Enhancing Elder Chronic Care through Technology and Care Coordination: Report from a Pilot

Abstract

The Rural Home Care Project is one of eight clinical demonstration pilots in an initiative of the Veterans Health Administration (VHA) Sunshine Network in Florida and Puerto Rico. In this project three care coordinators consisting of two nurse practitioners and a social worker collaborate with primary care providers in the management of high-risk, high-cost veterans with multiple chronic diseases such as diabetes and heart failure. The project staff uses home telehealth devices to monitor and educate patients to prevent health crises. The evaluation methodology is a quasiexperimental design that uses a nonequivalent control group of usual care veterans. Data were gathered through personal interviews with patients and providers, and statistical analysis was based on a series of repeated-measure of covariance modeling designed by a research team from the University of Maryland. Findings demonstrate that care coordination enhanced by technology reduces hospital admissions, bed days of care, emergency room visits, and prescriptions as well as providing high patient and provider satisfaction. Veterans also had improved perception of physical health as evidenced by a standardized functional status measure.

Impact of a Telehealth and Care Management Program on All-Cause Mortality and Healthcare Utilization in Patients with Heart Failure

“…Prior studies have found that use of the HBP was associated with greater compliance with prescription medications, 13 titration of medications, 14 and compliance with nonpharmacologic recommendations, 15 suggesting the HBP likely improved both care delivery and patient self-management, which may have contributed to reductions in mortality and hospitalization observed in the present study. In addition, secondary analyses of multiple randomized trials have shown improved outcomes in patients who demonstrate high pharmacologic adherence in the placebo arm comparable to those receiving the study drug, supporting the possibility that patient engagement may be a marker for other beneficial characteristics.…”

A Systematic Review of Clinician and Staff Views on the Acceptability of Incorporating Remote Monitoring Technology into Primary Care

“…1). 11,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Six studies provided perspectives from primary care…”

“…16,[19][20][21][22][23] Four studies published in five reports provided perspectives from clinical specialties including but not limited to primary care. 11,17,[25][26][27] Seven studies reported perspectives from primary care staff, administrators, or unspecified healthcare professionals.…”

“…11,16,17,[19][20][21][22][23][25][26][27] Three studies were conducted in the United States, 11,16,19 one in Canada, 21 one in Denmark, 20 two in Germany, 22,23 and one in Korea, 25 and two studies in the United Kingdom were published in three reports. 17,26,27 Clinicians in several studies conveyed positive views about RMT, and some reported RMT resulted in a decrease in workload due to delegation of activities to ancillary staff.…”

“…Gagnon et al 15 (2006) Goodrich et al 16 (2011) Hardisty et al 17 (2011); Peirce et al 27 (2011) Kim et al 25 (2011) Kobb et al 19 (2003) Lamothe et al 24 (2006) Liddy et al 21 (2008) Thompson Use of RMT contributed to changes in clinician and staff roles, as well as in patient relationships. Although clinicians wanted to review RMT data during patient visits, there was not always adequate time.…”