Outcomes of the Kaiser Permanente Tele-Home Health Research Project
Level of acuity and number of referrals for home health care have been escalating exponentially. As referrals continue to increase, health care organizations are encouraged to find more effective methods for providing high-quality patient care with cost savings.
To evaluate the use of remote video technology in the home health care setting as well as the quality, use, patient satisfaction, and cost savings from this technology.
Quasi-experimental study conducted from May 1996 to October 1997.
Home health department in the Sacramento, Calif, facility of a large health maintenance organization.
Newly referred patients diagnosed as having congestive heart failure, chronic obstructive pulmonary disease, cerebral vascular accident, cancer, diabetes, anxiety, or need for wound care were eligible for random assignment to intervention (n = 102) or control (n = 110) groups.
The control and intervention groups received routine home health care (home visits and telephone contact). The intervention group also had access to a remote video system that allowed nurses and patients to interact in real time. The video system included peripheral equipment for assessing cardiopulmonary status.
Three quality indicators (medication compliance, knowledge of disease, and ability for self-care); extent of use of services; degree of patient satisfaction as reported on a 3-part scale; and direct and indirect costs of using the remote video technology.
No differences in the quality indicators, patient satisfaction, or use were seen. Although the average direct cost for home health services was $1830 in the intervention group and $1167 in the control group, the total mean costs of care, excluding home health care costs, were $1948 in the intervention group and $2674 in the control group.
Remote video technology in the home health care setting was shown to be effective, well received by patients, capable of maintaining quality of care, and to have the potential for cost savings. Patients seemed pleased with the equipment and the ability to access a home health care provider 24 hours a day. Remote technology has the potential to effect cost savings when used to substitute some in-person visits and can also improve access to home health care staff for patients and caregivers. This technology can thus be an asset for patients and providers.
Available from: John Wildman
- "Changes consequent to the intervention were reported by Mann et al. (1999) as care aide costs, nurses, case managers, occupational and physical therapists and speech pathologists, nursing home stays and hospital costs . Johnston et al. (2000) included costs of pharmacy services, laboratory, physician visits, Emergency Department (ED) visits, and inpatient treatment as well as the direct costs of home healthcare . Noel & Vogel (2000) accounted for home visits, hospitalisations and ED visits . "
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ABSTRACT: Purpose of the StudyTo systematically review cost, cost-minimization and cost-effectiveness studies for assisted living technologies (ALTs) that specifically enable older people to ‘age in place’ and highlight what further research is needed to inform decisions regarding aging in place.DesignPeople aged 65+ and their live-in carers (where applicable), using an ALT to age in place at home opposed to a community-dwelling arrangement.MethodsStudies were identified using a predefined search strategy on two key economic and cost evaluation databases NHS EED, HEED. Studies were assessed using methods recommended by the Campbell and Cochrane Economic Methods Group and presented in a narrative synthesis style.ResultsEight eligible studies were identified from North America spread over a diverse geographical range. The majority of studies reported the ALT intervention group as having lower resource use costs than the control group; though the low methodological quality and heterogeneity of the individual costs and outcomes reported across studies must be considered.ImplicationsThe studies suggest that in some cases ALTs may reduce costs, though little data were identified and what there were was of poor quality. Methods to capture quality of life gains were not used, therefore potential effects on health and wellbeing may be missed. Further research is required using newer developments such as the capabilities approach. High quality studies assessing the cost-effectiveness of ALTs for ageing in place are required before robust conclusion on their use can be drawn.
PLoS ONE 07/2014; 9(7):e102705. DOI:10.1371/journal.pone.0102705 · 3.23 Impact Factor
- "Studies focusing on the impact of telemedicine on self-efficacy in patients with other chronic diseases such as diabetes, heart failure and arthritis show diverse results; some of these studies have reported a significant improvement in self-efficacy in the intervention group compared with the control group (Trief et al. 2007, Baker et al. 2011), whereas other studies have neither found significant changes in self-efficacy over time, nor differences between groups (Dale et al. 2009, Wakefield et al. 2009, 2012). Most telemedicine interventions take place at discharge from hospital (Casas et al. 2006, de Toledo et al. 2006, Vitacca et al. 2009, Sorknaes et al. 2011) or in a primary care setting (Johnston et al. 2000, Bourbeau et al. 2003, Dale et al. 2003, Trappenburg et al. 2008, Steventon et al. 2012), although studies have found patients with COPD to prefer homecare treatment of exacerbation (Gravil et al. 1998, Wedzicha et al. 2003). Telemedicine-based virtual admission as a replacement of hospital admission requires participation and commitment of the patients regarding monitoring, treatment and care. "
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ABSTRACT: To investigate how virtual admission during acute exacerbation influences self-efficacy in patients with chronic obstructive pulmonary disease, compared with conventional hospital admission.
