Home and Community Care Digest

Home and Community Care Digest June 2005 : 0-0

Home-telehealth initially costs more, but may save more in the long-run

Abstract

Home-telehealth can decrease costs by preventing unnecessary clinic visits, hospitalizations and trips to the emergency room. This study followed frail elderly veterans with coronary heart failure, chronic obstructed pulmonary disease, and/or diabetes mellitus using home-telehealth versus the usual care plus nurse case management for six months. Even though there were added costs to implement the hometelehealth system, the subsequent decrease in unnecessary nursing home visits, urgent care visits, emergency room visits, and hospitalizations more than justified the costs when compared with usual care plus nurse case management in veteran male patients.
Background: Some of the potential benefits of home-telehealth include improved health outcomes for the complex-ill elderly, enhanced integration and coordination of services, opportunities for long-term patient education and decreased cost of healthcare. The decreased costs are expected from preventing unnecessary clinic visits, hospitalizations and trips to the emergency room. This study examines the effect of using home-telehealth on a population of high-resource-use patients in the Veterans Affairs Connecticut Healthcare System (VACT). The project was conducted in real-world settings involving a corporate partner, home-telehealth units in homes and integration with the VACT information system.

Methods: Patients of VACT were randomly assigned to usual care plus nurse case management or home telehealth plus nurse case management. Male Veterans with coronary heart failure, coronary obstructed pulmonary disease, and/or diabetes mellitus were followed for six months. Cost data were collected for six months prior to and for six months while participating in the study.

Findings: A total of 104 patients participated in the study. At six months, bed-days-of-care decreased in the home-telehealth and usual care plus nurse management group. Overall, both groups had a decrease in the total number of visits (urgent + scheduled). The number of urgent visits decreased in the home-telehealth group, but increased in the usual care plus nurse case management group. The hometelehealth group showed improved cognitive status at twelve months. In contrast, the control group showed improved patient satisfaction with care, with no improvements in the quality of life outcomes at twelve months.

Data from 2002 were used to compare before and after costs. The home-telehealth group had an additional 11% savings compared with the group of male veterans who received usual care plus nurse case management. The cost per patient for usual care plus nurse case management decreased 47% during the study ($12,386 vs. $5832) compared with a 58% decrease in the home-telehealth group. The cost of system implementation ($1666 per patient) was factored into this cost saving analysis.

Conclusions: Combining home-telehealth, nurse case management and patient-centered care has the potential to control health care costs effectively and optimize wellness, especially for an increasing elderly population with complex, chronic co-morbidities. The results of the study demonstrated that connecting homebound patient data with the health care facility's information system provides mechanisms for early intervention, increased reinforcement strategies, increased patient compliance, and decreased unnecessary resource use in veteran men. Even though there were added costs to implement the home-telehealth system, the subsequent decrease in unnecessary nursing home visits, urgent care visits, emergency room visits, and hospitalizations more than justified the costs when compared with usual care plus nurse case management in veteran male patients. While this study is relatively small and limited to male veterans, the results suggest that home-telehealth may be more economical as the number of enrolee's increases to offset the costs to implement the system. Existing health care professionals may be able to treat a greater number of patients because of the technology.

Reference: Noel HC, Vogel DC, Erdos JJ. Cornwall D, Levin F. "Home telehealth reduces healthcare costs". Telemedicine Journal and e-Health. 2004; 10(2), 170-183.

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