TeleHomecare Management of Congestive Heart Failure in Rural Mississippi Cathy Smith, RN, BSN North...
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Transcript of TeleHomecare Management of Congestive Heart Failure in Rural Mississippi Cathy Smith, RN, BSN North...
![Page 1: TeleHomecare Management of Congestive Heart Failure in Rural Mississippi Cathy Smith, RN, BSN North Mississippi Medical Center Home Health Cardiac Outcomes.](https://reader030.fdocuments.us/reader030/viewer/2022033108/56649f335503460f94c4f9dc/html5/thumbnails/1.jpg)
TeleHomecare Management of Congestive
Heart Failure in Rural Mississippi
Cathy Smith, RN, BSN
North Mississippi Medical Center
Home Health
Cardiac Outcomes Manager
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TeleHomecare
Human Factors
Technology
Human Factors + Technology = TeleHomecare
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![Page 4: TeleHomecare Management of Congestive Heart Failure in Rural Mississippi Cathy Smith, RN, BSN North Mississippi Medical Center Home Health Cardiac Outcomes.](https://reader030.fdocuments.us/reader030/viewer/2022033108/56649f335503460f94c4f9dc/html5/thumbnails/4.jpg)
Why High Risk CHF Patients?• Poor prognosis
• Highest re-hospitalization rate
• High Medicare cost
• Most frequent cause of hospitalization in patients 65 and over with a cost of $6,268 per admission FY 2000
• Shift of care for medically fragile patients from hospital to home
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CHF Project Timeline
• TOP Grant Award - 10/99
• 23 Kodak units purchased - 5/00
• First CHF patient - 8/00
• Kodak pulls out 12/00
• Patient entry on hold
• American Telecare replacements 2/01
• New patients 2/01
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• Patient Selection • Hospitalization within 6 months
• OR ER visit within 6 months
• OR patient adherence problems
• Requirements• Caregiver present in the home
• Patient willing and able to learn how to use telecare system
• Patient has multiple home visits per week
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![Page 8: TeleHomecare Management of Congestive Heart Failure in Rural Mississippi Cathy Smith, RN, BSN North Mississippi Medical Center Home Health Cardiac Outcomes.](https://reader030.fdocuments.us/reader030/viewer/2022033108/56649f335503460f94c4f9dc/html5/thumbnails/8.jpg)
Clinical Assessments
Edema Validating Insulin Dosage
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Clinical Assessments
TelePhonic StethoscopeHeart and Lung Sounds
Rales, Wheezes, Decreased breath sounds
Abnormal heart sounds
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TeleHomecare Interventions
Nursing Intervention
Nursing Intervention
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Program Evaluation
• Outcomes– Hospitalizations– ER visits
• Qualitative measurements– OASIS
• functional, cognitive, emotional assessment
– Patient satisfaction survey
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Data Analysis• Retrospective review of hospitalizations and
ER visits– include CHF as primary and secondary
diagnosis
• INCLUSION CRITERIA– Patients have hospitalization or ED visit– Patients on home care (HC) and telehomecare
(TH) each for at least 3 months
• Data is annualized and compared
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Results• 8/15/00 to 9/30/01
– 29 patients – Mean length of stay(LOS)
• HC - 8.6 mos (0.1-36 mos)
• TH - 4.1 mos (0.1-13 mos)
• Not eligible for evaluation– 5 pts - no hosp/ER admissions– 4 pts - too short on TH– 5 pts - too short on HC– 2 pts - too short on HC and TH
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Results• 13 patients evaluated
– 11 hospitalized– 1 hospitalized and ER visit– 1 ER visit
• Assessment frame 1/00/00 - 9/30/01
• Mean patient LOS times– HC 10.8 mos (3-36 mos)– TH 5.7 mos (3-13 mos)
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Results
• HC - 16 hospitalizations, 3 ED visits• TH - 4 hospitalizations, 0 ED visits
• Annualized– HC 1.77 hospitalizations / pt/yr (0-6)– TH 0.52 hospitalizations/pt/yr (0-3)– HC 0.15 ED visits/pt/yr (0-2)– TH 0 ED visits/pt/yr
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Projected Savings
• Full capacity: 23 TH pts -- 46 TH pts/yr– FY 2000 mean cost of admission $6,268
• Projected annual admissions • based on hospitalizations/pt/year rates
– TH- 24 admissions -- $149,930– HC - 81 admission -- $510,340
• Projected annual savings
– $360,410
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Results
• OASIS data
23
6
23
6
22
7
23
6
23
6
DyspneaPain
FunctionalOral Meds
Cognitive0
5
10
15
20
25
# of
pat
ient
s
Improved
Decline
NMMC Home Health AgencyTelehealth
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Results
• Patient satisfaction
6.9%
24.1%
69.0%
12345
*Pt Satisfaction ratings with 1 being the lowest and 5 being the highest
North MS Medical Center Home Health AgencyPatient Satisfaction for Telemedicine
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CHF Study Limitations
• Pilot study - small sample size– continue collecting data– perform statistical analysis
• Below full TH capacity– expand services
• Incomplete cost evaluation– compare TH and HC costs of care analysis
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TH is Not for Everyone
• Early discharge from TH by doctor – pt declining– caregiver is apprehensive
• Pt’s daughter requests discharge after 3 mos– inconvenient to caregiver
• 2 hospitalizations during 3 mos prior to TH (HC)• 2 hospitalization during 3 mos after TH• 0 hosptitalizations during TH
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Summary• Patients have functional, cognitive and
emotional improvements on TH
• Patients are satisfied with TH
• TH appears to reduce the rate of hospitalizations
• At full capacity TH management projects a $360,000 annual cost of hospitalization savings
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internet: [email protected], Biomedical ServicesBiomed
377-3265 ( Work )377-4996 ( Preferred Fax )
[email protected] ( Work Preferred )
Mac Stanford
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internet: [email protected] Outcomes ManagerHome Health
(662)719-2129 ( Work )(662)841-3253 ( Preferred Fax )
[email protected] ( Work Preferred )
Cathy Smith