Over the past couple of years, nurses have witnessed the positive effects of telehealth home care through phone calls, the Web and remote monitoring using technology. Fewer hospitalizations and ED visits, and better patient outcomes are just a few of the byproducts. To quantify the results, home care agencies have started to track telehealth outcomes, such as reduced costs and fewer readmissions.
Across [Visiting Nurse Association of Central Jersey] and its affiliates, in 2009 VNACJ telehealth patients with heart failure totaled 284. Of those, only 34 [11.9%] were rehospitalized for exacerbation of heart failure, says Judy A. Fancelli, RN-C, BS, vice president of business initiatives for VNACJ, based in Red Bank. Between January and September of this year, telehealth heart failure hospital readmissions were 3.17%.
VNACJ has been working with Monmouth Medical Center in Long Branch, N.J., on a collaborative heart failure partnership with positive outcomes. From January 2008 to June 2010, 444 heart failure patients were referred to VNACJ. Of those, 115 were enrolled in telehealth with a 9% rehospitalization rate all cause, Fancelli says. Of the remaining 329 that were not enrolled in telehealth, there was a 33% rehospitalization rate all cause.
Similar progress has been seen at other home care agencies. Between Jan. 1 and June 30 at Metropolitan Jewish Health System in Brooklyn, N.Y., all nondiabetic enrollees with baseline averages above clinical guidelines had improvements in blood pressure that translated into a 34% reduction in risk of cardiac events and a 24% reduction in stroke risk.
For diabetic enrollees at Metropolitan Jewish, the average improvement in blood pressure translated into a 34% reduction in risk of cardiac events and a 24% reduction in risk of stroke.Improvements also were noted for those at risk for microvascular complications, peripheral vascular disease, MI, stroke, heart failure and cataracts. (The percentages are based on enrollees with a minimum of 40 days of readings per enrollment episode.) Fewer hospitalizations and visits to the ED mean less money spent.
Nationally, the net result [of telehealth services] is a potential annual savings of 20% or more a $400 billion savings to the U.S. healthcare system, according to a March 2008 paper by the Deloitte Center for Health Solutions, an arm of Deloitte LLP, which set out to establish the benefits of using telehealth services in home care.
Real-Time InterventionMarisol Vega-Beecham, RN
Monetary savings aside, one of the most attractive things about telehealth is the positive effect it has on nurse-patient relationships. Mary Jo Vetter, RN, NP, C, vice president for clinical production development at the Visiting Nurse Service of New York, believes telehealth is about assisting the patient to self-manage and using it as a tool to demonstrate how their behaviors have an effect on their health. The perspective we have is: Yes, we would like to lower visits because that would lower costs, she says, but the driver is about increasing encounters with patients.
The Deloitte paper also concluded that when patients use in-home technologies they increase medication adherence, reduce avoidable post-acute complications and improve their self-care in the management of chronic conditions.
At Metropolitan Jewish, the goal of the telehealth program is to reduce hospitalizations and ED visits. But the program is more about quality of care then anything else, says Marisol Vega-Beecham, RN, BSN, MA, telehealth manager. Basically, the information is available to the field nurse and the telehealth coordinator and can be shared with the patients primary care provider as well as the patient, she says. That definitely makes for better care management.
Patients are able to log in and monitor their own data, such as blood pressure, weight and glucose level, Vega-Beecham says. There is a Web page that the patient, caregiver and nurse can monitor, she says. The nurse can take advantage of the teachable moment with the patient and use the Web page as a teaching tool.Julie Cherry, RN
Five years ago, a similar program was established by the New York City Health and Hospitals Corporation. The House Calls program was created to monitor patients with diabetes. Admitted patients had A1Cs higher than 7%, with an average measurement of 9.6%. The goal of the program was to reduce patients A1Cs to an acceptable level while at the same time reducing overall costs, says Ann Frisch, RN, BSN, MBA, executive director of the program.
Since its inception, the Web-based program has managed more than 600 patients, with about 300 presently being serviced. Seven nurses telemonitor, including Frisch, who is one of three certified diabetes educators on staff. Because our program is Web-based, our nurses can be anywhere and still manage patients.
House Calls has been so successful that it recently launched a program for patients with heart failure that has 15 patients enrolled and has contracted to begin programs in psychiatry and obesity. There are so many different avenues that you can take with this, Frisch says.
Vetter agrees. Telehealth is a function that can be incorporated into many different types of care models, she says. Weve been involved in telehealth here for six years. Its an evolving experience. Were doing things with transitional care, chronic illness management and palliative care. [Telehealth] has a lot of utility.
VNSNYs program has helped more than 500 patients, says Vetter, some of whom benefitted from more home visits. We sometimes have to make clinically relevant visits, she says. VNSNYs system uses color coding to determine a patients status: Green is within monitoring parameters, yellow means the patients condition is beginning to show signs of instability which can be related to unhealthy choices and red means there are imminent health risks that must be addressed. We try to work very much in the yellow zone to get insight into why the patient isnt able to achieve stability in their BP, blood sugar or weight, she says. We intervene before the patient is in crisis and in danger of hospitalization.
Tech-Savvy ServicesMary Jo Vetter, RN
Companies such as Intel Digital Health Group, a division of Folsom, Calif.-based Intel Corporation, help hospitals and home care agencies bring telehealth services to patients. We work with healthcare organizations on their strategic plans for implementing programs to change their models of care delivery, says Julie Cherry, RN, MSN, PHN, director of professional services at IDHG. Weve done lots of research on understanding workflow needs of healthcare organization and providers and of people living with chronic conditions in the community and how technologies can help people remain in their homes.
Constant improvements in technology are affording home care agencies the opportunity to provide quicker and more thorough care to their patients. Nurses in the House Calls program use Blackberry devices. In addition, smartphone applications are emerging that can be used in telehealth. Even so, Cherry stresses that what a nurse uses to monitor her patients is not what’s important.
Its not about the technology at all, Cherry says. Its about the model of care and how you can best deliver that care to your patients using that technology.
Positive FeedbackJudy Fancelli, RN
Telehealth technology is only as good as the nurses who use it and the patients who benefit from it, and patients in the House Calls program absolutely love it, says Frisch. Even those who are resistant at first come around. Occasionally well have a patient who doesnt want it, but once they log on they love it, she says. They know that if they have a problem an alert is sent to us and they get an immediate response.
VNSNYs Vetter believes family members of patients using the system are happy too. Family members are usually the biggest advocates because it makes them feel more confident that their loved one is being well-managed, she says. The success is tangible.
Vega-Beecham agrees. Its a great tool for nurses because they can share this information with the care providers in real time rather than through a monthly report, she says. Because they can see if the patient is progressing or going in a negative direction, it has great potential for tracking trends.