Abstract 18211: Reducing the 30-Day Readmission Rate of Heart Failure Patients Through Home Telemonitoring

Abstract

Background: Heart failure (HF) is the number one reason for hospitalization, and over 25% of hospitalized HF patients are readmitted within 30-days. Many HF readmissions are preventable with improved care coordination, better symptom management, and adherence to medications and diet. In 2012, Centers for Medicare and Medicaid Services (CMS) began to financially penalize hospitals for excess HF readmissions costing facilities significant funds. OBJECTIVE: To determine the impact of a nurse-based home telemonitoring program on 30-day all-cause readmission rate of HF patients and the cost effectiveness of this program. METHODS: This was a quasi-experiment comparing 40 HF patients at high risk for readmission who were given a nurse-based telemonitoring program, with an 80-patient usual care (UC) group. Telemonitoring (TM) patients received two home visits by a nurse consisting of HF education and use of home telemonitoring equipment. TM patients transmitted vital signs, weight and pulse oximetry daily for 3 months. Data was reviewed by a nurse who contacted the patient if a significant change or trend emerged, as well as contacting the physician for an appropriate course of action. Baseline characteristics and readmission rates were compared between TM and UC groups using independent t-test and two-sample t-test between proportions. RESULTS: Baseline characteristics were similar between groups except for a lower ejection fraction in the TM group (UC 46% vs TM 38%; p=0.005). All-cause 30-day readmission rate for the TM group was 12.5% compared with 27.5% for the UC group (p=0.039); HF 30-day readmission rate for the TM group was 2.5% versus 10% for the UC group (p=0.052). Program financial analysis indicates a first year cost of $35,000 for the one-time purchase of 10 monitors with variable cost of roughly $400/patient. Total cost of the program approached $51,000 however the CMS penalty for excess HF readmission is nearly $183,500 for 2013. CONCLUSION: This study shows that home telemonitoring can significantly reduce 30-day readmission rates in HF patients. Additionally, the decrease in HF readmissions reduces the CMS penalty by approximately $118,400 showing that home telemonitoring can be a cost effective way to transition patients from hospital to home.