Outcomes of the Kaiser Permanente Tele-Home Health Research Project

Kaiser Permanente, Oakland, California, United States
Archives of Family Medicine 02/2000; 9(1):40-5. DOI: 10.1001/archfami.9.1.40
Source: PubMed


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.

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    • "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 [19]. 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 [20]. Noel & Vogel (2000) accounted for home visits, hospitalisations and ED visits [21]. "
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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
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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. "
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