Sample Ecology Paper on Effectiveness of Telehealth Monitoring To Prevent Re-Hospitalization of CHF Patients

Effectiveness of Telehealth Monitoring To Prevent Re-Hospitalization of CHF Patients

Abstract

Approximately, 5 million Americans have the congestive heart failure (CHF) condition. There are several instances of CHF patients living beyond the years ordinarily expected for people with the illness, commonly as a result of effective disease management. In recent developments, a relatively new technological alternative for CHF outpatient care, the telemedicine machine, has been used in the management of the CHF condition. The care of CHF patients remains complex and costly to the health care industry. According to Smith (2010), insurers’ yearly cost of heart failure is approximated to be more than $8,000 per head annually. Heart failure continues to be a leading cause of readmission of Medicare patients. The total cost of these hospital readmissions is high. Furthermore, the rate of heart failure is more predominant in persons aged 65 years and above, whose co-diseases worsen the intricacy of their care. Innumerable hospital re-admissions could be avoided by the utilization of telemedicine machine. The present research proposal investigates the effectiveness telehealth monitoring as a way of preventing re-hospitalization of CHF patients.

Effectiveness of Telehealth Monitoring to Prevent Re- hospitalization of CHF Patients

Introduction to Study

The average population of patients with chronic heart failure (CHF) is sharply increasing in the United States (U.S.). CHF is a leading cause of repeated hospitalizations in the patient population, particularly at the rate of 65 and above (Abraham et al., 2008). A total population of 5.7 million people diagnosed with CHF is contributing to the increasing healthcare expenditures as a result of recurrent medical care for managing symptoms (McGhee & Murphy, 2010). As a result of the existing rigorous alterations occurring in the federal compensation and financing of healthcare, healthcare experts are continually considering other options to protect poor patients from the consequences of the adverse health policies. A significant equipment that is crucial in caring for these individuals is the telehealth communications technology (The Institute of Medicine, 2012). In the recent past, the application of information technology (IT) has progressed in the healthcare industry. According to IOM (2012), the use of IT has become core for all healthcare practitioners including nurses. IOM inspires the use of effective technology, for instance, telehealth, if it is vital in enhancing the six components of healthcare delivery of safety, patient-centered, timely, equitable, effective, and efficient (IOM, 2012). Several studies have been conducted, which suggest that telehealth is a safe, consistent, practical approach in checking chronic conditions, for instance, hypertension and diabetes (Dewsbury, 2012). Nevertheless, investigations that are more similar are required to study the impact of telehealth on conditions, such as CHF to encourage extensive use of the technology. The United States Department of Health and Human Services (HHS) is presently backing up the financing to assess the effectiveness of telehealth programs. The HHS together with the American Medical Informatics Association (AMIA) has formed a national precedence to improve and implement information systems that enhance adeptness, uphold safety, and improve complete patient care (AMIA, 2012). Furthermore, American Association of Nurse Practitioners (AANP) research agenda emphasizes on means of advancing patient outcomes (AANP, 2010). If enquiry recommends that telehealth technology is valuable in checking chronic conditions, medical practitioners will be more likely to get used to the equipment. Insurance corporations will also be enthusiastic to offer full recompense of the care provided via telehealth, hence, encouraging the use of the technology.

Key words: Chronic Heart Failure (CHF), Telehealth Monitoring Machine, Length of Stay (LOS), Re-hospitalization, Telehealth Monitoring (TM).

Practice Issue

The increasing population of CHF patients in the United States is tremendously triggering the escalating costs of healthcare. Regardless of the presence of effective treatments, average hospital readmission rate is growing in the CHF diagnosis associated group. It is apparent that approximately 50% of the readmissions are possibly unnecessary (Centers for Medicare and Medicaid Services [CMS], 2011). Furthermore, the transience rate is 50% within five years of CHF analysis and the associated expenditures are approximately $34 billion annually (American Heart Association [AHA], 2012). It is evident that both verbal and written patient education concerning the management of the disease process is not adequate. According to Wilson (2003), more than 90 million populations in the United States experience difficulty in comprehending and applying health information. Moreover, the provision of disease education is largely offered in a tense, time-limited setting environment, for instance, doctor’s office or the healthcare setting where patients are overawed with information. The inadequate health literacy alongside the overall small literacy level among the majority of U.S. population promote no observance to treatment programs, resulting in a low control of personal risk factors and detrimental health consequences (Cho, Lee, Arozullah, & Crittenden, 2008). Therefore, patient education is recommended to complement other monitoring approaches to effective management of cardiovascular maladies (Taylor-Clarke et al., 2012).

