Cost Analysis of TeleHomecare  Kathryn H. Dansky, R.N., PhD  Liisa Palmer, PhD candidate  Dennis Shea, PhD  Kathy Bowles, R.N., PhD

Cost Analysis of TeleHomecare  TeleHomecare Project  Evaluation  Cost analysis  Lessons learned

Partners  Penn State University  The Visiting Nurse Association of Greater Philadelphia (VNA)  American TeleCare, Inc.

Sponsor  U.S. Department of Commerce National Telecommunications Information Administration (NTIA) Telecommunications and Information Infrastructure Assistance Program (TIIAP)

Project Objectives 1) Evaluate health status and quality of life 2) Evaluate health care costs 3) Evaluate patient satisfaction 4) Extend TeleHomecare technology to other underserved populations

System Description AVIVA 2020 (ATI)  Patient station  Clinician station  Communication links

Research Design  Sample: Homebound diabetics  Randomization to experimental and control groups  Pre- and post-testing (post-testing at 60 days or discharge)

Patient Demographics VideoControl % Female % Male Average Age Number 91 85

Patient Health Status VideoControl Mean Diabetes Severity Score Mean Number of Comorbidities

Evaluation: Indices 1. Health Status 2. Quality of Life 3. Self-Management of Diabetes 4. Patient Satisfaction 5. Health Care Costs

Evaluation Health Care Costs:  Direct costs: physician, hospital, home health, pharmaceutical  System and training costs  Indirect costs: morbidity, mortality, QALYs

Home Health Costs: RN Care ** (p < 0.05)

Home Health Costs: RN Care ** (p < 0.001)

Home Health Costs: Project

Project Costs: Video Group  Telehomecare units + upgrades  Peripherals  Printer  Carts and bins  Equipment installation, maintenance and removal  Education, training and meetings  Unsuccessful video visits

Considerations: Costs  Equipment discounted over 5 years, but no secondary market for equipment (salvage value =0)  Bureau of Labor average hourly wage for Registered Nurses in Philadelphia (1998) used for labor costs

Considerations: Uncertainty  Equipment - technical - operator  Appropriate number of video visits - substitution versus supplementation  Evaluation design

Impact on Patients: Discharge Status VideoControl % Discharged Home % Recertified for HHA % Hospitalized % Other

Lessons Learned: Costs  Technical support  Staff buy-in  Training  Hidden costs  Maximize potential

TeleHomecare Project Caring, Journal of Healthcare Information Management