Outcomes of the Kaiser Permanente Tele-Home Health Research Project
ABSTRACT 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.
- SourceAvailable from: John Wildman
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- "Four of the studies reported effects on one or more outcomes , , , . Mann (1999) reported on the effectiveness of assistive technologies and home environmental interventions using a variety of measures of functional independence as well as pain . "
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
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- "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. "
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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- "Desirable types of monitoring sensors were investigated by Lymberis . Specific types of sensor readings were evaluated for their applicability and usefulness by Tabar et al. , Lo et al.  and Johnston et al. . The proposals usually assume three-tier architecture with the sensor readings being recorded by a personal server and simply relayed to a remote care centre where they are assessed. "
ABSTRACT: Medical advances and historical fluctuations in the demographics are contributing to the rise of the average age in the Western world. These changes are creating a growing requirement for organizing home care for the elderly. For handling these demanding tasks, currently assigned to immediate family members, eHealth systems are considered and extensively researched. As these systems manage personal and health-related data, protection of privacy is paramount. To that end, we have developed privacy-preserving protocols based on a novel eHealth system architecture, so that user data is protected, while accountability is ensured and all necessary data is available to appropriate care-provisioning entities.12/2013; 9:1085-1092. DOI:10.1016/j.protcy.2013.12.121