Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

1071 — Short and Long Term Outcomes Following a Home Telehealth Intervention in Veterans with Heart Failure

Wakefield BJ (Columbia MO VAMC) , Ward MM (CRIISP; Univ of Iowa Dept of Health Management & Policy), Holman JE (CRIISP), Ray A (CRIISP), Scherubel M (CRIISP), Rosenthal GE (CRIISP; Univ of Iowa College of Medicine), Kienzle M (Univ of Iowa College of Medicine)

Objectives:
Heart failure (HF) 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 HF on readmission rates 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 received the intervention for 90 days following discharge from the hospital; subjects in the usual care group received traditional outpatient care. Kaplan-Meier survival analysis was used to assess the combined endpoint of hospital readmission and mortality at 3, 6, and 12 months. The groups were compared using the log-rank test and proportional hazards regression to adjust for baseline differences.

Results:
All 148 patients were male; 94% were white. Average age at enrollment was 69.3 years. Severity of illness at enrollment was comparable between the two groups (no significant differences for NYHA classification, index admission length of stay, left ventricle ejection fraction, prior revascularization, or length of CHF diagnosis using one-way ANOVA). Using Cox proportional hazards models we found a significant (p<0.05) intervention effect on the combined endpoint of first hospital readmission and mortality at 90 days following enrollment. However, this difference was not significant at 6 or 12 months follow-up.

Implications:
The intervention had a significant effect (controlling for the severity of illness and age) during the intervention phase, but the effect was not sustained after the 90-day intervention period.

Impacts:
Telehealth care has the potential to enable earlier detection of key clinical symptoms, triggering early intervention and thus reducing the need for hospitalization. Further work is needed to determine the optimal intervention dose and length of time.