November 2004

Grant Results

National Program

New Jersey Health Initiatives Program

SUMMARY

Valley Home Care, a subsidiary of Valley Health System in Bergen County, N.J., used telemonitoring from 2001 through 2003 to provide "virtual" home health services to older Passaic and Bergen County patients with congestive heart failure and hypertension.

The project was part of the Robert Wood Johnson Foundation (RWJF) New Jersey Health Initiatives national program (for more information see Grant Results).

Key Results

  • Through the Teleheart program, Valley Home Care provided telemonitoring home health visits for 122 older patients with congestive heart failure and 18 older patients with hypertension.
  • It trained nine nurses in telemonitoring and incorporated the Teleheart program into its home health program.
  • It incorporated telemonitoring into the Valley Home Care home health program. All home care patients now receive telemonitoring unless they have an incompatible phone line or do not have a caregiver to assist them with the telemonitoring equipment.

Key Assessment Findings
Project staff collected data on hospitalizations and quality of life before and after implementation of the Teleheart program. During the six months after patients joined Teleheart compared with the six months before program participation:

  • Hospitalizations decreased by 73 percent.
  • Hospital days decreased by 78 percent.
  • Emergency room visits decreased by 88 percent.

Funding
RWJF supported the project with a grant of $231,111 from November 2000 to October 2003.

 See Grant Detail & Contact Information
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THE PROBLEM

Congestive heart failure, the leading cause of hospitalization in people 65 and older, according to the American Hospital Association, costs more than $10 billion a year, according to a 1998 estimate by the Agency for Health Care Policy and Research. Many readmissions for congestive heart failure are preventable through adequate patient education and social support; better symptom control; and compliance with medications, diet and activity limits.

Since 1998, Valley Home Care, a community-based, nonprofit provider of home health care and support services to Bergen and Passaic County residents, has provided home care to congestive heart failure patients discharged from Valley Hospital through its Congestive Heart Failure Disease Management Program. Both Bergen and Passaic counties had a growing number of chronically ill, community-based older adults and a limited supply of home care nurses. There was a need to reduce health care costs while meeting the increasing demand for services.

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RWJF STRATEGY

New Jersey Health Initiatives, established in 1986, recognizes RWJF's special responsibilities to New Jersey, its home state. The program, through projects located throughout the state, seeks to improve health and health care for New Jersey residents through innovative, community-based health services.

New Jersey Health Initiatives projects span RWJF's four goals:

  1. To assure that all Americans have access to quality health care at reasonable cost.
  2. To improve the quality of care and support for people with chronic health conditions.
  3. To promote healthy communities and lifestyles.
  4. To reduce the personal, social and economic harm caused by substance abuse — tobacco, alcohol and illicit drugs.

This project meets RWJF's chronic health conditions goal.

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THE PROJECT

Valley Home Care added telemonitoring to its Congestive Heart Failure Disease Management Program in Bergen County and expanded the program to Passaic County. The overall objectives of the project, called "Teleheart," were to improve access to care, clinical outcomes and quality of life for congestive heart failure patients living at home or senior housing complexes and reduce health care costs.

Telemonitoring uses a two-way video camera and simultaneous audio, transmitted over a standard, dedicated telephone line. Specialized cardiac registered nurses interacted in real-time with patients through digital cameras at Valley Home Care and the patient's residence. The patient's unit included a stethoscope and other tools that enabled the nurse to perform home visit functions (e.g., evaluating blood pressure, pulse, weight, blood-oxygen levels, blood glucose levels, lung sounds and skin condition). Patients lived at home or in senior housing complexes.

In October 2001, Valley Home Care expanded Teleheart to include patients with hypertension. Valley Home Care expected to provide telemonitoring to 270 patients (90 per year) but only served 122 patients because participation by residents of senior housing complexes — where telemonitoring units could be shared — was less than expected (15 percent of patients needing telemonitoring were served).

Other Funding

Valley Hospital Auxiliary contributed $91,667 toward the purchase of the telemonitoring equipment. American TeleCare, the Eden Prairie, Minn.-based manufacturer of the telemonitoring units, provided $12,680 for extended equipment warranties, training and support and marketing materials.

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RESULTS

Valley Home Care:

  • Provided telemonitoring home health visits for 122 older patients with congestive heart failure in their homes and senior housing complexes in Bergen and Passaic counties.
  • Provided telemonitoring home health visits for 18 older patients with hypertension.
  • Trained nine nurses in telemonitoring and increased the number of patients per nurse in the community who were served. Nurses completed an average telemonitoring visit in 15 to 20 minutes, compared to approximately one hour for an in-home visit.
  • Incorporated telemonitoring into the Valley Home Care home health program (in the last six months of the grant). All home care patients now receive telemonitoring unless they have an incompatible phone line or do not have a caregiver to assist them with the telemonitoring equipment.

