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

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

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

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

5. 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

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

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

8. Patient Demographics VideoControl % Female 73.6 72.9 % Male 26.4 27.1 Average Age 74.8 74.2 Number 91 85

9. Patient Health Status VideoControl Mean Diabetes Severity Score2.282.29 Mean Number of Comorbidities1.912.07

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

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

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

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

14. Home Health Costs: Project

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

16. 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

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

18. Impact on Patients: Discharge Status VideoControl % Discharged Home 63.7 39.0 % Recertified for HHA 23.1 25.6 % Hospitalized 11.0 26.8 % Other 2.2 8.5

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

20. TeleHomecare Project Caring, Journal of Healthcare Information Management http://www.hhdev.psu.edu/hpa