A Home Telehealth Heart Failure Management Program for Veterans Through Care Transitions

Abstract

Heart failure (HF) is a new epidemic in the United States. Advanced HF is a fatal illness affecting our veterans and causing frequent hospital readmissions in both the Veterans Affairs hospital and throughout the nation's healthcare system. The clinician's obligation is to offer the best alternatives in the care of chronic illness. The Veterans Affairs healthcare system has a comprehensive approach to treating HF. The comprehensive implementation of home telehealth, clinical informatics, and disease management supports the care of patients with advanced HF.

Pilot Study

“…Figure 1. Application of ITHBC to HF patients, Adapted from "Integrated theory of health behavior change" by Polly Ryan, 2009, Clinical Nurse Specialist, 23, p. 164. Adapted with permission and "Application ofiTHBC to HF patients" by Analiza Baldonado, A (2013). Unpublished manuscript.…”

“…Project RED is the result of a five-year work of health professionals from Boston Medical Center (Jack & Bickmore, 2011). This effort was funded through grants from the National Heart Lung and Blood Institute (NHBLI) and Agency for Healthcare Research and Quality (AHRQ) (Jack & Bickmore, 2011 (Baldonado et al, 2013).…”

“…Al., 2008). The clinicians assist patients to take an active role in managing their illness with the use oftelemedicine tools (Baldonado et al, 2013).…”

“…The equipment may include different communication devices such as wireless apparatus, which collect physiological data. The patient records the blood pressure and takes pulse oximeters, blood glucose, and weight readings to obtain vital signs as directed (Baldonado et al, 2013). In addition, multiple health questions can be collected about behaviors and health status.…”

“…In addition, multiple health questions can be collected about behaviors and health status. The needed parameters are selected, which are individually tailored according to a patient's clinical presentation and comorbidities (Baldonado et al, 2013). These data are transmitted to the clinicians for interventions and coaching (The Fast Adoption of Significant Technologies, 2009).…”