Evaluation of a virtual home health heart failure program: A mixed methods study (Preprint)

Abstract

BACKGROUND Heart failure is a prevalent and debilitating condition, affecting millions globally and imposing significant burden on patients, families, and healthcare systems. Despite advancements in medical treatments, the gap in effective, continuous, and personalized supportive care remains glaringly evident. To address this pressing issue, virtual healthcare services, delivered by interdisciplinary teams, represent a promising solution. There is a lack of comprehensive data on the benefits of interdisciplinary virtual heart failure remote monitoring support programs on patient adherence, quality of life, and overall healthcare costs in Australia. Understanding the outcomes and experience of remote monitoring enabled chronic disease management programs can inform better resource allocation and healthcare policy decisions. OBJECTIVE The purpose of this study was to evaluate the clinical and behavioural outcomes of patients undertaking a Virtual Home Health Heart Failure Program (VHHHFP) and explore the experiences of patients and health care practitioners. METHODS A mixed methods study was conducted in collaboration with patients and health practitioners. Self-reported outcome data (KCCQ12, PHQ4, PAM13 and PREMS) were obtained from the records of patients (n=55) who completed the intensive phase (0- 3 months) of the VHHHFP; and interviews were conducted with patients (n= 9) and health practitioners (n= 6). RESULTS Thirty-one (77.5%) of the n=55 patients completed the baseline and three-month follow-up KCCQ12 assessment. The mean KCCQ12 Summary Score at three months was 72.20 which was significantly higher than the mean Summary Score at baseline of 50.51 (p<.001). These findings were similar for the KCCCQ12 sub-scales: Physical Limitations (47.09 and 69.43, p<0.001), Quality of Life (43.75 and 62.91, p<0.001), Symptom Frequency (60.40 and 91.70; p<0.001) and Social Limitation (50.0 and 82.50; p<0.001). The PHQ-4 measure of psychological health was completed by n=32 (80%). The median scores at baseline and follow-up for Total Distress (1.50 and 0.0; p<0.02), and the Anxiety sub-scale (1.0 and 0.0; p <0.02) reduced over time. Six hospital admissions were recorded for five patients (10.2% of n=49) within 30 days of commencement of the VHHHFP. Nine patient interviews were informed by the Value Based Healthcare (VBHC) Capability Comfort and Calm (CCC) Framework. Three themes were identified 1) Enhanced patient capability, 2) Improved patient comfort and 3) Positive influences on Calm. Six healthcare professionals shared experiences and perceptions of the VHHHFP, with three emerging themes- 1) Improved patient capability through shared decision making, 2) Improving Capability through care practices and 3) Promoting Comfort and Calm through virtual coordination and collaboration. CONCLUSIONS The use of technologies to support the management of HF is an area of growth and development. This study contributes to the understanding of how remote patient monitoring with interdisciplinary chronic disease support integrated into an existing system can improve clinical outcomes for patients.