Page 4 CaseStudiesinTelehealthAdoptionCenturaHealthatHomeHomeTelehealthastheStandardofCare

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and Porter Adventist Hospital. The typical participant current health status, and educational needs. Patients
was an older adult (average age of 76), living in his or are given peripheral devices, including a scale, blood
her own home, managing comorbid conditions, and pressure cuff, pulse oximeter, and thermometer. They
had recently experienced a hospitalization related to are monitored on a daily basis and transmit data
an exacerbation of a chronic health condition. Among through the phone line at least once daily, and more if
patients, 44 percent were diagnosed with conges- the condition requires it. Within 48 hours of discharge,
tive heart failure, 34 percent had chronic obstructive home care field nurses visit and conduct health and
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pulmonary disease, and 17 percent were diabetic. environmental risk assessments. In the following 24
Because nurses at the clinical call center were familiar hours, a telehealth technician visits the patient at home
with the use of telephonic technology but lacked train- to install and familiarize patients with the remote mon-
ing on information technology, the program empha- itoring technology. Nurses and installers are trained
sized support for nurse training and education in infor- to use the teach-back technique to assess the patient
mation technology. and family’s level of understanding and commitment.
Patients participating in the project were strati- At the same time, primary care physicians write up
fied into two categories. The first group used remote PRN orders (i.e., “as needed” orders that nurses can
patient monitoring technologies and had access to the modify), which allow the monitoring nurses to react to
24/7 clinical call center. A second tier of patients who trending and monitoring data within a specified set of
did not qualify for the Medicare homebound benefit parameters.
and tended to be more physically capable of caring for Once operational, dedicated telehealth nurs-
themselves received telephonic telehealth care through ing staff monitor patient data from the remote devices
the clinical call center. On average, the patients in the and call the patient if there are significant vital sign or
first group are enrolled in the program for 60 days. health status changes. Patients are also able to contact
Patients transmit monitoring data on a daily basis, or the clinical call center with questions 24/7. When tele-
more often if the condition requires close monitoring. health patients call, call center RNs can review patient
For patients in the second group, clinical call center data, provide assistance, and escalate the alert to a phy-
RNs set up weekly calls over a three-week timeframe sician, if needed. Primary care physicians are closely
after discharge to review medication lists and manage- involved in the program and monitor patients’ progress
ment, compare medications to discharge orders, and by reviewing weekly reports containing the patients’
educate patients using a teach-back technique that current medication list, vital sign and symptom read-
highlights patients’ level of understanding regarding ings, and nursing notes. For patients in the second
their condition and lifestyle behaviors. Upon comple- group who are solely using the clinical call center as
tion of the project, the duration of the telephonic care their telehealth strategy, clinical call center RNs set
intervention was extended to four weeks. During each up a series of weekly follow-up calls after discharge
call, nurses identified potential medical issues and to review care management plans and issues related to
decided which follow-up interventions were needed. patient self-efficacy.
Under the new integrated program, the first Patients can be discharged from the remote
group of patients using RPM received a base station patient monitoring program when they no longer meet
that displays and collects behavioral and general health home care criteria. Patients in the telephonic telehealth
questions, as well as vital sign data from peripheral intervention are discharged when the three weekly calls
devices. Baseline parameters are set using input from are complete or the patient self-discharges from the tel-
primary care physicians, as well as a telehealth algo- ephonic component. The program prepares patients for
rithm, which is customized for each patient using 2,000 eventual discharge by teaching them how to indepen-
different elements, based on patient health history, dently monitor core health indicators and to identify
red flags so they know when to contact their clinicians.