Aiding Chronic Obstructive Pulmonary Disease and Congestive Heart Failure Ultrasound-Guided Management Through Enhanced Point-of-Care Ultrasound (ACCUMEN-POCUS): Protocol for a Randomized Controlled Trial.

Abstract

Background: Hospital at home (HAH) programs offer acute care at home as a substitute for inpatient hospitalization, reducing health care costs while maintaining safety and care quality. Despite point-of-care ultrasound (POCUS) having been validated in inpatient and emergency settings, its role in HAH care remains underexplored. Common conditions treated in medical HAH programs, such as acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), acute decompensated heart failure (ADHF), and pneumonia, are highly amenable to POCUS integration into clinical decision-making and have been proven to improve health care use outcomes. The portability of POCUS makes it ideal for use in HAH; however, its feasibility remains to be proven given the need for health care provider training and use in online settings.

Objective: This study evaluates the feasibility and clinical utility of remotely interpreted lung and inferior vena cava (IVC) POCUS acquired by community paramedics to support real-time clinical decision-making for HAH patients with AE-COPD, ADHF, and pneumonia in Calgary, Alberta.

Methods: This randomized controlled trial compares usual HAH care (control) to lung and IVC POCUS-enhanced HAH care (intervention). Handheld POCUS devices captured images that were securely shared using a cloud-based application. This enabled real-time image sharing among the clinical team, facilitating immediate decision-making by remote physicians. A mixed methods approach will evaluate clinical outcomes, patient experiences, health care use, and health care provider perceptions of POCUS integration. The primary outcome is defined as the length of stay for the index HAH admission. Quantitative analysis will assess clinical efficacy and health care resource use, while qualitative methods, such as interviews and surveys, will capture patient and health care provider experiences.

Results: Study funding began in April 2022, and data collection commenced in December 2023. Patient recruitment was finalized on December 31, 2024. This study included a 3-month follow-up for significant outcomes and will include a 1-year follow-up for long-term health care use, including admissions to long-term care. In total, 20 patients were enrolled (intervention group: n=10, 50%; control group: n=10, 50%). Initial results highlighted the feasibility and potential benefits of remotely acquired POCUS imaging in HAH. Full data analysis is in progress.

Conclusions: This study is the first randomized controlled trial to investigate remotely acquired POCUS by nonphysician practitioners for real-time lung and IVC remote decision-making in HAH care. Findings will provide insights into whether serial lung and IVC POCUS assessments improve ADHF, AE-COPD, and pneumonia outcomes in the HAH setting, enhancing understanding of the value of POCUS integration from a health care provider's perspective. By assessing its clinical impact and feasibility, this research may inform future guidelines for incorporating POCUS into home-based care, ultimately improving patient care and optimizing health care resource use.

Trial registration: ClinicalTrials.gov NCT05423652; https://clinicaltrials.gov/study/NCT05423652.

International registered report identifier (irrid): DERR1-10.2196/76186.