2. PICO Question
In heart failure patients does follow-up care via
telehealth monitoring versus no follow-up care help
reduce readmission rates?
3. Introduction
● Approximately 5 million patients are treated for CHF every year
in the U.S with an estimated healthcare cost of $29.6 billion.
(Lemann et al., 2006)
● “CHF remains the most common medical reason for inpatient
hospitalization in adults over age 65” (Smith, 2014).
● Majority of the expense associated with CHF is due to frequent
hospitalizations, 16–25% of patients with CHF are re-
hospitalized within 30 days of being discharged (Lehmann et
al., 2006).
● “HF is associated with significant morbidity, mortality, and cost
from readmission rate” (Lee & Park, 2010).
4. Define Telehealth
“The Health Resources Services Administration defines
telehealth as the use of electronic information and
telecommunications technologies to support long-distance
clinical health care, patient and professional health-related
education, public health and health administration.
Technologies include videoconferencing, the internet,
store-and-forward imaging, streaming media, and
terrestrial and wireless communications” (HealthIT,
2014).
5. Significance
-“Comprehensive discharge planning plus post-discharge support may
reduce readmission rates and improve health outcomes for patients with
HF” (Lee & Park, 2010).
-Telephone-based interventions can make monitoring chronic illnesses
easier, while also lowering travel costs. This frequent supervision can
“detect patient’s worsening symptoms at an early stage, and thus
potentially prevent hospital readmission” (Lee & Park, 2010).
- 30 day readmission rates and possible changes in health care
reimbursement are driving a renewed interest in the development of
evidence based methods to reduce “avoidable” readmissions with CHF
patients, and telemonitoring may provide the utility to accomplish this
(Smith, 2014).
6. Current Practice
● CHF patients discharged from an acute care setting
should receive a follow-up phone call within 3 days from
a healthcare team member.
● After discharge, the CHF client will have a scheduled
follow-up appointment with his/her primary care
provider within 7-14 days
● (Yancy et al., 2013)
7. Summary of Evidence
● Telehealth significantly reduces the unitization of healthcare
and ultimately lowers the total cost of healthcare associated
with the CHF population (Lehmann et al., 2006).
● “...telephone-based post-discharge nursing care was a
significant intervention especially decreasing hospital
readmission rate among HF patients” (Lee and Park, 2010).
● It was argued that evidence supported the use of telehealth
technologies to decrease the rates of hospital readmission and
emergency department visits in patients with heart failure in
rural areas and can lead to reduced cost (Graves, et al., 2013).
8. Advantages
● Allows patients to age with dignity and remain in their own homes
while still having access to healthcare to manage their care and to
ensure their safety (Lehmann et al., 2006).
● Potential to enhance the quality of life and self-management for
patients (Graves et al., 2013).
● The technology can be an effective add-on tool for managing the
health of elderly patients with heart failure (Maeng et al., 2014).
● Allows provider and consumer to identify early changes in
condition and can tailor treatment accordingly (Lehman et al.,
2006).
● Telemonitoring contributes to an increased compliance with post
acute therapeutic regimens (Smith, 2013).
9. Advantages Con’t.
- Tele-health monitoring improves the continued
relationship with the client and health care team.
- Telehealth increases the client’s understanding of their
disease process.
(Radhakrishnan et al., 2016)
10. Disadvantages
● The availability of the service depends on where the patient
lives (Graves et al., 2013).
● Some health care professionals become reluctant to the system
because they have a misconception that it is being introduced to
replace clinical staff (Graves et al., 2013).
● A majority of the clients that have telehealth are not utilizing it
(Radhakrishnan et al., 2016).
● Providers suggest that telehealth is not individualized enough to
always pick up on early exacerbations (Radhakrishnan et al.,
2016).
● Nurses feel they are not trained properly to be able to manage
telehealth in a homecare setting (Radhakrishnan et al., 2016).
11. Disadvantages Con’t.
-Physicians feel this is a threat to client’s independence
and self-reliance (Radhakrishnan et al., 2016).
-There are potential variations in practices across sites that
could decrease the accuracy of information (Chaundhry,
Barton, Mattera, Spertus & Krumholz, 2007).
12. Considerations
● Need the right patient to participate in the telehealth monitoring
programs, for example patients who are blind or have dementia
would not be good candidates (Baker et al., 2013).
● Participants in telemonitoring programs must have access to
either landline or cellular communication to be able to utilize
the technology required for HF monitoring (Maeng et al., 2014).
● Participants must be well enough to step onto and balance on a
scale used for biometric data recording (Maeng et al., 2014).
13. Recommendations
● Based on this study, telephone-based post-discharge care
significantly decreased hospital readmission rates among
patients with HF (Lee & Park, 2010).
● The availability of telehealth monitoring systems was associated
with fewer hospitalizations and longer survival rates (Baker et
al., 2013).
● Current evidence suggests home telemonitoring can reduce
congestive heart failure related readmissions, however there was
no significant reduction in all-cause hospital readmissions.
Ongoing research and further clinical testing must still be
conducted (Smith, 2013).
14. References
(2014, Mar. 22 ). In What is telehealth? How is telehealth different from telemedicine?. Retrieved Mar. 22, 2016, from
https://www.healthit.gov/providers-professionals/faqs/what-telehealth-how-telehealth-different-telemedicine
Baker, L., Macaulay, D., Sorg, R., Diener, M., Johnson, S., Birnbaum, H. (2013). Effects of care management and telehealth: A
longitudinal analysis using medicare data. Journal of the American Geriatrics Society. 61(9), 1560-1567.
Chaudhry, S. I., Barton, B., Mattera, J., Spertus, J., & Krumholz, H. M. (2007). Randomized trial of telemonitoring to improve heart failure outcomes (Tele-HF):
Study Design. Journal of Cardiac Failure, 13(9), 709–714. http://doi.org/10.1016/j.cardfail.2007.06.720
Graves, B., Ford, C., Mooney, K. (2013) Telehealth technologies for heart failure in rural areas: An integrative research review.
Online Journal of Rural Nursing and Health Care, 13 (2) 56-83.
Lee, J., Park, S.. (2010,). The effectiveness of telephone-based post-discharge nursing care in decreasing readmission rate
in patients with heart failure: a systematic review. JBI Library of Systematic Reviews. 8(32), 1288-1303. Retrieved
Mar 3, 2016, from JB
Lehmann, C. A., Mintz, N., Giacini, J. M. (2006). Impact of telehealth on healthcare utilization by congestive heart failure patients.
Disease Management & Health Outcomes, 14(3) , 163-169.
15. References con’t.
Maeng, D. D., Starr, A. E., Tomcavage, J. F., Sciandra, J., Salek, D., &Griffith, D. (2014). Can telemonitoring reduce hospitalization
and cost of care? A health plan’s experience in managing patients with heart failure. Population Health Management,
17(6), 340-344 5p. doi:10.1089/pop.2013.0107
Radhakrishnan, K.a, Xie, B., Berkley, A., & Kim, M., (2016). Barriers and facilitators for sustainability of
tele-homecare programs: a systematic review. Health Services Research, 51 (1), PP 48-75.
Smith, A. C. (2013). Effect of telemonitoring on re-admission in patients with congestive heart failure. MEDSURG Nursing, 22(1),
39-44 6p.
Yancy, C. W., Jessup, M., Bozkurt, B., et al. (2013). ACCF/AHA guideline for the management of heart failure: A report of
the American college of cardiology Foundation/American Heart Association task force on practice
guidelines. Journal of the American College of Cardiology, 62(16), 147-239 93p. doi:10.1016/j.jacc.2013.05.019
