Wired for heath: Remote diabetes monitoring keeps patients on track

DAVENPORT – Within minutes of Kathy Shea pricking her finger and taking a blood glucose reading, a registered nurse nearly 2,800 miles away in North Carolina knows whether she’s “too sweet” and needs to adjust her diet or medication.

All this before Shea, 70, changes out of her pajamas or eats breakfast.

The retiree with Type 2 diabetes, diagnosed a year ago, is one of the initial participants in a new Health at Home pilot project offered by Lincoln Hospital District 3. Since the program started in April, it has been successful in helping diabetics in this rural farming community along U.S. Highway 2 monitor their blood sugar, blood pressure and weight.

For Shea, the monitoring program has given her a daily cheerleader – her nurse Rhonda Cotton in North Carolina, and inspiration to keep tracking her health even if she gives in to an urge for a candy bar or the temptation to skip a day’s blood sugar monitoring. Self-monitoring can be difficult and sometimes scary, and patients often worry if they are recording the correct numbers. This program removes the doubt.

“Sometimes it feels like Big Brother is watching over you,” Shea said, admitting she hates the idea of being forced to do something. “But this is good for me. This is going to help me not go blind or lose a leg or die early because I haven’t taken care of my diabetes.”

The program is voluntary and only works for people willing to have the interactive monitoring where the daily readings are sent via cellphone or landline to North Carolina.

The nurse looks at the readings daily but doesn’t call unless a statistic varies from normal or if the patient calls to talk. The health data is also regularly sent to the patient’s local provider at the Davenport clinic.

The goal is to improve the patient’s quality of life while reducing health crises and trips to the emergency room. It perhaps foreshadows the future of medicine – both rural and urban – in how to keep people with chronic illness such as diabetes, chronic obstructive pulmonary disease, cardiovascular disease and congestive heart failure – healthy, happy and in their homes longer.

“We really are a health care model for the future,” said Tom Martin, the CEO/administrator of Lincoln County Hospital District 3. “We want to maintain individual, overall well being and get on the forefront of health and wellness (by having) chronic disease managed properly.”

Shea and seven other patients first enrolled in the Health at Home program have seen an improvement in their A1C – the average blood sugar level control – for the past two or three months, with the average decrease being about two points. The higher a diabetic’s A1C level, the poorer their blood sugar control and the higher risk of complications. Thirteen more patients haven’t participated long enough to gather adequate data, said Alyssa Oestreich, the patient support program director.

The hospital district is expanding the program to include people with COPD, recently sending 31 letters to target patients who may qualify, usually those people 60 or older. Shea also has COPD and has breathing troubles, especially during wheat harvest and this summer’s wildfire season.

The Health at Home Program is free for patients and is covered by a grant to the Lincoln Hospital from the Empire Health Foundation, the region’s largest charitable foundation that manages an $86 million endowment to encourage healthy lifestyles in Eastern Washington. The Home at Health budget is about $275,000 for the planning and operation and is expected to last 18 to 24 months.

Brian Myers, the foundation’s program officer, said the pilot is important because it increases access and improves the quality and coordination of health care services for seniors with chronic disease who live in the Lincoln Hospital’s service area – about 8,000 people. It will also reduce health costs.

The ultimate hope is that the other 38 federally designated Critical Access Hospitals in rural Washington will adopt similar programs. Martin said insurance companies are considering supporting these types of home health programs because they could save money in terms of fewer medications and hospital stays.

The idea for Health at Home came in response to the 2012 closing of the district’s nursing home in Davenport and an assisted living facility in Wilbur. Forced by deep financial losses, the closure displaced 42 elderly residents. Martin said the community demanded that the district not abandon its elderly population. Technology is key to the transition of caring for people in their homes, he said.

After researching ways to create a “virtual nursing home,” the hospital staff discovered InScope Health and liked its Heath at Home programs on the East Coast. InScope manages the program and coordinates the supplies such as the blood pressure cuff, interactive scale and blood glucose test kits. It also contracts with the nursing staff, such as Cotton.

From her office in North Carolina, Cotton looks at all her patients’ morning readings and looks for trends, such as elevated blood sugar levels over several days. If she notices something, she calls the patient to check in. This frequent communication and discussion equates to patient trust and education as well as better compliance with testing.

“Mostly I’m a cheerleader,” Cotton said in a phone interview in Shea’s small living room, a conversation that frequently was interrupted by Shea’s three dogs who wanted to play ball as she tried to take her blood pressure.

“She’s really great at trying to determine what’s going on and why her readings are elevated,” Cotton added.

Because of all the excitement, Shea’s blood pressure reading was off the charts. Within 10 minutes her phone rang – another nurse calling, alerted to the abnormal reading.

Shea laughed that she can’t get away with anything.

On this particular December morning, Shea’s blood glucose reading also is high, a direct result of eating plump, juicy red grapes that she couldn’t resist in the store – basically little shots of sugar.

She knows that she has to go back to her strict low-sugar diet, walk the dogs more and drink more water. The monitoring is important to keeping her healthy. Cotton reminds her that the goal is long term, more than day-to-day.

“We’re human,” Oestreich said. “We have ups and downs. We just want people aware of their choices and how they feel. The piece we are looking for is that consistency.”