Over the past decade, the University of Oklahoma College of Medicine has witnessed a significant rise in the number of highly complex infections. This is attributed to several factors such as the declining health of the Sooner State population, the increase in complex surgeries performed by surgeons at the Oklahoma City-based medical school, and the substantial growth in immunosuppressive therapeutics for various diseases. The health system has also noticed a surge in antimicrobial resistance, limiting therapeutic options to parenteral/intravenous antibiotics. In response to this need, the outpatient parenteral antimicrobial therapy (OPAT) program was established, allowing patients to receive intravenous antibiotics at home. However, the day-to-day operations and ensuring patient adherence pose challenges. Remote therapeutic monitoring (RTM) technology offers promising solutions in this regard.

How Remote Therapeutic Monitoring Works

The patented RTM device latches onto the tube coming out of the IV antibiotic bag/pump/IV push and detects the flow of medication through the tube using proprietary technology. It records the start and end times of infusion and transmits the data through cellular communication to the company's AI system called IVE Mind. This system compares the observed infusions with the expected infusions based on the patient's treatment plan prescribed by their physician and generates an adherence rate and a weekly adherence report. Accountability/monitoring occurs at two levels - the company provides a team of infusion case managers to monitor daily adherence data and communicate with the patient if there is any lapse in adherence. The weekly adherence reports are also scanned into the patient's medical record.

The software is capable of interfacing with the Epic EHR, ensuring seamless integration into the healthcare system. Upon consenting, the patient is given a monitoring device and receives structured follow-up support. The first phone call occurs the day after discharge to confirm enrollment and address any immediate questions. Weekly check-in calls are scheduled to monitor progress and encourage adherence. Additional calls are made if any adherence issues arise.

Results of the Clinical Trial

The University of Oklahoma College of Medicine conducted an interim analysis with 64 patients enrolled on RTM and 95 contemporaneous controls. The two groups were similar in terms of baseline demographic characteristics, type of infection, insurance coverage, comorbid conditions, prior healthcare utilization, duration of outpatient therapy, and number of antibiotic doses per day. The results showed a sharp decrease in infection-related readmissions in the RTM group. At 30 days, there was a 74% reduction (4.7% versus 17.9%), at 60 days a 72% reduction (7.8% versus 28.4%), and at 90 days a 56% reduction (14.1% versus 31.6%). When a multivariable logistic regression model was built, controlling for various factors, the odds of infection-related readmissions were decreased in the RTM group by 76% at 30 days, 80% at 60 days, and 68% at 90 days.

The sustained response is significant, showing that RTM can break the vicious circle of never-ending infections and hospital readmissions. The median overall adherence rate in the RTM group was 94%, but the range was 18% to 100%, indicating that some patients need more support. More than half of the patients in the RTM group needed an extra intervention from the study team, and two-thirds of these interventions happened within the first week after hospital discharge. This early identification of issues allowed for better patient care and set them up for success.

Advice for Others

Remote therapeutic monitoring is a major technological breakthrough that has the potential to transform healthcare. It can change clinical outcomes in a tangible and beneficial way, as demonstrated by the University of Oklahoma College of Medicine's clinical trial. Healthcare organizations and physician practices should evaluate how RTM can be incorporated into their clinical practice and value-based care models. It has a wide range of applications in healthcare delivery, not only within OPAT but also in other home infusion models and pharmaceutical research.

The data generated by RTM has driven the University of Oklahoma College of Medicine to simplify some antibiotic regimens for some patients, increasing their adherence to 100%. Patients enrolled in the trial also reported feeling supported during their transition of care and throughout their antibiotic course, which contributed to their success.

Home healthcare in the 2020s has undergone a remarkable transformation. While some may recall the image of doctors making house calls with their black medical bags from the 1950s, the current landscape is vastly different. In 2024, it is not only a growing trend but one with a purpose - to maximize resources while ensuring the comfort and security of patients.

Revolutionizing Healthcare at Home

Why the Need for Home Healthcare is Growing

The world's population is aging, and this demographic shift is driving the demand for home healthcare. According to the World Health Organization, between 2015 and 2050, the proportion of the population over 60 years will increase from 12% to 22%. Additionally, people aged 80 years or older are expected to triple during the same period. A John A. Hartford survey from 2021 indicated that 71% of older adults prefer not to live in a nursing home. Coupled with a shortage of healthcare workers and emerging technologies, home healthcare is set to become a new wave in healthcare. In Kentucky, for example, the Cabinet for Health and Family Services lists roughly 80 entities with Medicaid provider identification numbers for home health, ranging from large healthcare providers to local health departments.A MedicalTechnologySchools.com report projects that nearly 8,000 home health and personal care aide jobs will be added in Kentucky between 2020 and 2030, representing a growth of more than 35%. In a Stacker.com list of most in-demand nursing jobs in the state, home health nurse tops the list, even surpassing registered nurses and nurse practitioners.

Services Offered by Home Health

To qualify for home health assistance, per Medicare guidelines, patients must have difficulty leaving the home, such as needing a walker, or be recommended by a doctor not to leave due to a medical condition. Telehealth has gained significant popularity since the COVID pandemic. What was once a trip to the doctor's office for a follow-up check can now be a virtual video chat, keeping patients at home and easing the strain on understaffed doctors' offices.Another development is home-monitoring technology. For instance, if a patient needs ongoing observation for a heart condition, it can be assessed from their own couch instead of through a hospital stay or repeated doctor visits. They may have an in-home unit or wear a biometrics device that monitors vital signs and transmits data in real time.Home health agencies are now capable of handling a wide range of services, from surgical recovery to end-of-life care. A patient can have hip replacement surgery at a hospital and go home the same day to receive follow-up care and rehab at home. The same applies to rehabbing an injury or various physical ailments. Home healthcare services can range from 24-hour-a-day in-home care to simple scheduled medication and meal drop-off.

The Benefits of Home Healthcare

The main benefit of home healthcare is better patient outcomes. The industry is still determining when home healthcare is a better option than clinical care. The ongoing shortage of healthcare workers has led to patients being discharged from hospitals too quickly, resulting in readmissions that stress both staff and facilities. Additionally, hospital reimbursements for readmitted patients are lower, further driving the move towards home healthcare. In general, people prefer to be treated or rehabilitated at home whenever possible.Finding the ideal balance between clinical care and home healthcare while building the workforce is a current challenge for the entire industry. It not only eases stress on healthcare systems but also ensures that patients receive the care they need.

Training More Healthcare Workers

Healthcare staffing shortages have been a long-standing problem, and in some states like Kentucky, it is critical. Rural areas face challenges with the closure of medical facilities and the purchase of doctors' offices by large corporations. Home health can make a significant difference in these areas by providing better outcomes for patients.A recent initiative by the University of Kentucky, the Advancing Kentucky Together Network, aims to build Kentucky's healthcare workforce and train new healthcare workers. The initiative will invest millions of dollars in resources to support partners in tracking, measuring, and documenting patient outcomes, enhance educational opportunities, and expand community outreach. Keeping people close to their homes and finding the best way to provide care effectively are key goals."Patients want to receive care at home; they do well at home," said Stephanie Henry. "There is a greater need for home care. Value-based care and optimizing care delivery is the trend - the right level of care at the right time. If possible, patients would rather be at home for these services."