Centura Health at Home Integrated Telehealth Program

 Technology 

Agency:
Centura Health at Home, Denver, Colorado.
 
Agency Description:
Centura Health at Home (CHAH), headquartered in Denver, Colorado, is the home care unit of Centura Health. CHAH provides home care, home hospice, residential hospice, palliative care, telehealth, independent living, assisted living, nursing home care, Alzheimer care, respite care, adult day care, pastoral counseling, and bereavement services to patients and residents in Denver, Colorado Springs, Pueblo, Canon City, Durango, Pagosa Springs and Summit County.

Founded in 1997, CHAH provides care to more than 20,000 patients each year and more than $500,000 of care is uncompensated or charity care. CHAH has more than 1,300 employees and is the first home health agency in Colorado to have implemented a telehealth system.
Centura Health is a non-profit, faith-based integrated health care system consisting of 13 hospitals, four freestanding emergency departments, seven senior living communities, and home health and hospice.
 
Population Impacted:
For this program CHAH selected 200 patients fitting the following criteria:
  • Having a chronic disease (congestive heart failure, chronic obstructive pulmonary disorder, hypertension, or diabetes).
  • At risk for falls.
  • Aged 80 or older.
  • Two or more hospitalizations in the past six months and/or two or more emergency room visits in the past six months.
  • Being on five or more medications.
  • A history of non-adherence to medications.
  • Patients were enrolled at two hospitals. The average age of participants was 76, living in his or her home, managing co-morbid conditions, and recently had a hospital visit relation to an exacerbated chronic condition. 
 
Strategic Partners:
The Centura Health system was a strategic partner in this program.
 
Project Description:
CHAC has seen success with its telehealth program and through that traditional programming, it has reduced the hospitalization rate of patients in the project to 6 percent. Building upon this, CHAH created a one-year long program to further reduce hospitalization rates and increase quality of life scores for older adults.

Participants were split into two groups. The first used remote patient monitoring (RPM) and had access to a 24-hour call center. This group was given a base station display that collects information as well as additional devices such as blood pressure cuff, pulse oximeter, thermometer, and scale. Patients are given their equipment within 48 hours of discharge. Once in place, telemedicine nurses monitor the patient data and call the patient with any significant changes. The patient is also encouraged to contact the call center with questions.

The second group had a clinical call center nurse set up weekly calls over a three week time frame to review the following:
  • Medication lists and management.
  • Compare medications to discharge orders.
  • Educate patients using the teach-back method to ensure their comprehension.

This program prepares patients for eventual discharge by teaching them how to independently monitor health indicators and how to identify red flags for follow up with a clinician.

This year-long project was funded by the Center for Technology and Aging as one of the five grant projects in the Remote Patient Monitoring Diffusion Grants program. The Center for Technology and Aging was established through the generous support of The SCAN Foundation to promote the independence and well-being of older adults through the broader diffusion of beneficial technologies. The center receives funding from multiple sources, including federal and state grants and contracts, corporate donations and grants, and private philanthropy.
 
Results:
The specific goals of the program were to enroll at least 200 patients and decrease the 30-day admission rates for the following conditions: congestive heart failure, chronic obstructive pulmonary disorder, and diabetes by two percent. In addition, they sought to increase quality of life for their patients.
Twenty-five of the patients used telephone telehealth. The majority of the remainder used RPM.
 
Outcome Measures:
Results showed that rehospitalizations for patients with congestive heart failure, COPD, and diabetes decreased by 62 percent for a rehospitalization rate of 6.3 percent. This number is significantly lower than the rehospitalization rate for traditional home care at 18 percent. CHAH’s average rehospitalization rate before the program was 19 percent.

Emergency department visits for patients in the program dropped from 283 to just 21 in the year the study was conducted. Quality of life for patients increased as did self-management and patient satisfaction. Patient data indicated positive perceptions about technology and satisfaction with technology. The frequency of nurse visits decreased, creating a cost savings of between $1,000 and  $1,500 per patient.
 
Barriers to Implementation:
This program found that redesigned training for clinicians and staff was necessary to the program’s success. An initial barrier to implementation was training nurses on information technology. Nurses were familiar with telephonic technology but needed training and education on information technology. CHAH learned that staff engagement and buy-in was critical to the success of the program, as well as effective communication training for nurses. An additional barrier was in selecting the technology itself. CHAH changed vendors to a more cost-effective solution that was only able to monitor patients whose vitals fall outside pre-determined parameters, ensuring immediate attention was given to the proper patients.