A recently concluded telehomecare pilot designed to monitor patients with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) showed a dramatic decrease in hospital and emergency room visits during a four-month trial.
The $6 million pilot, funded by the Ministry of Health and Long-Term Care and Canada Health Infoway, supplied 813 patients in Ontario with touch screen monitors and peripheral devices connected to their home telephone. Data from a blood pressure cuff and weigh scale were uploaded every day to the patient’s family health team, along with answers to a series of questions about how the patient was feeling.
The Timmins Family Health Team was one of eight family health teams selected by the Ontario Telemedicine Network to participate in the pilot.
“A nurse at the family health team would log onto her work station and would see data from all of the patients enrolled in the program,” said Laurie Poole, the OTN’s vice-president of telemedicine solutions. “If there were any vital signs outside the parameters set by the patient’s physician, there would be a red flag. The nurse would contact patients, ask how they were feeling, consult the physician and either ask the patient to come in or adjust the patient’s medication.”
Study
A Price-Waterhouse study following the conclusion of the pilot showed hospital visits during the four-month pilot fell by 66 per cent for CHF patients and 64 per cent for patients with COPD. Emergency room visits fell 72 per cent for CHF patients and 74 per cent for COPD patients. Walk-in clinic visits fell by between 95 and 97 per cent.
According to Poole, the Ministry of Health is “very pleased” with the outcome of the pilot program and is in discussions with the OTN about expanding it.
The monitoring devices were preprogrammed with upper and lower limits for blood pressure readings, pulse rate and weight for each patient prior to delivery. The data, along with answers to such questions as whether the patient’s shortness of breath was better or worse than the previous day, provided early warning signs of a possible deterioration in the patient’s status and allowed for corrective action to head off hospitalization or a visit to the ER.
The average age of the patients enrolled in the pilot was 74, but some were as old as 92.
In order to qualify for the pilot, patients had to have been hospitalized or visited an ER within the 12-month period preceding the pilot.
Patients also had to agree to participate in education sessions with a nurse, either on the phone or in group sessions. Topics included smoking cessation, diet and sodium intake. The family health teams recruited and enrolled the patients and brought them in to explain how the program worked.
Patient satisfaction
“There was a very high level of patient satisfaction with the program,” said Poole. In fact, some of them experienced anxiety when it ended and the equipment was removed from their homes.
The Timmins Family Health Team enrolled approximately 140 patients, said the teams’ executive director, Joy Galloway.
“The biggest benefit was that the patients became more aware of their own health and what changed their health status. They became better at managing themselves afterwards.”
Most showed up early for their orientation and education classes with a spouse or family member in tow. “They were a bunch of keeners,” said Galloway. “When the pilot ended, several of them asked, ‘Why can’t we do this forever?’ ”
One patient who participated in the pilot from the Hamilton area had resorted to moving all of his furniture against the walls to make it easier for paramedics to wheel in their stretchers and take him to hospital. After he enrolled in the telehomecare pilot, he moved the coffee table back to its proper position.
Second phase
A second phase of the program began in August, this time for patients with diabetes. Several hundred patients registered with four family health teams, including the Timmins Family Health Team, will be monitored for six months. Blood sugar readings, blood pressure and weight will be reported daily, and anomalies, or trends indicating deterioration in the patient’s health status dealt with proactively.
Using telehomecare technology to monitor the health status of patients with chronic diseases can lead to significant cost savings for the health-care system based on the demonstrated reductions in hospital admissions and ER visits, said Poole.
The OTN is still hoping to refine the technology to automatically populate the patients’ electronic health records with the data collected, and is working with vendors on wireless solutions. n
