9/6/11 By David Lindeman
One of CTA’s Remote Patient Monitoring Grantees, Centura Health at Home (CHAH), has completed their RPM Diffusion Grants Program project. The process of integrating two programs, the telehealth monitoring program and call center, increased the level of service and accessibility of older adults to manage their health care. The year long project demonstrated successful outcomes in terms of reducing the frequency of 30-day rehospitalizations, increasing patient quality of life, improving patient self-management and education, reducing the frequency of home RN visits as well as impacting policy change around payment to homecare agencies for telehealth services in Colorado. The following is a full description of what has been found with the Centura Health at Home Remote Patient Monitoring Project.
Project Description: The purpose of the Centura Health at Home (CHAH) project was to decrease 30-day rehospitalization rates and to increase older adult quality of life by augmenting the current telehealth continuum at CHAH by merging our two, independently successful, Call Center and Telehealth programs.
The successful integration of these two programs has significantly expanded the populations CHAH serves geographically and has also created a deeper level of service by making telehealth monitoring available 24 hours a day, seven days a week. Another key component to this project was the integration of the CHAH staff into the telehealth program, establishing telehealth as a new standard of care at CHAH. These key factors proved vital to the success of this project and also paved the way for CHAH to greatly increase the number of patients served by telehealth in the future.
Project Goals and Measures:
(1) Decreased rates of recidivism for 30-day readmissions at identified Centura Hospitals (St. Anthony’s Central, St. Anthony’s North, Parker Adventist, Littleton Adventist and Porter Adventist Hospital) by 2% after year one;
(2) Increased quality of life for project participants as measured through the Quality of Life SF-36; and
(3) Increased number of patients served in the telehealth program by a minimum of 200 per year after year one.
Patient Enrollment Criteria: All project participants were located in the Denver Metro area. The typical participant was an older adult, living in his or her own home, managing co-morbid conditions, and who had just experienced a hospitalization related to an exacerbation of their chronic health condition.
The project enrollment criteria included discharge from one of participating hospitals into the Telehealth Program or the Porter Adventist Hospital CHF Callback Project. Because the participants were part of the existing Centura programs, they were identified through the efforts of highly trained case managers and Home Service Coordinators at the hospitals, who conduct coordination for all hospitals at Centura, regardless of where the patient is going for aftercare. Home Service Coordinators at each of the targeted hospitals were a key component in referring patients to the Telehealth Program. Final numbers for project participants are as follow:
Remote Patient Monitoring Diffusion Grants Program
Reduction in frequency of re-hospitalizations. In alignment with the Tufts Medical Center Study, Centura Health at Home’s RPM project found that over a 30-day period following the initial hospital stay, hospitalizations related to heart failure, COPD and Diabetes were reduced by 62%. Rehospitalizations rates for telehealth home care patients vs. traditional home care patients not receiving telehealth is significant. During the project period, Centura’s 30-day rehospitalization rate for the entire patient population was 18% compared to 6.28% in the telehealth population.
Improved Quality of Life of Older Adults. In terms of Quality of Life, CHAH utilized the FS-36 QOL survey for entire study population, which included measures for clinical and mental domains. Results showed increases in QOL overall; and in evaluating male versus female, the survey showed a much greater increase in QOL for female participants, especially in mental domain.
Improved Patient Self-Management and Education. The project improved chronic disease management by extending the reach of the nursing staff. Thus, field nurses are able to focus their time and attention on “intentional” visits dictated by health circumstances, rather than routine assessments, which can be done via telehealth equipment. Another improvement noted is the improved opportunity for patient education. The monitoring nurse is able to connect with the patient in “real time,” helping patients to make the connection between cause and effect. Patient actions such as missed medications or a meal high in salt will be reflected in the monitoring. The nurse can effectively educate the patient in a “teachable moment” that will give the patient something tangible to make the correlation between actions and outcome.
Reduced the Frequency of Home RN Visits. The traditional home care model with like patients sets typical frequency of visits for the RN as two or three times per week over a 60-day episode of care. Often this is not enough to catch the subtle early warning signs of a health concern. By daily telehealth monitoring, the frequency of RN home visits was not only reduced to 2.69 over this 60-day period, but through biometrics and personally built algorithms based on health conditions, the monitoring Registered Nurse was able to closely monitor the most volatile patients, and take action toward early and timely intervention. With access to the RN 24 hours a day, seven days a week, the monitoring can be done at any time.
Policy change to Telehealth Services Payment to Homecare Agencies in Colorado. CHAH worked with the Home Care Association of Colorado to get the Telehealth Rule passed by the Medical Service Board of HCPF. As of October 1, 2011, the Telehealth Rule 8.520 will allow for payment to homecare agencies directly for telehealth services – not just homecare. However, this legislation allows payment for the Medicaid population only, so there is still a need for private support for those older adults not able to pay and not covered by Medicaid. Although this Rule is very restrictive in what they initially passed in terms of diagnosis, history of hospitalizations, etc., it is a step in the right direction.
CHAH is looking to expand their program to a larger number of patients as well as the possibility of linking this project into Patient Centered Medical Homes and accountable care organizations. CHAH’s Director of Telehealth, Ellery Aiken, is working to help develop evidence-based training programs for homecare nurses with modules around telehealth with the Colorado Center for Nursing Excellence. Additional opportunities lie within expansion of telehealth programs to CHAH’s seven other senior living communities and particularly with the independent living community at the Garden’s at St. Elizabeth(GSE) in Denver. CHAH is also working with CTA and the Center for Connected Health through a California HealthCare Foundation funded program to create an ROI model for remote patient monitoring of older adults with heart failure. Results of this project are expected at the end of 2011.
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