The older-adult, home health care patient population often includes individuals who are socially isolated and have various, complicated medical issues.As a result, strategies to reduce costs and other barriers to treatment are always needed. Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are frequently simultaneous conditions that are prevalent among home health care patients. A forthcoming article in The Gerontologist presents findings from a randomized controlled trial showing the impact of telehealth intervention for homebound older adults with HF or COPD.
Telehealth is the use of computer and telephone communication to provide long-distance health care. This can include education, health administration, or long-distance clinical care. Telehealth is particularly useful in rural areas, and is used to treat a wide range of medical conditions. This study examined a new telehealth intervention, called tele-HEART, which draws on recent research to provide improved home health services. This program provides an in-home assessment and telehealth setup and education, as well as ongoing support and education as a way of getting patients more involved in the program. The program also uses recent technology such as integrated, electronic medical records and computerized tracking tools to improve care quality. The program also uses auser-friendly, graphically intuitive interface.
Participants were home health care patients age 65 or better, randomly assigned to either the tele-HEART group or a control group that provided usual home health care ( in-home visits from registered nurses working as case managers.) In the tele-HEART system, nurses are available on a daily basis by telephone, and ongoing education and symptom monitoring is provided to the patient. This enabled daily reviewing of patient data by distance nurses, such as heart rate, oxygen saturation, and other vital signs. The tele-HEART system also provided audio and text prompts for self-care tasks.
Researchers hypothesized that the participants in the tele-HEART group would have improved physical and mental health outcomes, and would have less need for emergency medical services. Participants in both groups were assessed on a range of mental health and quality-of- life scales at baseline and after three months of treatment. Participants also filled out a satisfaction survey at the three-month point. Twelve months after baseline, researchers tallied the number of emergency department visits, hospital admissions, and home care visits in each group throughout the year.
At the three-month point, the tele-HEART group had significantly lower scores of depression symptoms, and significantly better self-reported quality-of-life in the areas of general health and social functioning. Both groups reported general satisfaction with their care. At 12 months, the control group had a significantly higher number of emergency visits. Although this study did not report cost outcomes, previous research has suggested that telehealth is cost-effective relative to home health care. This study suggests that person-centered, technologically current models of telehealth can be effective for homebound older adults.
Gellis ZD, Kenaley B, McGinty J, et al (2012). Outcomes of a Telehealth Intervention for Homebound Older Adults With Heart or Chronic Respiratory Failure: A Randomized Controlled Trial. The Gerontologist [epub ahead of print].