# Presentation: 699378

## TeleHomecare Management of Congestive Heart Failure  in Rural Mississippi 

- Cathy Smith, RN, BSN
- North Mississippi Medical Center
-  Home Health
- Cardiac Outcomes Manager

## TeleHomecare

**Human Factors**

**Technology**

**Human Factors + Technology = TeleHomecare**

**Notes:**
Identify a program manager.

TeleHomecare is an extension of the nurse.

Ann Franz research reference the Remington Report March/April 2000, p. 24-26.

100 surveys regarding the value of touch in home-care practice were sent to professional home care nurses across the US.  95 surveys were returned.

Results:  80% of the respondents believed that they could touch a patient without the physical laying on of hands.

## Slide 3

## Why High Risk CHF Patients?

- Poor prognosis
- Highest re-hospitalization rate
- High Medicare cost
- Most frequent cause of  hospitalization in patients 65 and over with a cost of $6,268 per admission FY 2000
- Shift of care for medically fragile patients from hospital to home

## CHF Project Timeline

- TOP Grant Award - 10/99
- 23 Kodak units purchased - 5/00
- First CHF patient - 8/00
- Kodak pulls out 12/00
- Patient entry on hold
- American Telecare replacements 2/01
- New patients 2/01

- Hospitalization within 6 months
- OR ER visit within 6 months
- OR patient adherence problems
- Requirements
- Caregiver present in the home
- Patient willing and able to learn how to use telecare system
- Patient has multiple home visits per week

## Slide 7

## Clinical Assessments

** ****Edema**

**Validating Insulin Dosage**

## Clinical Assessments

**TelePhonic Stethoscope**
**Heart and Lung Sounds**
**Rales, Wheezes, Decreased breath sounds **
**Abnormal heart sounds**

## TeleHomecare Interventions

**TeleHomecare Interventions**

**Nursing **
**Intervention**

**Nursing **
**Intervention**

## Program Evaluation

- Outcomes
- Hospitalizations
- ER visits
- Qualitative measurements
- OASIS
- functional, cognitive, emotional assessment
- Patient satisfaction survey

## Data Analysis

- Retrospective review of hospitalizations and ER visits
- include CHF as primary and secondary diagnosis
**INCLUSION CRITERIA**
- Patients have hospitalization or ED visit
- Patients on home care (HC) and  telehomecare (TH) each for at least 3 months
- Data is annualized and compared

## Results

- 8/15/00 to 9/30/01
- 29 patients
- Mean length of stay(LOS)
- HC - 8.6 mos (0.1-36 mos)
- TH -  4.1 mos (0.1-13 mos)
- Not eligible for evaluation
- 5 pts - no hosp/ER admissions
- 4 pts - too short on TH
- 5 pts - too short on HC
- 2 pts - too short on HC and TH

## Results

- 13 patients evaluated
- 11 hospitalized
- 1 hospitalized and ER visit
- 1 ER visit
- Assessment frame 1/00/00 - 9/30/01
- Mean patient LOS times
- HC 10.8 mos (3-36 mos)
- TH 5.7 mos (3-13 mos)

## Results 

- HC - 16 hospitalizations, 3 ED visits
- TH - 4 hospitalizations, 0 ED visits
- Annualized
- HC 1.77 hospitalizations / pt/yr (0-6)
- TH 0.52 hospitalizations/pt/yr (0-3)
- HC  0.15 ED visits/pt/yr (0-2)
- TH 0 ED visits/pt/yr

## Projected Savings

- Full capacity: 23 TH pts -- 46 TH pts/yr
- FY 2000 mean cost of admission $6,268
- Projected annual admissions
-  based on hospitalizations/pt/year rates
- TH- 24 admissions -- $149,930
- HC - 81 admission -- $510,340
- Projected annual savings
- $360,410

## Results

- OASIS data

## Results

- Patient satisfaction

## CHF Study Limitations

- Pilot study - small sample size
- continue collecting data
- perform statistical analysis
- Below full TH capacity
- expand services
- Incomplete cost evaluation
- compare TH and HC costs of care analysis

## TH is Not for Everyone

- Early discharge from TH by doctor
- pt declining
- caregiver is apprehensive
- Pt’s daughter requests discharge after 3 mos
- inconvenient to caregiver
- 2 hospitalizations during 3 mos prior to TH (HC)
- 2 hospitalization during 3 mos after TH
- 0 hosptitalizations during TH

## Summary

- Patients have functional, cognitive and emotional improvements on TH
- Patients are satisfied with TH
- TH appears to reduce the rate of hospitalizations
- At full capacity TH management projects a $360,000 annual cost of hospitalization savings

## Mac Stanford

**Director, Biomedical Services**
**Biomed**
**377-3265        ( Work  )****377-4996        ( Preferred Fax  )**
**Mac.Stanford@nmhs.net        ( Work Preferred  )**

**Mac Stanford**

## Cathy Smith

**Cardiac Outcomes Manager**
**Home Health **
**(662)719-2129        ( Work  )****(662)841-3253        ( Preferred Fax  )**
**Cathy.Smith@nmhs.net        ( Work Preferred  )**

**Cathy Smith**