Impact of telehealth on clinical outcomes in patients with heart failure.

The purpose of this randomized field study was to determine the effects of telehomecare on hospitalization, emergency department (ED) use, mortality, and symptoms related to sodium and fluid intake, medication use, and physical activity. The sample consists of 284 patients with heart failure. The authors used logistic regression to study the effects of telehomecare on health services utilization and mortality and a general linear model to analyze changes in self-reported symptoms. On average, patients in the telehomecare groups had a lower probability of hospitalizations and ED visits than did patients in the control group. Differences were statistically significant at 60 days but not 120 days. Results show a greater reduction in symptoms for patients using telehomecare compared to control patients. The technology enables frequent monitoring of clinical indices and permits the home health care nurse to detect changes in cardiac status and intervene when necessary.

Home-based telehealth: a review and meta-analysis.

We conducted a systematic review to identify studies on the effect of home telehealth on clinical care outcomes. The search was restricted to peer-reviewed publications (published between 2001 and 2007) about studies conducted in home or residential settings. The search yielded 154 potential articles and dissertations. A total of 29 articles met the inclusion criteria and were included in a meta-analysis. The weighted mean effect size for the overall meta-analysis was 0.50, and the z-statistic was 3.0, indicating that telehealth had a moderate, positive and significant effect (P < or = 0.01) on clinical outcomes. Subanalyses also indicated positive significant effects of telehealth for some disease categories (heart disease and psychiatric conditions), but not others (diabetes), patient populations and telehealth interventions. Overall, the meta-analysis indicated that telehealth positively affects clinical outcomes of care, even in different patient populations.

Use of telehealth by older adults to manage heart failure.

Telehealth, a clinical information system that transmits data over ordinary telephone lines, is used by individuals in their homes to communicate electronically with health care providers. This study investigated the influence of telehealth on self-management of heart failure in a sample of older adults. We hypothesized that the use of telehealth facilitates patient confidence, with subsequent effects on patients' ability to manage their treatment regimen more effectively. Patients in the intervention groups received a telehealth system during their episode of care; patients in the control groups received routine home visits only. Analyses, using a repeated measures design, found that confidence is a predictor of self-management behaviors. In addition, we found that patients using a video-based telehealth system showed the greatest gain in confidence levels with time. Managers and policy makers responsible for creating and funding programs that support the use of health information technologies by older adults can benefit from these results.

Baseline management practices at providers in better jobs better care.

High turnover and difficult recruitment of direct care workers are challenges for long-term care providers. This study reports the extent and variation of the use of management practices for direct care workers and their supervisors across four long-term care settings in the Better Jobs Better Care demonstration. Overall, there is limited use of direct care worker training, career advancement opportunities, and mentoring programs. Participation in care planning, communication about tasks, and direct care worker supervisor training and development practices vary significantly across long-term care settings. The paucity of training, career advancement opportunities, and mentoring programs suggests that government policies may be needed to encourage their use.

Can organizational support for technology influence job satisfaction?

The relationship between organizational support for telemedicine and nurses' job satisfaction in home health agencies (HHAs) is investigated in this study. Drawing from the theory of perceived organizational support, we propose that HHAs that provide strong support for telemedicine will have higher nurse job satisfaction levels than those that do not. Primary data were collected from 29 HHAs and 917 nurses from 2004 to 2005. The results of the analysis indicate a strong, positive, significant association between organizational support for telemedicine and home health nurses' job satisfaction. We conclude that technological implementation, with sufficient organizational support, can be a strong competitive strategy to attract and retain high-quality nurses.

A framework for evaluating eHealth research.

Health care is in the midst of a consumer-oriented technology explosion. Individuals of all ages and backgrounds have discovered eHealth. But the challenges of implementing and evaluating eHealth are just beginning to surface, and, as technology changes, new challenges emerge. Evaluation is critical to the future of eHealth. This article addresses four dimensions of eHealth evaluation: (1) design and methodology issues; (2) challenges related to the technology itself; (3) environmental issues that are not specific to eHealth but pose special problems for eHealth researchers; and (4) logistic or administrative concerns of the evaluation methodology selected. We suggest that these four dimensions must be integrated to provide a holistic framework for designing and implementing eHealth research projects, as well as for understanding the totality of the eHealth intervention. The framework must be flexible enough to adapt to a variety of end users, regardless of whether the end user is a healthcare organization, a for-profit business, a community organization, or an individual. The framework is depicted as a puzzle with four interlocking pieces.

