RESUMO
Background: Home telemonitoring (HTM) is a promising approach to improve quality of life (QoL) and decrease hospital utilization. Methods: This randomized-controlled study followed 89 community-dwelling Medicare outpatients with heart failure (HF) after discharge from home care for 6 months. Patients were randomized to HTM or comprehensive outpatient management (COM). HTM received weekly (video) televisits with daily vital sign monitoring. COM was contacted weekly by telephone. Outcomes included emergency department (ED) and inpatient utilization and QoL. Results : Average age at enrollment was 81.4 for HTM and 84.9 for COM. Thirty-eight percent of HTM had ≥1 ED visit versus 60% of COM (p = 0.04), while 48% of HTM had ≥1 hospitalization versus 55% of COM (p = 0.47). Length of stay (LOS) (days) was 4.0 for HTM versus 7.4 for COM (p = 0.39). Costs were $38,990 for HTM versus $50,943 for COM (p = 0.91). QoL improved by -9.66 for HTM and -3.56 for COM (p = 0.02). Although HF-related utilization did not differ between groups, HTM patients who were highly adherent obtained better all-cause outcomes than those with low adherence. Conclusions: Significantly improved all-cause ED utilization, LOS, and QoL were found for HTM; other differences were not significant. More research is needed to determine how to best utilize this technology to improve patient outcomes.
Assuntos
Insuficiência Cardíaca/epidemiologia , Vida Independente , Monitorização Ambulatorial/métodos , Qualidade de Vida , Telemedicina/métodos , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização , Humanos , Masculino , Prontuários Médicos , Medicare , Monitorização Ambulatorial/economia , Cooperação do Paciente , Autorrelato , Fatores Socioeconômicos , Estados Unidos/epidemiologiaRESUMO
Organizations are often overwhelmed when faced with a need to develop a comprehensive quality improvement program and use a cross-organizational team to improve outcomes. This article describes the total quality management program implemented in a long-term home health care program in New York State. It describes common issues, such as incidents, multidisciplinary clinical record documentation audits, and staff competency. As a result of this comprehensive performance improvement process, this organization has not only changed the manner in which it operates but also improved its performance.
