There's No Place Like Home

Featured Image: Ralph Page

2022 was the worst year of Ralph Page’s life.

“I went into the hospital with a stroke, and I needed some pretty comprehensive care, so they sent me to a long-term-care place,” recalls Ralph, who was 88 at the time and managing chronic heart disease, including heart failure and atrial fibrillation.

“While I was there, I had a more serious stroke, and I wound up staying more than three months before I was able to come home. It was difficult, and even more so because in March 2022 my wife passed away.”

Fortunately, a telehealth option called remote patient monitoring, or RPM for short, allowed Ralph to come home sooner than he might have otherwise, to recover physically and emotionally in a comfortable and familiar environment, surrounded by family. 

How does it work? Remote patient monitoring uses technology to track certain aspects of a patient’s health while a patient is at home. The technology feeds data about symptoms to health care providers, which allows them to monitor and manage acute and chronic conditions while still supporting a patient where they want to be – at their home.

The service, offered by The UVM Health Network - Home Health & Hospice, often helps improve recovery outcomes and a patient’s quality of life by reducing the length of their hospital stay and, in many cases, preventing a return trip to the hospital. The program allows patients to wirelessly transmit their vital signs from home to a nurse who can call if there are any changes or concerns.

Many RPM patients are cardiac patients who are returning home after a heart bypass surgery or who, like Ralph Page, have congestive heart failure. Others may have any of a number of chronic conditions that affect the heart or lungs, such as Chronic Obstructive Pulmonary Disease (COPD), or more common conditions like diabetes.

 “Hospitals are actually a terrible place to recover,” says Michael Latreille, MD, Primary Care Physician with The University of Vermont Health Network - UVM Medical Center. Patients get poor sleep because they’re constantly being woken up for vitals, alerts, blood draws, you name it. And you’re connected to all these tubes and wires, which also create an elevated fall risk. People recover better at home whenever it’s medically feasible.”

For Ralph, who is one of Dr. Latreille’s patients, that was certainly the case. “Once I got home, under the care of the home health nurse and my daughter Margaret, things began to pick up,” he says, noting that he enjoys frequent visits from his children and grandchildren.

Patients, many of whom are in their 80s and 90s, rarely have trouble operating the devices, according to Jaimie McKenzie, RPM Nurse Coordinator. The Home Health & Hospice care givers take time to introduce each patient to the monitoring devices, and when questions come in, the team is responsive to patient questions and concerns.

It’s as simple as this: A patient’s tablet dings and lights up each day to remind them to collect their vital signs. To log on, patients simply touch an icon on the screen and enter a simple 4-digit passcode. Each session starts with a health-education fact and a check-in question like, “Do you have enough of your medications to get you through the weekend?” If the patient reports concerning symptoms or has a question, a nurse gets an alert.

Ralph, who doesn’t use email, navigated it easily. “I am the least technical person in the world, but the system was quite easy to use. I had no problem with it,” he says. The technology has evolved to the point where now, everything needed -- tablet, stand, Bluetooth-enabled blood pressure cuff, digital scale, and fingertip pulse oximeter – fit in a plastic shoebox-sized container. If necessary, the patient can use their own thermometer and glucometer to monitor their temperature and blood glucose.

“Remote Patient Monitoring gives us all the items of interest, such as daily weight for congestive heart failure patients, glucose levels for patients with diabetes, and so on,” says Dr. Latreille. “If we see something that gets our attention, we can get in contact with the patient before the wheels come off the wagon, so to speak.”

In Ralph’s case, the daily weight monitoring alerted his caregivers that he was starting to retain fluid, a symptom of worsening heart failure. He had a brief trip to the hospital to remove the fluid, and Dr. Latreille prescribed an additional diuretic.

“We nipped things in the bud,” says Dr. Latreille.

While RPM is not a standalone service and doesn’t take the place of home visits, McKenzie and Dr. Latreille agree that this program is an example of using advances in medical technology to effectively manage patients with acute and chronic conditions while also giving them what they so often ask for: the ability to recover at home. While Remote Patient Monitoring can help prevent health complications in patients, it is particularly impactful for patients who aren’t able to easily travel because of certain health conditions. Patients also benefit because they learn how to self-monitor what’s normal and what’s not normal, so they can better communicate with their doctor.

Since his program ended in April, Ralph has continued to monitor his vital signs daily. “I like to know how I’m doing. And Dr. Latreille wants to keep pretty close tabs on me. He’s been my doctor for a long time, and I have every confidence in the world that I’m getting good care.”

In general, Ralph is feeling good. “I’m in really good shape. I’m not driving anymore, but I don’t have much trouble with my mobility. I can walk with a cane. Actually, I can walk quite well without the cane, but nobody wants me to,” he laughs. “I’m 98% back.”