Heart Failure Monitoring for Homebound Patients
Objectives
Our heart failure monitoring trial examined the role of telemonitoring devices in improving the quality and efficiency of medical care delivered to Class 3 and 4 heart failure home care patients. Devices were employed in the home to monitor heart rate, blood pressure, pulse oximetry and weight. The trial examined the effect of these interventions on clinical outcomes. This study was completed in collaboration with Partners Home Care.
Program Overview
Several trends suggested that telemedicine technologies and thoughtfully implemented disease management programs together play a role in enhancing management of heart failure patients. The trend in telemonitoring technologies is towards small, user-friendly devices that monitor heart rate, blood pressure, pulse oxymetry, and weight. This technology is relevant in the home care environment as patients continue to become more technology savvy. This trend is true even among the over 65 age group, the fastest growing segment of Internet users.
Homecare agencies are now reimbursed on a prospective system for Medicare patients. Consequently, they are eager to adopt technologies that can enhance the quality of care while streamlining costs. Partners Home Care offers opportunities, i.e. geographically dispersed patient population and a vision for the application of technologies in the home care practice to implement solutions that will enable economies of scale.
The trial began with the first patient enrollment in September 2003 and continued through April 2004. The trial involved a sample size of eighty-five patients, followed for a 2 month period following hospital discharge. The patient communication component included scripted disease management questions provided by the telemonitoring nurse. Patients transmitted their weight, blood pressure, and oxygen saturation daily to a telemonitor nurse, who evaluated each patient with a follow-up telephone call.
Results
This trial found that using telemonitoring devices, coupled with patient communications, had significant impact on efficiency of care and quality of life, while showing decreases in hospitalization rates.
Telemonitored patients required 40% fewer nursing visits to the home and had a 25% reduction in rehospitalization rates. These patients also reported improved quality of life and appreciation for increased involvement in their care. As a result of this study, Partners Home Care is extending the use of telemonitoring on an agency-wide basis. The Connected Cardiac Care program was also developed as a result of this study.