Telemedicine for Improving Outcome in Inner City Patient Population With Hypercapneic Respiratory Failure
| Status: | Terminated |
|---|---|
| Conditions: | Chronic Obstructive Pulmonary Disease, Insomnia Sleep Studies, Obesity Weight Loss, Neurology, Pulmonary, Pulmonary |
| Therapuetic Areas: | Endocrinology, Neurology, Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 10/31/2018 |
| Start Date: | October 18, 2017 |
| End Date: | October 26, 2018 |
Telemedicine as a Proposed Solution Towards Efficiency of Healthcare Delivery for Einstein Pulmonary Patients on PAP/NIPPV for Hypercapnia
The Hypercapnia Telemedicine Outreach Program (E-TOUCH Study) aims to utilize telemedicine
technology, as well as emergency medical services (EMS) home visits to address the problem
with poor follow-up and compliance among Einstein's hypercapnic patients.
The hypothesis is that reaching out to the subjects' homes will allow more consistent
healthcare delivery, increase healthcare efficiency and compliance with therapy, and overall
decrease acute decompensated states / hypercapnic respiratory failure, decreasing ED visits
and hospitalization.
technology, as well as emergency medical services (EMS) home visits to address the problem
with poor follow-up and compliance among Einstein's hypercapnic patients.
The hypothesis is that reaching out to the subjects' homes will allow more consistent
healthcare delivery, increase healthcare efficiency and compliance with therapy, and overall
decrease acute decompensated states / hypercapnic respiratory failure, decreasing ED visits
and hospitalization.
Hypercapnic respiratory failure is a prevalent medical problem, comprising a substantial
number of ED visits and readmissions. The target population that are at high risk for
developing hypercapnia are patients with obesity hypoventilation syndrome (OHS), chronic
obstructive pulmonary disease (COPD), sleep disordered breathing (SDB) overlapping with COPD,
and patients with neuromuscular disorders. These patients are commonly managed in the
progressive care units or the intensive care unit for extended periods of time, which can
over-utilize health systems resources. Einstein Medical Center's patient population includes
multiple low-income communities / neighborhoods. Their educational background varies and
constant education and counseling is an integral part of the treatment plan. These patients
are particularly vulnerable due to a lack of geographic access and difficulty contacting
healthcare providers via phone. Some of the patients may not be able to afford co-pays for
clinic visits or are not able to follow up with a physician. In addition, patients treated
with non-invasive ventilation in the hospital and require home therapy either never receive
the device or are sub-optimally trained in its appropriate utilization. These patients may
also be morbidly obese with mobility issues, which is another obstacle preventing patients
from following up with their providers.
Positive airway pressure (PAP) therapy/ non-invasive positive pressure ventilation (NIPPV)
are effective treatments to avoid acute hypercapnic respiratory failure; however, low
compliance and poor follow-up are often recurring issues. These high-risk patients present in
the emergency department acutely hypercapnic and encephalopathic with subsequent ICU
admission and mechanical ventilation.This Telemedicine Outreach Program aims to utilize
E-touch devices (Vivify-Go) in collaboration with home visits by EMS (Emergency medical
services) to improve compliance and the efficiency of healthcare delivery. These efforts will
hopefully lead to a decrease in acute decompensated respiratory states and hospital
readmission rates.
number of ED visits and readmissions. The target population that are at high risk for
developing hypercapnia are patients with obesity hypoventilation syndrome (OHS), chronic
obstructive pulmonary disease (COPD), sleep disordered breathing (SDB) overlapping with COPD,
and patients with neuromuscular disorders. These patients are commonly managed in the
progressive care units or the intensive care unit for extended periods of time, which can
over-utilize health systems resources. Einstein Medical Center's patient population includes
multiple low-income communities / neighborhoods. Their educational background varies and
constant education and counseling is an integral part of the treatment plan. These patients
are particularly vulnerable due to a lack of geographic access and difficulty contacting
healthcare providers via phone. Some of the patients may not be able to afford co-pays for
clinic visits or are not able to follow up with a physician. In addition, patients treated
with non-invasive ventilation in the hospital and require home therapy either never receive
the device or are sub-optimally trained in its appropriate utilization. These patients may
also be morbidly obese with mobility issues, which is another obstacle preventing patients
from following up with their providers.
Positive airway pressure (PAP) therapy/ non-invasive positive pressure ventilation (NIPPV)
are effective treatments to avoid acute hypercapnic respiratory failure; however, low
compliance and poor follow-up are often recurring issues. These high-risk patients present in
the emergency department acutely hypercapnic and encephalopathic with subsequent ICU
admission and mechanical ventilation.This Telemedicine Outreach Program aims to utilize
E-touch devices (Vivify-Go) in collaboration with home visits by EMS (Emergency medical
services) to improve compliance and the efficiency of healthcare delivery. These efforts will
hopefully lead to a decrease in acute decompensated respiratory states and hospital
readmission rates.
Inclusion Criteria:
- Adult patients > 18 years of age
- Evidence of hypercapnia (PCO2 ≥ 45mmHg) secondary to COPD-OSA overlap, OHS,
Neuromuscular disease / weakness
- Requiring NIV / NIPPV outpatient
- Ability to operate a smart device / tablet
- Informed consent
Exclusion Criteria:
- Non-English or Non-Spanish- speaking (device videos and surveys are available in
English or Spanish only)
- Patients unable to give consent
- Pregnant women
- Prisoners
- Patients <18 years of age
- Patient already on NIPPV/ CPAP at home and compliant on therapy
- Significant non-pulmonary conditions (CHF with EF < 40%), Pulmonary hypertension with
PASP> 60 mmGH, severe valvular heart disease, end-stage renal disease or end-stage
liver disease.
- Patients without health insurance
- Residing out of state (Pennsylvania)
- Patients with current or history of drug / narcotic dependence
We found this trial at
1
site
Korman Research Pavilion%2c Suite 100
Philadelphia, Pennsylvania 19141
Philadelphia, Pennsylvania 19141
215-456-7215
Phone: 215-456-6950
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