article will briefly review the definition, etiology, and risk factors of SIDS. Attention will then focus on ways to target specific associated risk factors and at risk populations to promote a continued downward trend in the number of SIDS deaths. Recent literature in SIDS research has focused on identifying infants at continued risk for SIDS. Children attending child care centers have an increased risk for SIDS, which is of particular concern as the number of infants in child care continues to rise. The reasons for this, along with strategies to decrease this risk, will be reviewed. In addition, the SIDS rate among black infants continues to be more than twice that of white infants. A review of the reasons for this disparity and ways to intervene through targeted campaigns will be discussed. Recent data has also suggested that the prevention of SIDS should not be an indication for use of home cardiorespiratory monitoring. The use of home monitoring may be warranted for some infants and will be reviewed. Our jobs as pediatricians should be to ensure that the incidence of SIDS continues to decline. This can be done through parent education at each and every well child visit, lobbying to enforce state law to implement SIDS education campaigns for child care centers and within African-American communities, and continued review of the most current literature in SIDS research to keep ourselves current and well informed.

SIDS, ALTE, apnea, and the use of home monitors.

1. Paula A. Farrell, MD* 2. Gary M. Weiner, MD* 3. James A. Lemons, MD† 1. *Department of Pediatrics, Section of Neonatal-Perinatal Medicine, James Whitcomb Riley Hospital for Children 2. †Hugh McK. Landon Professor of Pediatrics; Director, Section of Neonatal-Perinatal Medicine, Indiana University, Indianapolis, IN. After completing this article, readers should be able to: 1. Describe the effects of the “Back to Sleep” campaigns on the incidence of sudden infant death syndrome (SIDS). 2. Delineate modifiable risk factors of SIDS. 3. Explain the relationship of apnea and SIDS. 4. Delineate recommendations for the prevention of SIDS. Sudden infant death syndrome (SIDS) has been the focus of extensive research over the past several decades. This review examines the epidemiologic aspects of this syndrome, potential prevention strategies, and the use of home monitoring. Also referred to as crib or cot death, SIDS has been defined by the National Institutes of Health Consensus Development Conference on Infantile Apnea and Home Monitoring as “the sudden death of an infant or young child, which is unexplained by history and in which a thorough postmortem evaluation fails to demonstrate an adequate cause of death.” A thorough postmortem evaluation includes a complete autopsy, review of the death scene, and review of the clinical history. The consensus statement defined an apparent life-threatening event (ALTE) as “an episode that is frightening to the observer and is characterized by some combination of apnea, color change, change in muscle tone, choking, or gagging.” It is noted in this statement that terminology used previously, such as “aborted crib death” or “near-miss SIDS,” should be abandoned because it implies a possibly misleadingly close association between this type of spell and SIDS. Apnea of infancy is defined as an unexplained episode of cessation of breathing for 20 seconds or longer or a shorter respiratory pause associated with bradycardia, cyanosis, pallor, or marked hypotonia. This generally is applied to infants who are older than 37 weeks’ gestation. This diagnosis usually is reserved for infants who have ALTE for which a specific cause has not been delineated that is believed to have been related to …

Is home monitoring of lung function worthwhile for children with asthma?

Is home monitoring of lung function worthwhile for children with asthma?

Home apnea monitor use in preterm infants discharged from newborn intensive care units

Purpose: To identify current factors associated with home apnea monitor use in preterm infants and to determine whether home monitor use was associated with a shorter length of hospital stay. Setting: We evaluated neonates who were ≤34 weeks’ estimated gestational age and admitted for neonatal intensive care. We excluded neonates with congenital anomalies, neonates transferred out before discharge, and neonates who died. Methods: Using a database created with a computer-assisted tool that generates hospital notes, we reviewed the epidemiology of monitor use. Differences between neonates sent home with an apnea monitor and those who were not were evaluated by using stepwise logistic regression analysis to identify which factors were independently associated with a neonate being discharged with a monitor. Results: We studied 14,532 neonates; 1588 (11%) were sent home with monitors and 12,944 (89%) were not. The most important variables associated with being discharged with a monitor were site of care and a diagnosis of apnea. Site variation remained significant when adjusted for gestational age, diagnosis of apnea, and a history of use of methylxanthines. When corrected for gestational age, monitor use was not associated with shorter hospital stays. Conclusion: The data suggest that monitor use is more dependent on physician preference than medical indication and is not associated with earlier hospital discharge. (J Pediatr 2001;139:245-8)