Impact of a Telehealth and Care Management Program on All-Cause Mortality and Healthcare Utilization in Patients with Heart Failure

Abstract

Background: Telehealth has the potential to improve chronic disease management and outcomes, but data regarding direct benefit of telehealth in patients with heart failure (HF) have been mixed. The objective of this study was to determine whether the Health Buddy Program (HBP) (Bosch Healthcare, Palo Alto, CA), a content-driven telehealth system coupled with care management, is associated with improved outcomes in Medicare beneficiaries with HF. Materials and Methods: This was a retrospective cohort study of 623 Medicare beneficiaries with HF offered HBP enrollment compared with a propensity score-matched control group of Medicare beneficiaries with HF from the Medicare 5% sample. Associations between availability of the HBP and all-cause mortality, hospitalization, hospital days, and emergency department visits were evaluated. Results: Beneficiaries offered enrollment in the HBP had 24.9% lower risk-adjusted all-cause mortality over 3 years of follow-up (hazard ratio [HR] = 0.75; 95% confidence interval [CI], 0.63-0.89; p = 0.001). Patients who used the HBP at least once (36.9%) had 57.2% lower mortality compared with matched controls (HR = 0.43; 95% CI, 0.31-0.60; p < 0.001), whereas patients who did not use the HBP had no significant difference in survival (HR = 0.96; 95% CI, 0.78-1.19; p = 0.69). Patients offered the HBP also had fewer hospital admissions following enrollment (D = -0.05 admissions/quarter; p = 0.011), which was primarily observed in patients who used the HBP at least once (D = -0.10 admissions/quarter; p < 0.001). Conclusions: The HBP, a content-driven telehealth system coupled with care

Implementation and evaluation of comprehensive medication management in telehealth practices

“…Table 1 provides def-initions and examples of how these indicators have been measured for CMM practices. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] A comprehensive list of implementation frameworks together with the resources to support their use can be found at the Dissemination and Implementation Models website: https:// dissemination-implementation.org/. 33 The Active Implementation Framework (AIF) has formally been applied to CMM in primary care practices.…”

“…Few validated frameworks have been applied to CMM practices. Table provides definitions and examples of how these indicators have been measured for CMM practices . A comprehensive list of implementation frameworks together with the resources to support their use can be found at the Dissemination and Implementation Models website: https://dissemination-implementation.org/…”

The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association

“…Other challenges to the adoption of telemonitoring are the cost of devices and services (especially if there are monthly fees associated with monitoring), user perceptions of therapeutic effectiveness, remembering to wear/use the technology and to charge it when recharging is necessary, dealing with artifact, slow electronic processing of data, and data transfer and Internet failures. [202][203][204] Effective remote monitoring systems will require an intuitive and reliable interface for adoption. Systems and products must be simple to use ("plug and play") and accurate, hold value over time, enhance patient-centeredness, promote 2-way communication between patients and providers of care, and be driven by consumers.…”

Tele-nursing in patients with chronic illness: a systematic review

“…Un 56% (n=19) de los estudios seleccionados 10,14,16,18,20,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] identificaron el soporte virtual como una de las principales características de la tele-enfermería. Se caracteriza principalmente por el uso de páginas web o videos con fines educativos 25,27 , incluyendo formularios auto-evaluativos, enlaces a páginas web de interés y cursos de formación para fomentar un mayor automanejo y adaptación del paciente con el proceso crónico 30 .…”

“…Nueve de los estudios seleccionados 10,17,28,35,36,[40][41][42][43] (26%) presentaron el seguimiento telefónico como otra de las características clave de la tele-enfermería, cuyo objetivo es llevar a cabo una atención individualizada y específica de la conviven-cia del paciente con la enfermedad 36,38 . El seguimiento telefónico consiste en la planificación semanal de llamadas a través de las cuales el profesional sociosanitario fomenta una relación terapéutica 41 con el paciente donde este es el foco de atención, solventando las dudas referentes a su día a día con la enfermedad crónica 16,28,43 . A lo largo de todo este proceso, el profesional de enfermería se limita a ser el guía, asesorando y orientando al paciente en aspectos tan relevantes como son la aceptación, afrontamiento o integración de la enfermedad.…”