1. BANNER HOME CARE TELEHEALTH

2. Objectives Overview of BHC Telehealth program Home Health and Telehealth Patient selection and admissions Results and Revisions

3. HOME TELEHEALTH MONITORING Banner Home Care offers telehealth monitoring to patients who are on Banner Home Care services who have a primary diagnosis of Heart Failure, Diabetes, COPD, Post CABG, Hyper or Hypotension, or any other Cardio-Pulmonary condition There is no cost to the patient

4. GOAL: Reduction of emergency room and hospital visits Reinforce to the patient, the value of self monitoring and taking an active role in their own disease management. To provide additional education for the home care patient Enhance physician communication Better utilization of home care nursing resources

5. TELEHEALTH MONITORING The telehealth monitoring program is provided to the patient as an adjunct to the skilled nursing care they are receiving The monitoring system includes: –scale –blood pressure monitor –pulse oximeter –telestation monitor

6. WEBSITE MONITORING The patients and caregivers are taught to weigh and take their vital signs every day The telestation monitor captures the data and sends the information via a phone line, to a website The telestation also asks the patient to answer a short series of questions regarding their symptoms that is also sent to the website

7. REVIEW OF DATA A Banner Home Care RN reviews the clinical data 7 days per week If a patient alerts on vital signs, weight, or symptoms, a clinical telephone assessment will be performed Further interventions may be taken such as contacting the physician, doing a home visit, or directing the patient to the emergency room if symptoms are severe.

8. CUSTOM TELESTATION The telestation monitor is multi-functional –It can be customized to not only ask assessment questions but can also send short pieces of education to the patient on a daily basis The daily information is a reinforcement of what the RN is teaching to the patient during the skilled nursing visit –And an extension of what is taught in the hospital

9. PATIENT SELECTION CRITERIA Medicare or Medicare type payor must meet home bound criteria Frequent emergency room and hospital stays Demonstrated difficulty in self- management of their chronic conditions Lack of knowledge regarding their disease process and medications

10. PATIENT SELECTION CRITERIA Teachable, motivated, able to follow simple instructions –either the patient or caregiver Land telephone line-cellular data transmission is being added this year

11. Total Number of Units 55 units in Arizona 15 units in Colorado All patients are monitored via central monitoring station in Arizona At any given time monitoring station in Arizona is monitoring up to 70 patients

12. Strengths and Barriers of Telehealth STRENGTHS Consistency of staff Use of Best Practice Vendor support System support Networking and information availability Custom telestation BARRIERS Consistency with discharge planning Reimbursement Cost efficiency of marketing Technology Awareness

13. RESULTS REHOSPITALIZATION RATE IN 30 DAYS

14. Open Heart Telehealth module Categories 1. First week at home Incision,breathing,pain,activity & nutrition, 2. Lifestyle changes Diet, exercise, smoking cessation, stress 3. Medications General medications, Nitro, anti-arrythmics, **Daily feedback questions and end week quiz

15. Success Stories  Depression –Pt was delighted to see feelings she was having that day in the module.  Readmission - Improved module by adding questions that flag daily action to BHC nurse.

16. Conclusion New and innovative approach to healthcare Cutting edge for telehealth program. Aligns with our mission in the continuum of care to make a difference in peoples’ lives through excellent patient care.

17. References 1.Bradley, K.M. & Williams, D.M. (1990). A comparison of the preoperative concerns of open heart surgery patients and their significant others. The Journal of Cardiovascular Nursing. 5(1). P 43-53. 2.Barnason S., Zimmerman L., Nieveen J., & Hertzog M. (2006). Impact of tele-health and recovery outcomes of elderly patients undergoing coronary artery bypass grafting. Heart & Lung. 35(4). P 225-233. 3.Hannan, E.L., Racz, M.J., Walford, G., Ryan, T.J., Isom, O.W., Bennett, E., & Jones, R.H. (2003). Predictors of readmission for complications of coronary artery bypass graft surgery. Journal of the American Medical Association. 290(6). P 773-780. 4.Martin, C.G. & Turkelson, S.L. (2006). Nursing care of the patient undergoing coronary artery bypass grafting. Journal of Cardiovascular Nursing. 21(2). P 109-117. 5.Mika, V.S., Kelly, P.J., Price, M.A., Franquiz, M., & Villarreal, R. (2005). The ABCs of health literacy. Family and Community Health. 20(8). P 351-357. 6.Murphy-Knoll, L. (2007). Low health literacy puts patients at risk. Journal of Nursing Quality. 22(3). P 205-209.