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Case Reports
. 2022 May 11;3(3):146-155.
doi: 10.1016/j.cvdhj.2022.04.002. eCollection 2022 Jun.

VPExam Virtual Care for Heart Failure Optimizing Transitions of Care Quality Improvement Project (VPExam QI)

Nischay Shah  1 , Anthony Annam  1 , Nickolas Cireddu  2 , James V Cireddu  1   3   4
Affiliations
Case Reports

VPExam Virtual Care for Heart Failure Optimizing Transitions of Care Quality Improvement Project (VPExam QI)

Nischay Shah et al. Cardiovasc Digit Health J. .
No abstract available

Keywords: Physical exam; Quality improvement; Remote patient monitoring (RPM); Telemedicine; Transition of care.

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Figures

Figure 1
Figure 1
Traditional telemedicine barriers. Lack of physical exam data can result in loss of early enough detection of clinical decompensation, reduced clinical confidence in decision making, and increased risk of misdiagnosis and malpractice. COPD = chronic obstructive pulmonary disease.
Figure 2
Figure 2
VPExam Clinical App. A combination of augmented reality–based guidance with Bluetooth-enabled stethoscope allows a minimally trained user to capture key physical exam data.
Figure 3
Figure 3
VPExam Provider/Partner Portal. Virtual history, review of systems, medication reconciliation, document scanner, and virtual physical examination are reviewed in the Provider Portal. Skilled nursing facilities and home care receive HIPAA-compliant care coordination orders via the Partner Portal.
Figure 4
Figure 4
VPExam remote patient monitoring. Smartwatch data including electrocardiogram, heart rate, and pulse oximetry, as well as blood pressure, blood glucose, and scale data, can also be transmitted to the Provider Portal for earlier detection of decompensation.
Figure 5
Figure 5
Patient participation flow chart. A total of 84% of VPExam QI patients required moderate-significance modification of clinical care, improved by volume status assessment including jugular venous pressure (JVP) and edema (47.6%), cardiopulmonary auscultation (33.3%), electrocardiogram (ECG) (14.2%), and structured data transmission (95.2%).
Figure 6
Figure 6
Hospital readmission rates before and after VPExam QI intervention. Hospital readmission data have an average monthly 30-day readmission rate of 15.91% for the year leading up to VPExam QI. During the initial 6 months of VPExam QI, the average monthly 30-day readmission rate for all University Hospital of Cleveland Regional Hospitals fell to 7.98%. There were 0% readmissions found for the last 4 consecutive months of VPExam QI.
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