In addition, Valley Home Care provided health education programs on medication, nutrition and fall prevention to residents of Siena Village and Sisco Village, senior housing complexes.

Assessment

Project staff collected data on hospitalizations and quality of life before and after implementation of the Teleheart program. The assessment covered 97 patients (79 with congestive heart failure and 18 with hypertension) from 2001 through 2003. Project staff also used the University of Minnesota Living with Heart Failure Questionnaire to collect data on 12 congestive heart failure patients.

Assessment Findings

  • On average, Teleheart patients received 9.5 in-person home care visits and six Teleheart visits. Traditional home care patients received 9.7 in-person visits.
  • During the six months after patients joined Teleheart compared to the six months before program participation:
    • Hospitalizations decreased by 73 percent.
    • Hospital days decreased by 78 percent.
    • Emergency room visits decreased by 88 percent.
  • Congestive heart failure patients with less serious disease reported significant improvements in their perceived quality of life — both physically and emotionally. Sicker patients did not show these improvements.

Communications

Project staff developed a videotape about the Teleheart program and disseminated copies to physicians, policy-makers, insurers, patients, community groups and referral sources. Project staff made presentations at the annual meeting of the National Association for Home Care and to physicians, discharge planners and cardiac rehab staff in Passaic and Bergen Counties. A section of Valley Health System's Web site covers Teleheart. See the Bibliography for details. The Bergen Record, Star-Ledger and Nursing Spectrum published articles about Teleheart.

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LESSONS LEARNED

The project director offered seven lessons from the project:

  1. Recruiting patients into a new care program that requires physician consent and referral is a challenge. Valley Home Care found that physicians were concerned that patients might discontinue their office visits once telemonitoring was in place, felt that patients did not need further education on congestive heart failure beyond what they provided or did not want to deal with additional paperwork or phone calls. (Project Director)
  2. Identifying patients for a new care program who meet diagnostic criteria and are willing to participate is a challenge. Particularly at senior housing complexes, patients were not aware of their diagnosis of congestive heart failure or were not homebound and did not want to stay at home for a scheduled telemonitoring visit. (Project Director)
  3. Collaborating with management at senior housing complexes to reach out to residents and implement a care program requires persistence and ongoing communication. Initially, management at senior housing complexes expressed great interest in the Teleheart program. However, their follow-through (e.g., meeting with project staff and finding an appropriate location for telemonitoring equipment) was disappointing. (Project Director)
  4. Telemonitoring expands nursing resources. Valley Home Care found that nurses were typically able to complete three televisits in the same amount of time required to complete one in-person visit. (Project Director)
  5. Older adults can use technology. With training and minimal caregiver assistance, older patients were comfortable using the telemonitoring units. (Project Director)
  6. Protecting patient privacy when using technology to transmit patient information requires constant surveillance. Project staff had to remain vigilant that telemonitoring units in senior housing complexes and in the Valley Home Care headquarters were situated to allow patients privacy for speaking with nurses and transmitting information. (Project Director)
  7. Telemonitoring should be integrated into a home care agency's care plan. By making telemonitoring part of its care plan, Valley Home Care enhanced the way it did business. (Project Director)

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AFTER THE GRANT

Telemonitoring is now part of Valley Home Care's Congestive Heart Failure Disease Management Program. Valley Home Care is also using telemonitoring for patients with diabetes and those recovering from coronary artery bypass surgery. Valley Hospital Auxiliary provided $50,000 in 2004 to support telemonitoring.

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GRANT DETAILS & CONTACT INFORMATION

Project

Technological Congestive Heart Failure Disease Management for the Elderly

Grantee

Valley Home Care (Paramus,  NJ)

  • Amount: $ 231,111
    Dates: November 2000 to October 2003
    ID#:  040741

Contact

Karen Grant, R.N., M.S.N., C.P.H.Q.
(201) 291-6242
kgrant@valleyhomecare.com

Web Site

http://www.valleyhealth.com/valley_home_care.asp?id=136

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Audio-Visuals and Computer Software

TeleHeart Documentary, a 12-minute videotape describing the success of the Teleheart program and the effectiveness of telemonitoring from the perspective of the patient, nurse and physician. New York: Cicala Filmworks, May 2002. Being show to physician groups, referral sources and potential patients.

World Wide Web Sites

www.valleyhealth.com/valley_home_care.asp?id=136. "Teleheart Program" on the Valley Health System Web site provides an overview of the program. Ridgewood, N.J.: Valley Health System.

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Report prepared by: Karin Gillespie
Reviewed by: Lori De Milto
Reviewed by: Molly McKaughan
Program Officer: Pamela Dickson

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