Bowles, K. H, Hanlon, A. L, Glick, H. A, Naylor, M. D, O'Connor, M., Reigel, B., Shih, N. & Weiner, MG. (2011). Clinical effectiveness, access to, and satisfaction with care using a telehomecare substitution intervention: A randomized controlled trial. International Journal of Telemedicine and Applications,2011 1-14. Retrieved from https://doi.org/10.1155/2011/540138
Background. Hospitalization accounts for 70% of heart failure (HF) costs; readmission rates at 30 days are 24% and rise to 50% by 90 days. Agencies anticipate that telehomecare will provide the close monitoring necessary to prevent HF readmissions. Methods and Results. Randomized controlled trial to compare a telehomecare intervention for patients 55 and older following hospital discharge for HF to usual skilled home care. Primary endpoints were 30- and 60-day all-cause and HF readmission, hospital days, and time to readmission or death. Secondary outcomes were access to care, emergency department (ED) use, and satisfaction with care. All-cause readmissions at 30 days (16% versus 19%) and over six months (46% versus 52%) were lower in the telehomecare group but were not statistically significant. Access to care and satisfaction were significantly higher for the telehomecare patients, including the number of in-person visits and days in home care. Conclusions. Patient acceptance of the technology and current home care policies and processes of care were barriers to gaining clinical effectiveness and efficiency.
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