Best Practices in Telemanagement

The cost of managing chronic illness has become astronomical. Congestive heart failure is now a major chronic condition in the United States, with an estimated 5 million Americans living with the disease. The impact of heart failure and pulmonary hypertension is particularly severe among the elderly because of emotional and economic burdens like perpetual hospitalizations and functional decline, as well as lack of support systems, long-term medication therapy and depression.

In an effort to break an endless cycle of rehospitalizations and provide quality, cost-effective care, the Orlando Health Visiting Nurse Association (VNA), a hospital-based home health agency in Florida, piloted a Telehealth Disease Management Program in 2006 with 16 monitors. The evidence-based practice proved superior to other forms of practice in achieving better measurable outcomes. Thanks to Orlando Health hospital support, VNA now has 65 home telemonitors and has successfully improved patient outcomes and reduced cost while monitoring greater than 300 patients.

Early interventions through telemanagement technology are preventing rehospitalizations and improving quality of life by allowing those 65 and older to remain in their homes and live independently. Perhaps one of the greatest benefits of the telemanagement program is the peace of mind it brings to patients and their families.

Patient Consideration

Patients who met certain criteria were considered for the program. The criteria encompassed patients who:

• Experience repeat hospitalizations or ED visits for unstable conditions;
• Are high risk for chronic disease exacerbation or complications;
• Have difficulty managing diet and medications; and
• Are a risk for self-care adherence issues.

Before breaking down the specifics of the initiative, these actions proved to be key components:

• Conduct daily telemonitoring and assessment.
• Perform timely interventions based on current symptoms.
• Provide education to patient and caregiver.
• Promote treatment adherence.
• Customize care to patients needs.
• Empower patients to participate in self-care.
• Send tabular and graphic trend reports to a physician for review.
• Hold monthly team meetings.

Program Overview and Process

The initial step takes place when a nurse installs the telemonitoring equipment in the home. It takes the patient less than five minutes to transmit daily weight, blood pressure, heart rate and oxygen saturation level. The vital signs are triaged and monitored by a registered nurse at a central station computer seven days a week. A quick detection of a change in health status can prevent patient decompensation.

In addition to the monitoring team, a home health nurse assesses and educates the patient on disease management, diet restrictions, smoking cessation, medication instruction and when to call the nurse, doctor or 911. The goal of the program is to prevent rehospitalization by developing a patient’s self-management skills. This is achieved by teaching symptom awareness, disease knowledge and behavior change.