We spoke with Stephanie Caddell, a registered nurse with years of experience working with patients in a remote care setting. Stephanie shared her thoughts on how provider access to continuous health data improves insights and allows for more data-driven, proactive decision-making in care. This is the third in a three-part series; check out the first and second posts where Stephanie discusses the other impacts PGHD has had on her experience delivering remote care.
Do you see differences in patient outcomes when they are in a program using continuous data?
Absolutely. When a patient feels responsible for their self-care, they understand their own data, and they are educated on that data, they are more invested in the positive outcome instead of feeling as though they have no control over their medical destiny. Being able to see data throughout a day or a week can facilitate a conversation that otherwise wouldn’t take place, and be demonstrative of a necessary behavior change on the patient’s part. With this data, clinicians are better able to explain the reason why health improvement or decline occurs — which encourages patient engagement too.
What are the challenges with working with episodic data or historical data? For example, what challenges do patients with diabetes face in basing their treatment largely on a1c data, which is only taken every three months?
As clinicians know, and most likely patients as well, an A1c is information on a percentage of glucose in the patient’s bloodstream over a 3 month period, which is why this lab is only taken in that timeframe. This does not account for how specific choices affect a patient’s blood sugar. For example, a patient may wake every morning to find their blood sugar is over 200 mg/dL, only to find their blood sugar is bottoming out in the evening. Specific food choices, stress, or exercise can all affect blood sugar throughout the day. Having a real-time approach to these tests for trouble shooting with a clinician provides the opportunity to make different choices, adjust medications, increase exercise, etc in order to level out their lab work and have more positive outcomes in the long run. So, if a patient is able to see that they regularly have high blood sugar in the mornings, they can communicate with their clinician to determine what behavior change needs to occur – something that a three-month measure of blood sugar can’t determine.
How does continuous data affect your ability to intervene? Why does timing for interventions matter?
Medical care is all about timing. Have you ever heard a story from a friend or family member saying, “The doctor said if I’d waited another hour, I wouldn’t be here”? How scary! If there is already an increased risk of morbidity secondary to certain conditions such as high blood pressure or congestive heart failure, a patient knowing their risks can allow them to intervene at home when applicable. For example, an action plan can be put in place for someone whose weight increase is greater than 3 pounds in a 24 hour period. With their physician’s direction, perhaps a diuretic is in order. Beyond this, with PGHD, a clinician can help the patient figure out why his or her weight was up if the answer isn’t obvious. It’s not enough to be a Band-Aid. We need to understand the reasons behind the trigger.