Telehealth Program

 Technology 

Agency:
VNA Care Network Foundation and Subsidiaries, Charlestown, Massachusetts.
 
Agency Description:
VNA Care Network Foundation and Subsidiaries is a nonprofit provider of home health care, palliative care, hospice care, and wellness services in eastern and central Massachusetts. The organization includes the Visiting Nurse Association of Boston, VNA Care Network, and VNA Hospice Care, which together served more than 40,000 patients in more than 200 communities in 2013. Private duty care is provided by Home Staff, a joint partnership with Fallon Health. VNA Care Network Foundation is a member of Atrius Health, a nonprofit alliance that is developing better ways to coordinate care across multiple settings and finding new and improved ways to coordinate home health services with ambulatory care.
 
Population Impacted:
The Telehealth Program has improved the quality of life for home health patients with heart failure, hypertension, and COPD living in eastern and central Massachusetts.
 
Strategic Partners:
VNA Care Network Foundation and Subsidiaries developed the Telehealth Program. Clinicians from the organization collaborate with patients’ physicians to act quickly on telehealth data that falls outside of predetermined alert levels.
 
Project Description:
VNA Care Network Foundation and Subsidiaries’ Telehealth Program combines in-person home health care visits with remote monitoring. The telehealth equipment is most often used to measure blood pressure, heart rate, oxygen saturation (SpO2), and weight on a daily basis. Results are automatically transmitted via a traditional landline or wirelessly via cellular networks. This information is automatically included in the patients’ electronic health record. Pertinent information is available in the electronic medical record for the primary care nurse. Our staff assesses the data and responds to alerts indicating vital signs are outside the desired range for a particular patient.
 
Results:
VNA Care Network Foundation and Subsidiaries’ Telehealth Program:
  • Reduces unnecessary hospitalizations and emergency room visits.
  • Provides daily data of patient’s health status and enhances the ability to identify trends.
  • Encourages self-care management and adherence to the prescribed care plan.
  • Improves patient's ability to stay independent at home.
  • Provides patients with peace of mind because their health status is being monitored every day.
 
Outcome Measures:
VNA Care Network achieved close to a zero rehospitalization rate for the first 30 days after discharge from the hospital for Atrius Health medical group patients on the Telehealth Program during 2013.

VNA of Boston’s outcome data show a significantly lower rehospitalization rate for heart failure patients on the Telehealth Program. Nationally, the 30-day rehospitalization rate was 23 percent for heart failure patients while VNA of Boston’s heart failure patients experienced a 10 percent rate for all reasons and four percent rate for heart failure. VNA of Boston's cardiac patients on telehealth reported higher levels of improvement in pain, dyspnea, bathing, ambulation, and management of oral medications compared to cardiac patients nationally, whether on telehealth or not, according to data from OCS.
 
Barriers to Implementation:
The primary barrier to implementation and success of a remote monitoring program is the lack of reimbursement from insurers for the service despite the potential to substantially reduce overall health care costs by reducing rehospitalization rates for high-risk patients.

Organizations face additional barriers to implementation of a similar program. There are hundreds of options for remote monitoring technology and insufficient data to adequately guide clinical decisions on which technologies should be adopted. While most patients and families are supportive of telehealth’s use, some resist participating in self-care activities.

Despite the possible barriers to implementation, VNA Care Network Foundation and Subsidiaries' experiences and outcomes show the positive impact the technology combined with monitoring and home health care can have on the lives of patients at higher risk for rehospitalization.