The aim of this study was to determine whether home telehealth, when integrated with the health facility's electronic medical record system, reduces healthcare costs and improves quality-of-life outcomes relative to usual home healthcare services for elderly high resource users with complex co-morbidities. Study patients were identified through the medical center's database. Intervention patients received home telehealth units that used standard phone lines to communicate with the hospital. FDA-approved peripheral devices monitored vital signs and valid questionnaires were used to evaluate quality-of-life outcomes. Out-of-range data triggered electronic alerts to nurse case managers. (No live video or audio was incorporated in either direction.) Templated progress notes facilitated seamless data entry into the patient's electronic medical record. Participants (n = 104) with complex heart failure, chronic lung disease, and/or diabetes mellitus were randomly assigned to an intervention or control group for 6-12 months. Parametric and nonparametric analyses were performed to compare outcomes for (1) subjective and objective quality-of-life measures, (2) health resource use, and (3) costs. In contrast to the control group, scores for home telehealth subjects showed a statistically significant decrease at 6 months for bed-days-of-care (p < 0.0001), urgent clinic/emergency room visits (p = 0.023), and A1C levels (p < 0.0001); at 12 months for cognitive status (p < 0.028); and at 3 months for patient satisfaction (p < 0.001). Functional levels and patient-rated health status did not show a significant difference for either group. Integrating home telehealth with the healthcare institution's electronic database significantly reduces resource use and improves cognitive status, treatment compliance, and stability of chronic disease for homebound elderly with common complex co-morbidities.

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In 2007, the VA Connecticut Healthcare System began a home electronic messaging programme for mental health patients. During the first two years, 76 patients with diagnoses of schizophrenia, post traumatic stress disorder, depression and substance-use disorders received a home messaging device, which was connected via an ordinary telephone line. There were daily questions, which were based on disease management protocols, and included alerts, data and educational components. Patient data were sent to a nurse practitioner each day for triage and follow-up. Patients used the device for at least six months. In the six months prior to enrolment, 42 patients were hospitalized for 46 admissions. In the following six months, six patients were hospitalized for nine admissions (P < 0.0001). In the six months prior to enrolment, 47 patients had a total of 80 ER visits. In the following six months, 16 patients had a total of 32 ER visits (P < 0.0001). Questionnaire responses indicated a high level of satisfaction with the home messaging programme.

The Connecticut Veterans Affairs Healthcare System (CT-VAHCS) sought to improve the timeliness of lung cancer care by filling the new position of cancer care coordinator with an advanced practice nurse (APN) functioning as a nurse navigator. The multifaceted nature of diagnosing lung cancer and the barriers encountered by patients and families as they access the complex healthcare system contributed to substantial delays in diagnosing and treating this disease. Beginning in January 2007 when the cancer care coordinator was hired, she recorded data regarding timeliness and stage at diagnosis for all patients diagnosed with non-small cell lung cancer. CT-VAHCS created and modified several processes to improve timeliness and quality of cancer care as soon as a patient's imaging suggested a new diagnosis of malignancy. The cancer care coordinator effected a measurable improvement in timeliness. In 2003, the average was 136 days from suspicion of cancer to treatment compared to 55 days in 2010, with a trend toward diagnosis of non-small cell lung cancer at an earlier stage. Oncology-certified APNs in the position of cancer care coordinator can engage multiple disciplines to generate process changes and improve timeliness of lung cancer care.

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