# Presentation: 849489

## TeleHomecare:  Making a Difference in Home Care CHF Patients

- <date/time>

- TeleHomecare:  Making a Difference in Home Care CHF Patients

- Rhonda Chetney, RN, MS
- Director of Clinical Operations
- Sentara Home Care Services

## Sentara Home Care Services	

- Located in Chesapeake, VA
- Part of integrated health care system.
- 3 branch offices, 450 employees
- Skilled care, Hospice, Private Duty
- Free-standing, not-for-profit
- Medicare certified, JCAHO accred.
- Listed in Top 10 by HomeCare Magazine

## Data was collected over 1 year period
Initial patients selected had a history of frequent readmissions to the hospital
Screened new admissions for inclusion
Utilized a combination of skilled home care visits and telehomecare visits to provide assessment, teaching and early intervention.

- Initial patients selected had a history of frequent readmissions to the hospital
- Screened new admissions for inclusion
- Utilized a combination of skilled home care visits and telehomecare visits to provide assessment, teaching and early intervention.

## Does the use of telemedicine in a home care environment decrease hospital admissions and emergency room visits and improve quality of life for CHF patients over 65?

## Criteria developed for inclusion:      Diagnoses of CHF  NYHA Class 3 or 4  Age greater than 65                                Physician orders

## Method

- Measured Hospital admission and ER visit utilization for 6 month period prior to start of telehomecare.
- Baseline Quality of Life survey completed by patient on admission
- Home visits co-mingled with telehealth visits
- Physician orders and patient consent obtained

## Total of 12 patient’s data utilized in results.

## Subsequent Quality of Life and Utilization data measured at 3 months and 6 months post implementation of telehomecare. 

## Demographic Characteristics of Sample:

- 11 females                  1 male
- NYHA Class 3 = 11     Class 4 =1
- Inner City
- Low-middle income/social security
- Medicare recipients
- Age range 65 - 93  Majority late 70’s early 80’s

## Results:

## Quality of Life Scores(Lower score = Higher Quality of Life)

- <date/time>

- Quality of Life Scores(**Lower score = Higher Quality of Life**)

**45% improvement from Admission base after 3 mths.  51% improvement from base after 6 mths**.

## Decline in Hospital Admissions

- <date/time>

**95% decrease after 3 mths.  84% decrease after 6 mths**.

## Decrease in ER Visits

- <date/time>

**90% decrease after 3 mths.  76% decrease after 6 mths**.

## Physician Office Visits

- 6 month pre-telehomecare average of                5 visits/patient
- Visit frequency initially increased
- By 6 months a decrease to an average of 4 visits/patient.

## Telehomecare visit note 10/12/2001Patient with changes in cardiorespiratory status past 2 days.  Weight increase 2 lbs, scattered crackles, expiratory wheezes noted upper lobes.  Dyspnea at rest.  Call placed to Dr. re above.  Increase Lasix today.  Son instructed to report any changes.Telehomecare visit note 10/15/2001Patient improved since last visit.  States feels better since additional Lasix given.  Dyspnea now resolves with rest. Decreased wheezes noted.  Weight decreased by 3 lbs.  Color good. No edema.

## Limitations:

- Data obtained from patient interviews
- Quality of Life survey validity testing
- Keeping patients on the program for a full 6 months.
- Small sample size.

## Incidental Findings

- Age was not a factor in proficiency of using the monitor.
- Patients developed self-care attitudes.
- Quality of Life scores continued to improve with time
- Nurses were extremely accepting of project

## Home Health Cost Savings	

- Pre-tele health cost/episode = $1748 (average 19 visits)
- 1st episode post tele cost =        $1370 (average 10 visits + 15 tele visits)
- 2nd episode post tele cost =    $  882 (average 6 visits + 11 tele visits)
- N =8 patients   49% reduction in cost by 2nd episode

## Summary

- Quality of Life scores improved 51%
- Hospital Admissions decreased within the first 3 months by 95% and by 84% at 6 months averting 16 hospital stays.
- ER visits decreased within the first 3 months by 90% and by 76% at 6 months.
- Significant cost savings achieved.

## Summary continued:

- Older adults utilized technology well.
- Patients self-care attitudes appeared to increase.
- Nurses promoted and referred patients to program.
- Physician referrals increased as a result of program.

## Slide 21

## Special thanks to:

- Patricia Strickland, RN, BSN
- Linda Jordan, RN
- and the nursing staff at
-  Sentara Home Care Services