Impact of Telehealth on Healthcare Utilization by Congestive Heart Failure Patients
Craig A. Lehmann
Jean Marie Giacini
Background: Advances in telehealth are proving to be extremely conducive to effective management of congestive heart failure (CHF) and other disease states, particularly in ambulatory settings. In order to assess the impact of telehealth on healthcare utilization in CHF patients, telehealth technology was introduced into a demonstration project established by the Secretary of Health and Human Services. Demonstration projects examine health delivery factors that encourage the delivery of improved quality of care and have already implemented protocols to evaluate methods to improve quality of care and reduce expenditures provided to Medicare beneficiaries with chronic conditions (including methods to permit Medicare beneficiaries to direct their own healthcare needs and services). This study, funded in June of 2002 by the Centers for Medicare and Medicare Services, focused on The Jewish Home & Hospital Services, Lifecare Plus (New York, NY, USA), one of the US's federally funded national demonstration projects. The study measured the impact of managing CHF patients via telehealth technology on overall healthcare utilization, physician office visits, emergency department (ED) visits, and hospital readmissions. Methods: To be eligible for the Jewish Home & Hospital Services Lifecare Plus demonstration project, patients had to be aged >=65 years, have both Medicare parts A & B, have had at least three doctor visits or one hospitalization in the previous 12 months, reside at a Manhattan or Bronx address in New York, and have one of the following diagnoses: heart disease, diabetes, liver disease, lung disease, vascular disease, cerebrovascular disease, psychotic major depression or anxiety, cancer, Alzheimer disease, or dementia. This particular study included 20 homebound CHF patients, of whom 10 were in the telehealth study group and 10 were in the control group. Results: The findings demonstrated that patients managing their CHF via telehealth technology decreased their overall utilization of healthcare resources by 41% (p_=_0.00183). Physician office visits decreased by 43% (p_=_0.00253), ED visits by 33% (p_=_0.3770), and hospitalizations by 29% (p_=_0.3872). Conclusions: The significant reduction in overall healthcare utilization and physician office visits demonstrate that this technology could offer significant cost savings for long-term disease management and could offer clinicians a new form of service delivery that may improve the quality of care. Hopefully, the outcomes of this study will serve as a catalyst for future larger studies, thus reducing the obvious limitations associated with small studies such as this one.
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