Hospitals, and now home health agencies, are being challenged to reduce hospital readmissions. To identify one of the greatest opportunities for achieving this goal, one needs to look no further than patients with congestive heart failure.
Nationally, nearly one in four CHF patients is readmitted for events that likely were preventable, and more than one in 10 CHF patients is readmitted within 15 days of being released, according to the Medicare Payment Advisory Commission (MedPAC).
That’s not all. In the U.S., heart failure is not only the leading cause of death, but also the most common hospital discharge diagnosis for Medicare patients. Medicare CHF patients are among the most expensive to treat, which is one reason why Medicare now refuses to pay for unnecessary readmissions of patients with heart failure.
What’s the Answer?
Consider this: In 2011, Advanced TeleHealth Solutions conducted a study that looked at how improving CHF management post-discharge could be a strategy for reduced hospitalizations. The study evaluated 83 heart failure patients with four to five co-morbidities each who were discharged from an integrated health system in Southwest Missouri between February and August in 2011. The patients were divided into two groups: one received telemonitoring services for six months, and the other, a control group, did not.
The 83 patients in the control group and the telemonitoring group were sent home from the hospital with medications and instructions provided by their discharge nurses. Patients in both groups may have also received home health services paid for by their insurance companies. For the purposes of the study, the patients in the telemonitoring group received an additional layer of care: remote patient monitoring from a URAC-accredited health call center that included daily measurements of their biometric readings and questions regarding their symptoms along with daily phone conversations with an Advanced TeleHealth Solutions nurse who was certified in chronic care and trained to coach patients through their recovery.
About the Study
Every day, the patients used peripherals such as a pulse oximeter to measure oxygen levels and heart rate, weight scales, and a blood pressure cuff to record vital sign changes. With a touch of a button, these measurements and answers to questions regarding the patients’ symptoms were transmitted to the Advanced TeleHealth Solution nurses. The patients had established parameters for their vital signs. Anytime the patients’ vital signs were outside the acceptable parameters or the patients replied to the questions regarding their symptoms in a negative way, the patients received a call from their Advanced TeleHealth Solutions nurse. The information provided a framework for the daily conversation between the patient and caregiver about the specific health issues the patient was having that day. The nurse also provided proven clinical interventions and coordinated with the patients’ other care providers.
After ongoing coaching, patients and their families were able to determine on their own when a vital sign had changed enough to be a cause for concern. When problems occurred, patients were instructed to call Advanced TeleHealth Solutions, which provided nursing help around the clock. The amount of time the nurse and the patient spent on the phone depended on the condition of the patient, education provided, and care coordination. If a physician needed to be contacted, the Advanced TeleHealth Solutions nurse made the call and coordinated any changes to the plan of treatment with the patient.
The Results Speak for Themselves
The results of the study were analyzed by a Missouri State University researcher who found that patients who received telemonitoring services were less likely to be readmitted and more likely to take their medications than patients in the control group. Heart failure patients often suffer from depression because their illness can seriously limit their activities, sleep, and social relationships. Compared to the control group, the patients in the telemonitoring group indicated a greater quality of life, as measured by the scores on the Minnesota Living with Heart Failure (MLWHF) scale, a commonly used Likert-scale patient self-assessment of how heart failure affects patients’ daily lives.
Without a doubt, remote patient monitoring is an effective strategy for reducing hospital readmissions. In addition to preventing costly readmissions, telemonitoring has the added benefit of helping patients comply with their medication instructions and improving their quality of life. While patients have the comfort of knowing their vital signs and symptoms are evaluated daily, hospital administrators are learning that telemonitoring can help reduce healthcare costs and keep hospital rooms free for patients with the most urgent needs.
About Karen Thomas
Karen Thomas is a certified management accountant and the president of Advanced TeleHealth Solutions, one of the leading telehealth monitoring companies in the U.S. Karen is a nationally renowned speaker, a lecturer for Missouri State University’s graduate-level Health Care Administration program, and a contributing author to, “Home Telehealth: Connecting Care Within the Community,” published by Royal Society of Medicine Press Ltd. Karen has appeared on numerous webinars and has spoken at dozens of conferences on the benefits of remote patient monitoring, generating enhanced clinical outcomes, patient engagement, and coordination of care. She is a member of the Missouri Governors Innovation Task Force, a past board member of the National Association for Home Care and Private Duty Home Care Association, a member of the American Telemedicine Association and the American Society on Aging, and a past ex-officio member of the advisory board of HealthCare Technology Association of America.