Telehealth helps hospital cut readmissions by 75%

New approach to heart failure saves money

Fuqua Heart Center of Atlanta (GA) at Piedmont Hospital has used telehealth technology to significantly reduce the rate of hospital readmissions for heart failure patients. Data collected by the facility show that hospital readmission 30 days after discharge for heart failure patients in the program was 75% lower than for patients not in the program (a 1.45% readmission rate vs. a 5.85% readmission rate.)

"Heart failure is a very expensive population, and they tend to come to the hospital a lot," notes Jennie Mattia, RN, CCRN, CPHQ, manager, cardiovascular quality and heart failure disease management for the Fuqua Heart Center. "The majority of hospitals lose money for every heart failure admission, so institutionally you should be looking at what your margin is," she says. It's not that it will necessarily make a tremendous impact on the bottom line, she adds, "but streamlining your process and paying close attention to care on the outside can prevent readmissions — which we did."

Long time commitment

Piedmont, notes Mattia, has a long history of commitment to care of chronic conditions. "In the mid-90s we really started looking at disease states, aligning their care in the hospital, and at ways to funnel patients to appropriate outpatient resources," she says. "Because it is such a financial burden, you want to be able to handle heart care as efficiently and cost-effectively as possible."

They began with two advanced practice nurses going to the homes of patients who had been identified as high risk, and who had been cited by their primary care physicians as good candidates for outpatient management. "This was effective; we took the gains from that and then asked how we could increase intensity of service and geographical reach," says Mattia, noting that by using the nurses for home visits they could see perhaps two patients a day per nurse.

"That led us to explore telehealth in 2001-2002," says Mattia, who notes that the initial venture was PC-based, using Internet access and a video camera. "We took the PC out, showed patients how to use it, and hooked up the video cam in our office," she recalls. The nurses would ask the patient, for example, to point down to their feet to see if they were swollen. "Then, we could call the doctor and tell them what was happening," she adds.

Limitations noted

However, Mattia points out, this approach also had limitations. "If the patient was not computer literate, it would not work," she says. "So we had to triage who would and who would not get the service."

By mid-1993, says Mattia, it became very clear the PC-based program was not working well enough. "We had five computers; they were cumbersome, and most patients who needed help couldn't work with the computers because they were either not skilled enough or not well enough," she recalls.

Mattia and her staff started to investigate a more user-friendly approach, and came across a company called WebVMC in nearby Conyers, GA. "Their product is a tiny box that sits on a table; you plug in a blood pressure monitor, a scale, a phone line, and a power plug," she explains. "It uses a touch screen, so you do not have to be computer literate to use it." All of the data go to a secure server. "We can access the information from wherever we are with Internet access," says Mattia.

One of the hallmarks of this program, she continues, is that the patient has to do something in order for the program to work. "We have to teach them how to effectively self-manage their condition, and it is their tool, and their responsibility to get us the information," she explains.

If the nurse has not heard from the patient in a couple of days they will give them a call. "We might say something like, 'You are consistently not weighing yourself on Monday; what are you doing on the weekend you do not want us to know about?'" Mattia explains. "We don't let them go stagnant for very long."

Assessing the value

Mattia is certain of the program's value, although she has not formally calculated its return on investment. "We didn't have to; this is part of the hospital's commitment to disease management," she explains.

Nevertheless, she adds, "it's not tremendously expensive in the scheme of things, and the cost is certainly reasonable for the product we are getting." She says there is an ongoing monitoring fee based on patient utilization, and the hospital provides it to the patients free of charge.

Still, she insists, the program is "absolutely" beneficial from the hospital's perspective in terms of geographic reach alone. "It allows more efficient use of nurses' time," Mattia explains.

Piedmont has ordered a total of 70 monitors, having brought 45 on board initially (about a year ago) and then adding others later in the year. "We were almost instantly able to impact the number of patients we were able to interact with, so instead of a population of 40 people we could actively manage we were able to go to 100 — monitor them remotely, and know they were OK," she says. "We know who the problem people are, and we can prioritize their care."

It also has helped workload efficiency, Mattia notes. "We refer these people who are inpatients for outpatient disease management by protocol," she says. "We have been able to impact ED visits as well as hospital admissions because, for example, they can get the same IV on an outpatient basis."

This approach, she adds, is also "A tremendous patient satisfier — the patients do not want to go to the hospital, and we are able get better management on an outpatient basis."

Through the program, the hospital also is able to get the patients on optimal therapy much faster than it would if they were using a standard approach, Mattia asserts. "Typically a patient is discharged from the hospital, has a follow-up visit with their cardiologist in two weeks, then comes back in a month, and sees very slow, incremental changes," she notes. "This way, we are able, for example, to monitor their response to the meds we give and scientifically and quickly adjust them to the appropriate levels the patient needs."

[For more information, contact: Jennie Mattia, RN, CCRN, CPHQ, Manager, Cardiovascular Quality and Heart Failure Disease Management, The Fuqua Heart Center at Piedmont Hospital, 1968 Peachtree Road NW, Atlanta, GA 30309. Phone: (404) 605-5000.]