How a Home Monitoring Program Slashed Hospitalizations and Bed Days

The proof is always in the pudding.  How about THIS pudding…..

May 27, 2014 | Eric Wicklund – Editor, mHealthNews

Hospital systems looking for the value of a home-based monitoring program for discharged patients might be interested in a nine-month project undertaken by North Carolina-based Vidant Health.

The health system, a nine-hospital, 70+-clinic network serving some 29 counties and 1.4 million people, reported a whopping 67 percent reduction in hospitalizations and a 68 percent reduction in hospital bed days, according to a case study prepared by Bonnie Britton, MSN, RN, ATAF, Vidant’s telehealth program administrator, and the LeadingAge Center for Aging Services Technologies.

The study further proof that health providers are seeing measured success in connecting recently discharged patients and those with chronic conditions to home-based care programs that make use of monitoring devices and a communications link to care providers.

Hospital administrators proposed the post-hospital discharge program to target patients with cardiovascular disease and pulmonary disease, who are generally part of a health network’s high-risk, high-cost population. The project was designed to measure patient communication and access to care after discharge, as well as readmissions and days spent in the hospital as a result (bed days).

According to the case study, Vidant Health enrolled 1,323 cardiovascular and pulmonary disease patients – identified through the health system’s electronic health record – in the program. Candidates were asked to take a Patient Activation Measurement (PAM) survey, and if they scored high enough and agreed to participate, they and their family members were visited by a telehealth nurse technician (TNT), who conducted a home safety assessment, installed the home monitoring technology, trained the patient and catalogued and compared all medications in the home to ensure they met the hospital’s discharge medication list.

Once activated, the patient was asked to, on a daily basis, collect his or her biometric data, which were then encrypted and transferred to a cloud-based server and reviewed each day by a telehealth nurse. If the nurse found any reason for a medical intervention, he or she contacted the patient’s doctor via the EHR.

Patient data was collected for the three months prior to the project, the three month duration of the project, and three months after the project was completed. Hospitalizations dropped from 820 in the three months prior to 270 during the project to 248 in the three months after the project, while hospital bed days dropped from 3,778 before to 1,182 during to 1,210 after, according to the case study,

The health system also reported a patient satisfaction rate of 56 percent, taken at the mid-point of the program.

While health system officials haven’t figured the impact on hospital costs, charges, readmission and reimbursement – they’re waiting for the end of the fiscal year to compile those results – they did estimate that hospitalization costs to payers dropped 68 percent as a result of the program.

In terms of ROI so far, officials said the remote monitoring program and associated medication monitoring reduced hospitalizations, bed days and emergency room visits, while enabling officials to earlier identify and treat disease exacerbations. It also improved patient engagement.

The health system also offered several lessons learned from the experience:

  • Each telehealth program is different, and has to be planned and evaluated based on the unique goals of the provider and the population and conditions to be addressed.
  • Integrating a telehealth program with the provider’s EHR is difficult.
  • Focus on the services offered to patients, rather than the technology
  • Make sure the organization’s chief financial officer is part of the project, and identify what data will be collected ahead of time to ensure ROI is understood and demonstrated.
  • Focus on high-risk, high-cost patient populations.

Ideal Life CEO Jason Goldberg, who presented at one of the American Telemedicine Association conference’s industry council executive sessions, sees home health monitoring programs finally finding their foothold in the healthcare landscape.

The Toronto-based Ideal Life provided in-home monitoring equipment for the Vidant Health project and also distributed the case study at the ATA show.

During an interview with mHealth News earlier this year, Goldberg said providers and payers are seeing the value in connecting with consumers in their homes.

“The market is growing effectively,” Goldberg told mHealth News. “It’s still probably a year away fundamentally from (universal healthcare acceptance), but it’s becoming a standard of care.”