Background and Significance of the Problem

Congestive heart failure or commonly referred to as heart failure is an intricate ailment that involves multiple organs. Heart failure happens when the heart is incapable of plumbing sufficient blood to meet body needs. In an attempt to correct this discrepancy, the kidneys then preserve excess fluid. The fluid accumulates in the lungs, liver, legs, and around the eyes. Among the signs and symptoms of heart failure include shortness of breath, untiring coughing or puffing, exhaustion, lack of appetite, seasickness, confusion and increased heart rate among others (American Heart Association, 2010). CHF is a progressive condition with explicit cure but has management options that assist in controlling the symptoms. The various treatment options include lifestyle changes, medical managing using medications and medical procedure. The management treatment routine of the CHF patient is determined not only by medical needs, but by also monetary, emotional, and social circumstances. Patients with CHF normally have various conditions, which contribute to the intricacy of care. In the management model, the care of the patient is personalized precisely to the patient’s general needs and is therefore able to tackle multiple chronic conditions the patient may be going through (Annema et al., 2009). The explicit aim of this research is to appraise if telehealth monitoring is an effective method of reducing re-hospitalizations in this population, hence, improving patient quality of life, an all-embracing objective of Healthy People 2020 (HP, 2020).

Problem Statement

In a period of improved focus on decreasing health care expenditures, it is apparent that one of the leading causes of costly hospital readmission is CHF and other related heart failure. Increased readmission rates, in spite of improvements in the inhibition and treatment of heart failure, contribute to the cost of management patients with this lingering condition. This suggested research will investigate the effectiveness of telehealth monitoring to prevent re-hospitalization of CHF patients.

Objective of Study

A developing equipment of telehealth monitoring (TM) not only contributes to effective management of CHF patients, but also emphasizes on Healthy People 2020 objectives of enhancing access to care, refining patient outcomes, and offering cost-effective care. The purpose of this study is to examine the effectiveness of telehealth monitoring to prevent re-hospitalization of CHF patients. Furthermore, the overall patient gratification with the services provided by the equipment with heart failure will be appraised. The twofold research hypotheses for this research will be: 

  1. The application of telehealth will decrease in-patient re-hospitalizations in the CHF patient population.
  2. If re-hospitalization is justified, the length of stay (LOS) in the healthcare facilities associated to a CHF exacerbation will be decreased for patients receiving telehealth services.

The independent variable entailed in this research will be the application of telehealth monitoring system. Telehealth monitoring system is an instrument that screens the CHF patients’ significant signs of heart rate, blood pressure, and weight on an everyday basis. The dependent variables will be re-hospitalization rates and length of stay. The re-hospitalization rate is the proportion of times the patient is admitted as an in-patient in this case 24 hours in a healthcare facility. The length of stay involves the amount of days the patient stays in the healthcare facility before being discharged back home or to a recuperation facility.

Review of Literature

According to Marineau (2007), optimistic and undesirable experiences of tele monitoring of ten patients who had been admitted in the healthcare facility with an ailment and transitioning at home was analyzed. The increasing issue provided that telehealth system was easy to use, management of the condition alterations were made on time and that the model allowed for a more self-control care. Furthermore, the patients who took part in the research underscored the significance of recuperating at home, in a relaxed setting. The healthcare facility environment was observed as sub-optimal, where care provided hindered the recovery process. This was as a result of perpetual rest disturbances, nosocomial contaminations, reduced appetite, feeling of despair and needs not attained. Among the positive perception of tele monitoring was that the care approach reduced the expenditures several clinic visits and the time consumed. In urban settings, the physician wait times range from about 11 to 15 days, hence, deferring the care required and increasing the likelihood of worsening the patients’ condition (Dehours et al., 2012). A number of the participants in the TM care model were not enthusiastic about using the TM technology since they believed it was a second choice care while other partakers assumed they were hastily discharged from healthcare facility, and were fortified to use the technology at home for the remaining recovery period (Marineau, 2007).

