TeleHomecare Management of Congestive

Heart Failure in Rural Mississippi

Cathy Smith, RN, BSN

North Mississippi Medical Center

Home Health

Cardiac Outcomes Manager

TeleHomecare

Human Factors

Technology

Human Factors + Technology = TeleHomecare

Why High Risk CHF Patients?• Poor prognosis

• Highest re-hospitalization rate

• High Medicare cost

• Most frequent cause of hospitalization in patients 65 and over with a cost of $6,268 per admission FY 2000

• Shift of care for medically fragile patients from hospital to home

CHF Project Timeline

• TOP Grant Award - 10/99

• 23 Kodak units purchased - 5/00

• First CHF patient - 8/00

• Kodak pulls out 12/00

• Patient entry on hold

• American Telecare replacements 2/01

• New patients 2/01

• Patient Selection • Hospitalization within 6 months

• OR ER visit within 6 months

• OR patient adherence problems

• Requirements• Caregiver present in the home

• Patient willing and able to learn how to use telecare system

• Patient has multiple home visits per week

Clinical Assessments

Edema Validating Insulin Dosage

Clinical Assessments

TelePhonic StethoscopeHeart and Lung Sounds

Rales, Wheezes, Decreased breath sounds

Abnormal heart sounds

TeleHomecare Interventions

Nursing Intervention

Nursing Intervention

Program Evaluation

• Outcomes– Hospitalizations– ER visits

• Qualitative measurements– OASIS

• functional, cognitive, emotional assessment

– Patient satisfaction survey

Data Analysis• Retrospective review of hospitalizations and

ER visits– include CHF as primary and secondary

diagnosis

• INCLUSION CRITERIA– Patients have hospitalization or ED visit– Patients on home care (HC) and telehomecare

(TH) each for at least 3 months

• Data is annualized and compared

Results• 8/15/00 to 9/30/01

– 29 patients – Mean length of stay(LOS)

• HC - 8.6 mos (0.1-36 mos)

• TH - 4.1 mos (0.1-13 mos)

• Not eligible for evaluation– 5 pts - no hosp/ER admissions– 4 pts - too short on TH– 5 pts - too short on HC– 2 pts - too short on HC and TH

Results• 13 patients evaluated

– 11 hospitalized– 1 hospitalized and ER visit– 1 ER visit

• Assessment frame 1/00/00 - 9/30/01

• Mean patient LOS times– HC 10.8 mos (3-36 mos)– TH 5.7 mos (3-13 mos)

Results

• HC - 16 hospitalizations, 3 ED visits• TH - 4 hospitalizations, 0 ED visits

• Annualized– HC 1.77 hospitalizations / pt/yr (0-6)– TH 0.52 hospitalizations/pt/yr (0-3)– HC 0.15 ED visits/pt/yr (0-2)– TH 0 ED visits/pt/yr

Projected Savings

• Full capacity: 23 TH pts -- 46 TH pts/yr– FY 2000 mean cost of admission $6,268

• Projected annual admissions • based on hospitalizations/pt/year rates

– TH- 24 admissions -- $149,930– HC - 81 admission -- $510,340

• Projected annual savings

– $360,410

Results

• OASIS data

23

6

23

6

22

7

23

6

23

6

DyspneaPain

FunctionalOral Meds

Cognitive0

5

10

15

20

25

# of

pat

ient

s

Improved

Decline

NMMC Home Health AgencyTelehealth

Results

• Patient satisfaction

6.9%

24.1%

69.0%

12345

*Pt Satisfaction ratings with 1 being the lowest and 5 being the highest

North MS Medical Center Home Health AgencyPatient Satisfaction for Telemedicine

CHF Study Limitations

• Pilot study - small sample size– continue collecting data– perform statistical analysis

• Below full TH capacity– expand services

• Incomplete cost evaluation– compare TH and HC costs of care analysis

TH is Not for Everyone

• Early discharge from TH by doctor – pt declining– caregiver is apprehensive

• Pt’s daughter requests discharge after 3 mos– inconvenient to caregiver

• 2 hospitalizations during 3 mos prior to TH (HC)• 2 hospitalization during 3 mos after TH• 0 hosptitalizations during TH

Summary• Patients have functional, cognitive and

emotional improvements on TH

• Patients are satisfied with TH

• TH appears to reduce the rate of hospitalizations

• At full capacity TH management projects a $360,000 annual cost of hospitalization savings

internet: mac@NMHS.netDirector, Biomedical ServicesBiomed

377-3265 ( Work  )377-4996 ( Preferred Fax  )

Mac.Stanford@nmhs.net ( Work Preferred  )

Mac Stanford

internet: cwsmith@NMHS.netCardiac Outcomes ManagerHome Health

(662)719-2129 ( Work  )(662)841-3253 ( Preferred Fax  )

Cathy.Smith@nmhs.net ( Work Preferred  )

Cathy Smith