Managing Congestive Heart Failure with Telemedicine.

Technology brings efficiency, savings and patient satisfaction to home health industry.

Barbara McFalls, 54, of Sacramento, CA, is one of up to 70 patients enrolled in a study at University of California, Davis to demonstrate that telemedicine can help keep congestive heart failure (CHF) patients from being readmitted to the hospital while improving their quality of life and saving money.

Every Wednesday at 10 a.m., McFalls sits in her living room facing a portable telemedicine unit provided as part of the UC Davis Health System study. The PC-sized has a miniature video camera, stethoscope and automated blood pressure cuff, and is connected via a regular telephone line to a telemedicine terminal at UC Davis Medical Center 10 miles away. There, nurse Carmen Martinez listens to McFalls' heart and lungs, monitors her blood pressure and pulse, and checks for ankle swelling or other symptoms.

McFalls may have to maneuver the stethoscope and activate the blood pressure cuff herself, but she doesn't have to travel across town or even change out of her nightgown. The check-up takes five or 10 minutes.

A New Horizon for Telehealth

In a short span of time, telemedicine has enabled healthcare delivery into rural areas, and served as a patient education tool, allowing virtual classes in asthma management, heart disease prevention and prenatal care.

But only recently has telemedicine been considered for use in the $22.3 billion home healthcare industry. Why not before? Because now shorter hospital stays mean many patients require more home nursing services for full recovery. Because now health plans have a financial stake in helping patients learn to self-manage complex illnesses at home. Because now telemedicine equipment is more affordable, portable and patient-friendly than ever.

CHF accounts for more than 700,000 U.S. hospital admissions each year; 20 percent to 50 percent of these patients are readmitted within six months, accounting for a major share of the $6 billion in annual costs for heart failure.

Anthony Jerant, M.D., assistant professor of family and community medicine at UC Davis and principal investigator for the study, says many CHF patients have functional limitations that make frequent visits to a doctor arduous. Careful monitoring by a healthcare provider can prevent costly readmissions to the hospital and the need for frequent visits by a home-health nurse.

Jerant calculates that preventing one readmission to a hospital emergency room would save enough money to pay for one or more home telemedicine units. The equipment used in the UC Davis study costs about $5,000 for each home installation. Patients are trained to use the equipment by a home health nurse. A single one- or two-hour home visit is required to install the equipment and to train the patient.

Achieving Patient Satisfaction

Thomas Nesbitt, assistant dean for regional outreach and telehealth at UC Davis, last year surveyed patients who participated in the first 1,000 telemedicine consults with UC Davis specialists. Patients reported being "very satisfied" overall and said they would use telemedicine again.

Patients with chronic diseases use the most healthcare resources. According to the Journal of the American Medical Association in 1996, diabetes affected more than 14 million people at an annual cost of $100 billion; similarly, heart disease affected 60 million, costing more than $104 billion per year. With such burgeoning costs, it's likely that telemedicine for home-based follow-up can only gain momentum.

Typical Equipment/Services    Sources/Examples

Equipment:                    POTS Video unit such as
Videoconferencing             American TeleCare Aviva or
workstation                   CPhone H.324

Application Layer:            Aviva Central Workstation
Software

Network Transport Services:   Pacific Bell/Citizens
POTS Telephone                capable of 33.6 Kbps or better

Leslie Sandberg is a member of HMT's editorial advisory board and is chief liaison officer for the Institute for Health and Technology, at the University of California, Davis, Health System.