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Telehealth is an Effective and Efficient Approach to
Delivering Home Care. The
Centers for Medicare and Medicaid Services estimates total
national health expenditures for home care was $36.1 billion
in 20021. Historically, this
has been about one-half of the total estimated expenditures
by government, private insurance and consumers in this area.
Of growing concern is the human and financial cost of coping
with long-term, chronic diseases, especially diabetes and
congestive heart failure: |
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- Type
II diabetes mellitus is quickly becoming the most common
chronic disease in the United States. It affects more than
7% of the adult population. Nearly 16 million people in
the United States have been diagnosed, but an additional
8 million do not yet know they have the disease.2 With America's obesity rate increasing, the incidence of
Type II diabetes is expected to increase as well.3 Diabetes can lead to several secondary complications including
blindness, kidney failure, coronary artery disease, stroke,
nerve damage, and infections.
- Congestive
heart failure affects about 5 million Americans each year.
About 20 percent of hospitalized patients who are over 65
have heart failure. Each year, another 550,000 people are
diagnosed for the first time. It contributes to or causes
about 300,000 deaths each year.
Home care
providers, care givers and consumers are turning to telemedicine
to improve patient care, reduce home visit rates and to continuously
monitor chronic medical conditions with the goal of reducing
costly hospital utilization. |
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Home telehealth allows the patient the
dignity of remaining in their own home for as long as possible
and by providing care that is equal to or superior than approaches
that rely solely on health providers coming into the home
for scheduled visits.
- An
independent analysis of monitored and non-monitored patients
conducted for a telemedicine equipment vendor,4 assessed OASIS data from over 178 home health agencies using
remote home monitoring and 300 agencies that do not use
home monitoring. The study concluded that use of remote
monitoring has proven to "reduce hospitalization and
emergent care visits while improving functional status when
compared with a comprehensive clinical management program."5 For diabetes care, the average improvement/stabilization
rate in Activities of Daily living (ADL) for patients using
remote monitoring was 77.2% vs. 70.4% for those patients
not using remote monitoring. For Chronic Obstructive Pulmonary
Disease the improvement for remotely monitored patients
was 80.3% vs. 71.8%
- A study
published in the Journal of the American College of Cardiology
looked at a group of patients suffering from grade 3-4 congestive
heart failure for two years, 12 months prior to the use
of home monitoring and 12 months after the introduction
of the home telehealth monitor. After the use of the remote
monitor, the mean total hospitalization rate was reduced
from 3.2+/-1.5 to 0.8+/-1.1 hos/yr and duration from 26+/-14
to 6+/-7 days/yr (p<0.001 for both). Cardiovascular admission
decreased from 2.9+/-1.5 to 0.8+/-1.1 hos/yr and duration
from 23+/-13 to 4+/-4 days/yr (p<0.001). The vital status
(the ability to perform daily activities, expressed in a
1-4 scale) was improved from 1.4+/-0.9 to 2.3+/-0.7 (p<0.001).6
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Home monitoring programs for the elderly
are particularly cost-effective. Telemedicine can provide
effective patient monitoring for a cost of only $30 per day
in the U.S., less than half the cost per day of home care
and one-third the cost per day for nursing care. The cost
savings are most dramatic when compared to the $820 per day
cost for inpatient hospital care.7
- A demonstration
of telemedicine used in over 1,000 patient encounters in
Tennessee showed significant savings. More than 62,000 miles
of travel were saved by using telehealth. This translates
into a savings of $16,191 (62,274 miles at $0.26/mile) in
mileage that did not have to be reimbursed in the 39 months
since the program began. Additionally, nurse driving time
that did not have to be reimbursed totaled $33,042 (97,181
minutes at $0.34/minute). Overall this represented a savings
of $50.29 per home visit. Cost savings for the first 15
months of the program were $49.33 per home visit. The more
visits that are done through telehealth over time, the greater
the cost savings per visit.
- Kaiser
Permanente of Sacramento, Calif., conducted a study from
May 1996 through November1997. The study comprised intervention
and control groups of one hundred patients each with chronic
conditions. The control group continued to receive home-care
visits according to their existing plan of care, while the
intervention group was remotely monitored with a home telehealth
system as a supplement to home-care visits. The data revealed
that home telehealth provided instant access to care, created
considerable efficiency in the delivery of home care and
reduced hospitalization by two hundred days in the intervention
group.
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- In
a recent study by Wakefield et al.,8 the results indicated that 72 percent of telemedical consultations
conducted to skilled nursing facilities resulted in the
avoidance of a transport for health care evaluation. In
the cases of avoided transport, 52 percent of the consults
resulted in a change in the course of treatment for the
resident. The State of Florida published its 1999-2001 transportation
savings for a Florida Diabetes Telemedicine Program. The
cost savings with averted transportation costs were $4,699
(15 visits in 1999), $5,122 (24 visits in 2000), and $4,895
(17 visits in 2001).9
- Pringle-Specht
et al (2001) conducted a study of a wound care program in
a long-term care facility. The objective of the study was
cost analysis. The cost perspectives of the consulting agency,
the referring agency and the patient were all examined.
The average cost of a chronic wound teleconsultation was
$136.16 (acute care). Cost for an in-person traditional
visit with transportation was $246.28.10
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Using Telemedicine to Increase Productivity in the Workplace
Ben Raimer, MD, FAAP, University of Texas Medical Branch
Telehomecare: Making A Difference in Home Care CHF Patients
Rhonda Chetney, RN, MS Sentara Home care Services
Economic Assessment of Delivery Models for a Tele Homemonitoring Service
Karl A. Stroetmann PhD MBA, Institute for Communications and Technology Research
Cost Savings by Florida Diabetes Telehealth Program
Toree Malasanos, MD, Florida Department of Health, University of Florida
The Value of Interactive Home Telehealth in a Disease Management Program
Sandra Young, MSN, RN BC, Adult Medicine Clinical Nurse Specialist
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