Telehealth reduced readmissions, hospital days: report

When done right, telehealth programs work.

That's the bottom line from a 10-page report, “Scaling Telehealth Programs: Lessons from Early Adopters,” by the Commonwealth Fund. It focuses on three pioneers of home health monitoring technologies and programs: the Veterans Affairs Department, Boston-based Partners HealthCare and Centura Health, Englewood, Colo.

The authors concluded, based on the experiences of these early adopters, that home monitoring programs can improve care and patient experiences, reduce hospitalizations and cut costs. Followers wanting to emulate the success of these early adopters should focus more on the people than the technology.

“Early lessons include promoting a culture of openness and preparedness; using a multidisciplinary team-based approach; establishing leadership support; minimizing barriers to patient enrollment, like cost; and including nonstandard measures, like patient experience and staff satisfaction, in program evaluation,” according to the report.

Not that the technology is trivial. “The real-time transmission of monitoring data, for example, allows nurses to provide patients with just-in-time care and education,” the authors said. “The use of personal health data can help educate and motivate patients to make necessary lifestyle changes and realize better clinical outcomes.”

Followers also are counseled to be patient. “Successful programs can take time to scale successfully,” the authors said. “It takes time to integrate technology into care delivery and allow staff to adapt.” The VA's Care Coordination/Home Telehealth program targeting chronically ill veterans, for example, was launched in 2003. Now, with 70,000 veterans receiving home telehealth care, the program boasts patient satisfaction levels greater than 85%.

In a data sample from 2004 through 2007, the VA reported reductions in bed days of care across all eight targeted chronic conditions, ranging from a 20% drop for the nearly 9,000 enrolled diabetes patients to a 56% decrease for the nearly 340 patients then receiving home health monitoring for depression, and a 45% drop for nearly 140 patients with post-traumatic stress disorder.

Partners has had 1,200 patients enrolled thus far in its Connected Cardiac Care Program since its launch as a pilot study in 2006. It has “consistently experienced an approximate 50% reduction in health failure-related readmission rates for enrolled patients,” according to the Commonwealth reporters, with an estimated savings in utilization of about $10 million.

Centura Health at Home combines a remote patient monitoring program begun in 2004 with a clinical call center effort from the 1990s. A pilot in 2010 and 2011 focused on three conditions, congestive heart failure, chronic obstructive pulmonary disease and diabetes. During the pilot, 30-day readmission rates across all three conditions dropped 62% at an estimated cost savings of $1,000 to $1,500 per patient, the report said. Centura plans to expand the telehealth program to 2,000 patients by the end of 2013.