America's healthcare crisis—in terms of increasing costs and disappointing outcomes—is largely the result of attempting to manage long-term chronic conditions in short-term acute care settings. While patients with chronic disease occasionally exacerbate and require acute care, most of their needs can and should be met in home and community based environments. Fortunately, the advent of new health information technologies is facilitating non-acute chronic care on an unprecedented scale.
As a provider of homecare services, Baptist Home Health Network noted a steady increase in recent years of their patient population with one or more chronic conditions. As that percentage approached the 50% mark, they decided to implement a home telemonitoring program for these patients in 2005. Over 100 monitors are currently deployed in homes throughout central Arkansas.
Patients referred to home health by their physicians with a chronic disease diagnosis are evaluated for a telehealth unit at the time of admission. If deemed appropriate, a unit is deployed by a staff member who installs it and instructs patients and family members in its use. Priority is given to patients with multiple chronic conditions as they are most likely to exacerbate.
The unit has peripheral devices attached – either by wires, or wirelessly, depending on the model – that collect various biometric measures: weight, blood pressure, blood glucose, and pulse oximetry-–even EKG on patients with heart conditions. Patients typically collect data twice daily, although it can be as often as deemed necessary. Following collection, data is transmitted via the patient's phone line to a secure website. The data on this website is accessible by the patient, any family member they choose to designate, the patient's physician(s) and the home health staff.
At a central monitoring station in the home health office, nurses monitor incoming patient data seven days a week. Acceptable parameters have been established for each patient, and data that falls outside those parameters generates an alert for the monitoring nurse to address. Alerts are color coded according to severity to assist the nurses in targeting the most urgent needs. In some cases, a phone call to the patient to discuss the data is initiated. That in turn may result in a consultation between the monitoring nurse and the patient's physician. In other cases, a home health nurse may be sent to the home to assess and treat the patient to prevent an unnecessary trip to the emergency department and an avoidable rehospitalization.
Since neither public nor private payers reimburse the home health agency for the cost of the units, the supply is limited and there is often a waiting list. Products from several different vendors have been purchased, ranging in price from $3,000 to $6,000 per unit. These purchases have been funded from agency operations to provide the highest level of care to the patients they serve.
In order to standardize the care provided to patients with chronic conditions, the agency developed a new care delivery model that incorporates technology as a key pillar. One of the basic tenets of this model is that technology cannot stand alone in the provision of high-quality healthcare; it must be coupled with evidence-based clinical practices to achieve the desired patient outcomes.
As a result of implementing telehealth within the context of this model, the following impacts have been noted:
- Care delivery to patients with chronic disease has been enhanced and standardized with the inclusion of biometric data collected daily in the patient's home.
- Patients satisfaction has increased as chronic conditions previously out of control are stabilized.
- Quick interventions to treat patients in their homes have resulted in a significant decrease in the agency's rehospitalization rate—from 29% to 20%.
- Coordination of care with physicians and other healthcare providers has been improved.
- Data availability has supported positive reinforcement of healthy behaviors by agency staff (which further increases patient self-confidence).
- Improved quality of life for patients has occurred as they learn strategies for successful self-management and experience fewer disease exacerbations.
- Overall costs to the healthcare system have been decreased as chronic conditions are being managed in the least expensive setting: the patient's home.
In addition to the telehealth units, this program has required the following dedicated resources to implement and operate:
- Program director (.5 full-time employees, or FTEs).
- 2.5 Nursing FTEs for data monitoring.
- One FTE for equipment deployment, maintenance and troubleshooting.
Baptist Health Home Health Network has presented their program to the Governor's Roundtable on Healthcare in Arkansas to illustrate how patient outcomes can be improved while costs are decreased through this care delivery model. They have requested a recommendation for the American Recovery and Reinvestment Act of 2009, or stimulus law, funding to replicate this program in other home health agencies throughout the state. The agency has also presented a similar request to Arkansas Telehealth Oversight Management (ATOM) for stimulus law funding that they may receive and distribute. In addition, a proposal has been submitted to the state Medicaid program to fund home-based telehealth with their stimulus monies.
The success experienced with this program can be reproduced throughout our state—and the nation—with sufficient funding for equipment and specialized training in chronic-disease management.
David L. House
Vice president and chief information officer of information services
Baptist Health
Little Rock, Ark.
