Home monitor reduces CHF readmissions
A two-month telephonic home cardiac monitoring program conducted at the University of Illinois at Chicago dramatically reduced readmission rates for congestive heart failure (CHF) patients for just dollars a day.
For a cost of about $408.44 or $6.28 a day per hospital discharge, the program cut CHF readmissions for 35 patients from 60 admissions at a cost of $607.201 in the 12 months prior to the monitoring program to 13 admissions at a cost of $132,770 in the six months after completing the program, says Mary Bondmass, MSN, RN, PhDC, nurse coordinator of home monitoring services at the University of Illinois Medical Center in Chicago. "Local home health agencies charge about $2,000 per hospital discharge for each incidence of CHF, so we consider the program very cost-effective," she adds.
All patients in the program were CHF patients with New York Heart Association (NYHA) functional class III or IV. (For more information about NYHA classifications, see Case Management Advisor, December 1995, p. 171.) The medical center recently completed a National Institutes of Health Phase I trial of the home monitor developed by Boaz Avitall, MD, in conjunction with Advanced Medical Devices in Milwaukee, WI. The Phase I trial combined home cardiac monitoring with telephonic case management, as needed. The medical center is now beginning a Phase II study of the home monitoring program.
Patients transmit weight, heart rate, blood pressure, and oxygen saturation three times daily via modem to a telephone monitoring unit at the medical center, notes Bondmass. "The teleunit has 24-hour coverage. Each patient has clinical parameters preset by his or her physician. If any of the patient’s measures fall outside the preset parameters, it sets off an alarm that must be manually cleared by the teleunit technician," says Bondmass.
"The technician calls the patient immediately and asks whether the patient needs to go to the emergency room [ER]. If the patient seems comfortable, rather than sending an ambulance to take the patient immediately to the ER, I’m contacted and call the patient back within 10 minutes to evaluate the problem," she explains.
Patients in the home monitoring program receive telephonic case management as needed on such issues as fluid restriction, dietary guidelines, and medication compliance. To make telephonic case management easier, physicians provide standing orders for each patient on when to increase diuretic dosages, for example, adds Bondmass.
Patients need reteaching
Bondmass contacts patients in the program at least once a week to go over elements of CHF management. "We find that patients only retain about one-eighth of what you tell them during each contact. It takes two months of constant reinforcement to teach patients everything they need to know about diet, exercise, and medication compliance to manage their CHF," notes Bondmass. In addition, each patient in the home monitoring program receives a booklet on CHF management.
"In the first week after discharge, patients are still getting used to using the machine. They may be able to remember to try to cut down on salt, and that’s about it," notes Bondmass. "We take the different CHF management issues slowly and build on them each week. We just chose two months as our monitoring period. It’s a number that seems to be working," she adds. (For further discussion of CHF patient education efforts, see story on p. 46.)
The research team also finds that quality-of-life scores improve for patients who complete the monitoring program, says Bondmass. "We’ve had significant improvement in quality-of-life scores in patients participating in the monitoring program," she says, adding that the assessment tool is administered once a month beginning one month into the monitoring program and continuing for six months after completion of the program.
[Advanced Medical Devices expects to receive U.S. Food and Drug Administration approval within the next six months to begin marketing the home cardiac monitor for pilot trials. For more information, contact: Joe Kletch, vice president, Advanced Medical Devices, 152 W. Wisconsin Ave., Milwaukee, WI 53203. Telephone: (414) 291-0844. Fax: (414) 291-0809.]
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