Phil Tropeano and Dr. Richard Alexander
On a recent Sunday in August, Phil Tropeano gathered with nearly 50 family members and friends to celebrate his 92nd birthday. There was also an extra reason to blow out the candles – the birth of Tropeano’s great-great-grandson, Nicholas.
The party came a few weeks after Tropeano met with his longtime physician, Dr. Richard Alexander. The regularly scheduled office visit had also yielded good news. Tropeano, who suffers from diabetes, congestive heart failure and kidney failure, showed no changes in his condition.
Dr. Alexander, who has treated Tropeano since 1980, says a big part of his success is the use of a telemedicine monitor. For three years, Tropeano starts each day by weighing himself and measuring his blood pressure and blood oxygen saturation level, using a console supplied by Partners HealthCare. The readings are automatically transmitted to a nurse care manager at North Shore Medical Center, who can instantly spot deviations that could be warning signs.
Dr. Alexander reviewed the readouts on his computer, noting that Tropeano typically weighs 155 pounds. If that goes up by two or three pounds in a day or two, it could spell trouble.
“If you gain three pounds in two days, it’s water retention,” said Dr. Alexander, a member of North Shore Physicians Group in Salem. “You can’t gain that much weight with calories. Two pounds one day and then two more – next thing you know, the patient is really short of breath and winds up in the emergency room and in the hospital.”
“But a simple phone call telling the patient to double his dose of diuretic [a drug that helps the body eliminate water] and you can avoid all that trouble.”
The close monitoring is necessary because of Tropeano’s unique mix of complex medical conditions. The congestive heart failure means that excess water accumulates in Tropeano’s lungs, making it difficult to breathe. Just eating a salty meal can be enough to trigger temporary water retention. But eliminating too much water makes it difficult for his weakened kidneys to perform their function.
“We’re watching a couple of really simple things,” said Dr. Alexander. “Weight. Blood counts. Blood pressure. This isn’t rocket science. It’s very basic stuff. But it makes a huge difference. It has kept him out of the hospital for a long time.”
Tropeano and his daughter Valerie
Tropeano’s daughter Valerie, who takes him to all his medical appointments, said, “Before we began the telemonitoring, he was going into the hospital every three or four months with congestive heart failure.”
“We have probably prevented six to eight hospitalizations, easily,” said Dr. Alexander.
The telemedicine console and the nurse case managers who oversee Tropeano’s condition are part of North Shore Medical Center’s Integrated Care Management Program (iCMP). They are used to help treat the highest-risk and most medically complex patients.
iCMP, in turn, is just one of the ways Partners HealthCare is using advanced population health management techniques to improve outcomes and control the cost of treating patients.
A pilot care management program at Massachusetts General Hospital showed that having care managers work directly with medically complex patients reduced hospital readmissions by 20 percent, and overall mortality rates by 4 percent.
Dr. Alexander said he has about 50 patients in the iCMP program, many of them using telemedicine consoles to provide daily readings of vital signs.
“Just trying to see a patient in the office once every three months is not enough,” he said. “People get sick on a daily basis. You have to know what’s going on. And this helps me nip problems in the bud.”
“I think Phil has been a poster child for staying out of the hospital.”