Project Summary

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is expanding the use of recorded home oximetry, or RHO, shown in a recent study to help reduce the amount of time premature infants stay on home oxygen therapy.

Infants who are born prematurely may have health problems, such as difficulty breathing. These infants often need home oxygen therapy after they leave the hospital. Use of home oxygen therapy can be stressful for families. A lack of reliable and safe options for managing home oxygen may result in longer stays in the neonatal intensive care unit, or NICU, or longer durations of therapy for premature infants.

What is the goal of this implementation project?

Recorded home oximetry, or RHO, is a way for parents of premature infants to check their infants’ oxygen levels at home. A PCORI-funded research study found that families who used RHO and brought their infants for monthly clinic visits were able to stop home oxygen therapy sooner than infants who only had their oxygen levels checked at monthly clinic visits.

Based on these results, the project team is developing a program to expand RHO use for premature infants on home oxygen.

What will this project do?

The project team is putting the RHO program in place in 14 diverse medical systems that care for premature infants in 12 states. The team is working with lung specialists and other clinicians who provide care for premature infants on ways to make RHO part of regular care for infants on home oxygen.

In the program, doctors are working with families whose premature infants will need oxygen after they leave the hospital. They are giving parents an oximeter that lets them measure their infant’s oxygen levels at home. The device sends the data on oxygen levels to a center that can analyze the information. Twice a week, the data center sends results to the infants’ doctors to help guide care. Parents and infants also have monthly visits with their doctor.

To help put the program in place, the project team is:

  • Creating educational and training materials about home oxygen therapy for doctors, nurses, and families
  • Helping hospitals adopt consistent ways to decide when premature infants may be ready to go home with home oxygen
  • Training doctors and nurse practitioners to work with families on setting up and managing RHO
  • Offering ongoing coaching and feedback to clinics through phone calls and site visits
  • Working with champions at each site to support the program

What is the expected impact of this project?

This project will demonstrate what’s required to make the RHO program part of standard care for premature infants who need home oxygen therapy after they leave the hospital. More than 600 families with premature infants will receive RHO. In addition, the project will show how different data centers can support the RHO program.

The project evaluation will confirm that RHO works as intended to decrease the amount of time infants have home oxygen therapy.

More about this implementation project:

Stakeholders Involved in This Project

  • Parent Advisory Board
  • Regional and national oximeter manufacturers
  • Home care durable medical equipment (DME) companies
  • Health insurers

Implementation Strategies

  • Use an electronic system that includes clinical decision support, providing data analysis, interpretation, and recommendations.
  • Adapt the RHO program based on sites’ needs and to work with sites’ existing resources and workflows.
  • Provide sites with tools to support implementation, including algorithms and protocols.
  • Provide web-based educational materials to families.
  • Train clinicians to deliver the program, including neonatologists, pediatric pulmonologists, neonatal nurse practitioners/physician assistants, and pediatric pulmonary nurse practitioners, in person and through webinars.
  • Use a phased implementation approach, launching the program in two waves.
  • Conduct cyclical small tests of change.
  • Provide sites with audit and feedback reports.
  • Identify and prepare local champions at sites.
  • Conduct site visits.
  • Provide technical assistance to sites, including coaching and consultation.
  • Partner with national stakeholder organizations to promote implementation.

Evaluation Outcomes

To document implementation:

  • Number of infants receiving RHO
  • Clinician use of the RHO protocol
  • Barriers and facilitators to protocol implementation
  • Adaptations to RHO protocol

To assess healthcare and health outcomes:

  • Length of stay in the NICU
  • Duration of home oxygen therapy
  • Number of rehospitalizations for respiratory concerns
  • Infant growth outcomes
  • Adverse events
  • Family experience with using RHO
  • Clinician experience with using RHO

Project Information

Lawrence Rhein, MD, MPH
University of Massachusetts Medical School

Key Dates

September 2020
January 2024

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Monitoring Oxygen Levels of Premature Babies at Home and in the Clinic--The RHO Trial


State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Project Details Type
Last updated: December 5, 2022