{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T06:31:23Z","timestamp":1772001083379,"version":"3.50.1"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003We report on our experience of deploying a continuous remote patient monitoring (CRPM) study soft launch with structured cascading and escalation pathways on heart failure (HF) patients post-discharge. The lessons learned from the soft launch are used to modify and fine-tune the workflow process and study protocol.<\/jats:p><jats:p>\n          Methods\u2003This soft launch was conducted at NorthShore University HealthSystem's Evanston Hospital from December 2020 to March 2021. Patients were provided with non-invasive wearable biosensors that continuously collect ambulatory physiological data, and a study phone that collects patient-reported outcomes. The physiological data are analyzed by machine learning algorithms, potentially identifying physiological perturbation in HF patients. Alerts from this algorithm may be cascaded with other patient status data to inform home health nurses' (HHNs') management via a structured protocol. HHNs review the monitoring platform daily. If the patient's status meets specific criteria, HHNs perform assessments and escalate patient cases to the HF team for further guidance on early intervention.<\/jats:p><jats:p>\n          Results\u2003We enrolled five patients into the soft launch. Four participants adhered to study activities. Two out of five patients were readmitted, one due to HF, one due to infection. Observed miscommunication and protocol gaps were noted for protocol amendment. The study team adopted an organizational development method from change management theory to reconfigure the study protocol.<\/jats:p><jats:p>\n          Conclusion\u2003We sought to automate the monitoring aspects of post-discharge care by aligning a new technology that generates streaming data from a wearable device with a complex, multi-provider workflow into a novel protocol using iterative design, implementation, and evaluation methods to monitor post-discharge HF patients. CRPM with structured escalation and telemonitoring protocol shows potential to maintain patients in their home environment and reduce HF-related readmissions. Our results suggest that further education to engage and empower frontline workers using advanced technology is essential to scale up the approach.<\/jats:p>","DOI":"10.1055\/s-0041-1740480","type":"journal-article","created":{"date-parts":[[2021,12,29]],"date-time":"2021-12-29T23:41:44Z","timestamp":1640821304000},"page":"1161-1173","source":"Crossref","is-referenced-by-count":9,"title":["Continuous Remote Patient Monitoring: Evaluation of the Heart Failure Cascade Soft Launch"],"prefix":"10.1055","volume":"12","author":[{"given":"Wei Ning","family":"Chi","sequence":"additional","affiliation":[{"name":"Outcomes Research Network, NorthShore University HealthSystem, Evanston, Illinois, United States"}]},{"given":"Courtney","family":"Reamer","sequence":"additional","affiliation":[{"name":"Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States"}]},{"given":"Robert","family":"Gordon","sequence":"additional","affiliation":[{"name":"Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States"}]},{"given":"Nitasha","family":"Sarswat","sequence":"additional","affiliation":[{"name":"Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States"},{"name":"Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States"}]},{"given":"Charu","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States"}]},{"given":"Emily","family":"White VanGompel","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States"},{"name":"Department of Family Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States"}]},{"given":"Julie","family":"Dayiantis","sequence":"additional","affiliation":[{"name":"Home and Hospice Services, NorthShore University HealthSystem, Evanston, Illinois, United States"}]},{"given":"Melissa","family":"Morton-Jost","sequence":"additional","affiliation":[{"name":"Home and Hospice Services, NorthShore University HealthSystem, Evanston, Illinois, United States"}]},{"given":"Urmila","family":"Ravichandran","sequence":"additional","affiliation":[{"name":"Health Information Technology, NorthShore University HealthSystem, Evanston, Illinois, United States"}]},{"given":"Karen","family":"Larimer","sequence":"additional","affiliation":[{"name":"Clinical Department, physIQ, Inc., Chicago, Illinois, United States"}]},{"given":"David","family":"Victorson","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine, Evanston, Illinois, United States"}]},{"given":"John","family":"Erwin","sequence":"additional","affiliation":[{"name":"Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States"},{"name":"Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States"}]},{"given":"Lakshmi","family":"Halasyamani","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States"},{"name":"Department of Family Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States"}]},{"given":"Anthony","family":"Solomonides","sequence":"additional","affiliation":[{"name":"Outcomes Research Network, NorthShore University HealthSystem, Evanston, Illinois, United States"}]},{"given":"Rema","family":"Padman","sequence":"additional","affiliation":[{"name":"The Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States"}]},{"given":"Nirav S.