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Case management can extend its reach through wearable technology that tracks a patient’s exercise level, sleeping habits, vital signs, medication use, injuries, gait, and other data.
Wearable technology is transforming case management in workers’ compensation and other areas, collecting reams of accurate data on patients’ adherence to therapy and treatment.
“This is exciting, new, and it benefits patients,” says Zack Craft, ATS, ATP, CRTS, vice president, national product leader for CarePath and durable medical equipment, and rehab engineer at One Call Care Management in Jacksonville, FL.
“There are different types of devices that can collect, store, and transmit some type of datapoint,” Craft says. “They’re not always wearables like a watch, but they could be a sensor that picks up data and sends it to the phone, and the application gives you some kind of information.” Chief benefits include enhancing the healing process or assisting with a return-to-work model, he says.
Wearable technology gives providers a better understanding of patients’ behaviors, says Yue Liao, MPH, PhD, CPH, instructor in the department of behavioral science, division of OVP, cancer prevention, and population sciences at The University of Texas MD Anderson Cancer Center. “If we’re monitoring their activity levels, we know how they are. If we have monitoring tools for medication, we know if they’re following their schedule of medication.”
Devices that collect useful patient information vary broadly in data collection and how they work. They include watches, necklaces, bracelets, and sensors placed in clothing. They can be divided into three categories, depending on the quality of their data, Craft says: “There is medical-grade data, clinical-grade data, and consumer information,” he explains.
For example, technology that collects medical-grade data may include FDA-approved devices for collecting precise vital sign measurements. Or, they could be devices used to document patients’ gait during rehabilitation. (See story on examples of wearables in case management in this issue.)
Clinical-grade data could be transmitted to case managers for observation of patients’ adherence to treatment and medication regimens. Consumer information devices include wearables, such as bracelets, that count a person’s steps or that provide GPS location information.
In case management, wearables assist with smooth transitions of care. Patients who were monitored for medical status, vital signs, and nutrition in the hospital could be monitored by wearable devices after they are discharged.
Before these technological advancements, case managers would have little to no information about what was going on in a discharged patient’s daily life, Liao says. “If they were prescribed medication, we would hope they were following the instructions and doing the things we told them to do,” she adds.
Now, it is possible for patients to wear sensors that collect precise data on many of the patient’s activities and functioning. They also can record their activities in a smartphone app, providing case managers with real-time data.
“This lets us know what foods they ate, their pain level, and physical functioning,” Liao says. “This information will give us a better chance to understand how patients are doing once they are discharged. If we have that information, then next time we see them, we can better evaluate treatment options.”
Since wearable technology data collection is real-time, it can be useful for preventing health crises. For instance, sensors can provide continuous glucose monitoring: “This tiny device can continuously collect your glucose data for up to 14 days. Every 60 minutes, it gets a reading of glucose data,” Liao says.
This device is more convenient for patients, as they no longer have to prick their skin several times a day. But it is useful from a clinical perspective, as providers can obtain a much better picture about patients’ daily glucose patterns, she adds. “With continuous glucose data, we can tell what their fasting glucose is, their overnight glucose, and their after-meal glucose level,” Liao explains. “We see the glucose pattern, average, and the time they spent above the threshold.”
Clinicians can see signs of problems as soon as they occur. Then, the physician can revise the patient’s treatment plan, change the insulin dosage, and prevent a crisis that might land someone in the ED.
This level of data collection is particularly useful with high-risk populations, and with patients at risk of developing diabetes or other chronic illnesses, Liao says. “People with pre-diabetes or who are obese are at risk of type 2 diabetes,” she notes. “Now, we can get information to prevent or delay the development of diabetes by helping them change their lifestyle, eating, and activity to achieve target glucose levels.”
Patients with type 1 and 2 diabetes use wearable sensors to help them know when to take their medications, Liao says. “In the future, I hope we can use these sensors to collect information to prevent diabetes,” she adds.
Wearable devices also can be used by case managers. For instance, a wearable can improve safety for case managers who visit patients, Craft says.
“When a case manager is going into an environment for the first time, this monitors their environment,” he says. “It has a camera with 360 degrees of video recording. It can fit on a purse strap, transmitting to the cloud.”
Wearable technology also can assist with monitoring the quality and quantity of patients’ sleep, Liao says. For example, smartwatches and bracelets can track heart rate and sleep movement. They can estimate a person’s sleeping state, whether it is a light sleep or deep sleep. The devices can collect enough information about sleep patterns to provide someone with a summary of how many hours they slept, how many times they awoke in the night, and whether their sleep was light or deep, Liao explains.
“One research area I am starting to devote more of my effort to is how the case manager or healthcare professional can have an idea about patients’ sleep patterns,” Liao says. “Sleep is a really important behavior, impacting a person’s life and health status. If we don’t have enough sleep, we don’t have the energy to perform.”
Case managers can learn a lot from sleep monitoring technology. Without technology, they have to rely on patients’ self-reports on the length and quality of sleep.
“People might not have a good sense of that information,” Liao says. “But if someone is wearing a sensor, we can see if the person consistently is not getting enough sleep, or if two days out of the month they are not getting enough.”
Patients’ sleep patterns can be compared with their disease management. “We are trying to get deeper into that field, and have only recently started to have that type of sleep monitoring,” Liao explains. “We don’t have a lot of answers at this point, but we can collect more data and do more studies about using a device to monitor sleep.”
Case managers could assist in studies about sleep patterns and chronic illness management. “It can be a home-based, real-life study about how well they’re sleeping, and how it will influence the next day, and daily functioning,” she adds. “Knowing that information would be helpful to decide whether we need to intervene on their sleep.”
Financial Disclosure: Author Melinda Young, Editor Jill Drachenberg, Editor Jonathan Springston, Editorial Group Manager Leslie Coplin, Nurse Planner Toni Cesta, PhD, RN, FAAN, and Accreditations Manager Amy Johnson, MSN, RN, CPN, report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.