Tele-monitoring approach is significant in early identification of indications of disease extent, therefore, ensuing timely application of medical care. Additionally, a chronic predominant illness affects one out of three Americans and is allied to a high rate of indisposition and transience (CDC, 2011). Evidence founded interpositions are highly demanded to manage the severe consequences of diseases like CHF and stroke. An unsystematic, investigational and longitudinal research assessed the impacts of tele monitoring on decreasing blood pressure (BP) among 394 African Americans (Artinian et al., 2007). Apart from going to see primary care providers, the interventional persons were invited to send their BP readings to the tele-monitoring nurse on a weekly basis via the device. After the analyses were attained, the nurse made phone calls to deliver feedback in accordance to medication observance, lifestyle adjustment, and targeted objectives. In 12 months, the tele-monitoring group experienced both clinically and statistically noteworthy decreases as compared to the control group that only showed up frequently as per the doctor’s schedule (Artinian et al., 2007).

Moreover, the lack of information of the management of the chronic disease process can be an obstacle to the patients who are motivated in caring for their conditions. Therefore, tele-monitoring offers considerable education in the course of the monitoring process, which bridges this gap (McGhee & Murphy, 2010). It is significant that considerable education is obligatory to the management of CHF disease process. Investigators integrated the significance of education in the research undertaken by Stone et al. (2010). This was through incorporating a nurse specialist to constantly observe, instruct, and amend medications as desired after getting the regular conveyed ideals of blood glucose levels, BP, and weight of the TM group. The research demonstrates that surplus, continuing education and the infrequent programmed office visit is significant in the management of chronic diseases. Subsequent investigations on tele monitoring recommended on targeting several patient populations to test the effectiveness of the TM technology.

Healthcare practitioners have recognized the significance of TM as an immediate intermediation to CHF remedial management. Indeed, several studies carried out previously show that TM enhances patient self-management hence resulting in ultimate lifestyle changes (Gellis et al., 2012). Many people need a recurrence to institute a comprehension of the significance of disease management education (Taylor-Clarke et al., 2012). Therefore, TM is important in enhancing the delivery of profitable education by nurses, as substitutes of physicians, in the home setup instead of healthcare facility or clinical setting.

Research Question

Can Telehealth monitoring prevent re-hospitalization of CHF patients?

Methodology

Research Design

To assess the effectiveness of telehealth to reduce the rate of re-hospitalizations and duration of stay in healthcare facilities among the CHF patients, a quantitative group design will be applied. This study will use the quasi-experimental research design as a result of lack of randomization. The research setting is home health patients who are offered to sign consent to have a telemedicine machine at home to monitor BP, Pulse and weight in comparison with patients who do not accept telehealth the rate of hospitalization, to prove how telehealth (or telemedicine) prevent or decrease re-hospitalization of CHF patients.   The research will be done with patients admitted to home health over a 6th month period from January to July. All patient will sign a consent to be part of the project.

Participants

Home health patients were recruited from two regions and the Kingsway Home Care Agency. This agency was selected as a result of the big majority CHF patients it controlled under its care. Because the application of telehealth was in a testing stage, this was significant in undertaking standard matching of the main variables. A total of 90 out of all the homecare patients qualified for the study. The primary researcher communicated with the interested participants in the group who met the inclusion measures to get the informed consent. The research procedure was revised and the participants were educated on the possible benefits of everyday monitoring and education by a telehealth nurse to manage CHF ailment. Also, ethical values were incorporated in the research design and were appraised with the cognizant consent with the participants. A pledge of discretion was upheld to guard each participant’s right to privacy. Furthermore, as a way of enhancing confidentiality, personal identification number will be assigned to patients.

Data Collection

Data was collected from two groups of participants. The first group involved the patients from the home care agency, which received the TM intervention. The other group of participants received the usual care treatment involving of weekly face-to-face visits to healthcare facilities in the management of the disease process. All the groups had access to a nurse allotted to the case for concerns or questions. All the patients were based at home.

Data Analysis

A tool created on a data construct tool advanced by the Health Care Excel program and incorporated by Hodgen et al. (2002) will be applied to gather patients’ demographics, hospital charges, patient education, satisfaction rates and readmission rates. Patient gratification with case management services will be evaluated with questions from the Picker/Commonwealth Hospitalization Satisfaction Survey. Chi-square will be used to evaluate any statistical variances between the two patient’s groups. The mean LOS in healthcare facilities will be ascertained in addition to the financial implication, which will be further categorized into mean number of readmissions, patient education, and total hospital charges. Moreover, health care expenditures will be calculated from acknowledged hospital costs based on diagnostic-related groups and altered for other-related healthcare costs. Patient gratification will be assessed from returned surveys. T-test examination will be used to determine patient satisfaction with the care management by TM.