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United 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the American Heart Association","volume":"141","author":"S S Virani","year":"2020","journal-title":"Circulation"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.ahj.2017.01.003","article-title":"Trends in health care expenditure among US adults with heart failure: the medical expenditure panel survey 2002-2011","volume":"186","author":"J B Echouffo-Tcheugui","year":"2017","journal-title":"Am Heart J"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1161\/CIRCOUTCOMES.109.883256","article-title":"Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission","volume":"2","author":"H M Krumholz","year":"2009","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"14","key":"ref7","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1056\/NEJMsa0803563","article-title":"Rehospitalizations among patients in the Medicare fee-for-service program","volume":"360","author":"S F Jencks","year":"2009","journal-title":"N Engl J Med"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s10729-014-9316-9","article-title":"The cost of hospital readmissions: evidence from the VA","volume":"19","author":"K Carey","year":"2016","journal-title":"Health Care Manage Sci"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.ijcard.2018.12.043","article-title":"Heart failure: Same-hospital vs. different-hospital readmission outcomes","volume":"278","author":"S Lahewala","year":"2019","journal-title":"Int J Cardiol"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s11748-020-01286-6","article-title":"Remote monitoring for better management of LVAD patients: the potential benefits of CardioMEMS","volume":"68","author":"J F Veenis","year":"2020","journal-title":"Gen Thorac Cardiovasc 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Cardio"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1055\/s-0039-1685167","article-title":"Evaluating the effect of monitoring through telephone (tele-monitoring) on self-care behaviors and readmission of patients with heart failure after discharge","volume":"10","author":"R Negarandeh","year":"2019","journal-title":"Appl Clin Inform"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.ijmedinf.2005.03.007","article-title":"Understanding technology adoption in clinical care: clinician adoption behavior of a point-of-care reminder system","volume":"74","author":"K Zheng","year":"2005","journal-title":"Int J Med Inform"},{"issue":"07","key":"ref22","doi-asserted-by":"crossref","first-page":"e18072","DOI":"10.2196\/18072","article-title":"Understanding clinicians' adoption of mobile health tools: a qualitative review of the most used frameworks","volume":"8","author":"C Jacob","year":"2020","journal-title":"JMIR Mhealth Uhealth"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"e006513","DOI":"10.1161\/CIRCHEARTFAILURE.119.006513","article-title":"Continuous wearable monitoring analytics predict heart failure hospitalization: the LINK-HF multicenter study","volume":"13","author":"J Stehlik","year":"2020","journal-title":"Circ Heart Fail"},{"issue":"08","key":"ref24","doi-asserted-by":"crossref","first-page":"e0238065","DOI":"10.1371\/journal.pone.0238065","article-title":"Clinical Analytics Prediction Engine (CAPE): development, electronic health record integration and prospective validation of hospital mortality, 180-day mortality and 30-day readmission risk prediction models","volume":"15","author":"N Shah","year":"2020","journal-title":"PLoS One"},{"issue":"06","key":"ref25","doi-asserted-by":"crossref","first-page":"e137","DOI":"10.1161\/CIR.0000000000000509","article-title":"2017 ACC\/AHA\/HFSA focused update of the 2013 ACCF\/AHA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America","volume":"136","author":"C W Yancy","year":"2017","journal-title":"Circulation"},{"issue":"16","key":"ref26","first-page":"e240","article-title":"2013 ACCF\/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on practice guidelines","volume":"128","author":"C W Yancy","year":"2013","journal-title":"Circulation"},{"issue":"05","key":"ref27","first-page":"747","article-title":"Enhancing Recovery in Coronary Heart Disease (ENRICHD) study intervention: rationale and design","volume":"63","author":"ENRICHD Investigators","year":"2001","journal-title":"Psychosom Med"},{"issue":"10","key":"ref28","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1007\/s11606-018-4542-3","article-title":"Heart failure home management 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