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TEL 20-015 – HSR&D Study

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TEL 20-015
An Evaluation of Home-Based Telemedicine Services
Faith P. Hopp PhD MA MSW
VA Ann Arbor Healthcare System, Ann Arbor, MI
Ann Arbor, MI
Funding Period: July 2001 - June 2004

BACKGROUND/RATIONALE:
Tele-home health care, which providers for video interactions between home-based veterans and home care nurses, is a potentially useful adjunct to home care services. However, few randomized trials have been conducted of this technology.

OBJECTIVE(S):
The primary objectives were to determine if tele-home health care patients, compared with patients receiving usual home care, have:1) higher levels of health related quality of life and home care satisfaction; 2) fewer inpatient admissions, hospital stays, and outpatient and emergency room visits; and 3) higher levels of home care access, in terms of the total number of contacts between HBPC nurses and patients.

METHODS:
Patients were randomly assigned to the intervention or to the control group. Video tele-health units were installed in patient homes for the intervention group, and control group patients received usual home care services. Baseline and six month follow up surveys included questions on perceived health related quality of life and home care satisfaction. T-tests were used to compare intervention and control group members in terms of six month changes in health related quality of life and satisfaction with home care. Multivariate analyses were used to assess group differences in six month health care service use, with prior service use and survival included as covariates.

FINDINGS/RESULTS:
Intervention group patients had greater improvement in mental health scores (mean change=4.05 intervention vs. -4.11 control; p=0.04), and non significant group differences were observed for physical health status (mean change=1.56 intervention vs. 0.64 control; p=0.77). There was a trend toward fewer outpatient visits for intervention group members compared with controls (mean=29.06 vs. 38.89; p=0.10). However, there were no significant group differences in terms of emergency room visits (mean=1.00 vs. 2.11; p=0.83), inpatient admissions (mean=0.67 vs. 1.26; p=0.61), or inpatient stays (mean=2.83 vs. 7.11 control; p=0.41). Intervention group members had a significantly greater number of total home care contacts (mean 20.78 vs. 6.79; p <.01). Non significant differences in six month changes in satisfaction were observed between groups (mean change=-1.00 intervention vs. -1.56 control; p=0.64). Satisfaction with the tele-health equipment among intervention group members was high (means exceeded 4.0 on six measures ranging from 1-5).

IMPACT:
The use of tele-health services was associated with greater access to home care services and more improvement in mental health status. However, such differences were not observed for physical health changes or for the use of inpatient and emergency room services. Further work, utilizing larger sample sizes and multiple sites, is needed to further investigate the relationship between tele-health service use and study outcomes.

PUBLICATIONS:

Journal Articles

  1. Hopp F, Woodbridge P, Subramanian U, Copeland L, Smith D, Lowery J. Outcomes associated with a home care telehealth intervention. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2006 Jun 1; 12(3):297-307.
  2. Hopp F, Woodbridge P, Subramanian U, Copeland L, Smith D. Home telehealth's role in diabetes case management. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2005 Apr 1; 11:220.
  3. Subramanian U, Hopp F, Lowery J, Woodbridge P, Smith D. Research in home-care telemedicine: challenges in patient recruitment. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2004 Jun 1; 10(2):155-61.
Reports

  1. Hopp FP, Lowery J, Woodbridge P. Home Telemedicine and the VA Workforce: Potential and Challenges. 2003 Jun 1. 4-4 p.
Conference Presentations

  1. Hopp F, Woodbridge P, Subramanian U, Copeland L, Smith D, Lowery J. A Randomized Trial of VA Home Telehealth: Study Outcomes. Paper presented at: American Telemedicine Association Annual Meeting; 2005 Apr 1; Denver, CO.
  2. Subramanian U, Hopp F, Woodbridge L, Copeland L, Smith D, Lowery J. Randomized Controlled Trial of a Tele-health Intervention for Home Care Patients: Utilization and Patient Satisfaction. Paper presented at: Society of General Internal Medicine Annual Meeting; 2004 May 1; Chicago, IL.
  3. Subramanian U, Smith D, Lowery J, Woodbridge C, Anderson C, Hopp F. Home Care Telemedicine: Challenges in Patient Recruitment. Paper presented at: American Geriatrics Society Annual Meeting; 2004 Mar 1; Baltimore, MD.
  4. Hopp FP. Targeting home care patients for tele-home health care services. Paper presented at: American Telemedicine Association Annual Meeting; 2001 May 1; Fort Lauderdale, FL.


DRA: Health Systems
DRE: Epidemiology, Treatment - Observational, Technology Development and Assessment
Keywords: Home care, Nursing, Telemedicine
MeSH Terms: none

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