Remote monitoring slashes hospitalizations

Nurses work with patients in home, monitor remotely

Bayada Nurse's program that combines face-to-face education and remote monitoring of clinical information reduces hospitalizations for patients with congestive heart failure and hypertension.

Patients with congestive heart failure who participated in the remote monitoring pilot program experienced 59% fewer hospital visits than a control group of patients with the same condition who received only the education component of the program, according to Brian Farber, MBA, MA, director of the telehealth program.

Hospital visits were reduced by 40% for patients with hypertension.

Bayada Nurses, with headquarters in Moorestown, NJ, provides home health nurses and home health aides in 18 states and the United Kingdom.

The home care agency conducted a pilot project using the telemonitoring equipment in 2007 and achieved excellent clinical outcomes, including the reduction in hospitalizations, Farber says.

"Based on the success of the pilot, we are expanding the program throughout the company," he adds.

Patients in the program measure their weight and blood pressure daily using a Bluetooth-enabled digital weight scale and a blood pressure monitor. The wireless devices automatically send timely data to telehealth nurses, who monitor them seven days a week.

"Right now, there is no reimbursement for telehealth, but we decided to implement the program because of the good outcomes. By investing in the program, we're hoping that insurance companies can see the benefit and authorize reimbursement for it," Farber says.

Telemonitoring saves money

Preventing just one hospitalization can save as much as $30,000, Farber points out.

"Remote monitoring is going to be an important component of patient care in the future. It provides real-time data that indicate when a chronic disease is exacerbated and enable the health care provider to make adjustments, saving a trip to the emergency department or a hospitalization," he says.

The system saves expenses, because the nurses don't have to make a home visit to check the patient's vital signs — and patients don't have to go back to the doctor's office as frequently, he adds.

Patients in the program have advanced chronic diseases, such as congestive heart failure, hypertension, diabetes, or, most likely, a combination of diseases.

"This is not a typical telephonic disease management program. We go to the clients' homes and help them learn to manage their disease face to face in conjunction with their physician. By using telemonitoring, we are able to monitor their vital signs and other information seven days a week and identify any exacerbations that are occurring before they become acute," Farber says.

Eligible patients are identified when they are experiencing acute exacerbations, are referred by physicians, or recently have been discharged from the hospital and need help learning how to manage their condition and receive a home visit from a Bayada nurse.

"Once the patient is stable, the nurses start assessing their chronic diseases and their need for support in adhering to their treatment plan and keeping their condition under control," he says.

When the Bayada home health nurses identify a patient who may be eligible for the telemonitoring program, they contact the patient's physician and get permission for the telemonitoring to be part of the patient's plan of care.

The nurse schedules a visit to introduce the patient to the service and to demonstrate how to use it.

On each visit to clients' homes, the nurses follow a protocol that includes specific teaching points. For instance, they educate congestive heart failure patients on what foods to avoid, how to recognize signs that their illness is exacerbating, and when they should call the doctor.

The nurses develop a close relationship with the patients, listen, and identify the time that they are most ready to hear the message about making changes to manage their conditions.

"When someone has a chronic disease and is doing well, they aren't very open to education. But once someone's disease state starts to exacerbate and they're not feeling well, they are open to education at that exact point. The nurses teach whatever the patient is ready to learn. If the patient hasn't absorbed the last lesson, they repeat it," he says.

The goal of the program is to help the clients take ownership of their own disease process.

"We can't be with them all the time, so they need to learn to manage the disease on their own," Farber says.

The nurses schedule at-home visits based on the patient's condition and the information received on the telemonitoring device. They communicate with the patients by telephone at regular intervals and make home visits when needed.

Telemonitoring doesn't replace face-to-face visits by the nurses, but it enables them to maximize their time and manage a larger caseload.

"Because we are monitoring the patients seven days a week, we can determine if we need to visit. If the nurses and the patient are working well together and getting the patient's condition under control, there is no need to send a nurse out there. Instead, we can send the nurses to see someone else where it is more appropriate," he says.

When the nurses see patients developing problems, they work in conjunction with the physician to get the patient back on track.

In some cases, it might be as simple as reminding the patient to change his or her eating habits. Other times, the physician may adjust the medication.

For instance, if a congestive heart failure patient has gained weight, the nurse will ask what he or she ate the day before and may determine that a salty food is causing the weight gain.

Since the nurses are getting objective data every day, they can work with the physicians to help them make more informed decisions.

For instance, if a patient has an appointment with his or her physician, the nurses can provide three weeks worth of daily biometrics on which the physician can base treatment decisions.

"We believe if we monitor patients daily, we have a better chance of helping them keep their condition under control and increasing their quality of life," Farber says.

For instance, the monitoring data may show that a patient with hypertension has a spike in blood pressure. The nurse passes the information on to the doctor, who may make a change in the medication, stabilizing the patient's blood pressure.

The average patient stays in the telemonitoring program for 60 days, longer if they need more support.

"The clients feel a sense of comfort, because someone is looking out for them. Sometimes a call from the nurse is the only communication a client gets that day," Farber says.

(For more information, contact: Brian Farber, Bayada Nurses,