Significance of the Study

Chronic heart failure is an advancing condition that necessitates frequent hospitalizations and results in lessened quality of life (AHA, 2012). Generally, the transition care from the hospital to home is a traumatic experience to both patient and family caregivers (Pressler et al., 2009). Furthermore, the intense tasks of observing signs and symptoms of heart failure, recognizing an alteration in condition, and following up with proper day-to-day care can increase the physical, emotional, and economic stressors and undesired consequences (Chiang, Chen, Dai, & Ho, 2012). This research is aimed at promoting self-confidence to undertaking a specific behavior through offering continuous education and feedback, through TM on the affected parties of CHF disease status. Gaining knowledge and self-effectiveness on the management of CHF through TM is significant in enhancing self-care actions, for instance, better adherence to medical routine, nutritional commendations, observing of signs and symptoms. These significant behavioral modifications learned through TM technology results in better-quality patient outcomes and declined incidence of re-hospitalizations and shorter LOS.

Limitations and Recommendations

Several limitations impacting on the generalization of the outcomes are expected in this investigation. These include the size of the sample and the restricted geographic area from which the sample will be drawn. Research population is largely the elderly in the home care agency, efforts will be made to get a huge representation. Despite the fact that some this study has involved the CHF patient population in tele monitoring studies, more studies there is need for a more patient population for further examination. Moreover, the CHF population is exclusively considered to have intricate medication routines with poor observance management.

The main objective of telemedicine is to progress the delivery of health services to all areas. Nevertheless, challenges of enrollment have aggravated the studies that pay attention to rural residents. It is apparent that chronic conditions constrain travel and movement for the patients, irrespective of residency place. Consequently, the extension of research demographics to take account of both urban and rural contributors could be better to expedite better enrollment. Future studies can also be reinforced with the inclusion of a polyglot form of the software. This will stop any partialities from confining the research population. This approach will also offer an opportunity to inspect variances and comparisons between rural and urban populaces in the health benefits attained through the application of telemedicine equipment.

Conclusion

This presentation involves a description and methodology of the proposed training. The purpose of this study will be to assess the effectiveness of telehealth monitoring to prevent re-hospitalization of congestive heart failure patients. This study will comprise a target sample of 90 patients meeting the indicated criteria. Data collection will be undertaken using a single tool from the Health Care Excel program. Chi-square and t-test will be applied in the data analysis. Additional data or information from this investigation will support the use of tele-health monitoring equipment to decrease health care cost and hospital readmissions in CHF patients. The findings will offer valued information on how the telehealth machine impacts the health care outcomes for heart failure patients with regards to hospital readmissions.

References

Abraham, W., Fonarow, G., Albert, N., Stough, W., Gheorghiade, M., Greenberg, B., & Young, J. (2008). Predictors of in-hospital mortality in patients hospitalized for heart failure: Insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). Journal of the American College of Cardiology (JACC), 52(5), 347-356.

American Association of Nurse Practitioners. (2010). Nurse practitioner research agenda round table. Retrieved http://www.aanp.org/research/np-research-agenda

American Heart Association. (2010). Warning signs of heart failure. Retrieved from http://www.heart.org

American Medical Informatics Association. (2012). Mission and history. Retrieved from http://www.amia.org/about-amia/mission-and-history

Annema, C., Luttik, M. L., & Jaarsma, T. (2009). Do patients with heart failure need a case manager? Journal of Cardiovascular Nursing, 24(2), 127-131.

Artinian, N., Flack, J., Nordstrom, C., Hockman, E., Washington, O., Jen, K., & Fathy, M. (2007). Effects of nurse-managed telemonitoring on blood pressure at 12-month follow-up among urban African Americans. Nursing Research, 56(5), 312-322.

Centers for Disease Control and Prevention (CDC). (2011). Vital signs: prevalence, treatment, and control of hypertension. United States, 1999-2002 and 2005-2008. MMWR, 60(4), 103-8.

