Reducing Hospital Admissions and Amputation Prevention: Remote Temperature Monitoring
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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
A Diabetic Foot Ulcer (DFU) can very easily lead to an amputation or even death for a diabetic Veteran. The most at-risk Veterans face a 5-year mortality rate of 43% after developing their first DFU. With 25 percent of Veterans suffering from diabetes, DFUs are a major concern for VA. Last year, VA treated 75,000 DFUs, which accounted for more than 80% of no
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A Diabetic Foot Ulcer (DFU) can very easily lead to an amputation or even death for a diabetic Veteran. The most at-risk Veterans face a 5-year mortality rate of 43% after developing their first DFU. With 25 percent of Veterans suffering from diabetes, DFUs are a major concern for VA. Last year, VA treated 75,000 DFUs, which accounted for more than 80% of non-traumatic amputations in VA, resulting in a cost of more than $3.2 billion.
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The solution
VA’s groundbreaking partnership with Podimetrics, led by Suzanne Shirley, VHA IE Director of Fellowships & Community Engagement, has designed and tested new care models that bring remote temperature monitoring to at-risk, diabetic Veterans. Remote temperature monitoring involves the use of the Podimetrics SmartMat that uses thermal imaging to measure the da
...
VA’s groundbreaking partnership with Podimetrics, led by Suzanne Shirley, VHA IE Director of Fellowships & Community Engagement, has designed and tested new care models that bring remote temperature monitoring to at-risk, diabetic Veterans. Remote temperature monitoring involves the use of the Podimetrics SmartMat that uses thermal imaging to measure the daily temperature of a Veteran’s foot. These mats can detect diabetic foot ulcers (DFUs) up to five weeks before they would normally present.
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The results
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, ... 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
• 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
| Resource type | Resource description |
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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
The National Task Force to End Diabetic Limb Loss was established in 2019 by VHAIE. The task force led trials and audits in DFU prevention practices, established national guidelines to define clinical criteria for RTM systems, and collaborated with our industry partner to successfully redesign the VAs DFU prevention care model to incorporate remote temperat
...
The National Task Force to End Diabetic Limb Loss was established in 2019 by VHAIE. The task force led trials and audits in DFU prevention practices, established national guidelines to define clinical criteria for RTM systems, and collaborated with our industry partner to successfully redesign the VAs DFU prevention care model to incorporate remote temperature monitoring.
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!