
Reducing Hospital Admissions and Amputation Prevention: Remote Temperature Monitoring
Last updated
Share PrintOne in four Veterans has diabetes. Last year, VA treated 75,000 Diabetic Foot Ulcers (DFU), which accounted for 80% of non-traumatic amputations, resulting in a cost of $3.2 billion. VHAIE's "National Initiative to End Diabetic Limb loss", has designed and tested a new care model in DFU prevention. Since COVID, we have shifted from traditional in-clinic treatment, to virtual-based prevention.
Origin:
Adoptions:
95 successful
Awards and Recognition:
Diffusion of Excellence Promising Practice, Igniting Innovation Award, iNET Spread Investee, VHA Shark Tank Winner

Recent Updates
Overview
The problem
The solution
The results
• 97% early detection of DFU, 5 weeks before the onset of symptoms (Frykberg, 2017)
• 86% patient engagement (almost daily use after 12 months) (Frykberg, 2017)
• Total elimination of all major amputations (VA QI Audits, 2019 and Isaac, 2020)
• Near elimination of DFU (VA QI audits, ... Multisite QI audits as well as published clinical trial data has shown:
• 97% early detection of DFU, 5 weeks before the onset of symptoms (Frykberg, 2017)
• 86% patient engagement (almost daily use after 12 months) (Frykberg, 2017)
• Total elimination of all major amputations (VA QI Audits, 2019 and Isaac, 2020)
• Near elimination of DFU (VA QI audits, 2019)
• 52% reduction in hospitalizations (Isaac, 2020)
• 40% reduction in ER visits (Isaac, 2020) See more
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Multimedia
Images

Above:
1300 Veterans participate in remote temperature monitoring. More than 40 Podiatry Clinics offer this empirically-based preventative intervention. "When we shift the approach from treatment to prevention, we empower Veterans, improve outcomes, and save lives" Dr. Brantley, Podiatry Chief Richmond VA
Videos
Above:
VHA Innovate the Smart Mat to Save Lives
Above:
The Initiative to End Diabetic Limb Loss
Implementation
Timeline
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Month 1-2
- Meet with key stakeholders for buy in and awareness (Podiatry, PAVE Coordinator, Prosthetics, Facility Telehealth Coordinator, Chief of Staff)- Coordinate with Kyle.Nordrum@va.gov and/or Lindsay.Craig@podimetrics.com for in-service once ordering providers are identified- Create Remote Temperature Monitoring clinic (primary stop code of your service, secondary stop code 698)- Ensure your CAC has installed the national Remote Temperature Monitoring Templates- Currently the mat is recommended for PAVE III patients with neuropathy and a history of foot ulcer, lower extremity amputation, and/or Charcot.- Identify candidates from face to face visits and by patients known to specialty foot care providers. Can also look back who has been in specialty foot care clinics retroactively over last 3-6 months. Another option is to use the PAVE, non-healing ulcer, or amputee cubes to help identify candidates.- Virtual onboarding can be done by calling patients or doing a VVC visit if you are not seeing them face to face.- National funding is available through March '22 or until funding is exhausted (projected to run out in December of '21). Ordering a smart mat using national funding is as simple as sending an encrypted email with the patient’s name, last 4, address, and phone number to lindsay.craig@podimetrics.com- Vendor ships the RTM SmartMat to the patient's home and trains the patient virtually.- After onboarding a patient the program is now in sustainment. Providers will receive notifications when DFU is suspected.- Provider decides on method for follow up whenever an escalation alert is received from Podimetrics.
Departments
- Podiatry
- Purchasing and supplies
Core Resources
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Files
- clinical trial 2017 that shows high patient adherence and 5 weeks early detection of DFU Frykberg Study 2017 (VA)
- 2020 Rothenberg VA study Rothenberg Study 2019 (VA)
- VA Provider education deck on remote temperature monitoring Remote Monitoring Presentation- Dr. Brian Warne
- This document is an example of how a remote temperature monitoring clinic was created for capturing remote monitoring workload in Cincinnati. example of clinic profile document for remote temperature monitoring
- Guide for using the national templates for remote temperature monitoring Remote Temperature Monitoring Template Guide
- The Office of Connected Care has requested new Account Level Budgeter Cost Centers (ALBCCs) to map provider time for care associated with specific Asynchronous Store & Forward Telehealth (SFT) clinics and Remote Patient Monitoring outside the Home Telehealth (HT) Program. The ALBCC Suffix “AW” for Asynchronous Workload may be added to the ALBCC for the Distant Clinician’s Store & Forward Telehealth and Remote Patient Care Monitoring outside the HT Program Workload. Provider interpretation time for Asynchronous Store and Forward Telehealth is not ever scheduled or booked. The use of “AW” suffix will help support the Bookable Hours initiative. Instructions for Labor Mapping to Asynchronous Workload Suffix
Links
- blogpost on the Initiative to End Diabetic Limb Loss Innovation Partnerships Blog VA VantagePoint
- Article on the partnership NextGov.com VHA Innovation Ecosystem/Podimetrics
- Office of Connected Care Remote Temperature Guidance Document Guide- Remote Temperature Monitoring for the Prevention of Foot Ulcers and Amputations
- Remote Temperature Monitoring Encounter Documentation and Escalation Pathway Escalation Pathway
- Temperature Monitoring Devices Standard Operating Procedure TMD SOP
- This document provides guidance for the Remote Monitoring community to support adjustments to bookable time expectations for providers using remote monitoring technologies or asynchronous care. This guidance is needed to account for unscheduled remote monitoring clinical workload and ensure providers can achieve expected, quality outcomes and patient care standards. Remote monitoring modalities (example Remote Temperature Monitoring) generate clinical workload outside bookable hours. To account for this, it is appropriate to adjust/decrease providers’ bookable hours to ensure they have time for this clinical workload based on clinical activity. See the MCAO guidance at the end of this document for labor mapping providers providing this type of care Recommendations for Bookable Hours
Contact
Comment
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Email VHA12CCRPMPGTemperatureGuidedAvoidanceTherapy@va.gov with questions about this innovation.
About
Origin story
Original team
Jeffrey Robbins, DPM
Director Podiatry Service, VACO
Kyle Nordrum, PT, DPT
Physical Therapist Cincinnati VAMC
Lindsay Riegler, Ph.D., CCC-SLP, CBIS
Innovation Specialist Cincinnati VAMC
This is an excellent innovation for the VA; it is saving patient's limbs, allowing for better quality of life, and reducing care costs!