Cost-Effectiveness Analysis in Telehealth: A Comparison between Home Telemonitoring, Nurse Telephone Support, and Usual Care in Chronic Heart Failure Management.

OBJECTIVES: To assess the cost effectiveness of home telemonitoring (HTM) and nurse telephone support (NTS) compared with usual care (UC) in the management of patients with chronic heart failure, from a third-party payer's perspective. METHODS: We developed a Markov model with a 20-year time horizon to analyze the cost effectiveness using the original study (Trans-European Network-Home-Care Management System) and various data sources. A probabilistic sensitivity analysis was performed to assess the decision uncertainty in our model. RESULTS: In the original scenario (which concerned the cost inputs at the time of the original study), HTM and NTS interventions yielded a difference in quality-adjusted life-years (QALYs) gained compared with UC: 2.93 and 3.07, respectively, versus 1.91. An incremental net monetary benefit analysis showed €7,697 and €13,589 in HTM and NTS versus UC at a willingness-to-pay (WTP) threshold of €20,000, and €69,100 and €83,100 at a WTP threshold of €80,000, respectively. The incremental cost-effectiveness ratios were €12,479 for HTM versus UC and €8,270 for NTS versus UC. The current scenario (including telenurse cost inputs in NTS) yielded results that were slightly different from those for the original scenario, when comparing all New York Heart Association (NYHA) classes of severity. NTS dominated HTM, compared with UC, in all NYHA classes except NYHA IV. CONCLUSIONS: This modeling study demonstrated that HTM and NTS are viable solutions to support patients with chronic heart failure. NTS is cost-effective in comparison with UC at a WTP of €9000/QALY or higher. Like NTS, HTM improves the survival of patients in all NYHA classes and is cost-effective in comparison with UC at a WTP of €14,000/QALY or higher.

Enhanced registered nurse care coordination with sensor technology: Impact on length of stay and cost in aging in place housing.

BACKGROUND: When planning the Aging in Place Initiative at TigerPlace, it was envisioned that advances in technology research had the potential to enable early intervention in health changes that could assist in proactive management of health for older adults and potentially reduce costs. PURPOSE: The purpose of this study was to compare length of stay (LOS) of residents living with environmentally embedded sensor systems since the development and implementation of automated health alerts at TigerPlace to LOS of those who are not living with sensor systems. Estimate potential savings of living with sensor systems. METHODS: LOS for residents living with and without sensors was measured over a span of 4.8 years since the implementation of sensor-generated health alerts. The group living with sensors (n = 52) had an average LOS of 1,557 days (4.3 years); the comparison group without sensors (n = 81) was 936 days (2.6 years); p = .0006. Groups were comparable based on admission age, gender, number of chronic illnesses, SF12 physical health, SF12 mental health, Geriatric Depression Scale (GDS), activities of daily living, independent activities of daily living, and mini-mental status examination scores. Both groups, all residents living at TigerPlace since the implementation of health alerts, receive registered nurse (RN) care coordination as the standard of care. DISCUSSION: Results indicate that residents living with sensors were able to reside at TigerPlace 1.7 years longer than residents living without sensors, suggesting that proactive use of health alerts facilitates successful aging in place. Health alerts, generated by automated algorithms interpreting environmentally embedded sensor data, may enable care coordinators to assess and intervene on health status changes earlier than is possible in the absence of sensor-generated alerts. Comparison of LOS without sensors TigerPlace (2.6 years) with the national median in residential senior housing (1.8 years) may be attributable to the RN care coordination model at TigerPlace. Cost estimates comparing cost of living at TigerPlace with the sensor technology vs. nursing home reveal potential saving of about $30,000 per person. Potential cost savings to Medicaid funded nursing home (assuming the technology and care coordination were reimbursed) are estimated to be about $87,000 per person. CONCLUSIONS: Early alerts for potential health problems appear to enhance the current RN care coordination care delivery model at TigerPlace, increasing LOS for those living with sensors to nearly twice that of those who did not. Sensor technology with care coordination has cost saving potential for consumers and Medicaid.

