1. CAVHS—Where Veterans Come First DISCLOSUREDISCLOSURE 1. No planner, presenter, faculty, authors, or content expert has identified a conflict of interest that would affect the educational activities. 2. No commercial interest has provided financial or in-kind support for this educational activity. 3. The Arkansas Nurses Association has provided financial or in-kind support for this educational activity in the form of printing and food costs. 4. Neither ANCC, SCAP, or ARNA endorse any commercial products discussed/displayed in conjunction with this educational activity. South Central Accreditation Program (SCAP) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

2. CAVHS—Where Veterans Come First The Impact of Telehealth Programs on Chronic Heart Failure Patient Outcomes: A Literature Review Central Arkansas Veterans Healthcare System October 2015 Britteny Bass BSN, RN, LaRhonda Bealer BSN, RN, Becky Wimberly MA, BSN, RN

3. CAVHS—Where Veterans Come First PretestPretest Approximately 10% of CHF patients are re- hospitalized within 6 months of discharge. True or False In 2010, the estimated direct and indirect annual cost of heart failure was $39 billion. True or False Literature shows significant risk reduction of 28% in CHF hospitalization with home telehealth versus usual care. True or False

4. CAVHS—Where Veterans Come First ObjectivesObjectives 1. By the end of this session, participants will be able to describe at least two ways that CHF impacts patients in the US. 2. By the end of this session, participants will be able to describe at least to ways to manage CHF through telehealth outreach programs. 3. By the end of this session, participants will be able to describe at least two ways telehealth programs can impact CHF treatment plans.

5. CAVHS—Where Veterans Come First What is Chronic Heart Failure Heart failure is a common chronic disease marked by frequent exacerbations often resulting in hospitalization and death. Heart failure is the leading cause of hospitalization for Americans over age 65. Approximately 50% of CHF patients are re- hospitalized within 6 months of discharge.

6. CAVHS—Where Veterans Come First National Measure National Veterans Health Administration (VHA) – to reduce hospital readmissions of the CHF patient as a way of improving quality and reducing costs. A CHF Readmission is defined by patients who had an initial hospitalization for CHF & were readmitted at least once to acute care in the hospital within 30 days of discharge for CHF

7. CAVHS—Where Veterans Come First AHA Policy Statement By 2030, you - and every U.S. taxpayer could be paying $244 a year to care for heart failure patients

8. CAVHS—Where Veterans Come First Projected Cost of CHF

9. CAVHS—Where Veterans Come First CHF Arkansas Cost Average cost for inpatient stay is $16,641 Or $3,390 per BDOC

10. CAVHS—Where Veterans Come First CHF Arkansas

11. CAVHS—Where Veterans Come First CHF CAVHS COST 235 discharges in FY15 –Average cost per discharge $13,864 –Total expense $3,258,241 356 discharges in FY14 388 discharges in FY13

12. CAVHS—Where Veterans Come First Home Telehealth at CAVHS Is defined as a program into which Veterans are enrolled that applies care and case management principles to coordinate care using health informatics, disease management and Home Telehealth (HT) technologies to facilitate access to care and to improve the health of Veterans with the specific intent of providing the right care in the right place at the right time.

13. CAVHS—Where Veterans Come First Home Telehealth The goals of Home Telehealth (HT) –improve clinical outcomes and access to care –reduce complications, hospitalizations, clinic and/or emergency room visits

14. CAVHS—Where Veterans Come First Home Telehealth Four components to the HT program: 1. Disease Management 2. Care/Case Management 3. Self-Management of Chronic Disease 4. Telehealth technologies used to deliver these components.

