Outcomes of Chronic Heart Failure

Benatar, Daniel; Bondmass, Mary D.; Ghitelman, Jaime; Avitall, Boaz

doi:10.1001/archinte.163.3.347

Cited by 238 publications

(233 citation statements)

References 25 publications

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“…The cost savings were attributed to fewer hospitalizations while the quality of care remained stable. Benatar et al 6 and Dansky et al 2 both significantly decreased hospitalization charges for their randomized telehomecare patients versus controls.…”

Section: Effects On Costsmentioning

confidence: 93%

“…Research has shown decreased rehospitalization rates in patients with HF, 4,6,7,28 diabetes, 2,21 and spinal cord injury 8 ; better diabetic management 16 ; and the ability to assess chronic wound progression using telecommunications technology. 9 However, variations in sample characteristics, such as age, equipment type used, intervention length, and study design, make generalizations difficult.…”

Section: Effects On Chronic Illnessmentioning

confidence: 99%

“…Most studies used relatively small sample sizes (n = 11-90), 4, 5 , 7 -9 ,26,28 with the exception of 4 studies that used samples of 174, 216, 226, and 297. 2,6,17,18 Findings from these larger studies suggest that telehomecare used with elders with chronic illnesses such as HF and DM, will lead to improved clinical outcomes. However, only 2 of these larger trials were randomized with a control group.…”

Section: Effects On Chronic Illnessmentioning

confidence: 99%

“…Three larger studies 2,6,25 showed that although initially care delivery costs were increased due to the cost of equipment, overall costs of care were decreased due to decreased hospital charges and travel costs. In most studies, small sample sizes and lack of robust economic analyses preclude generalization of financial results.…”

Section: Effects On Costsmentioning

confidence: 99%

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Applying Research Evidence to Optimize Telehomecare

Bowles

Baugh

2007

The Journal of Cardiovascular Nursing

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Telemedicine is the use of technology to provide healthcare over a distance. Telehomecare, a form of telemedicine based in the patient's home, is a communication and clinical information system that enables the interaction of voice, video, and health-related data using ordinary telephone lines. Most home care agencies are adopting telehomecare to assist with the care of the growing population of chronically ill adults. This article presents a summary and critique of the published empirical evidence about the effects of telehomecare on older adult patients with chronic illness. The knowledge gained will be applied in a discussion regarding telehomecare optimization and areas for future research. The referenced literature in PubMed, MEDLINE, CDSR, ACP Journal Club, DARE, CCTR, and CINAHL databases was searched for the years 1995-2005 using the keywords "telehomecare" and "telemedicine," and limited to primary research and studies in English. Approximately 40 articles were reviewed. Articles were selected if telehealth technology with peripheral medical devices was used to deliver home care for adult patients with chronic illness. Studies where the intervention consisted of only telephone calls or did not involve video or in-person nurse contact in the home were excluded. Nineteen studies described the effects of telehomecare on adult patients, chronic illness outcomes, providers, and costs of care. Patients and providers were accepting of the technology and it appears to have positive effects on chronic illness outcomes such as selfmanagement, rehospitalizations, and length of stay. Overall, due to savings from healthcare utilization and travel, telehomecare appears to reduce healthcare costs. Generally, studies have small sample sizes with diverse types and doses of telehomecare intervention for a select few chronic illnesses; most commonly heart failure. Very few published studies have explored the cost or quality implications since the change in home care reimbursement to prospective payment. Further research is needed to clarify how telehomecare can be used to maximize its benefits among diverse adult chronic illness populations. Keywords home care; telecommunications; telemedicineTelemedicine is defined as the use of technology to provide healthcare over a distance. 1 Telehomecare, a form of telemedicine based in the patient's home, is a communication and clinical information system that enables the interaction of voice, video, and health-related data using ordinary telephone lines. 2 As noted in other articles in this issue, typical equipment can include a telephone line; simplified, regular computer, or wireless devices; videocamera; and physiologic monitoring equipment such as a blood glucose monitor, stethoscope, blood

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Section: Effects On Costsmentioning

confidence: 93%

Section: Effects On Chronic Illnessmentioning

confidence: 99%

Section: Effects On Chronic Illnessmentioning

confidence: 99%

Section: Effects On Costsmentioning

confidence: 99%

See 2 more Smart Citations

Applying Research Evidence to Optimize Telehomecare

Bowles

Baugh

2007

The Journal of Cardiovascular Nursing

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“…In diabetes, several studies demonstrated reduced glycosylated hemoglobin levels after use of telemedicine systems [5][6][7][8][9][10] . In congestive heart failure, telemedicine improved quality of life, decreased hospitalizations, and decreased hospitalization costs in the telemedicine group [11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

A Randomized, Controlled Trial of Home Telemanagement in Patients With Ulcerative Colitis (UC HAT)

Cross¹,

Cheevers²,

Rustgi³

et al. 2011

Gastroenterology

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Thirty-Day Readmission Rates for Medicare Beneficiaries by Race and Site of Care

Joynt¹

2011

JAMA

648

455

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Context Understanding whether and why there are racial disparities in readmissions has implications for efforts to reduce readmissions. Objective To determine whether black patients have higher odds of readmission than white patients, and if these disparities are related to where black patients receive care. Design Using national Medicare data, we examined 30-day readmissions after hospitalization for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia. We categorized hospitals in the top decile of proportion of black patients as “minority-serving.” We determined the odds of readmission for black patients compared with white patients at minority-serving versus non-minority-serving hospitals. Setting U.S. hospitals. Participants 3.1 million Medicare fee-for-service recipients, discharged in 2006–2008. Intervention None. Main Outcome Measure Risk-adjusted odds of 30-day readmission. Results Overall, black patients had higher readmission rates than white patients (24.8% versus 22.6%, odds ratio [OR] 1.13, 95% confidence interval [CI] 1.11 to 1.14, p<0.001); patients from minority-serving hospitals had higher readmission rates than those from non-minority-serving hospitals (25.5% versus 22.0%, OR 1.23, 95% CI 1.20, 1.27, p<0.001). Among AMI patients, using white patients from non-minority-serving hospitals as our reference group (readmission rate 20.9%), we found that black patients from non-minority-serving hospitals had the highest readmission rate (26.4%, OR 1.20, 95% CI 1.16, 1.23), while white patients from minority-serving hospitals had a 24.6% readmission rate (OR 1.23, 95% CI 1.18, 1.29) and black patients from minority-serving hospitals had a 23.3% readmission rate (OR 1.35, 95% CI 1.28, 1.42, p<0.001 for each); patterns were similar for CHF and pneumonia. The results were unchanged after adjusting for hospital characteristics including markers of caring for poor patients. Conclusions Among elderly Americans, black patients were more likely to be readmitted after hospitalization for three common conditions, a gap that was related to both race and to the site where care was received.

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Outcomes of Chronic Heart Failure

Abstract: The adaptation of state-of-the-art computerized technology to closely monitor patients with HF with advanced-practice nurse care under the guidance of a cardiologist significantly improves HF management while reducing the cost of care.

Cited by 238 publications

References 25 publications

Applying Research Evidence to Optimize Telehomecare

Applying Research Evidence to Optimize Telehomecare

A Randomized, Controlled Trial of Home Telemanagement in Patients With Ulcerative Colitis (UC HAT)

Thirty-Day Readmission Rates for Medicare Beneficiaries by Race and Site of Care

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