Can Telehealth Improve Chronic Disease Outcomes in the Community?

Kavita Radhakrishnan, RN, PhD, and assistant professor at the University of Texas at Austin School of Nursing

Kavita Radhakrishnan, RN, PhD

Knowing someone with a chronic disease is the new norm. Chronic diseases afflict 45 percent of Americans and cause seven in 10 deaths each year in the United States. Heart failure, stroke and pulmonary conditions are some of the most expensive chronic diseases to manage.

Remote monitoring technologies, such as telehealth, have emerged as potential solutions for managing chronic diseases in the community and helping to reduce re-hospitalization and health-care utilization costs. Can telehealth meet the challenges of managing chronic diseases effectively?

What is telehealth?

Telehealth has been broadly defined as the “delivery of health-related services and information via telecommunications technologies.” In home health settings, the technology typically consists of an electronic communication device in patients’ homes that transmits physiological data, such as blood pressure or weight, as well as data entered by patients on their daily symptoms. The transmission of physiological and daily symptom data allows home health agencies (HHAs) to monitor patient conditions at a distance.

Why did telehealth gain popularity among HHAs to manage chronic diseases?

1.   Financial Benefits

Reduction in home health utilization

Home health patients with chronic diseases could be monitored on a daily basis through telehealth. Delivery of high-quality care without a corresponding increase in nursing visits is one financial benefit of HHAs. For example, a patient with heart failure who receives three home nursing visits a week could have visits reduced to once in two weeks with telehealth. Travel time for home health nurses could drastically be reduced as nurses could remotely care for patients and visit them only during emergencies. Telehealth could allow easy, prompt and frequent interaction with patients that could improve their level of satisfaction with the care delivered by HHAs without a corresponding increase in nursing cost.

Reduction in hospitalization

Daily telehealth monitoring could allow early identification of health crises in patients. Interventions and/or changes in their care plan could be implemented early on to prevent a worsening health crisis resulting in re-hospitalizations.

2.   Promotion of Patient Self-care

Telehealth data can potentially provide home health nurses with contextually relevant information to promote self-care in their patients. For example, if the telehealth blood pressure of a patient with hypertension is higher than normal, the nurse can use this context to provide teaching and information on a low-salt diet. The nurse can provide effective patient teaching and engage patients with self-care behaviors by connecting the telehealth data point with a behavior. Also, by using telehealth daily, patients can develop the habit of self-monitoring their daily weight, which is an essential self-care practice required of patients with diseases like heart failure.

3.   Sense of Security

Daily telehealth home monitoring, especially for elderly patients living alone, could provide their family members and health-care providers with a sense of security. Patients could also feel more secure when assured that a home health provider is watching over their health and will know what to do if a health crisis strikes.

Daily tele-monitoring could be convenient especially for frail, homebound patients who would not have to leave home to have their vital signs checked.

—Kavita Radhakrishnan, RN, PhD, MSEE, assistant professor

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Next month on Longhorn Nursing blog
Part 2: How Telehealth Can Fail to Fulfill the Promise of Managing Chronic Diseases Effectively

3 thoughts on “Can Telehealth Improve Chronic Disease Outcomes in the Community?

  1. Hi Dr. Radhakrishnan,
    I enjoyed reading your posting. I am aware of the potential for reducing home health utilization with telehealth, primarily from speaking with HHAs that have implemented programs. Are you aware of any studies that have demonstrated a reduction in home health utilization?
    Thank you,
    Johanna

  2. The VA has generally shown lower utilization costs for patients on telehealth (Stone, 2011, Jia 2011, Chumbler 2005). Some other home health studies which tended to have lower utilization in the telehealth group include Golbeck 2011, Chen 2011, Pekmezaris 2011, Bowles 2011. But numerous other studies did not find any difference in the utilization rates in the telehealth group. Exactly what contributes to lowering utilization rates or costs in a telehealth group is still unclear.
    What 1 study found in HHA is that higher the disease severity, higher could be the utilization costs with telehealth, lower the disease severity lower are the utilization costs. Pekmezaris, et al. (2011) had an interesting finding that utilization costs were lower in NYHA class 1 or 2 but higher in 3 and 4.

    Here are the refs:
    1. Jia H, Feng H, Wang X, Wu SS, Chumbler N. A longitudinal study of health service utilization for diabetes patients in a care coordination home-telehealth programme. Journal of Telemedicine & Telecare. 2011;17(3):123-126.
    2. Stone RA, Rao RH, Sevick MA, et al. Active care management supported by home telemonitoring in veterans with type 2 diabetes: the DiaTel randomized controlled trial. Diabetes Care. 2010;33(3):478-484.
    3. Chumbler NR, Neugaard B, Ryan P, Qin H, Joo Y. An observational study of veterans with diabetes receiving weekly or daily home telehealth monitoring. Journal of telemedicine and telecare. 2005;11(3):150-156.
    4. Bowles KH, Hanlon AL, Glick HA, et al. Clinical Effectiveness, Access to, and Satisfaction with Care Using a Telehomecare Substitution Intervention: A Randomized Controlled Trial. International Journal of Telemedicine and Applications. 2011;2011(Article ID 540138).
    5. Pekmezaris R, Mitzner I, Pecinka KR, et al. The impact of remote patient monitoring (telehealth) upon Medicare beneficiaries. Telemed J E Health. Mar 2012;18(2):101-108.
    6. Golbeck AL, Hansen D, Lee K, Noblitt V, Christner J, Pinsonneault J. Telemonitoring improves home health utilization outcomes in rural settings. J Telemed Telecare. 2011;17(5):273-278.
    7. Chen, HF, Kalish, MC, Pagan, JA.. Telehealth and Hospitalizations for Medicare Home Healthcare Patients. The American Journal of Managed Care. 2010 July; 17. (6): e224-e230

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