Ashley HeupelJacqueline Grace

Jasmine LewisBrian Flannery

Telehealth Monitoring

PICO Question

In heart failure patients does follow-up care via telehealth monitoring versus no follow-up

care help reduce readmission rates?

Introduction

● Approximately 5 million patients are treated for CHF every year in the U.S with an estimated healthcare cost of $29.6 billion. (Lemann et al., 2006)

● “CHF remains the most common medical reason for inpatient hospitalization in adults over age 65” (Smith, 2014).

● Majority of the expense associated with CHF is due to frequent hospitalizations, 16–25% of patients with CHF are re-hospitalized within 30 days of being discharged (Lehmann et al., 2006).

● “HF is associated with significant morbidity, mortality, and cost from readmission rate” (Lee & Park, 2010).

Define Telehealth

“The Health Resources Services Administration defines telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications” (HealthIT, 2014).

Significance

-“Comprehensive discharge planning plus post-discharge support may reduce readmission rates and improve health outcomes for patients with HF” (Lee & Park, 2010). -Telephone-based interventions can make monitoring chronic illnesses easier, while also lowering travel costs. This frequent supervision can “detect patient’s worsening symptoms at an early stage, and thus potentially prevent hospital readmission” (Lee & Park, 2010).- 30 day readmission rates and possible changes in health care reimbursement are driving a renewed interest in the development of evidence based methods to reduce “avoidable” readmissions with CHF patients, and telemonitoring may provide the utility to accomplish this (Smith, 2014).

Current Practice

● CHF patients discharged from an acute care setting should receive a follow-up phone call within 3 days from a healthcare team member.

● After discharge, the CHF client will have a scheduled follow-up appointment with his/her primary care provider within 7-14 days

● (Yancy et al., 2013)

Summary of Evidence

● Telehealth significantly reduces the unitization of healthcare and ultimately lowers the total cost of healthcare associated with the CHF population (Lehmann et al., 2006).

● “...telephone-based post-discharge nursing care was a significant intervention especially decreasing hospital readmission rate among HF patients” (Lee and Park, 2010).

● It was argued that evidence supported the use of telehealth technologies to decrease the rates of hospital readmission and emergency department visits in patients with heart failure in rural areas and can lead to reduced cost (Graves, et al., 2013).

Advantages

● Allows patients to age with dignity and remain in their own homes while still having access to healthcare to manage their care and to ensure their safety (Lehmann et al., 2006).

● Potential to enhance the quality of life and self-management for patients (Graves et al., 2013).

● The technology can be an effective add-on tool for managing the health of elderly patients with heart failure (Maeng et al., 2014).

● Allows provider and consumer to identify early changes in condition and can tailor treatment accordingly (Lehman et al., 2006).

● Telemonitoring contributes to an increased compliance with post acute therapeutic regimens (Smith, 2013).

Advantages Con’t.

- Tele-health monitoring improves the continued relationship with the client and health care team.

- Telehealth increases the client’s understanding of their disease process.

(Radhakrishnan et al., 2016)

Disadvantages

●The availability of the service depends on where the patient lives (Graves et al., 2013).

● Some health care professionals become reluctant to the system because they have a misconception that it is being introduced to replace clinical staff (Graves et al., 2013).

● A majority of the clients that have telehealth are not utilizing it (Radhakrishnan et al., 2016).

● Providers suggest that telehealth is not individualized enough to always pick up on early exacerbations (Radhakrishnan et al., 2016).

● Nurses feel they are not trained properly to be able to manage telehealth in a homecare setting (Radhakrishnan et al., 2016).

Disadvantages Con’t.

-Physicians feel this is a threat to client’s independence and self-reliance (Radhakrishnan et al., 2016).

-There are potential variations in practices across sites that could decrease the accuracy of information (Chaundhry, Barton, Mattera, Spertus & Krumholz, 2007).

Considerations

● Need the right patient to participate in the telehealth monitoring programs, for example patients who are blind or have dementia would not be good candidates (Baker et al., 2013).

● Participants in telemonitoring programs must have access to either landline or cellular communication to be able to utilize the technology required for HF monitoring (Maeng et al., 2014).

● Participants must be well enough to step onto and balance on a scale used for biometric data recording (Maeng et al., 2014).

Recommendations

● Based on this study, telephone-based post-discharge care significantly decreased hospital readmission rates among patients with HF (Lee & Park, 2010).

● The availability of telehealth monitoring systems was associated with fewer hospitalizations and longer survival rates (Baker et al., 2013).

● Current evidence suggests home telemonitoring can reduce congestive heart failure related readmissions, however there was no significant reduction in all-cause hospital readmissions. Ongoing research and further clinical testing must still be conducted (Smith, 2013).

References

(2014, Mar. 22 ). In What is telehealth? How is telehealth different from telemedicine?. Retrieved Mar. 22, 2016, from

https://www.healthit.gov/providers-professionals/faqs/what-telehealth-how-telehealth-different-telemedicine

Baker, L., Macaulay, D., Sorg, R., Diener, M., Johnson, S., Birnbaum, H. (2013). Effects of care management and telehealth: A

longitudinal analysis using medicare data. Journal of the American Geriatrics Society. 61(9), 1560-1567.

Chaudhry, S. I., Barton, B., Mattera, J., Spertus, J., & Krumholz, H. M. (2007). Randomized trial of telemonitoring to improve heart failure outcomes (Tele-HF):

Study Design. Journal of Cardiac Failure, 13(9), 709–714. http://doi.org/10.1016/j.cardfail.2007.06.720

Graves, B., Ford, C., Mooney, K. (2013) Telehealth technologies for heart failure in rural areas: An integrative research review.

Online Journal of Rural Nursing and Health Care, 13 (2) 56-83.

Lee, J., Park, S.. (2010,). The effectiveness of telephone-based post-discharge nursing care in decreasing readmission rate

in patients with heart failure: a systematic review. JBI Library of Systematic Reviews. 8(32), 1288-1303. Retrieved

Mar 3, 2016, from JB

Lehmann, C. A., Mintz, N., Giacini, J. M. (2006). Impact of telehealth on healthcare utilization by congestive heart failure patients.

Disease Management & Health Outcomes, 14(3) , 163-169.

References con’t.

Maeng, D. D., Starr, A. E., Tomcavage, J. F., Sciandra, J., Salek, D., &Griffith, D. (2014). Can telemonitoring reduce hospitalization

and cost of care? A health plan’s experience in managing patients with heart failure. Population Health Management, 17(6),

340-344 5p. doi:10.1089/pop.2013.0107

Radhakrishnan, K.a, Xie, B., Berkley, A., & Kim, M., (2016). Barriers and facilitators for sustainability of

tele-homecare programs: a systematic review. Health Services Research, 51 (1), PP 48-75.

Smith, A. C. (2013). Effect of telemonitoring on re-admission in patients with congestive heart failure. MEDSURG Nursing, 22(1),

39-44 6p.

Yancy, C. W., Jessup, M., Bozkurt, B., et al. (2013). ACCF/AHA guideline for the management of heart failure: A report of

the American college of cardiology Foundation/American Heart Association task force on practice guidelines.

Journal of the American College of Cardiology, 62(16), 147-239 93p. doi:10.1016/j.jacc.2013.05.019