Increasing Remote Patient Monitoring Usage Among Heart Failure Patients via a New Clinic Protocol: A Quality Improvement Project

Background: Heart failure effects six million adults in the United States and the prevalence is expected to increase 46% from 2012 to 2030. The advancement of technology has provided significant improvements to our disease management of heart failure, specifically, the use of remote patient monitoring (RPM). The lack of technological competency and overall use of RPM among clinic staff has been identified as potential quality improvements that could benefit both patient and provider. Methods: A quality improvement project was developed to educate clinic staff (physicians, nurses, advanced practice providers, and medical assistants) on utilization of RPM and increase the overall ordering frequency. Data was gathered from a pre-survey that assessed staff's (n=17) perceived barriers to RPM ordering and helped to lay the frame work for a new clinic protocol. The protocol was created and implemented with incorporated screenshots, example dialogue, and a flowsheet demonstrating the RPM ordering process. RPM order frequency was then compared for seven weeks for both pre- and post- implementation to assess the protocol's effectiveness. At the end of the post-implementation collection period, another survey was distributed to assess protocol useability, feasibility, and satisfaction among the clinic staff who used the protocol. Results: Post-protocol implementation showed a 2.3% total increase in RPM order frequency when compared to pre-protocol. Post-protocol implementation data also revealed that of the 23 RPM orders were submitted on the day of the patient's clinic visit, 18 (78.3%) occurred within the first two weeks of the protocol initiation. Every medical assistant (n=5) reported being satisfied with the protocol and all but one intended to continue using it. Conclusions: The new clinic protocol, focused on technological competency and utilization, proved to increase RPM ordering frequency. The most significant limitation to our project was the lack of provider utilization of the protocol. While the providers helped create and supported the clinic protocol, it was decided that the actually ordering of RPM would be delegated to the medical assistants. Looking forward, patient resource accessibility and increased clinic promotion with all role use of the protocol may further boost order frequency.