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BACKGROUND/RATIONALE:
Congestive heart failure (HF) is one of the most common reasons for hospitalization in patients aged 65 years and older. Many hospitalizations for HF are potentially preventable if the warning signs of decompensation are recognized and treated before the situation becomes emergent. Home-based intervention programs have reduced unplanned readmission rates for patients with CHF by up to 50%. Using advanced telecommunications technologies it is now possible to provide greatly improved access and availability of services in a more timely and cost effective manner directly to patients' homes. Although telehealth offers a number of theoretical advantages, few empirical studies have compared telehealth to traditional delivery modes, and virtually no studies have compared the effectiveness of alternative telehealth applications.
OBJECTIVE(S):
The purpose of this study was to evaluate the efficacy of a telehealth-facilitated post-discharge support program in reducing resource use in patients with HF. The primary hypothesis was that patients who received a telehealth-facilitated intervention (using telephone or videophone) after discharge would have lower post-discharge resource use (readmission rates, time to first readmission, hospital days, urgent care clinic visits), higher 12-month survival rates, and improved quality of life compared to patients receiving usual care.
METHODS:
The study was a randomized controlled clinical trial. We compared usual care to an intervention delivered by either telephone or interactive video to veterans following discharge from the hospital. A total of 148 subjects were enrolled over 42 months. Subjects in the treatment groups (telephone or interactive video) received the intervention for 90 days following discharge from the hospital. Data collected included measures of quality of life, self-efficacy, satisfaction, resource use, and mortality.
FINDINGS/RESULTS:
Subject enrollment began July 1, 2002. 148 subjects were enrolled; 12-month follow up was completed September 2006. The intervention resulted in significantly longer time to readmission but had no effect on readmission rates or mortality. There were no differences in hospital days or urgent care clinic use. All subjects reported higher disease-specific quality of life scores at one-year.
IMPACT:
There was evidence of the value of telephone follow-up but there was no evidence to support the benefit of videophone care over telephone care. Telehealth care enables earlier detection of key clinical symptoms, triggering early intervention and thus delaying the need for hospitalization. Rigorous evaluation is needed to determine which patients may benefit most from specific telehealth applications and which technologies are most cost-effective.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Quality of Care, Technology Development and Assessment, Resource Use and Cost
Keywords:
Management, Nursing, Organizational issues, Quality assurance, improvement, Research method, Telemedicine
MeSH Terms:
Diabetes Mellitus, Telemedicine, Nursing Care
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