Telemonitoring reduces HF readmissions
Program monitors weight, answers questions
UCare's telemonitoring program for at-risk members with heart failure has resulted in a 40% reduction in inpatient admissions and a 26% drop in emergency department visits.
Patients are eligible for the high-intensity program if they have had two or more hospital admissions or emergency department visits for heart failure in the past 15 months. Some patients are referred to the program by their primary care physician or the UCare health coaches, who review monthly claims reports and call members with heart failure and screen them for their risk level, according to Jodie Milner, RN, CHC, manager of health improvement for the Minneapolis-based health plan.
Members with heart failure who are considered at-risk are offered the health plan's Healthy Heart program, which includes telephonic health coaching.
UCare sends referrals for the program to a vendor which administers the telemonitoring program. Patients receive a welcome letter that explains the program and how they were identified, and gives them an opportunity to opt out. An enrollment specialist calls patients who want to participate, and explains the program. Participants receive a telemonitoring device along with detailed, easy-to-understand instructions on how to hook the device into a telephone jack and electrical outlet. Members who don't have a land line receive a device that works with a cellular telephone.
The telemonitoring scale is available in a number of languages.
Members weigh themselves daily on the scale and answer a series of 13 to 15 questions related to heart failure that can be answered "yes" or "no." Questions include:
- Are you more short of breath today?
- Are your ankles more swollen today?
- Have you taken all of your medicine?
- Are you coughing?
The questions may change on a daily basis depending on the member's response. In addition, the vendor nurse can send targeted messages across the screen on the device.
When the member answers "yes" to any question, the device, using branching logic, asks more questions that drill down to determine the cause of the symptom.
The member's weight and the results of the questions are transmitted over a toll-free line to a computer screen that is monitored by a nurse. If members report symptoms that are outside the normal parameters, the nurse receives a red flag alert.
"If a member has gained or lost weight or reports a symptom that could indicate a red flag, the nurse follows up by telephone and asks more questions to find out what is going on," Milner says. For instance, if members have gained weight, the nurse may ask about recent meals to determine if they need to reduce their salt intake.
The nurse follows up with any patient who appears to be experiencing problems. The nurse may manage the problem by telephone or refer the member to his or her primary care physician for a same-day appointment.
If members do not weigh in, the nurse calls them to find out why. Members who have been doing well receive a call from the nurse each month. During the phone calls, the nurse educates patients on managing their disease, diet and exercise, smoking cessation, the importance of getting flu and pneumonia shots, and tips for healthy living.
When members have had their weight under control and haven't reported any symptoms for a period of time, they will be discharged from the program.
"Patients often don't want to leave the program. They get used to using it as a safety net, but we want them to get in the habit of weighing themselves daily, eating right, exercising, and taking their medication on their own," Milner says. n