Home monitoring effectiveness studied

Sinai using web-connected devices to engage heart patients, improve care

Derek Scott and his wife had just dropped off two of their three children at school one day last fall when he started having trouble breathing. By the time the Pikesville father arrived at Sinai Hospital’s emergency room he was gasping for air.

“I didn’t know what was going on,” Scott said. “And I couldn’t even talk well enough to tell anyone what was wrong.”

It turned out that Scott, 44, was among the 6 million Americans suffering from heart failure, a complex condition that keeps the heart from pumping normally. The condition is often poorly managed, sending about a quarter of patients back to the hospital within a month of their initial treatment.

When Scott returned to the emergency room two weeks later, again short of breath, he was enrolled in a study assessing the effectiveness of a new home monitoring program overseen by Dr. Mauro Moscucci, medical director of the LifeBridge Health Cardiovascular Institute and chairman of Sinai’s department of medicine.

The program is one of many efforts by health care providers to find the best method of engaging patients in their care at home so they stay out of the hospital.

Sinai’s program, in partnership with the American Heart Association, is testing intensive education and internet-connected scales and blood pressure cuffs that automatically send data to a team of clinicians who can interpret changes and intervene while there is still time.

“One of the challenges with telemonitoring has been getting patients to measure their blood pressure and weight consistently and report their results,” Moscucci said. “We are interested to see if this remote wireless technology will make it simpler and easier for them to be more consistent.”

Perhaps the most essential element of the program, however, is personal care plans that involve daily emails with reminders to take medications and tailored advice on diets and activity. Patients also can report how much they exercise, what they eat and whether they experience symptoms such as lethargy, shortness of breath or fluid retention that might indicate a brewing problem not captured by data.

Tonja Howell, clinical research manager for the study, checks patients’ vital signs remotely and answers questions via email or phone in concert with Moscucci. Doctors also look for trends. Howell said the goal is to enroll 50 patients in the study.

She and the doctor have responded when, for example, a patient’s blood pressure was dangerously high. They discovered that the man’s wife was out of town and he forgot his medication. They got him back on track in two days. Another patient with well-controlled glucose levels during the day was having spikes at night after his caretakers left, so they referred him for dietary education.

Not one of the 15 patients enrolled in the study has returned to the hospital this year, which is a relief to patients and to Sinai, as hospitals are penalized financially by federal and state regulators for unnecessary readmissions. Moscucci said 15 percent to 20 percent usually would be readmitted during that time span.

Patients will be followed intensively for six months with the aim of ingraining better habits in those with moderate to severe heart failure. If successful, the program could be rolled out to those with less severe heart failure, Moscucci said.

“We need to determine what can work for patients,” he said. “They may have gotten themselves into trouble, and not all patients will easily change their behavior. They need motivation and teaching.”