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This study investigates the use of remote patient monitoring (RPM) and quality metrics within hospital at home (HaH) units. Semi-structured interviews were conducted with leaders from 9 institutions with HaH programs to assess RPM capabilities and the use of quality metrics, finding variability in RPM implementation and quality measurement. The study highlights the need for standardized RPM practices and patient-centered quality metrics in HaH settings.
The variability in RPM use and quality measurement across HaH units suggests a need for standardized protocols to ensure consistent and effective remote patient care.
Background Remote patient monitoring (RPM) holds potential in improving the quality and accessibility of hospital at home (HaH) care. However, no studies have described the use of quality metrics to evaluate HaH RPM and limited guidance exists to inform best practices. Therefore, we sought to characterize RPM usage and its quality initiatives within HaH units. Methodology Semi-structured interviews of HaH leaders were conducted using an interview guide focused on the RPM capabilities of each institution and use of quality metrics. We classified quality metrics according to the National Quality Forum’s Telehealth Measurement Framework Domains and Subdomains. Additionally, we performed a thematic analysis of motivations for and barriers to RPM quality measurement. Results We invited potential participants at 14 institutions and ultimately interviewed participants representing 9 institutions (response rate, 64%). Participants represented HaH units primarily at community health systems (5/9) in urban geographies (6/9) with relative mature RPM programs (6/9, implemented remote patient monitoring for 2 or more years). All participating institutions had remote vital sign monitoring, while the minority deployed monitoring equipment to capture a continuous single lead EKG (3/9) or detect falls (3/9). Most institutions utilized quality metric(s) related to operational and technical effectiveness. Only 2 institutions reported measuring a metric related to access to care. Data fidelity concerns were the most cited barrier (4/9) to quality metric development. Conclusions We found varied RPM use across HaH units and identified variation in quality measurement use and content. Development of RPM standards and patient-centric quality metrics is warranted to guide HaH and RPM leaders in implementing and advancing the use of this technology as a key pillar of high-quality, accessible HaH care.
