Opening a Window of Opportunity through Technology and Coordination: A Multisite Case Study

Abstract

The Community Care Coordination Service (CCCS) program was implemented in April, 2000, at the Veterans Integrated Service Network (VISN 8). The goals of the CCCS were to improve the coordination of care for clinically complex patients, referred to as veterans, and to increase their access to care while reducing complications, hospital admissions, and emergency room (ER) visits. This program used a coordinated care approach, a process whereby veterans were followed throughout the continuum of care. The information presented in this case study is specific to three medical centers that implemented the CCCS: Ft. Myers, Lake City, and Miami. Analysis of utilization and clinical impact were conducted after 18 months. Inpatient admissions were reduced by 46% at Ft. Myers, 68% at Lake City, and 13% at Miami. ER encounters were reduced by 19% at Ft. Myers, 70% at Lake City, and 15% at Miami. Reductions in bed days were demonstrated at Ft. Myers (29%) and Lake City (71%). In Miami, there was a 13% increase in the number of bed days of care for the patients after 1 year in the program. In addition to these changes in health-care utilization, quality of life was significantly improved as evidenced by increases in the four of the eight components scores of the Medical Outcomes Study 36-item Short Form health survey for veterans (SF36V) at Lake City and Ft. Myers. In the CCCS model of care using home telehealth technology, the Care Coordinators bridged the gap between office visits by providing a daily connection between the coordinators and the patients. This daily communication made it possible for problems to be identified early and interventions implemented before problems escalated.

Feasibility study of home telerehabilitation for physically inactive veterans

“…Other studies using the HB have reported varying adherence rates depending on the method used to calculate them, the condition being monitored, and the length of follow-up [25][26][27]. For example, Cherry et al reported 12-month adherence rates ranging from 64 to 83 percent for patients with congestive heart failure, chronic obstructive pulmonary disease, diabetes mellitus, hypertension, and coronary artery disease [26]. They calculated compliance as the number of sessions taken by the patient divided by the total number of available sessions.…”

Cost Effectiveness of a Telerehabilitation Program to Support Chronically Ill and Disabled Elders in Their Homes

“…It has been proposed that telehealth applications could help meet these challenges. [8][9][10][11][12][13][14][15][16] Home-based telehealth is a specific clinical application of monitoring patients in their place of residence from a central station usually located at a hospital or clinic. The premise is that improvements in healthcare services and reductions in healthcare costs can be affected by establishing a continuum of patient care from the patient's home to service providers in the healthcare sector.…”

Telestroke in Stroke Survivors

“…Studies have also shown the effectiveness of telemedicine for a variety of chronic diseases care management such as: general health status monitoring (self-reported, or with home-based devices) with scheduled interventions such as nurse visit or GP consultation (video, telephone or physical attendance) [29,32,33,34,35,36]; medication compliance and modification, depending on symptoms and side effects, and the early detection of deterioration of patient leading to ‘just-in-time’ interventions, thereby preventing unnecessary admissions and escalating healthcare costs [37,38,39]. …”