Performance model for telehealth use in home health agencies.

Increasingly, home health agencies (HHAs) are considering the value of implementing telehealth technology. However, questions arise concerning how to manage and use this technology to benefit patients, nurses, and the agency. Performance models will be beneficial to managers and decision makers in the home health field by providing quantitative information for present and future planning of staff and technology usage in the HHA. This paper presents a model that predicts the average daily census of the HHA as a function of statistically identified parameters. Average daily census was chosen as the outcome variable because it is a proxy measure of an agency's capacity. The model suggests that including a telehealth system in the HHA increases average daily census by 40%-90% depending on the number of nurse full-time equivalent(s) (FTEs) and amount of travel hours per month. The use of a home telecare system enhances HHA performance.

Polypharmacy and possible drug-drug interactions among diabetic patients receiving home health care services.

OBJECTIVES: In this study, we examined the drug regimens of diabetic patients receiving home health care services to measure the prevalence of polypharmacy and to assess the likelihood of drug-drug interactions, a consequence of polypharmacy. DESIGN: The sample consisted of 139 diabetic patients who received home health care services from one home health agency in a large mid-Atlantic city. The data were collected from March 1, 1998 to September 30, 1999. Information regarding medications was collected by the home health nurse during the initial home visit and was recorded on the medication sheet in the patient's clinical record. Any changes in medications were noted on the medication sheets. METHODS: We identified all systemic medications prescribed for 139 home health patients. To assess drug-drug interactions, we used Micromedex formulary DRUG-REAX System. OUTCOMES: We calculated (1) the number of systemic medications taken, and (2) the number of possible severe, moderate, and mild drug-drug interactions. RESULTS: We found that the average number of medications taken was 8.9 (SD 3.4) prescribed medications per day. Our results show that 38.8% of the patients in the sample could potentially be subject to at least one severe drug-drug interaction. Nearly all of the patients (92.8%) were at risk for moderate drug-drug interactions, and 70.5% could have mild drug- drug interactions. CONCLUSION: We conclude that polypharmacy is a concern for home health care patients with diabetes and the potential for drug-drug interactions is substantial. Our results indicate that the drug regimens of diabetic patients should be monitored systematically to avoid adverse events such as hospitalization. Family practitioners and home health care takers are in a unique position to identify polypharmacy and to modify drug regimens.

Marketing telehealth to align with strategy.

Telehealth is a twenty-first century solution to an old problem-how to deliver quality health services with shrinking resources. Telehealth enables healthcare providers to interact with and monitor patients remotely, thus adding value to service delivery models. On occasion, telehealth can substitute for live encounters, saving time and resources. Furthermore, as the geriatric population increases, telehealth will support independent living by supplementing the existing network of care. To be used most effectively, however, telehealth services must be carefully planned and executed. This study investigated management practices used to promote telehealth services, focusing on strategic goals for adopting telehealth. Interviews with senior managers from 19 home health agencies identified three strategic goals for adopting telehealth: (1) clinical excellence, (2) technological preeminence, and (3) cost containment. Organizational documents were analyzed to determine the extent to which the telehealth program was featured in marketing materials. Documents included the organization's brochure, newspaper ads and articles, and each home health agency's web site. Results showed that marketing practices vary widely but are correlated with motivations to adopt telehealth. The organizations with the highest marketing scores emphasize clinical excellence as a major reason for using telehealth, whereas those with the lowest marketing scores tend to focus on cost containment. Although this study focused on management practices in home health agencies, results are applicable to hospital and outpatient services as well as to other community-based programs. Using a strategic management framework, the authors offer recommendations to help organizations develop effective marketing approaches for telehealth programs.

Accountability framework for managing stakeholders of health programs.

Understanding the incentives of stakeholders and employing effective management practices with various stakeholder groups is essential for program sustainability. This paper offers a conceptual model that depicts four different types of stakeholder interests that are relevant to health service organizations. The study identified the major stakeholders of telehealth programs, compared the influence of stakeholders by organizational ownership and investigated the practices used to manage these stakeholders. Quantitative and qualitative analyses demonstrated empirical support for the stakeholder model. The paper suggests that the model can be used as a stakeholder management tool in healthcare organizations and offers an assessment of the utility of the stakeholder framework in organizational research

Racial and ethnic diversity and organizational behavior: a focused research agenda for health services management.

