BACKGROUND/RATIONALE:
Congestive heart failure (CHF) is one of the most common reasons for hospitalization in patients aged 65 years and older. Many hospitalizations for CHF are potentially preventable if the warning signs of decompensation are recognized and treated before the situation becomes emergent. Home-based intervention programs have reduced unplanned readmission rates for patients with CHF by up to 50 percent. Using advanced telecommunications technologies it is now possible to provide greatly improved access and availability of services in a more timely and cost effective manner directly to patients’ homes. Although telehealth offers a number of theoretical advantages, few empirical studies have compared telehealth to traditional delivery modes, and virtually no studies have compared the effectiveness of alternative telehealth applications.

OBJECTIVE(S):
The purpose of this study is to compare the effectiveness and resource use of two telehealth interventions to traditional care provided for recently discharged outpatients with CHF. Four hypotheses will be tested. Compared to subjects who receive usual care, subjects who receive telehealth interventions (telephone or interactive video) following discharge will: 1) have lower readmission rates; 2) report improved quality of life, self-efficacy, and satisfaction with care; 3) use fewer resources, including hospital days, urgent care visits, and telephone calls; and 4) have higher survival rates.

METHODS:
The study is a randomized controlled clinical trial. We will compare usual care to an intervention delivered by either telephone or interactive video to veterans following discharge from the hospital. A total of 198 subjects will be enrolled over three years. Subjects in the treatment groups (telephone or interactive video) will receive the intervention for 90 days following discharge from the hospital. Data to be collected includes measures of quality of life, self-efficacy, satisfaction, resource use, and mortality.

FINDINGS/RESULTS:
Subject enrollment began July 1, 2002; 123 subjects have been enrolled as of 1/09/05. No findings to report.

IMPACT:
Telehealth care will enable earlier detection of key clinical symptoms, triggering early intervention and thus reducing the need for hospitalization. Reduced hospitalization will result in decreased overall costs, and improved outcomes for veterans with CHF.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Darkins A, Ryan P, Kobb R, Foster L, Edmonson E, Wakefield B, Lancaster AE. Care Coordination/Home Telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2008 Dec 1; 14(10):1118-26. [view]
2. Wakefield BJ, Ward MM, Holman JE, Ray A, Scherubel M, Burns TL, Kienzle MG, Rosenthal GE. Evaluation of home telehealth following hospitalization for heart failure: a randomized trial. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2008 Oct 1; 14(8):753-61. [view]
3. Wakefield BJ, Bylund CL, Holman JE, Ray A, Scherubel M, Kienzle MG, Rosenthal GE. Nurse and patient communication profiles in a home-based telehealth intervention for heart failure management. Patient education and counseling. 2008 May 1; 71(2):285-92. [view]
4. Wakefield BJ, Holman JE, Ray A, Morse J, Kienzle MG. Nurse and patient communication via low- and high-bandwidth home telecare systems. Journal of telemedicine and telecare. 2004 Apr 1; 10(3):156-9. [view]
5. Wakefield BJ, Holman JE, Ray A, Morse J, Kiensie M. Nurse and patient preferences for telehealth home care. Geriatric Times. 2004 Mar 1; V(2):27-30. [view]
6. Wakefield BJ, Holman JE, Ray A, Scherubel M, Burns TL, Kienzle MG, Rosenthal GE. Outcomes of a home telehealth intervention for patients with heart failure. Journal of telemedicine and telecare. 2009 Jan 1; 15(1):46-50. [view]
7. Wakefield BJ, Orris LJ, Holman JE, Russell CL. User perceptions of in-home medication dispensing devices. Journal of gerontological nursing. 2008 Jul 1; 34(7):15-25. [view]

Book Chapters

1. Bylund C, Wakefield B, Ray A, Morse J. Bringing care home to the rural elderly: clinician and patient satisfaction with telehealth communication. In: Whitten P, Cook D, editors. Understanding Health Communication Technologies. San Francisco, CA: Jossey-Bass; 2004. Chapter 26. 235-243 p. [view]

Conference Presentations

1. Wakefield BJ. A comparison of low-and high-intensity remote monitoring in veterans. Paper presented at: Midwest Nursing Research Society Annual Conference; 2009 Mar 27; Minneapolis, MN. [view]
2. Wakefield BJ, Fortney JC. Advances in telehealth research in the VA health care system. Paper presented at: National Center for Research Resources Annual Future of Telehealth Conference; 2009 Jun 25; Bethesda, MD. [view]
3. Wakefield BJ. Assessing nurse patient communication using telephone and interactive video. Paper presented at: American Telemedicine Association Annual Meeting; 2004 May 1; Tampa, FL. [view]
4. Wakefield B, Holman JE, Ray A, Griffieon L. Assessing nurse patient communication using telephone and interactive video. Paper presented at: VA Care Coordination and Telehealth Leadership Annual Forum; 2005 Apr 6; Salt Lake City, UT. [view]
5. Wakefield BJ. Meta Analysis of Outpatient Heart Failure Patient Management Interventions. Poster session presented at: Midwest Nursing Research Society Annual Conference; 2010 Apr 9; Kansas City, MO. [view]
6. Wakefield BJ, Klobucar TF, Kaboli PJ. Remote Cardiac Rehabilitation. Poster session presented at: VA Telehealth 2010 and Beyond Conference on Expanding Patient-Centric Care; 2010 May 12; St. Louis, MO. [view]
7. Wakefield BS, Ward MM, Holman JE, Ray A, Scherubel M, Rosenthal GE, Kienzle M. Short and long term outcomes following a home telehealth intervention in veterans with heart failure. Paper presented at: VA HSR&D National Meeting; 2007 Feb 23; Arlington, VA. [view]
8. Wakefield B. The evidence base for care coordination and home telehealth. Paper presented at: VA Care Management Annual Conference; 2005 Apr 27; Minneapolis, MN. [view]

DRA: Aging, Older Veterans' Health and Care, Health Systems Science
DRE: Epidemiology, Technology Development and Assessment
Keywords: Chronic heart failure, Home care, Telemedicine
MeSH Terms: none