Telemedicine for Improving Outcome in Inner City Patient Population With Hypercapneic Respiratory Failure
Telemedicine for Improving Outcome in Inner City Patient Population With Hypercapneic Respiratory Failure
The Hypercapnia Telemedicine Outreach Program (E-TOUCH Study) aims to utilize telemedicine
 technology, as well as emergency medical services (EMS) home visits to address the problem
 with poor follow-up and compliance among Einstein's hypercapnic patients.

 The hypothesis is that reaching out to the subjects' homes will allow more consistent
 healthcare delivery, increase healthcare efficiency and compliance with therapy, and overall
 decrease acute decompensated states / hypercapnic respiratory failure, decreasing ED visits
 and hospitalization.
Hypercapnic respiratory failure is a prevalent medical problem, comprising a substantial
 number of ED visits and readmissions. The target population that are at high risk for
 developing hypercapnia are patients with obesity hypoventilation syndrome (OHS), chronic
 obstructive pulmonary disease (COPD), sleep disordered breathing (SDB) overlapping with COPD,
 and patients with neuromuscular disorders. These patients are commonly managed in the
 progressive care units or the intensive care unit for extended periods of time, which can
 over-utilize health systems resources. Einstein Medical Center's patient population includes
 multiple low-income communities / neighborhoods. Their educational background varies and
 constant education and counseling is an integral part of the treatment plan. These patients
 are particularly vulnerable due to a lack of geographic access and difficulty contacting
 healthcare providers via phone. Some of the patients may not be able to afford co-pays for
 clinic visits or are not able to follow up with a physician. In addition, patients treated
 with non-invasive ventilation in the hospital and require home therapy either never receive
 the device or are sub-optimally trained in its appropriate utilization. These patients may
 also be morbidly obese with mobility issues, which is another obstacle preventing patients
 from following up with their providers.

 Positive airway pressure (PAP) therapy/ non-invasive positive pressure ventilation (NIPPV)
 are effective treatments to avoid acute hypercapnic respiratory failure; however, low
 compliance and poor follow-up are often recurring issues. These high-risk patients present in
 the emergency department acutely hypercapnic and encephalopathic with subsequent ICU
 admission and mechanical ventilation.This Telemedicine Outreach Program aims to utilize
 E-touch devices (Vivify-Go) in collaboration with home visits by EMS (Emergency medical
 services) to improve compliance and the efficiency of healthcare delivery. These efforts will
 hopefully lead to a decrease in acute decompensated respiratory states and hospital
 readmission rates.
Inclusion Criteria:

 -  Adult patients > 18 years of age

 -  Evidence of hypercapnia (PCO2 ≥ 45mmHg) secondary to COPD-OSA overlap, OHS,
 Neuromuscular disease / weakness

 -  Requiring NIV / NIPPV outpatient

 -  Ability to operate a smart device / tablet

 -  Informed consent

 Exclusion Criteria:

 -  Non-English or Non-Spanish- speaking (device videos and surveys are available in
 English or Spanish only)

 -  Patients unable to give consent

 -  Pregnant women

 -  Prisoners

 -  Patients <18 years of age

 -  Patient already on NIPPV/ CPAP at home and compliant on therapy

 -  Significant non-pulmonary conditions (CHF with EF < 40%), Pulmonary hypertension with
 PASP> 60 mmGH, severe valvular heart disease, end-stage renal disease or end-stage
 liver disease.

 -  Patients without health insurance

 -  Residing out of state (Pennsylvania)

 -  Patients with current or history of drug / narcotic dependence