Home Health Care With Telemonitoring Improves Health Status for Older Adults With Heart Failure

Abstract

Home telemonitoring can augment home health care services during a patient's transition from hospital to home. Home health care agencies commonly use telemonitors for patients with heart failure although studies have shown mixed results in the use of telemonitors to reduce rehospitalizations. This randomized trial investigated if older patients with heart failure admitted to home health care following a hospitalization would have a reduction in rehospitalizations and improved health status if they received telemonitoring. Patients were followed up to 180 days post-discharge from home health care services. Results showed no difference in the time to rehospitalizations or emergency visits between those who received a telemonitoring vs. usual care. Older heart failure patients who received telemonitoring had better health status by home health care discharge than those who received usual care. Therefore for older adults with heart failure telemonitoring may be important adjunct to home health care services to improve health status.

Utilizing Home Healthcare Electronic Health Records for Telehomecare Patients With Heart Failure

“…For example, early education might be prioritized for patients who have skin issue(s) from diabetes or edema. Since telehomecare services are becoming increasingly attractive to home health care agencies interested in reducing rehospitalization rates and medical costs through fewer nursing visits, 31,32 it may be critical for the efficient use of telehomecare to appropriately target high-risk patients.…”

Risk Factors for All-Cause Rehospitalization Among Medicare Recipients with Heart Failure Receiving Telehomecare

“…The sample size determination was based on the following assumptions: a two-sided alpha equal to 0.05, and the percentage of female patients (74%) as an independent variable of interest in the telehomecare group. 8 A sample of 499 subjects was found to achieve 80% power to detect an odds ratio as high as 0.53, which corresponds to a 10% point reduction in the rehospitalization rate from 25% in women (i.e., to 15% in men), using a logistic regression model that is statistically significant at an alpha level of 0.05. Thus, a sample of 552 in this study was sufficient to achieve 80% power to detect significance.…”

“…By monitoring patients' physiological data, such as vital signs and weight, using telehomecare on a daily basis, home care providers and patients can identify early signs of HF exacerbation to prevent rehospitalization. [4][5][6][7][8] Although telehomecare has been widely used, the majority of telehomecare clinical trials conducted in the United States for the HF population have yielded mixed results. 7,8 One potential way to optimize the use of telehomecare in HF patients is to identify risk factors for rehospitalization from the start of care, to facilitate early recognition of those individuals who need additional support while receiving telehomecare.…”

An ethical analysis of telemedicine: implications for future research

“…A systematic review of the literature, inclusive of all remote monitoring studies meeting the inclusion criteria from the Veterans Health Administration or Department of Veteran Affairs from 2000 to 2009, suggests an increase in veterans' access (Hill et al, 2010). In the home health setting, Madigan et al, (2013) suggest that patients with chronic diseases, who received the remote monitoring intervention, had increased communication with visiting nurses. Visiting nurses were also able to receive timely updates on patients' health status, enabling them to proactively mitigate adverse events (Madigan et al, 2013).…”

“…In the home health setting, Madigan et al, (2013) suggest that patients with chronic diseases, who received the remote monitoring intervention, had increased communication with visiting nurses. Visiting nurses were also able to receive timely updates on patients' health status, enabling them to proactively mitigate adverse events (Madigan et al, 2013). Dansky et al (2008) affirm results that suggest that remote monitoring leads to greater access to bidirectional flow of information; however, greater access to care for the majority has not been confirmed in the literature.…”