15. CAVHS—Where Veterans Come First Telehealth Technologies Device-Based Telemonitoring Interactive Voice Response System Web-Based Telemonitoring

16. CAVHS—Where Veterans Come First Telehealth Technologies

17. CAVHS—Where Veterans Come First Telehealth Technologies Device-Based Telemonitoring –Electronically submitted vital sign data and symptom responses using attached peripheral devices –Includes modems, broadband or landline

18. CAVHS—Where Veterans Come First Telehealth Technologies Interactive Voice Response System -manual input of data using telephone keypad to send information concerning vital signs and symptoms to healthcare provider

19. CAVHS—Where Veterans Come First Telehealth Technologies Web-Based Telemonitoring –manual input of data using internet access, allowing patient to gain secure access to web-based portal to enter their vital signs obtained through stand- alone peripheral devices

20. CAVHS—Where Veterans Come First Who Could Benefit ∙ Diabetes ∙ Chronic Obstructive Pulmonary Disease (COPD) ∙ Hypertension (HTN) ∙ Congestive Heart Failure (CHF) ∙ Bipolar Disorder ∙ Depression ∙ Schizophrenia ∙ Substance Abuse ∙ Post-Traumatic Stress Disorder (PTSD) May be a combination of above diagnosis

21. CAVHS—Where Veterans Come First Why Participate? Use every day at home Gain confidence & improves independence at home Links Veteran directly to RN Care Coordinator Alerts health care team before problems occur Personalized and individualized care Prevents unnecessary clinic, hospital or ER visits Helps Veteran follow prescribed plan of care Provides daily knowledge of health status Improves quality of life Provides peace of mind

22. CAVHS—Where Veterans Come First TelehealthTelehealth There is a trend to the way health care is being delivered due to: –Increased age of population –Needs of returning service members from conflicts in Iraq & Afghanistan –Limited access to care in rural/remote areas MAKES THE HOME AND COMMUNITY THE PREFERRED SITE OF CARE

23. CAVHS—Where Veterans Come First Telehealth Performance It’s been shown that the recording of data & answering of symptom related questions could reduce mortality risk by 34% & the risk of CHF-related hospitalization by 15%. By adding the monitoring of HR, mortality could be reduced by 40% & CHF-related hospitalizations by 43%. Studies have shown it significantly reduces all-cause mortality by an average of 24%, CHF-related hospitalization by 28% and CHF-related LOS by 1.4 days.

24. CAVHS—Where Veterans Come First Home Telehealth Stories http://vaww.telehealth.va.gov/resources/video/mlmhmc.asf

25. CAVHS—Where Veterans Come First QuestionsQuestions

26. Post-testPost-test Approximately 10% of CHF patients are re- hospitalized within 6 months of discharge. True or False In 2010, the estimated direct and indirect annual cost of heart failure in the US was $39 billion. True or False Literature shows significant risk reduction of 28% in CHF hospitalization with home telehealth versus usual care. True or False

27. CAVHS—Where Veterans Come First ReferenceReference American Heart Association Policy Statement (2013). American Heart Association: Direct, indirect costs to treat heart failure could more than double in 2030. 2012 Arkansas Department of Health, Chronic Disease Prevention & Control Branch Heart Disease & Stroke Prevention Section. www.healthy.arkansas.govwww.healthy.arkansas.gov 2010 VHA Facility Quality and Safety Report, Dept. of Veterans Affairs, VHA October 2010; p. 20-21 Spyros, K., Pare, G., & Jaana, M. (2015). Effects of home telemonitoring interventions on patients with chronic heart failure: An overview of systematic reviews. Journal of Medical Internet Research, 17(3), e63. doi: 10.2196/jmir.4174 Varon, C., Alao, M., Minter, J., Stapleton, M., Thomson, S., Jaecques, S., Brunner-La Rocca, H.P., & Van Huffel, S. (2015). Telehealth on heart failure: Results of the Recap project. Journal of Telemedicine and Telecare, 0(0), 1-8. doi: 10.1177/1357633X15577310 Xiang, R., Li, L., & Liu, S.X. (2013). Meta-analysis and meta-regression of telehealth programmes for patients with chronic heart failure. Journal of Telemedicine and Telecare, 19(5), 249-259. doi: 10.1177/1357633X13495490