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One company wondered how chronically ill patients could use the computer to access its Web-enabled disease management programs. It conducted a year-long study on three groups of patients with congestive heart failure (CHF), and demonstrated reduced hospitalizations and shorter hospital stays. Additional findings demonstrated improved compliance, beneficial lifestyle modification, and cost savings.
LifeMasters Supported SelfCare, a provider of interactive health management services in Newport Beach, CA, chose its study population from patients of the Physicians Medical Group in Santa Cruz County, CA. The group of 69 primarily elderly patients with moderate to severe CHF was randomized into two study groups.
The first group, the Web Intervention Group, used a personal computer and the Internet to enter vital signs and symptoms into the LifeMasters database. Web users also had access to disease-specific content, community chat, and e-mail interaction with a LifeMasters nurse.
The second group, the Interactive Voice Response (IVR) Intervention Group, used a touch-tone telephone to enter similar measurements into the same database. IVR users had access to printed disease-specific patient education materials and telephonic interaction with a LifeMasters nurse. A third group, the Non-Intervention Group, did not participate in the intervention but received traditional medical care. Participation in the study was coordinated by Physicians Medical Group and was funded in part by Intel Corp. of Santa Clara, CA.
The author of the study expected to find some resistance to using the computer from patients of this age — 92% of the participants had not used a computer before. However, she found them surprisingly willing to try it. "We didn’t have anyone who said they did not want to use a computer before they tried it. We had two who tried it and said it wasn’t something that held their interest," says Christine Ruggerio, RN, MSN, manager of Clinical Web Programs for LifeMasters. She presented the results of the study at the 2001 Annual Healthcare Information and Management Systems Society Conference and Exhibition in New Orleans.
The patients adapted to the technology well, she says. "Not only did the technology engage them, but compliance with daily data entry was greater than 80%."
The Web group showed other positive results too. Here are some of the study’s findings:
• Patient satisfaction: Eighty-three percent of the patients reported high satisfaction with the program, and 73% expressed a belief that the program was making a difference in their care (combined data for Web and IVR groups).
• Hospitalizations: The Web group had 20 hospitalizations, while the IVR group had 39 hospitalizations.
• Length of stay: The Web group had 149 hospital days; the IVR group had 258 hospital days.
• Patient compliance: The Web group had 84% compliance; the IVR group had 76% compliance.
• Lifestyle change: Findings indicated positive changes related to diet, exercise, and medication regimens (combined data for Web and IVR groups).
"Overall health care claims costs for the study population remained stable, while overall health care claims costs for the non-enrolled population increased by over $3,600 annually per individual," Ruggerio explains. "This data reflects the impact of a proactive intervention in halting the expected progression of a chronic disease."
In addition, the study population had a decrease in cardiac claims costs of approximately $2,400 annually per individual, while the non-enrolled population had an increase in cardiac claims of greater than $1,200 annually per individual. The study also found that with training and coaching, patients (average age: 79) were able to use the personal computer and the Internet as a health care tool, as well as to increase socialization. The group eventually used the Internet for other purposes beyond health care, such as e-mailing family and friends, playing games on-line, researching investments, and exploring other interests.
"This is particularly important for chronically ill patients who are often isolated or homebound," Ruggerio explains. "Resulting depression can often contribute to the progression of their disease. The study showed that the computer can play a contributing role in engaging patients and actually improving a patient’s quality of life."
At the completion of the study in October 2000, 90% of the patients elected to continue using the computer for Web entry of vital signs, health care monitoring, and other Internet uses.
The study challenged two negative beliefs, says Wells Shoemaker, MD, medical director for Physicians Medical Group of Santa Cruz, CA: first, bad outcomes are unavoidable for CHF patients; and second, senior citizens cannot master modern electronic communications. "Beyond the reduction in burden of illness and associated financial costs, the project gave participants a new confidence and enthusiasm in their ability to control their own health status."
The results of this study prove that the Internet can be used successfully as a platform for the delivery of quality care, Ruggerio says. "The Web allows us to give our patients more options and the flexibility to tailor programs to meet the varied needs of the individual among large populations."
The next step is to try to find out exactly what these results mean and how they can be generalized, she says. "We haven’t completed all of the statistical analysis that we would like on the results," Ruggerio notes. LifeMasters has also provided computers to a group of diabetic patients and is showing good results with them. However, this study was not conducted as a randomized clinical trial.
The researchers also need to look at the number of patients who are getting computers on their own, Ruggerio adds. For example, elderly people constitute one of the fastest-growing populations of computer users. "More patients who have chronic illnesses are going to have access to computers," she says. "We need to find ways to help them."