Jt Comm J Qual Patient Saf. 2024 Nov;50(11):775-783. doi: 10.1016/j.jcjq.2024.07.004. Epub 2024 Jul 26.
Congestive heart failure (HF) is a leading cause of hospitalization and readmission, leading to increased health care utilization and cost. This is complicated by high incidence, prevalence, and hospitalization rates among racial and ethnic minorities, with a widening in the mortality disparity gap. Remote patient monitoring (RPM) has the potential to proactively engage patients after discharge to optimize medication management and intervene to avoid rehospitalization. However, it also may widen the equity gap due to technological barriers and bias.
A prospective, observational quality improvement (QI) initiative leveraging an amended tool from the Institute for Healthcare Improvement Model for Improvement was incorporated with an equity lens and five Plan-Do-Study-Act (PDSA) cycles at a single site. The intervention used an HF bundle that included RPM, clinical telepharmacy, remote therapeutic monitoring, and community paramedicine.
Between May 2022 and March 2023, five PDSA cycles were run involving 90 enrolled patients. In total, 38 (42.2%) patients received the complete HF bundle, 42 (46.7%) a partial bundle, and 10 (11.1%) only RPM. The patients with the complete bundle had a readmission rate of 2.6% compared to 14.3% in the partial bundle and 20.0% in RPM alone. The biggest impact of this program was the incorporation of community paramedicine. The program also noted an improvement in equitable enrollment after adjusting mid-program by avoiding cellular phone-enabled devices and transitioning to a hub-based model.
This single-site QI-based initiative implemented an HF-based RPM program that leveraged clinical telepharmacy and community paramedicine. This program identified a disparity of care gap regarding the equitable distribution of services and made mid-study adjustments to improve the disparity gap. The program found that use of the HF bundle resulted in a decreased hospital readmission rate.
充血性心力衰竭（HF）是住院和再入院的主要原因，导致医疗保健利用率和成本增加。这种情况因少数族裔的发病率、患病率和住院率高而变得更加复杂，而且死亡率差距也在扩大。远程患者监测（RPM）有可能在出院后积极与患者互动，优化药物管理并进行干预以避免再次住院。然而，由于技术障碍和偏见，它也可能扩大公平差距。
一项前瞻性观察性质量改进（QI）计划，利用来自改善医疗保健国际研究所（IHI）的改进模型工具，结合公平视角和五个计划-执行-研究-行动（PDSA）循环，在一个地点实施。该干预措施使用了一个 HF 套件，包括 RPM、临床远程配药、远程治疗监测和社区护理人员。
在 2022 年 5 月至 2023 年 3 月期间，进行了五个 PDSA 循环，涉及 90 名入组患者。共有 38 名（42.2%）患者接受了完整的 HF 套件，42 名（46.7%）接受了部分套件，10 名（11.1%）仅接受 RPM。接受完整套件的患者再入院率为 2.6%，而部分套件和 RPM 单独治疗的患者再入院率分别为 14.3%和 20.0%。该计划的最大影响是纳入了社区护理人员。该计划还注意到，通过避免启用蜂窝电话的设备并过渡到基于中心的模型，在中期调整后，公平参与率得到了提高。
这项基于单点的 QI 计划实施了一项基于 HF 的 RPM 计划，该计划利用了临床远程配药和社区护理人员。该计划发现了服务公平分配方面的护理差距，并在研究中期进行了调整以缩小差距。该计划发现，HF 套件的使用降低了住院再入院率。
