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TeleHomecare Management of Congestive Heart Failure in Rural Mississippi

TeleHomecare Management of Congestive Heart Failure in Rural Mississippi. Cathy Smith, RN, BSN North Mississippi Medical Center Home Health Cardiac Outcomes Manager. TeleHomecare. Technology. Human Factors. Human Factors + Technology = TeleHomecare. Why High Risk CHF Patients?.

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TeleHomecare Management of Congestive Heart Failure in Rural Mississippi

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  1. TeleHomecare Management of Congestive Heart Failure in Rural Mississippi Cathy Smith, RN, BSN North Mississippi Medical Center Home Health Cardiac Outcomes Manager

  2. TeleHomecare Technology Human Factors Human Factors + Technology = TeleHomecare

  3. 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

  4. 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

  5. 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

  6. Clinical Assessments Edema Validating Insulin Dosage

  7. Clinical Assessments TelePhonic Stethoscope Heart and Lung Sounds Rales, Wheezes, Decreased breath sounds Abnormal heart sounds

  8. TeleHomecare Interventions Nursing Intervention Nursing Intervention

  9. Program Evaluation • Outcomes • Hospitalizations • ER visits • Qualitative measurements • OASIS • functional, cognitive, emotional assessment • Patient satisfaction survey

  10. 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

  11. 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

  12. 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)

  13. 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

  14. 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

  15. Results • OASIS data

  16. Results • Patient satisfaction

  17. 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

  18. 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

  19. 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

  20. Mac Stanford internet: mac@NMHS.net Director, Biomedical Services Biomed 377-3265 ( Work  )377-4996 ( Preferred Fax  ) Mac.Stanford@nmhs.net ( Work Preferred  )

  21. Cathy Smith internet: cwsmith@NMHS.net Cardiac Outcomes Manager Home Health (662)719-2129 ( Work  )(662)841-3253 ( Preferred Fax  ) Cathy.Smith@nmhs.net ( Work Preferred  )

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