Spectrum telehealth trial shows fewer readmissions for heart failure patients

June 14, 2010
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Early results show that a Spectrum Health pilot program has reduced hospital readmissions for congestive heart failure patients by more than 70 percent, a doctor said.

A home health monitoring program, in which patients submit daily blood pressure and weight readings via a secure Internet connection to Spectrum Health’s home health nurses, has made a big impact on the patients who have participated over the past six to nine months, said Dr. Michael Dickinson.

“What we’re seeing is that it’s a really effective tool to teach patients how to take care of themselves, how to monitor their disease and help us be involved in their care,” said Dickinson, who oversees Spectrum’s heart failure clinic.

The Spectrum Health pilot program is being conducted along with its health insurer, Priority Health, and Spectrum Health Visiting Nurses Association. The program’s aim is to see whether telehealth care can forestall readmissions for heart failure, improve patients’ health and save money.

Nearly 80 patients have participated so far, said Karen Pakkala, executive director of the Spectrum Health Visiting Nurse Association.

Doctors and nurses identify patients who are being discharged following inpatient heart failure treatment and who face a high possibility of readmission within a month, Dickinson said.

A telehealth monitor is installed in the home, he said. The equipment includes a blood pressure cuff, a scale and an interactive screen that asks questions about the patient’s health, symptoms and medications.

“It’s very simple to utilize, simple to install, very compact and very simple to use,” Pakkala said. “It has a little video display and talks to the patient. Every day, when they get up get on the scale, the machine will say, ‘Good morning.’ It tells exactly what their weight is, instructs them to put on the blood pressure cuff. … It asks an algorithm of questions, typically 10 questions.”

The monitoring identifies day-to-day challenges of managing heart failure, such as running out of medication or an abrupt weight gain. A VNA can be sent to the home or a doctor’s visit set up before the patient’s condition deteriorates enough to warrant readmission, Dickinson said.

“The interaction with the nurse is key. We really become detectives in understanding symptom presentation,” Pakkala said.

However, she added, telehealth doesn’t replace doctors’ visits. In a recent Journal of the American Medical Association article, a Northwestern University study showed that heart failure patients who have a doctor’s visit within seven days of discharge are 15 percent less likely to be readmitted within 30 days.

“It (telehealth) is a huge benefit from the patient’s perspective and it clearly will save dollars by avoidance of readmissions,” said Dr. Jim Byrne, Priority Health medical director.

“Patients love it,” Pakkala added.

A study for computer chip-maker Intel Corp., released in May, indicated that telehealth is poised to undergo a surge. The study cites a U.S. and European market of $3 billion in 2009 that could grow to $7.7 billion by 2012, according to Data Monitor.

The biggest obstacles to market growth are resistance to technology adoption by patients and clinicians, as well as a lack of reimbursement by health insurance companies, the report stated.

“I think it is probably the future for a lot of chronic disease states,” Dickinson said. “Hospitals don’t get paid for readmissions within 30 days. It’s in the system’s best interest to reduce re-hospitalizations. And, it’s coming down the pike, how health care is going to be paid by Medicare and others is going to change dramatically.”

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