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Reducing Hospital Admissions and Amputation Prevention: Remote Temperature Monitoring
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***If you are a veteran interested in VA’s Remote Temperature Monitoring Program for Amputation Prevention this program is currently recommended for our highest risk patients who have sensory neuropathy (numbness in their feet) as well as a history of foot ulcers, lower extremity amputations, or Charcot foot. In addition, some patients may not benefit from the program if they have conditions that don’t allow their body to show inflammation such as poor blood flow or certain autoimmune conditions. The best way to find out if your facility has this program and if you are eligible is to contact your local Podiatry provider. If you are not currently following with Podiatry you can talk to your Primary Care Provider to see if you would benefit from a Podiatry referral.***
More than one in four Veterans has diabetes. Last year, VA treated nearly 40,000 new Diabetic Foot Ulcers (DFU), which accounted for 80% of non-traumatic amputations, resulting in a cost of over $1 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:
96 successful
Awards and Recognition:
Diffusion of Excellence Promising Practice, Igniting Innovation Award, iNET Spread Investee, VHA Shark Tank Winner
Partners:
Diffusion of Excellence, Health Services Research & Development, VHA Innovators Network
Recent Updates
Overview
Problem
Solution
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)
• 52% reduction in hospitalizations (Isaac, 2020)
• 40% reduction in ER visits (Isaac, 2020)
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Multimedia
Images
Nearly 10,000 veterans participate in remote temperature monitoring. "When we shift the approach from treatment to prevention, we empower Veterans, improve outcomes, and save lives" Dr. Brantley, Podiatry Chief Richmond VA
Videos
VHA Innovate the Smart Mat to Save Lives
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 vendor 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.*caution with those with any condition that may impair patient's ability to mount an immune/inflammatory response such as advanced PAD, ESRD, etc - these patients may benefit from increased follow up frequency vs remote temperature monitoring- 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.- To enroll a patient simply enter an Enrollment Note using the national Remote Temperature Monitoring template- VA ships the RTM SmartMat to the patient's home and the vendor will walk the patient through first scan.- After onboarding a patient the program is now in sustainment. Providers will receive notifications when DFU is suspected via encrypted email.- 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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PEOPLE |
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PROCESSES |
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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)
- 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
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
- Guide for Using the National Remote Temperature Monitoring Templates Template Guide
Contact
Comment
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Email Kyle.Nordrum@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
Interested in information on adopting this at South Texas VA
This comment has been deleted.
I am interested in participating in the remote foot temperature monitoring
This is an excellent innovation for the VA; it is saving patient's limbs, allowing for better quality of life, and reducing care costs!
I have been a type 1 diabetic for 40 years. I am a service-connected veteran, I have neuropathy in both feet and would like to use this device.