Aspects of heart-failure day-to-day health monitoring include adherence to medication, diet, and physical activity recommendations, and identifying changes in dyspnea, fatigue, or lower-limb edema. Participation in a telehealth program can guide day-to-day health monitoring toward healthy behaviors and symptom recognition. The purpose of this study was to characterize telehealth data, nurse responses to telehealth alerts, and healthcare utilization by participants. A retrospective review was conducted of the initial 90 days of 187 older veterans with heart failure participating in one Care Coordination Home Telehealth program from September 2007–September 2013. Data were collected from telehealth records and electronic medical records. Descriptive statistics were used to identify differences in call compliance, telehealth alerts, and nurse responses to alerts. Rates of heart-failure-related healthcare utilization were analyzed using logistic regression. Participants were predominantly male and non-Hispanic White, with the comorbidity of hypertension and an average age of 73.9 years. Telehealth call compliance was 75.8%. There was a sharp decline in daily compliance the 1st week of program participation, with a significant nonlinear effect. The mean proportion of submissions measuring within alert range was 23.3% (SD = 24.6) for weight and 1.3% (SD = 3.3) for dyspnea. The mean proportion of timely nurse response to alert range data was 15.1% (SD = 17.7) for weight and 48.5% (SD = 43.0) for dyspnea. Among the sample, 17.6% required an emergency department visit and 18.2% required inpatient hospital care. Hospital length of stay was likely to increase among participants with chronic renal disease (incidence rate ratio [IRR] = 1.78, p < 0.001), advancing age (IRR = 1.01, p < 0.001), presence of telehealth alerts (IRR = 1.006, p < 0.035), and presence of nurse responses to alerts (IRR = 1.013, p < 0.001). The initial rapid drop in daily compliance by older adults highlights the need for equipment training and follow-up support throughout the 1st week of participation. Telehealth alerts and nurse responses to alerts were statistically significant predictors for heart-failure-related hospital length of stay. Future healthcare utilization risk models and clinical trials of telehealth systems should include measures related to telehealth alert-range data and nursing responses to changes in patient status identified by telehealth alerts.
|Commitee:||Beck, Susan, Linder, Lauri, Supiano, Mark, Wong, Bob|
|School:||The University of Utah|
|School Location:||United States -- Utah|
|Source:||DAI-A 77/09(E), Dissertation Abstracts International|
|Keywords:||Heart failure, Hospitalization, Telehealth, Veterans|
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