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Clinical Studies

Case study: remote monitoring for cystic fibrosis in children

By July 28, 2021October 3rd, 2021No Comments

Addenbrooke’s Hospital, Cambridge, UK with satellite sites at Ipswich Hospital and Peterborough City Hospital

The Paediatric Respiratory Service at Addenbrooke’s Hospital, together with satellite sites at Peterborough City and Ipswich Hospitals, provide expert care to children with lung conditions.  Thank you to staff at these centres for sharing their experiences of establishing a remote monitoring programme for over 150 children with cystic fibrosis and other complex respiratory conditions. 

Indication:

Cystic fibrosis and chronic respiratory conditions, including complex asthma and respiratory complications of neuromuscular disease, in paediatrics (aged 6 years+).

Clinical centre: 

Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK.

Satellite sites at Ipswich Hospital and Peterborough City Hospital.

The situation: 

Paediatric patients with chronic respiratory conditions like cystic fibrosis typically require spirometry assessments every three months. This is usually conducted at routine out-patient clinics – but this became impossible during COVID-19 due to the severe restrictions around aerosol generating procedures.

The aim:

An alternative to clinic spirometry was urgently required to provide ongoing care for chronic respiratory condition patients.  The primary aim was to enable lung function assessment of paediatric patients during virtual consultations.

Solution: 

Remote monitoring using the patientMpower platform was implemented for paediatric patients aged six and over. The solution deployed comprised:

  • The  patientMpower app: Patient and carer versions of the app enable parents and older children to be involved in care.

  • Integrated spirometer: The Bluetooth enabled device is clinically validated in children from age 6 years and older.

  • Web based clinical portal: Patient captured data is shared in real time with the clinical team via a web based portal.

Implementation: 

Implementing remote monitoring for a paediatric population during a pandemic presented some unique challenges. Initial patient set-up was mostly face-to-face, to enable childrens’ height to be accurately assessed (as a determinant of predicted lung function) and to provide coaching on spirometry technique. Given concerns regarding technique in children, home devices were validated against the clinical spirometer during set-up, which showed good reproducibility. To ensure safety set-up was conducted in a non-clinical building on the hospital grounds, with spirometry conducted outside.

Day-to-Day Running:

Remote monitoring is now integrated into standard clinical practice. Routine reviews of patients are now being conducted both virtually and in-clinic on an alternate basis, reducing out-patient appointments from four to two visits per year. Joint access to the clinical portal across tertiary and satellite sites has been valuable in enabling shared care.

Perceptions and Feedback: 

The patientMpower platform was easily adopted by clinical users. Review of patient data typically takes around 30 minutes per week, substantially off-set by the advantages of  earlier identification of complications or avoiding clinic presentations.

Home monitoring is generally preferred to out-patient appointments by patients and families due to reduced travel time, less school and work absenteeism and avoiding risk of hospital infections. Any initial patient/carer reluctance regarding accuracy of home assessments is reducing,  with growing confidence in reproducibility versus clinic measurements.

Outcomes: 

  • Ensured continuity of care for over 150 patients during the COVID pandemic

  • 50% of out-patient clinic appointments now being conducted virtually

  • Increasing clinic capacity during COVID recovery, with clinical contacts comparable to pre-pandemic levels

  • Enabling early identification of complications, resulting in rapid in-patient admission and successful treatment

  • Avoiding CF clinic visits and providing reassurance for patients requiring advice

  • Reducing burden of care on patients and families

  • Enabling shared care

Next Steps:

With increasing familiarity with the platform, the clinical staff are examining the use of the platform in aiding future care prioritisation or to help provide tailored patient care.

The clinical team at Addenbrooke’s Hospital’s Paediatric Respiratory Service have kindly agreed to share their standard operating procedures for the benefit of other NHS centres setting up similar programmes. Please contact us hcp@patientMpower.com if you are based at a clinical centre interested in establishing a remote monitoring programme in respiratory health, post kidney transplantation or for patients with heart failure. 

Weighing Scales

Get valuable health insights by using our Bluetooth connected weighing scales to monitor body weight. Measured values will be transferred directly to the patientMpower application for healthcare professionals to review in real time.

Blood Pressure Monitor

Our Bluetooth enabled blood pressure monitor accurately measures patients’ blood pressure, measured values will be transferred directly to the patientMpower application for healthcare professionals to review in real time.

Pulse Oximeter

Our Bluetooth connected pulse oximeter measures arterial oxygen saturation and heart rate. Measured values will be transferred directly to the patientMpower application for healthcare professionals to review in real time.

Spirometer

Spirobank SMART spirometer - connects to patientMpower app via Bluetooth for seamless recording of pulmonary function. Measured values will be transferred directly to healthcare professionals to review in real time. Measures:

  • Forced Vital Capacity (FVC)
  • Forced Expiratory Volume in 1st second (FEV1)
  • PEF
  • FEV1/FVC
  • FEV6
  • FEF25/75

US Reimbursement for remote monitoring 

How will you get paid? Centers for Medicare and Medicaid Services (CMS) have reimbursement codes available for remote patient monitoring (RPM).

US Reimbursement for remote monitoring 

How will you get paid? Centers for Medicare and Medicaid Services (CMS) have reimbursement codes available for remote patient monitoring (RPM).