# Presentation: 409450

## Low Cost Standards-based TeleHomeCare Demonstration Project 

- 		Stanley M Finkelstein, PhD
- 		Stuart M Speedie, PhD
- 		George Demiris, PhD
- 		Jan Marie Lundgren, BS
- 		Marshall Hoff, BA
- 		University of Minnesota, Minneapolis, MN
- 	Supported by Grant #27-60-98031 from the TIIAP, Dept of Commerce and matching funds from program clinical and industry partners
- 	http://www.telehomecare.umn.edu

## Program Partners

- University of Minnesota
- Fairview Home Care, Minneapolis
- HomeHealth Partnership, Crosby & Aitkin,  MN
- Lakewood Health System, Staples, MN
- Tri-County Hospital, Wadena, MN
- CareFacts Information Systems, St Paul, MN
- Onvoy, Minneapolis, MN
- QRS, Minneapolis, MN

## Partner Sites

## Telemedicine 

- The use of telecommunications and information technology to provide health care services
- within or across institutional boundaries
- between providers
**between patient and provider**

## Telemedicine from Home

- Places patient directly in care loop
- Patient becomes an active contributor in the care process
- Easy, inexpensive approach to link patient and provider

## Home Health Care

- 11 million homebound patients
- Cost in 1998 estimated at $42 billion
- Medicare/Medicaid/out of pocket
- Often elderly and/or poor
- Rural and urban
- Long term condition, recovery from acute episode, permanent disability, terminal illness

## Objectives

- To demonstrate that a telemedicine program combining videoconferencing, Internet access, and physiological home monitoring within a home health care setting can
- improve quality of care
- reduce cost of care
- increase access to care
- improve patient satisfaction with care

## Outcome Measures

- Mortality and morbidity
- Time to transfer to higher level of care
- Patient satisfaction
- Utilization of services
- Patient/program costs

## Methods - Full Study

*Recruitment Plan*
- Subjects with congestive heart failure, chronic obstructive pulmonary disease, chronic wound care (40/disease group)
- Control or Study Group 1 or Study Group 2
- Control - standard home care (medical problem guidelines)
- Study Group 1 -  standard care + videoconference +  Internet
- Study Group 2 - standard care + videoconference + Internet + monitoring

## Methods

**         *****Equipment -- ******Home Health Care Agency***
**Videophone/Camera (ViaTV VC105)**
**Monitor**
**VCR**
**PC with clinical information system (CareFacts CIS)**

## Nursing Work Station

- ViaTV

## Methods

***          ******Equipment -- ******Subject’s Home Station***
**Television**
**Telephone**
**Videoconferencing/Internet browser (ViaTV VC55)**
**Camera (Philips eyeball, 512x492 pixels)**
**Monitoring equipment (Study group 2)**

## Internet Home Equipment

## Monitoring Components

- QRS Spirometer

- Pulse Oximeter

- Also includes a scale and blood pressure cuff

## Internet Home Page

## Patient Diary Forms

##    Weekly Report -  Numeric Data

## Weekly Report -  Categorical Data

## Feasibility Study Results

- Number of subjects recruited : 24
- Satisfactory participation: 13
- CHF: 4      COPD: 9
- Age: 73.8 +/- 12.9 SD yrs
- Unsatisfactory participation: 11 (1 drop-out, 7 refusals after sign-up, 3 homes not acceptable)
- CHF: 3      COPD: 7      wounds: 1
- Age:  73.0 +/- 12.6 SD yrs

## Feasibility Study Results

- Average length of each case: 35 days
- Average number of virtual visits/subject: 6.7
- Average time of virtual visits: 25 minutes
- Average number of actual visits/subject: 5.9
- Average time of actual visit: 33 minutes
- Content of virtual and actual visits comparable (9 basic themes)

## Full Study - Initial Results

- 68 patients agreed to participate
- 53 (19 C, 15 V, 19 M) subjects completed study
- Failure to complete study due to illness/hosp, phone lines, concerns with equipment, move, another study, nurse change
- Average age/range (yrs):
- active: 72.0 (50-89) in C, 79.3 (65-90) in V, 73.1 (50-85) in M
- drop-outs: 78.0 in C, 77.8 (60-96) in V, 77.7 (68-87) in M

## Full Study - Initial Results

- # of actual visits: 440 in C, 262 in V, 325 in M
- # of virtual visits: 280 in V, 262 in M
- Technical quality of virtual visits, rated by HC nurses: 94.7% (range 57.1 - 100%)
- Usefulness of virtual visits, rated by HC nurses: 91.8% as good as actual visit
- Subject perception of telehomecare increased significantly after participating in the study
- 32% of C and 12% of V/M were d/c to nursing home or hospital

## Conclusions - TeleHomeCare

- Virtual visits can be conducted over POTS
- Nurses and patients can successfully interact in a virtual visit
- Virtual visits closely parallel actual visits in time and content
- Patients can learn to use monitoring devices, daily diaries via the Internet and web browsing
- Physiological monitoring can be a positive addition to the telemedicine portfolio
- Physiological monitoring and daily diaries can “fill the gaps” between home care visits (actual/virtual)
- Transition to home health care protocols is successful

## Major Challenges

- Reimbursement
- Identifying appropriate subjects
- Agency commitment to
- administrative planning and promotion,
- training and incentive for nurses,
- identify nurse leader (technical aptitude and motivation)
- provide technical support staff