Effectiveness of a Nurse‐Led Tele‐Homecare Program for Patients With Multiple Chronic Illnesses and a High Risk for Readmission: A Randomized Controlled Trial

Abstract

Purpose Multiple chronic illnesses, such as those associated with advanced age, are leading causes of poor health, disability, death, and high healthcare expenditures. Tele‐homecare is a novel method for providing home care to patients with chronic illnesses. The purpose of this study was to evaluate the effectiveness of an integrated nurse‐led tele‐homecare program for patients with multiple chronic illnesses and a high risk for readmission. Design A randomized controlled trial. Methods Two hundred patients from a regional hospital who were scheduled to receive home care after discharge were randomly assigned to the intervention group (n = 100) or the control group (n = 100). The patients in the intervention group participated in an integrated tele‐homecare program. For outcome evaluation, primary outcomes included the number of emergency department (ED) visits as well as readmittance and mortality. Secondary outcomes included patients’ medication adherence, activities of daily living, health status, and quality of life (QOL). Data were collected at three time points: pretest baseline (T0), 3 months after intervention (T3), and 6 months after intervention (T6). A generalized estimating equation model was used to compare changes and evaluate the effect of differences between the two groups over time. Findings For primary outcome evaluation, we found that the tele‐homecare program significantly reduced mortality and ED visits, whereas no significant effect on readmission was observed. For secondary outcome evaluation, patients’ QOL indicated significant improvement. Conclusions and Clinical Relevance The nurse‐led tele‐homecare program involves daily 24‐hr remote monitoring and surveillance. In this study, the system detected patients’ physical changes early and provided timely and appropriate management, consequently reducing ED visits and mortality. Additionally, it improved patients’ QOL. On the basis of our findings, nurses’ independent roles and functions revealed that the effectiveness of this nurse‐led tele‐homecare program strengthened the care of patients with multiple chronic illnesses.

Inclusion of Older Adults in Digital Health Technologies to Support Hospital-to-Home Transitions: Secondary Analysis of a Rapid Review and Equity-Informed Recommendations

“…A total of 9% (n=3) of studies used a mixed methods methodology [ 3 , 87 , 96 ], whereas the remaining studies (28/34, 82%) used a quantitative methodological approach. Of the 28 quantitative studies, 8 (n=8, 28%) used a randomized controlled trial design [ 89 , 90 , 97 , 101 , 106 , 107 , 109 , 110 ]. Other quantitative studies have used observational or nonrandomized trial designs.…”

“…Electronic health records and databases [ 79 , 81 , 95 , 97 , 98 , 102 , 104 ] have been widely used for digital innovation. The use of wearable body sensors or devices [ 80 , 99 , 107 ], web-based chatting platforms [ 82 ], and automated emails [ 109 ] were less common.…”

“…A total of 2 interventions aimed to improve communication processes among health care providers regarding discharge processes and care plans [ 93 , 109 ]. Many interventions aimed at monitoring bodily function and health status (including mental health) [ 80 , 84 , 85 , 88 , 90 , 94 , 99 , 101 - 103 , 107 , 110 ], often to alert members of the older adult’s care team of the need to schedule follow-up appointments or calls to help prevent adverse effects [ 97 , 98 ]. One study used digital technology to support home-delivered meals [ 87 ].…”

“…There was heterogeneity in the mean age of the participants included in the studies. The mean of age included older adult participants ranged from 65 to 69 years [ 83 , 99 , 105 , 111 ], 70 to 74 years [ 3 , 80 , 84 , 85 , 89 , 94 , 101 , 106 , 108 ], and 75 to 79 years [ 82 , 87 , 92 , 97 , 101 ] to 80 to 84 [ 86 , 88 , 90 - 93 , 96 , 104 , 107 , 109 , 110 ]. Only 2 studies had a mean age of ≥85 years [ 79 , 109 ].…”

The impact of the SARS‐CoV‐2 pandemic on the management of chronic limb‐threatening ischemia and wound care

“…A French, Level 2 RCT described in the Telemedicine section confirmed that remote monitoring for wound care via home healthcare had the same good outcomes as in‐person clinic care 79 . In a Level 2 RCT that was carried out in Taiwan before the pandemic, Liang et al demonstrated that nurse‐led remote home care provided to 100 patients with chronic illnesses was more effective than traditional homecare provided to 100 patients, with significantly reduced mortality (8% vs. 19%, p = 0.027) and emergency department visits (12% vs. 26%, p = 0.013) at 6 weeks 91 . Remote home care involved 24/7 remote monitoring and surveillance using a one‐touch smartphone, blood pressure monitor, glucometer (for diabetes), medication dispenser, and a necklace emergency call button.…”