Clinical Problem

1. Evidence Favoring TM Clinical Problem Intervention With a TM system, CHF patients are required to take blood pressure, heart rate, oxygen saturation, and weight on a daily basis at the same predetermined time. Patients are prompted to answer yes/no questions regarding the CHF process with a single key press. The data is collected within 5-10 minutes and sent via phone line to the health care agency, where telehealth nurses review the data, and follow-up with a phone call for abnormal readings. The telehealth nurse provides education on the importance of body weight measurements, medication compliance, dietary and fluid restrictions, and symptoms of worsening CHF. The telehealth nurse is able to collaborate with the patient’s provider for new orders, and make a home visit if necessary. • In U.S. 660,000 new cases of CHF diagnosed yearly. • 5.8 million in U.S. and 23 million people in the world have CHF. • CHF is the most common cause of rehospitalizations and the mortality rate is 50% within 5 years of diagnosis. • CHF healthcare costs total to $34 billion. • 1 million rehospitalizations in the year 2000 & 2010, signifying no improvement in care. • 50% of CHF-related rehospitalizations are avoidable • (AHA, 2012; CDC, 2012) Incorporating Telemedicine (TM) to Reduce the Rates of Rehospitalizations in the Chronic Heart Failure (CHF) PopulationRoshini M. Mathew RN, BSN, Erica Robertson RN, BSN,Jennifer Hoggatt RN, BSN, Chadwick Boberg RN, BSN Background • Verbal or written education and 2-3 weekly homecare visits by nurses are insufficient methods to manage disease. • TM delivers safe, cost-effective care by providing constant remote surveillance of high-risk patients using digital technology. • TM improves access to care, eliminates disparities, and improves patient outcomes. • TM promotes self-management of disease process, resulting in lifestyle changes. • TM assists in identifying signs and symptoms of CHF exacerbation, thus resulting in earlier implementation of medical care and preventing rehospitalizations. • (IOM, 2012; Taylor-Clarke et al., 2012; Weintraub et al., 2010) Evaluation Donabedian Method: Supports IOM priority concern regarding CHF disease process by evaluating all aspects of care that may contribute to the outcomes. Stakeholders Outcomes • Practice change team/agents: Administrators, RN’s, Nurse Practitioner, Cardiologist, Primary Care Physician, PT, OT, Nutritionist, Telehealth Nurse, HomeMed reps • Key Informants/reps/agents: Hospitals, Heart Failure Clinics, Home Health Agencies, Social Workers, Patients, Caregivers • Baseline hospitalization data was compared with the post study data to reveal Cronbach’s alpha was greater than 0.80 (0.85). • The pilot study supports the use of TM in the CHF patient population to reduce rehospitalizations. • Intermediate outcomes: lower blood pressure, greater medication and diet adherence, improved mental, physical, and emotional well-being. Evidence Based Practice Model (Rosswurm & Larrabee, 1999) Step 1-Assess need for Change in Practice Step 2-Locate the Best Evidence Step 3-Critically Analyze the Evidence Step 4-Design Practice Change Step 5-Implement /Evaluate Practice Change Step 6-Integrate /Maintain Practice Change Clinical Implications PICOT In patients with CHF (P), how effective is the implementation of TM in the home (I) compared to the visitation of home healthcare nurses (C) in the prevention of rehospitalizations (O) over a 6-month time period (T)? • TM, while a costly initial intervention, supports long-term benefits of cost savings and increased quality of life in the CHF population. • Clinicians can better monitor and educate CHF patients via TM while still maintaining personal contact. • TM improves access to care, avoiding barriers such as inadequate transportation and financial resources. • TM assists patients and caregivers in learning about CHF disease process and prevention strategies.