Subscribe to RSS
Using Telehealth to Reduce All-Cause 30-Day Hospital Readmissions among Heart Failure Patients Receiving Skilled Home Health ServicesThe authors would like to acknowledge and thank the University of Pennsylvania Health System for their support of this program.
20 November 2015
accepted: 02 February 2016
16 December 2017 (online)
The reduction of all-cause hospital readmission among heart failure (HF) patients is a national priority. Telehealth is one strategy employed to impact this sought-after patient outcome. Prior research indicates varied results on all-cause hospital readmission highlighting the need to understand telehealth processes and optimal strategies in improving patient outcomes.
The purpose of this paper is to describe how one Medicare-certified home health agency launched and maintains a telehealth program intended to reduce all-cause 30-day hospital readmissions among HF patients receiving skilled home health and report its impact on patient outcomes.
Using the Transitional Care Model as a guide, the telehealth program employs a 4G wireless tablet-based system that collects patient vital signs (weight, heart rate, blood pressure and blood oxygenation) via wireless peripherals, and is preloaded with subjective questions related to HF and symptoms and instructional videos.
Year one all-cause 30-day readmission rate was 19.3%. Fiscal year 2015 ended with an all-cause 30-day readmission rate of 5.2%, a reduction by 14 percentage points (a 73% relative reduction) in three years. Telehealth is now an integral part of the University of Pennsylvania Health System’s readmission reduction program.
Telehealth was associated with a reduction in all-cause 30-day readmission for one mid-sized Medicare-certified home health agency. A description of the program is presented as well as lessons learned that have significantly contributed to this program’s success. Future expansion of the program is planned. Telehealth is a promising approach to caring for a chronically ill population while improving a patient’s ability for self-care.
- 1 Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Lui S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, Moy CS, Munter P, Mussolino ME, Nasir K, Nichol G, Neumar RW, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie S, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner M. Heart disease and stroke statistics - 2015 update: A report from the American Heart Association, 2015. Retrieved from http://circ.ahajournals.org/content/early/2014/12/18/CIR.0000000000000152.full.pdf+html.
- 2 Caffrey C, Sengupta M, Moss A, Harris-Kojetin L, Valverde R. Home health care and discharge hospice care patients: United States, 2000 and 2007. National Health Statics Report 2011; 38: 1-27.
- 3 Centers for Medicare and Medicaid Services. Chronic conditions among Medicare beneficiaries: Chartbook 2012. Retrieved from https://www.cms.gov/research-statistics-data-and-systems/statistics-trends- and-reports/chronic-conditions/downloads/2012chartbook.pdf.
- 4 Centers for Medicare & Medicaid Services, Office of Information Products and Data Analytics. National Medicare readmission findings: Recent data and trends. 2012 Retrieved from http://www.academyhealth.org/files/2012/sunday/brennan.pdf.
- 5 Medicare Payment and Advisory Commission. Report to the congress: Medicare payment policy. 2013 Retrieved from http://www.medpac.gov/documents/reports/mar13_entirereport.pdf?sfvrsn=0.
- 6 Krumholz HM, Merrill AR, Schone EM, Schreiner GM, Chen J, Bradley EH, Wang Y, Wang YF, Lin Z, Straube BM, Rapp MT, Norman ST, Drye EE. Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission. Circ Cardiovasc Qual Outcomes 2009; 02: 407-413.
- 7 Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009; 360: 1418-1428.
- 8 Moore C, McGinn T, Halm E. Tying up loose ends discharging patients with unresolved medical issues. Arch Intern Med 2007; 167: 1305-1311.
- 9 Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: Results of a randomized controlled trail. Arch Intern Med 2006; 166 (17) 1822-1828.
- 10 Davidson PM, Cockburn J, Newton PJ. Unmet needs following hospitalization with heart failure: Implications for clinical assessment and program planning. J Cardiovasc Nurs 2008; 23 (06) 541-546.
- 11 Madigan EA, Gordon NH, Fortinsky RH, Koroukian SM, Pina I, Riggs JS. Rehospitalization in a national population of home health care patients with heart failure. Health Serv Res 2012; 47 (06) 2316-2338.
- 12 Naylor MD, Aiken LH, Kurtzman ET, Olds DM, Hirschman KB. The care span: The importance of transitional care in achieving health reform. Health Aff (Millwood) 2011; 30 (04) 746-754.
- 13 O’Connor M, Hanon AL, Bowles KB. Impact of frontloading of skilled nursing visits on the incidence of 30-day hospital readmission. Geriatr Nurs 2014; 35: S37-S44.
- 14 Health Resources and Service Administration (HRSA) rural health. Retrieved from www.hrsa.gov/rural health/about/telehealth
- 15 Kitsiou S, Pare Jaana M. Effects of home telemonitoring interventions on patients with chronic heart failure: An overview of systematic reviews. J Med Internet Res 2015; 17 (03) e63.
- 16 Bowles KB, Dykes P, Demiris G. The use of health information technology to improve care and outcomes for older adults. Res in Gerontol Nurs 2015; 08 (01) 5-10 doi:10.3928/19404921-20121222-01.
- 17 Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS. Transitional care of older adults hospitalized with heart failure: a randomized controlled trail. J Am Geriatr Soc 2004; 52 (05) 675-684.
- 18 O’Connor M. Hospitalization among Medicare-reimbursed skilled home health recipients. Home Health Care Manag Prac 2012; 24 (01) 25-35 doi:10.1177/1084822311419498.
- 19 Thomason TR, Hawkins SY, Perkins KE, Hamilton K, Nelson B. Home telehealth and hospital readmissions. Home Healthc Now 2015; 33 (01) 20-26.
- 20 Burke RE, Coleman EA. Interventions to decrease hospital readmissions: keys for cost-effectiveness. JAMA Intern Med 2013; (08) 695-698.