Abstract Rationale In 2016, Pulmonary Disease Navigators (PDNs) were implemented in five Intermountain Health trauma hospitals. PDNs utilized medical executive approved chronic obstructive pulmonary disease (COPD) exacerbation protocols based on Global Initiative for Chronic Obstructive Lung Disease standards. PDNs utilized a manual process for following admitted/discharged subjects. Prior to PDN implementation, enterprise COPD readmissions were18.2%. Utilizing this baseline rate, a technology driven COPD Playbook guiding disease management was created. PDNs, using the protocol, decreased 30-day hospital readmissions to 7%. The same process was then created for adult asthma management with the protocol based on Global Initiative for Asthma guidelines. The reported improved outcomes allowed the exploration of EHR solutions with remote subject monitoring (RPM) devices and artificial intelligence (AI) to scale population health management. The Intermountain Health COPD & Adult Asthma Remote Evaluation (iCARE) study launched in March 2024. The study utilizes RPM device data on subject Smartphones® blue-toothed® to the AI platform. RPM device data includes: forced expiratory volume (FEV1), heart rate, respiratory rate, perfusion index, oxygen saturation, “jackets” on inhalers to record date, time, inspiratory flow, inhaler shake compliance as applicable, and moisture in dry powdered inhalers. We sought to identify exacerbations earlier and intervene remotely hypothesizing this would decrease hospital admissions, readmissions and cost. Methods To assess the efficacy of personalized care augmented by “high-touch, high-technology”, three data sources are utilized: 1) medical records, subject feedback, physiologic data from the RPM devices, 2) data assessment for risk escalation to PDNs and nudges to subjects, and 3) a feedback loop of physiologic data, subject surveys, air quality, and PDN notes. Limits and thresholds are stratified by parameter severity based on pre-determined thresholds displayed as red, yellow, or green on the PDN’s continual monitoring dashboard. There are 18,000 to 21,000 data points/subject analyzed with 1,500-1,800 potential nudges/alerts per subject. Data is used to prioritize care for those suspected of early exacerbations to determine needed therapeutic intervention(s) and revisions of the patient’s personalized care plan coordinated with subjects’ physician. Results Eight hundred and forty-eight subjects have enrolled in the study to date with 767 currently active. Of these, 697 have complete data. Hospital admissions, readmissions, and cost pre-/post-study enrollment of study subjects are reported in Figure One. Conclusions Consolidating, adapting, and codifying known care elements for COPD and adult asthma utilizing RPM on an AI platform appears to reduce hospital admissions, readmissions, and cost in this subset of subjects. This abstract is funded by: Intermountain Health, CareCentra, and Adherium
Bennion et al. (Fri,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: