Remote monitoring programs take many shapes – and offer different promises of outcomes. Three such programs launched in the Partners HealthCare network are showing that success can be measured in many ways.
Rajani LaRocca, MD, a primary care physician at Massachusetts General Hospital's Charlestown HealthCare Center, tried out a simple project with nine diabetic patients between 60 and 75 years old, who meet with her every week for 90-minute group therapy. At one session, she handed out fitness bands, and asked only that they measure their steps each week and try to walk more than the previous week.
Just having the fitness bands prompted everyone to increase their activity, LaRocca said during a panel presentation at Partners HealthCare's Connected Health Symposium last month in Boston. And talking about their accomplishments each week gave them a sense of camaraderie in improving their health.
Eventually, LaRocca said, some of the members stopped using their fitness bands – but only because they were walking more anyways and felt they didn't need to measure their steps any more.
Kristen Barnicle, MA, director of Partners HealthCare's Community Health program, tried out a text messaging program for low-income and vulnerable OB-GYN patients served through the programs 20 community health centers. Two to three text messages were sent out each week during each patient's pregnancy, offering health advice and reminding them to keep up with appointments.
Barnicle said the program did show some improvements in birth outcomes, but the more dramatic results came in patient engagement.
"Patient satisfaction was through the roof," she said, adding that it's sometimes hard to measure ROI in just connecting with people who don't usually talk to their healthcare providers.
"In some cases this was the only positive communication they got all day," she said. "That really mattered to them."
LaRocca said she also found other ways to measure ROI than in clinical outcomes. For many of her patients, she said, this project wasn't necessarily about improving one's health as it was about finding a friendly connection, making healthy choices and improving one's self-confidence.
"One of my objectives … was to unmedicalize health," she said.
At the other end of the spectrum was Mary Neagle, MSW, a program manager for Mass General's Integrated Care Management Program. Her project, undertaken in 2006, involved setting up a home-based telemonitoring program for medically complex patients, those with two to four comorbidities and taking more than a dozen medications a day. Neagle said these patients are the top drivers of costs and hospital admissions, and are well known in the system ("Everybody knows their names," she said.).
Neagle's program worked to have those patients record their weight and other vital signs each day. That data was used in daily communications with care managers, and was shared with all members of the care team.
The ROI for this program was rooted in clinical outcomes, particularly reduced medical emergencies and fewer hospitalizations.
"We found that this was a really successful tool for many patients," she said. And for their care providers, she added, having "those extra sets of eyes and ears" helped to make sure each complex care plan was being followed.
All three panelists agreed that mobility plays an important part in bringing care to the patient, rather than trying to get the patient to come in for care. By tailoring programs around the patient and making providers a partner in that process, patient engagement improved, and the outcomes – whatever they were – were positive.
Sree Chaguturu, MD, vice president of Partners HealthCare's Population Health Management program and the panel's moderator, said remote monitoring programs have to focus on the intangibles. Set something up with perhaps one goal to strive for, but keep an open mind to measuring other results.