Teleostomía y telecura. También en el paciente urológico / No disponible

La teleostomía y la telecura son consultas virtuales que permiten al paciente recibir cuidados especializados en el propio domicilio. Con esto vamos a conseguir que los pacientes tengan que desplazarse con menor frecuencia al centro de referencia, mejorando así el confort y tranquilidad que les ofrece su propio hogar. Dicha consulta facilita la tarea diaria de enfermería de Atención Primaria contando con el apoyo de profesionales expertos, que pueden orientar, ayudar y guiar en la realización de los cuidados específicos relacionados con las heridas crónicas y/u ostomías. Esto le permitirá al profesional ser más resolutivo, a la vez que se reducirán los ingresos hospitalarios y consecuentemente el gasto sanitario

No disponible

Using interactive voice response to improve disease management and compliance with acute coronary syndrome best practice guidelines: A randomized controlled trial.

BACKGROUND: There is evidence from large clinical trials that compliance with standardized best practice guidelines (BPGs) improves survival of acute coronary syndrome (ACS) patients. However, their application is often suboptimal. PURPOSE: In this study, the researchers evaluated whether the use of an interactive voice response (IVR) follow-up system improved ACS BPG compliance. METHOD: This was a single-centre randomized control trial (RCT) of 1,608 patients (IVR=803; usual care=805). The IVR group received five automated calls in 12 months. The primary composite outcome was increased medication compliance and decreased adverse events. RESULTS: A significant improvement of 60% in the IVR group for the primary composite outcome was found (RR 1.60, 95% CI: 1.29 to 2.00, p <0.001). There was significant improvement in medication compliance (p <0.001) and decrease in unplanned medical visits (p = 0.023). At one year, the majority of patients ( 85%) responded positively to using the system again. Follow-up by IVR produced positive outcomes in ACS patients.

Telehealth in primary healthcare: an analysis of Belo Horizonte's experience.

BACKGROUND: Telehealth resources were implemented in the city of Belo Horizonte, providing tools for the medical assistance model as well as strengthening the quality of primary healthcare attention. OBJECTIVE: The objective of this study was to analyze the characteristics of the incorporation of telehealth resources in Belo Horizonte, Brazil, and its contribution to the structuring of primary healthcare. MATERIALS AND METHODS: This study focused on a description of the telehealth projects related to primary healthcare in the city and the results of the implementation process. The sources for this analysis include documents presented to financing institutions, reports from the Belo Horizonte City Department of Health, and articles and technical reports related to the evaluations of the project. RESULTS: The BHTelehealth Project has been established in 148 basic health units in Belo Horizonte. It develops assistance and educational activities by using 3D modeling, interactive videos, and animations. The analysis of this implementation process identified both positive and negative aspects. Telehealth has strengthened the role of primary healthcare as the coordinator of attention. It has reinforced primary care units by widening the scope of attention offered at this level and has provided primary care staff with a powerful arsenal of up-to-date information and tools. CONCLUSION: BHTelehealth served as a model for implementing the National Telehealth Program, in course in Brazil, involving 900 cities. This is attributed to its positive impact on the training of primary care unit professionals.

Using technology to create a medication safety net for cardiac surgery patients: a nurse-led randomized control trial.

PURPOSE: Interactive voice response (IVR) technology was used to increase medication compliance and reduce adverse events (hospitalization and emergency visits) in post-cardiac surgery patients. METHOD: Patients randomized to intervention received 11 automated IVR calls in the six months after discharge. A total of 331 patients (164 IVR, 167 usual care) participated. RESULTS: Findings showed significant differences in the IVR group for the primary composite outcome of compliance and adverse events (relative risk (RR] and 95% confidence interval [CI]: 0.60 [0.37, 0.96), p = 0.041) and the secondary outcome of medication compliance (RR: 0.34 (0.20, 0.56), p < 0.0001). There was no significant impact on emergency room visits (RR: 1.04 (0.63, 1.73J) and hospitalization (RR: 0.77 [0.41, 1.45]). Most patients (93%) preferred IVR follow-up to no follow-up.

Mobile phone technology in chronic disease management.

Mobile phones are being used to improve nurse-patient communication and monitor health outcomes in chronic disease. Innovative applications of mobile technology are expected to increase over time in community management of cancer, heart disease, asthma and diabetes. This article focuses on mobile phone technology and its contribution to health care.