Congestive heart failure is an expensive and resource-intensive illness. According to the American Heart Association, CHF is one of the leading causes of hospitalization for people age 65 and older, and nearly half of these patients are readmitted within six months. The Agency for Healthcare Research and Quality estimates the economic impact of the condition at $10 billion a year.
Among Most Wired hospitals, 20 percent are piloting the use of telemonitoring with heart patients as part of a comprehensive CHF disease management program. The home telemonitoring program at the Mid America Heart Institute, Saint Luke’s Health System, Kansas City, Mo., was designed for patients that are screened as being high risk for readmission with heart failure. In operation since 1999, the program cost is recognized as “cost avoidance.”
“Telemonitoring is an integral part of our risk-based multidisciplinary patient care protocols designed to empower the patient and caregiver to more effectively manage the disease process,” says Janice McCord, R.N., telehealth coordinator. “We are able to provide in-home telemonitoring of vital signs including weight, blood pressure, heart rate and oxygen saturation by pulse oximetry.”
Patients respond to a series of diagnosis-related questions by pressing “yes” or “no” buttons on the device. They also can request contact with a clinician using this method. The Honeywell HomMed monitors can be programmed to initiate a monitoring event up to four times daily. A “retest” feature allows patients to check their vitals at other times. The results are transmitted via a wireless two-way pager system or by a standard telephone line to a central station monitored by a cardiac nurse who interprets results, initiates contact with patients for more in-depth assessments and communicates findings with a patient’s nursing or therapy case manager and physician as needed.
At Mountain States Health Alliance, Johnson City, Tenn., the CHF Disease Management Program is the first part of a broader plan to improve quality and reduce costs for ongoing care for chronic diseases. The 3-year-old program is the result of a multidisciplinary physician-hospital organization team, consisting of physicians and home health, call center, quality improvement, decision support and information systems representatives. The PHO team works with telemonitoring vendor Heart Alert.
“The PHO currently provides the funding for the project,” says Stacie Fox, IT planning coordinator. “As the outcomes demonstrate lower costs for employers and payers, these sources will be explored for continued funding.”
Since the program’s inception, there’s been a 68 percent drop in admissions for heart failure-related reasons, a 30 percent drop in admissions for all other reasons and a 63 percent reduction in inpatient days. The program also has led to a sixfold increase in the number of patients requiring no hospital admissions or ED visits. Finally, 88 percent of patients report that the program has improved their quality of life, defined as the “ability to do normal daily or recreational activities and my general enjoyment of life.”
Home telemonitoring is a promising tool to extend quality health care from the hospital to the home for chronic disease management.
This article first appeared in the Summer issue of HHN's Most Wired Magazine.
To respond to this article, please click here.