Centers for Medicare and Medicaid Services (CMS). (2011). Medicare Hospital Quality Chart book. Retrieved from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Downloads/HospitalChartBook2011.pdf

Cho, Y. I., Lee, S. Y., & Arozullah, A. M. (2008). Effects of health literacy on health status and health service utilization amongst the elderly. Social Science Medicine, 66(1), 1809-1816.

Dehours, E., Vallé, B., Bounes, V., Girardi, C., Tabarly, J., Concina, F., Pujos, M., & Ducassé, J. (2012). User satisfaction with maritime telemedicine. Journal of Telemedicine & Telecare, 18(4), 189-192.

Dewsburys, G. (2012). Telehealth: the hospital in your home. British Journal of Healthcare Assistants, 6(7), 338-340.

Gellis, Z. D., Kenaley, B., McGinty, J., Bardelli, E., Davitt, J., & Ten Have, T. (2012). Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory railure: A Randomized controlled trial. Gerontologist, 52(4), 541-552.

Institute of Medicine. (2012). The role of telehealth in an evolving health care environment. Retrieved from http://www.iom.edu/Activities/HealthServices/Telehealth/2012-AUG-08/webcast.aspx

Marineau, M. (2007). Telehealth advance practice nursing: The lived experiences of individuals with acute infections transitioning in the home. Nursing Forum, 42(4), 196-208.

McGhee, G., & Murphy, E. (2010). Research on reducing hospitalizations in patients with chronic heart failure. Home Healthcare Nurse28(6), 335-340.

Smith, D. H., Johnson, E. S., Thorp, M. L., Crispell, K. A., Yang, X., & Petrik, A. F. (2010). Integrating clinical trial findings into practice through risk stratification: The case of heart failure management. Population Health Management, 13(3), 123-129.

Stone, R.A., Rao, R.H., Sevick, M.A, Cheng, C., Hough, L.J., Macpherson, D.S, Franko, C.M., Anglin, R.A., Obrosky, D. S., & Derubertis, F. (2010). Active care management supported by home telemonitoring in veterans with type 2 diabetes: The DiaTel randomized controlled trial. Diabetes Care, 33(3), 478-484.

Wilson, J. F. (2003). The crucial link between literacy and health. Annual Internal Medicine, 139(1), 875-878.

Appendices

Appendix 1

 Consent Form

I understand I am being requested to take part in a research undertaken by ………. graduate student. The research undertaken will assess if the use of a medical technology reoffered to as telehealth will assist in decreasing the frequency of a patient with a heart failure problem gets to visit a healthcare facility. The research will also determine if this technology can decrease the number of days the patient spends in healthcare facility.

I acknowledge that I was selected as a probable participant for this research because the homecare organization I am using for healthcare services is testing the new technology to see if the equipment is useful to those who have CHF.

If I approve to take part in the research, I understand that I will record my health status using the telehealth device for a period of six months. Besides, I understand that I will also respond to simple yes/no questions on the device regrading my heart failure condition each day. The process will take about 5-10 minutes every day. The results will be delivered to a nurse be without disclosing my identity. There are no likely dangers in this research.

            I acknowledged that all the information gathered will be confidential and may be shared in nursing periodicals to assist other providers to coming up with better healthcare management practices. If this occurs, no specific information will be made public.

I acknowledged that this is a voluntary participation process and there are no consequences if I opt to pull out at any time during the study process and I will continue to receive my treatment and appreciated in the same way.

In case of any need, I can get in touch with Dr. Chris Danvol, Ph.D. at ……. University, School of Nursing, through (937) 775-3848 or via email at ………………………….

This research has been clarified to me and all my queries answered. I have read and understood all the information on this consent form. I agree to take part in this investigation.

_______________________________________      ____                            _________________

Signature of Participant                                                                                 Date

_______________________________________      ____                                       

Signature of Witness                                                                                      Date

_______________________________________      ____                           

Signature of Investigator                                                                                Date

Appendix 2

Research Questions

  1. Are you above 40 years of age?
  2. Do you attend regular clinical or hospital visit to see a physician for your condition?
  3. Is there a difference in the delivery of patient education between patients with heart failure who receive telehealth machine care and those patients who do not receive such services?
  4. Is there a difference in number of readmissions and cost of care between patients with heart failure who receive telehealth machine care management and those patients who do not receive such services?
  5. How do patients with heart failure rate their satisfaction with telehealth machine care services?