1. TeleHomecare Management of Congestive Heart Failure in Rural Mississippi Cathy Smith, RN, BSN North Mississippi Medical Center Home Health Cardiac Outcomes Manager

2. TeleHomecare Human Factors Technology Human Factors + Technology = TeleHomecare

4. Why High Risk CHF Patients? Poor prognosis Highest re-hospitalization rate High Medicare cost Most frequent cause of hospitalization in patients 65 and over with a cost of $6,268 per admission FY 2000 Shift of care for medically fragile patients from hospital to home

5. CHF Project Timeline TOP Grant Award - 10/99 23 Kodak units purchased - 5/00 First CHF patient - 8/00 Kodak pulls out 12/00 Patient entry on hold American Telecare replacements 2/01 New patients 2/01

6. Patient Selection Hospitalization within 6 months OR ER visit within 6 months OR patient adherence problems Requirements Caregiver present in the home Patient willing and able to learn how to use telecare system Patient has multiple home visits per week

8. Clinical Assessments EdemaValidating Insulin Dosage

9. Clinical Assessments TelePhonic Stethoscope Heart and Lung Sounds Rales, Wheezes, Decreased breath sounds Abnormal heart sounds

10. TeleHomecare Interventions Nursing Intervention Nursing Interventio n

11. Program Evaluation Outcomes –Hospitalizations –ER visits Qualitative measurements –OASIS functional, cognitive, emotional assessment –Patient satisfaction survey

12. Data Analysis Retrospective review of hospitalizations and ER visits –include CHF as primary and secondary diagnosis INCLUSION CRITERIA –Patients have hospitalization or ED visit –Patients on home care (HC) and telehomecare (TH) each for at least 3 months Data is annualized and compared

13. Results 8/15/00 to 9/30/01 –29 patients –Mean length of stay(LOS) HC - 8.6 mos (0.1-36 mos) TH - 4.1 mos (0.1-13 mos) Not eligible for evaluation –5 pts - no hosp/ER admissions –4 pts - too short on TH –5 pts - too short on HC –2 pts - too short on HC and TH

14. Results 13 patients evaluated –11 hospitalized –1 hospitalized and ER visit –1 ER visit Assessment frame 1/00/00 - 9/30/01 Mean patient LOS times –HC 10.8 mos (3-36 mos) –TH 5.7 mos (3-13 mos)

15. Results HC - 16 hospitalizations, 3 ED visits TH - 4 hospitalizations, 0 ED visits Annualized –HC 1.77 hospitalizations / pt/yr (0-6) –TH 0.52 hospitalizations/pt/yr (0-3) –HC 0.15 ED visits/pt/yr (0-2) –TH 0 ED visits/pt/yr

16. Projected Savings Full capacity: 23 TH pts -- 46 TH pts/yr –FY 2000 mean cost of admission $6,268 Projected annual admissions based on hospitalizations/pt/year rates –TH- 24 admissions -- $149,930 –HC - 81 admission -- $510,340 Projected annual savings –$360,410

17. Results OASIS data

18. Results Patient satisfaction

19. CHF Study Limitations Pilot study - small sample size –continue collecting data –perform statistical analysis Below full TH capacity –expand services Incomplete cost evaluation –compare TH and HC costs of care analysis

20. TH is Not for Everyone Early discharge from TH by doctor –pt declining –caregiver is apprehensive Pt’s daughter requests discharge after 3 mos –inconvenient to caregiver 2 hospitalizations during 3 mos prior to TH (HC) 2 hospitalization during 3 mos after TH 0 hosptitalizations during TH

21. Summary Patients have functional, cognitive and emotional improvements on TH Patients are satisfied with TH TH appears to reduce the rate of hospitalizations At full capacity TH management projects a $360,000 annual cost of hospitalization savings

22. internet: mac@NMHS.net Director, Biomedical Services Biomed 377-3265 ( Work ) 377-4996 ( Preferred Fax ) Mac.Stanford@nmhs.net ( Work Preferred ) Mac Stanford

23. internet: cwsmith@NMHS.net Cardiac Outcomes Manager Home Health (662)719-2129 ( Work ) (662)841-3253 ( Preferred Fax ) Cathy.Smith@nmhs.net ( Work Preferred ) Cathy Smith