Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1032 — Resource Use in Veterans with Congestive Heart Failure Following a Home Telehealth Intervention

Author List:
Wakefield BJ (VA Medical Center, Columbia, MO)
Ward M (Center for Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VAMC)
Holman J (CRIISP)
Ray A (CRIISP)
Sherubel M (CRIISP)
Kienzle M (University of Iowa College of Medicine)
Masteller M (Iowa City VA Medical Center)
Kilberger D (Iowa City VA Medical Center)
Burns T (University of Iowa College of Public Health)
Rosenthal G (CRIISP & University of Iowa College of Medicine)

Objectives:
Congestive heart failure (CHF) is one of the most common reasons for hospitalization in older patients, and frequent admissions are common. While advanced telehealth technologies make it possible to detect early signs of decompensation in these patients and thus prevent hospitalization, few empirical studies have compared telehealth to traditional outpatient care, and virtually no studies have compared the effectiveness of alternative telehealth applications. The purpose of this study was to compare the effectiveness of two telehealth interventions to traditional care provided for recently discharged outpatients with CHF on readmission rates, urgent care visits, and survival.

Methods:
Using a randomized controlled clinical trial, we compared usual care to a nurse managed intervention delivered by either telephone or videophone to veterans following discharge from the hospital. Subjects in the treatment groups (telephone or videophone) received the intervention for 90 days following discharge from the hospital; subjects in the usual care group received traditional outpatient care.

Results:
All 104 patients were male; 97% were white. Average age at enrollment was 69.5 years. Severity of illness at enrollment was comparable across the three groups (no significant differences for NYHA classification, index admission length of stay, left ventricle ejection fraction, prior revascularization or length of CHF diagnosis). Preliminary data analyses show no significant differences across the three groups in 90 day readmission rates. A one-way analysis of variance (ANOVA) showed significant differences in 180 day readmission rates across the three groups (F=0.0263); post hoc analyses showed significantly higher (p=0.05) readmission rates in the videophone (mean=0.85±0.87) compared to either the telephone (mean=0.28±0.58) or usual care group (mean=0.64±0.99). There were no significant differences across the three groups in Urgent Care Clinic visits at 90 or 180 days. While 6-month mortality was higher in the videophone (21%) compared to the telephone (12%) and usual care (13%) group, this difference was not statistically significant.

Implications:
Although the nurse intervention was identical in the telephone and videophone groups, the telephone intervention only was effective in reducing 180-day readmission rates. Neither intervention was effective in reducing 90-day readmissions or mortality compared to the usual care group.

Impacts:
Telehealth care has the potential to enable earlier detection of key clinical symptoms, triggering early intervention and thus reducing the need for hospitalization. The VA Office of Care Coordination is implementing these systems nation wide. Further work is needed to determine which technologies work for specific patient populations.