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

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 (Δ = -0.05 admissions/quarter; p = 0.011), which was primarily observed in patients who used the HBP at least once (Δ = -0.10 admissions/quarter; p < 0.001). CONCLUSIONS: The HBP, a content-driven telehealth system coupled with care management, was associated with significantly better survival and reduced hospitalization in Medicare beneficiaries with HF. Prospective study is warranted to determine the mechanism of this association and opportunities for optimization.

Impact of a telehealth and care management program for patients with chronic obstructive pulmonary disease.

RATIONALE: Improving outcomes and health resource use for patients with chronic obstructive pulmonary disease (COPD) care is a priority for health systems. The Health Buddy Program, a content-driven telehealth system coupled with care management, is designed to enhance patient education, self-management, and timely access to care. OBJECTIVES: To examine the effects of the Health Buddy Program on resource use among Medicare patients with COPD who participated in a Centers for Medicare and Medicaid Services demonstration project from 2006 to 2010. METHODS: Medicare fee-for-service beneficiaries with COPD who enrolled in the intervention at two participating clinics were propensity-score matched to similar patients with COPD identified from a 5% random sample of Medicare patients. Difference-in-difference analyses descriptively compared the program's effect on quarterly healthcare resource use over the 3-year study period compared with baseline. Negative binomial models estimated the association of the program with healthcare resource outcomes adjusting for significant (P<0.05) baseline differences post matching. MEASUREMENTS AND MAIN RESULTS: The effect of the Health Buddy Program on quarterly all-cause and respiratory-related hospital admissions, hospital admissions for COPD exacerbations, and all-cause emergency department use was assessed after matching. Intervention (n=619) and matched control subjects (n=619) had similar baseline characteristics after matching. The Health Buddy Program was associated with 23% lower quarterly all-cause hospital admissions and 40% lower quarterly respiratory-related hospital admissions compared with baseline for intervention beneficiaries versus control subjects. In subgroup analyses, patients who engaged in the intervention during the study period (n=247) demonstrated significantly lower quarterly hospital admissions for COPD exacerbations. The Health Buddy Program was not associated with reductions in quarterly emergency department use. Results were robust in analyses that adjusted for significant differences in baseline characteristics after matching. CONCLUSIONS: A content-driven telehealth system combined with care management has the potential to improve health outcomes in Medicare beneficiaries with COPD.