 Presented by Kara Derry, Oksana Marchenko, Sonja Wrobewski, and Carolyn Zielinski

 Telehealth monitoring, telephone and in-person visits were equally effective in preventing readmissions according to Bowles, Holland, and Horowitz (2009)  Evidence by Dansk, Vasey and Bowels (2008) did not support the use of telehealth monitoring to decrease re-hospitalization  Telehealth monitoring proved effective in medication compliance and symptom management in the Dansk, et al. study (2008)

 Trips to the Emergency Room, re-hospitalization rates, and mortality rates were equal according to the early education and telephone follow- up study by Dominuges, Clausell, Altit, Dominguez, and Robelo (2011).  Pilot testing of the Home-Care, Education, Assessment, Remote- Monitoring, and Therapeutic Activities (HEART) trial, intervention was a foundational step in preparation for a larger study.  The HEART intervention demonstrated a high feasibility for teaching HF patients regarding disease management.

 Home health care is ordered for a certain number of days, often 60 with a renewal of services if needed. Telehealth monitoring can provide a short term intervention for palliative care in heart failure (HF) patients.  Home health nursing visits can be enhanced with the use of telehealth monitoring. o Better medication adherence o Better diet adherence o Patient involvement in disease management

 The use of the HEART intervention for education increased patients’ perceptions of knowledge regarding self-management of HF.  The HEART program is valuable as it provides a home care-based, multidisciplinary approach to improve outcomes for HF patients.  Telephone follow-up is an extra benefit in reinforcing good health practices.

Companies who distribute the telehealth monitoring technology advocate its use to prevent re-hospitalization. The research of telehealth monitoring as a mechanism for decreasing the readmission of HF patients to the hospital has not been demonstrated in these studies. The research does provide insight into its usefulness in conjunction with patient education. These include:  Medication and diet adherence,  Early detection of symptoms,  Patient involvement in self-care, and  Providing better patient health status to providers.

 Telehealth monitoring does have a place in home health care related to symptom management and medication compliance.  Telehealth monitoring is useful as an assessment tool but not as affective as a preventative tool.  Telephone follow-up provides an extra benefit as a means of follow up.  The HEART program is useful as a nurse-directed multicomponent home intervention.

The cost of medical care for chronic conditions, such as HF will continue to increase as the population ages. Finding effective interventions to reduce HF hospital readmission will be imperative to health care. As the study by Dang, Dimmick, and Kelkar (2009) shows, more data are needed to determine the ideal patient population, frequency and duration of telemonitoring, and the right combination of education, in-person visits, and monitoring that would show consistent and improved outcomes for patients with HF.

Figure 1 – Study diagram representation. Domingues et al., 2011.

 Bowles, K. H., Holland, D. E., & Horowitz, D. A. (2009). A comparison of in-person home care, home care with telephone contact and home care with telemonitoring for disease management. J Telemed Telecare, 15(7), doi: / jtt  Dang S, Dimmick S, Kelkar G. (2009). Evaluating the evidence base for the use of home telehealth remote monitoring in elderly with heart failure. Telemed J E Health, 10(8), doi: /tmj  Dansky, K., Vasey, J., Bowles, K. (2008). Impact of telehealth on clinical outcomes in patients with heart failure. Clinical Nursing Research, 17(3), dio: /  Delaney, C., Apostolidis, B. (2010). Pilot testing of a multicomponent home care intervention for older adults with heart failure. Journal of Cardiovascular Nursing, 25(5), E250-E40. doi: /JCN.0b013e3181da2f79

 Domingues, F., Clausell N., Aliti, G., Dominguez, D., & Rabelo, E. (2011). Education and telephone monitoring by nurses of patients with heart failure: Randomized clinical trial. Arquivos Brasileiros de Cardiologia, 96(3),