Telemedicine solutions have been highlighted as a possible way to increase self-efficacy in patients with chronic diseases, such as chronic obstructive pulmonary disease. However, little is known about how telemedicine-based virtual admission as a replacement of hospital admission during acute exacerbation affects chronic obstructive pulmonary disease patients' self-efficacy.
This study was a nonblinded, randomised clinical multicentre trial. The study was a substudy to The Virtual Hospital, investigating the feasibility and safety of telemedicine-based treatment at home for patients with acute exacerbation of chronic obstructive pulmonary disease.
Participants were consecutively randomised to virtual admission or conventional hospital admission. Data from 50 patients were analysed. Self-efficacy was assessed at baseline, three days after discharge, and also six weeks and three months after discharge, using the Danish version of 'The chronic obstructive pulmonary disease self-efficacy scale'.
Intergroup comparison showed no significant differences between the two groups at baseline, three days after discharge, six weeks after discharge or three months after discharge. Furthermore, intragroup comparison did not reveal significant differences in the chronic obstructive pulmonary disease self-efficacy scale mean sum score within the two groups.
The results of the study suggest that there is no difference between self-efficacy in chronic obstructive pulmonary disease patients undergoing virtual admission, compared with conventional hospital admission. However, the anticipated sample size could not be reached, which prompts caution regarding interpretation of the findings.
This study provides new insight into how virtual admission affects chronic obstructive pulmonary disease patients' self-efficacy. Clinicians should consider the timing, duration and the content in the design of telemedical interventions directed at improving chronic obstructive pulmonary disease patients' self-efficacy, as telemedicine solutions alone may not be sufficient to enhance self-efficacy.
Journal of Clinical Nursing 01/2014; 23(21-22). DOI:10.1111/jocn.12553 · 1.26 Impact Factor
Available from: PubMed Central
- "Several reports published during recent years have studied if COPD care can be improved through nurse telemedicine consultation when monitoring COPD patients at home and thus if it can prevent hospital admissions [8-16]. However, few studies implement telemedicine video-consultation (TVC) when monitoring COPD patients at home [12,16,17], using information technology to monitor patients at home, while the clinician stays in the hospital. "
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ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a major cause of acute hospital admissions. The main object of our study was to evaluate the effects of telemedicine video-consultation (TVC) on the frequency of hospital re-admissions due to COPD exacerbations. Our secondary aim was to assess the impact of TVC on the length of re-admission stays within 6 and 12 months follow up after TVC. Patient satisfaction was also evaluated.
The study was a retrospective observational study of COPD patients who after hospital discharge or during outpatient treatment for acute COPD exacerbations, were monitored for 2 weeks by TVC at home by a specialist nurse at the hospital during a pilot project period. Retrospectively, we compared the frequencies (chi-square test) and durations of hospital re-admissions (paired t-test) due to COPD exacerbations within 6 and 12 months follow up after TVC to comparable events 6 and 12 months prior to TVC.
Among 99 patients followed for 6 months after TVC, 56 were followed for totally 12 months. The number of patients re-admitted and the number of re-admissions due to COPD exacerbations were not reduced within 6 or 12 months post-TVC, as compared to 6 and 12 months pre-TVC.The mean length of re-admission stays within 12 months post-TVC was markedly reduced as compared to pre-TVC. Patients hospitalised the last 6 and 12 months pre-TVC, had significantly shorter re-admission stays, p = 0.033 and p = 0.001, respectively. Patient satisfaction was high.
Despite the failure to demonstrate reduced frequency of re-admissions within 6 and 12 months post-TVC, the re-admission length within 12 months post-TVC was markedly reduced as compared to pre-TVC. The patient satisfaction was high. Future prospective, randomised, controlled trials must be performed before TVC can be recommended in COPD management.
Multidisciplinary respiratory medicine 01/2014; 9(1):6. DOI:10.1186/2049-6958-9-6 · 0.15 Impact Factor
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