Initiatives to reduce racial and ethnic disparities are conceptualized as a three-legged stool. Public policy: to ensure a legal and regulatory environment designed to eliminate disparities in access and health status; clinical practice: to ensure patient satisfaction and loyalty and improve treatment outcomes through the cultural competence of clinicians; and organizational behavior: to ensure that leadership, staff, and the culture of the health services organization represents and values the communities they serve. Our review of the health services and general management literature published since 1990 reveals a paucity of research on organizational behavior. Based on our review of health services and general management organizational behavior and racial/ethnic diversity literature, we offer an agenda for future research in this area. Factors that will facilitate or inhibit the pursuit of the proposed research agenda are also identified and discussed. The literature reviewed is mainly from the United States and the proposed research agenda results from that review, which presents a potential limitation to its applicability internationally.

Organizational strategy and diversity management: diversity-sensitive orientation as a moderating influence.

Empirical studies on diversity suggest that health care organizations have been slow to embrace diversity management. We propose that sensitivity to diversity, at the corporate level, moderates strategic decision making, which influences human resource management practices such as diversity initiatives. This study of 203 hospitals explored the relationships among organizational strategy, organizational sensitivity to diversity, and diversity management practices.

Quality management practices in telehealth programs: a stakeholder accountability framework.

Improved technologies, distances between providers and patients, and an emphasis on cost-containment have encouraged the use of telehealth as a method of service delivery. Despite the increased use of this technology, few studies have been conducted on management of telehealth programs. Research on quality management is essential for disseminating and generalizing information on best practices in telehealth programs. This study focused on quality management practices used in telehealth programs, using a Stakeholder Accountability Framework. We propose that different indicators of quality are employed to satisfy the expectations of different internal and external stakeholders. A national survey of telehealth programs (N=93) was conducted in January, 2001. Wide variations in practices were found, with the most notable differences between not-for-profit and proprietary programs. The dimensions illustrated in the Stakeholder Accountability Framework were supported empirically. Implications of differences are examined as they relate to advancing quality in telehealth.

Racial/ethnic diversity management and cultural competency: the case of Pennsylvania hospitals.

Major demographic trends are changing the face of America's labor pool, and healthcare managers increasingly face a scarcer and more diverse workforce. As a result, healthcare organizations (HCOs) must develop policies and practices aimed at recruiting, retaining, and managing a diverse workforce and must meet the demands of a more diverse patient population by providing culturally appropriate care and improving access to care for racial/ethnic minorities. Ultimately, the goal of managing diversity is to enhance workforce and customer satisfaction, to improve communication among members of the workforce, and to further improve organizational performance. Research on diversity management practices in HCOs is scarce, providing few guidelines for practitioners. This study attempted to close that gap. Results show that hospitals in Pennsylvania have been relatively inactive with employing diversity management practices, and equal employment requirements are the main driver of diversity management policy. The number and scope of diversity management practices used were not influenced by organizational or market characteristics. The results suggest that hospitals need to adopt diversity management practices for their workforces and need to pay particular attention to marketing and service planning activities that meet the needs of a diverse patient population.

Lessons learned from a telehomecare project.

This article provides an update on the results of the Telehomecare Project, a demonstration funded by the US Department of Commerce through its Technology Opportunity Program. The goal of the project was to demonstrate and evaluate the use of telephone-based information technology (IT) in the provision of home health services. This effort was described in the August, 1999 (vol. 18, no. 8) issue of CARING.

Teaching self-management of diabetes via telehomecare.

This study demonstrates that telehomecare is an effective way to improve patient education and self-management outcomes. The cost effectiveness of this technology makes it an attractive medium for reaching patients who require close monitoring, reinforced teaching, and reassurance. telehomecare can also support caregivers and connect socially isolated individuals to their care providers. The possibilities for using telehomecare are just beginning to be realized. With the advent of PPS, telehomecare may be an effective substitute for visits that focus on teaching and monitoring. It is a new tool in the arsenal for the home care nurse to use for monitoring patients and promoting knowledge and behavior change. The video visits are short, focused opportunities for increased patient teaching; the one-on-one focus, audio-visual aids, and opportunities for patients to use the machines to self-monitor are all positive aspects.