Implementation of a novel remote patient monitoring device in a home parenteral nutrition program during the global COVID-19 pandemic

Background: The global COVID-19 pandemic forced the abrupt transition of in-person clinic visits to a virtual care platform in the Home Parenteral Nutrition (HPN) Program. Remote patient monitoring technology (TytocareTM) allows for accurate and validated vital sign and nutritional assessment by the caregiver which is shared asynchronously or in real-time with medical providers. This novel FDA-approved device provides high quality data, facilitates precise clinical diagnosis and requires caregiver training and participation. Without remote patient monitoring, accurate nutritional assessments during virtual visits are challenging. The implementation process of this novel device after a 6-month pilot period was investigated. Methods: Tytocare™ (TytoHome™kits, weight scales, pulse oximeters and blood pressure machines) devices (Figure 1) were provided through a Federal Communication Commission grant funding the employment of telemedicine services during the COVID-19 pandemic. 139 devices were deployed to all patients in the HPN program through mail or clinic visit/hospital distribution. 21 Tytocare™devices were returned or not accounted for due caregivers not yet reporting to have received the device (n=10), caregiver opt-out (n=4), discharge from the HPN program (n=3), repatriation (n=2), prolonged inpatient admission (n=1) and death (n=1). From November 2020 through May 2021, 97 unique Tytocare™visits were completed. Patients/caregivers were trained on how to use the TytoCare™app with their device. Patients either saw a provider online in a real-time virtual visit or submitted a TytoCare™exam asynchronously in preparation of their scheduled virtual clinic visit. Assessments included weight, pulse oximetry, heart rate, respiratory rate, blood pressure and temperature. Precise photographs of key components of the examination of a patient with intestinal failure on HPN were sent, including central venous catheter (CVC) dressings, CVC insertion sites, skin rashes and enteral tube sites. A 10-question patient experience survey was emailed to the 118 caregivers with active devices after 6 months of device deployment. Results: 85% (n=118) of patients in our HPN program reported use of the Tytocare™device during or prior to telehealth visits. Patient age ranged from 5 months to 34 years old. Of the nine responses received, results were overall favorable. The average was 7.22 for patient satisfaction (ten-level Likert scale;1 = extremely unsatisfied, 10 = extremely satisfied). 0 disagreed with the statement regarding the Tytocare™device being helpful for patient care management (five-level Likert scale;1 = strongly agree, 5 = strongly disagree) and the average for recommending the device to others was 7.56 (ten-level Likert scale;1 = extremely unlikely, 10 = extremely likely). Conclusion: With the assistance of the Innovation and Digital Health Accelerator team, the HPN program successfully and promptly implemented a remote patient monitoring program to complement our telehealth platform. The ability to utilize Tytocare™during the global COVID-19 pandemic was well-received by caregivers of patients requiring home parenteral nutrition. Of the survey responders, caregiver satisfaction and experience were favorable. However, the data presented may not be a true representation of overall impressions given the limited response rate. Future studies will investigate the feasibility, accuracy and impact of remote patient monitoring in complex pediatric populations and will focus on improving patient experience survey response rates.