Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

1048 — The Effectiveness of a Heart Failure Care Coordination/Home Telehealth Program on Resource Use and Mortality

Neugaard BI (James A. Haley VAMC) , Chumbler NR (Rehabilitation Outcomes Research Center), Andresen EM (Rehabilitation Outcomes Research Center), Schofield RS (North Florida/South Georgia Veterans Health System), Brumback B (University of Florida), Lutz B (Rehabilitation Outcomes Research Center), Foulis PR (James A. Haley VAMC), Barbier GH (James A. Haley VAMC)

Objectives:
Disease management programs have been implemented in an attempt to reduce re-hospitalizations and mortality rates. This study examined the effectiveness of a VA Heart Failure Care Coordination and Home Telehealth (CCHT) program, which extends disease management to improve patient-centered outcomes.

Methods:
This study was conducted at two VAMCs and employed a quasi-experimental design. The CCHT patients had their symptoms and health status monitored in their homes by a cardiology nurse practitioner through an in-home messaging device. The four comparison heart failure (HF) groups received either primary care or were enrolled in a HF clinic. Only patients with documented ejection fractions <40% were included. Service use outcomes (all-cause and HF hospitalization rates, all-cause and HF hospital days, and emergency room visits) were measured at 12 months before and after the study start date. The risk of mortality was measured at 12 months. Regression models (logistic, ordinary least squares regression, and Cox proportional-hazards) were used in the analyses and were adjusted for key clinical variables (e.g. ejection fraction), patient demographics, and prior service utilization.

Results:
We included 162 patients who received CCHT, 149 CCHT waiting list patients who received primary care, 141 HF clinic patients, and 532 patients who received primary care (240 at one site, 292 at the other site). Average age of the patients in the study sample ranged from 68-71 years. The CCHT cohort had the lowest average ejection fraction (24.9%), signifying more severe HF. Compared to the CCHT cohort, the primary care cohort from the CCHT site had an increased risk of mortality (OR 1.58, 95% CI=1.02, 2.48) and both the CCHT waiting list cohort and the HF clinic cohort had significantly more ER visits (0.53 and 0.32 days, respectively). Patients in the CCHT program experienced higher hospitalization rates, yet there were no differences in hospital days among the groups.

Implications:
Intensive monitoring of patients with advanced HF through a technology-based daily weight, blood pressure, and symptom monitoring system was associated with a significant reduction in risk of mortality and emergency department visits.

Impacts:
These results demonstrate that a CCHT care model improves survival and reduces emergency room visits through intensive daily monitoring.