IMPACT OF TELEHOMECARE ON HEALTH SYSTEM UTILIZATION IN PATIENTS WITH HEART FAILURE

Abstract

In 2007 Ontario Telemedicine Network (OTN) launched pilot of telehomecare (THC) for HF patients residing in Central West (CW), Toronto Central (TC) and North East (NE) local health integration networks (LHINs). Phase 1 program expansion was initiated in 2012, based on pilot results indicating that THC may improve quality and access to care among HF population. The quasi experimental pre-post study aimed to assess impact of THC on health system utilization in HF patients enrolled in THC across 3 LHINs. Primary research data was linked to National Ambulatory Care Reporting System (NACRS) and Discharge Abstract Database (DAD) between July 26th, 2012 and up to March 31, 2014. THC impact on composite outcome (ED visits and hospitalizations); and disease specific ED visits and hospitalizations was assessed for a period of 30 days and 180 days pre and post THC enrollment. Data was analyzed based on intention to treat approach using generalized linear mixed model procedures in SAS. Subgroup analysis assessed impact of THC on gender and whether the impact varied by LHIN. In cohort of N=783 HF patients, average 76.93 ± 10.97 years of age; 51% were females; whereas N=257 (33%); N=155 (20%); and N=371 (47%) were recruited from CW, NE and TC LHINs respectively. Results indicate significant decrease in: composite outcome (95% CI: -0.70 to -0.44)/ (95% CI interval: -0.44 to -0.31); disease specific ED visits (95% CI: -1.55 to -0.87)/ (95% CI interval: -1.02 to -0.66) and hospitalizations (95% CI: -1.90 to -1.13)/ (95% CI interval: -1.20 to -0.82) in 30 days and 180 days post-THC. NE and TC LHINs patients experienced significant reductions in disease specific ED visits (95% CI interval: -1.09 to -0.12) (95% CI interval: -0.74 to -0.04) and hospitalizations (95% CI interval: -2.61 to -1.07) (95% CI interval: -0.83 to -0.22) in 30 days post-THC. Compared with women, men experienced higher rates of composite outcome (95% CI interval: 0.05 to 0.29) and all cause hospitalizations (95% CI interval: 0.08 to 0.33) 180 days post-THC. High system users experienced increased rates of system utilization 30 and 180 days post-THC. Results indicate that THC may impact health system utilization of HF patients. The impact may differ between genders; and program may be of benefit to patients residing in particular LHINs. Findings of the study merit further investigation on impact of THC.