Clinical Effectiveness, Access to, and Satisfaction with Care Using a Telehomecare Substitution Intervention: A Randomized Controlled Trial

Kathryn H Bowles,Barbara Riegel,Mary D Naylor,Melissa O'Connor,Nai-Wei Shih,Henry A Glick,Alexandra L Hanlon,Mark G Weiner

doi:10.1155/2011/540138

Kathryn H Bowles, Barbara Riegel + Show 6 more

Open Access

https://doi.org/10.1155/2011/540138

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Abstract

Background. Hospitalization accounts for 70% of heart failure (HF) costs; readmission rates at 30 days are 24% and rise to 50% by 90 days. Agencies anticipate that telehomecare will provide the close monitoring necessary to prevent HF readmissions. Methods and Results. Randomized controlled trial to compare a telehomecare intervention for patients 55 and older following hospital discharge for HF to usual skilled home care. Primary endpoints were 30- and 60-day all-cause and HF readmission, hospital days, and time to readmission or death. Secondary outcomes were access to care, emergency department (ED) use, and satisfaction with care. All-cause readmissions at 30 days (16% versus 19%) and over six months (46% versus 52%) were lower in the telehomecare group but were not statistically significant. Access to care and satisfaction were significantly higher for the telehomecare patients, including the number of in-person visits and days in home care. Conclusions. Patient acceptance of the technology and current home care policies and processes of care were barriers to gaining clinical effectiveness and efficiency.

Highlights

Heart failure (HF) is the most common chronic illness in home care, affecting almost six million Americans today
The purpose of this study was to compare the effects of a telehomecare intervention that substitutes for 45% of in-person skilled nursing visits on time to readmission, readmission rates, hospital days, emergency department use, access to care, and satisfaction for older adults following hospital discharge for heart failure (HF) to standard skilled home care services
The most frequent reasons for ineligibility were no referral to home care (18%), unable to reach for enrollment prior to two weeks after discharge (16%), cognitive impairment (11%), or unable to hear well enough on the phone (6%)

Summary

Introduction

Heart failure (HF) is the most common chronic illness in home care, affecting almost six million Americans today. Increasing incidence and prevalence of HF [9], “quicker and sicker” hospital discharges [10], and the current nursing shortage [11] make it challenging to efficiently provide the necessary close monitoring and teaching that HF patients require. Hospitalization accounts for 70% of heart failure (HF) costs; readmission rates at 30 days are 24% and rise to 50% by 90 days. Agencies anticipate that telehomecare will provide the close monitoring necessary to prevent HF readmissions. Randomized controlled trial to compare a telehomecare intervention for patients 55 and older following hospital discharge for HF to usual skilled home care. Access to care and satisfaction were significantly higher for the telehomecare patients, including the number of in-person visits and days in home care. Patient acceptance of the technology and current home care policies and processes of care were barriers to gaining clinical effectiveness and efficiency

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Conclusion