cavhs—where veterans come first disclosuredisclosure 1. no planner, presenter, faculty, authors,...

CAVHS—Where Veterans Come First

DISCLOSUREDISCLOSUREDISCLOSUREDISCLOSURE

1. No planner, presenter, faculty, authors, or content expert has identified a conflict of interest that would affect the educational activities.2. No commercial interest has provided financial or in-kind support for this educational activity. 3. The Arkansas Nurses Association has provided financial or in-kind support for this educational activity in the form of printing and food costs. 4. Neither ANCC, SCAP, or ARNA endorse any commercial products discussed/displayed in conjunction with this educational activity.

South Central Accreditation Program (SCAP) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.


The Impact of Telehealth Programs on Chronic Heart Failure Patient

Outcomes: A Literature Review

Central Arkansas Veterans Healthcare System

October 2015

The Impact of Telehealth Programs on Chronic Heart Failure Patient

Outcomes: A Literature Review

Central Arkansas Veterans Healthcare System

October 2015

Britteny Bass BSN, RN , LaRhonda Bealer BSN, RN , Becky Wimberly MA, Britteny Bass BSN, RN , LaRhonda Bealer BSN, RN , Becky Wimberly MA, BSN, RNBSN, RN


PretestPretestPretestPretest

• Approximately 10% of CHF patients are re- hospitalized within 6 months of discharge. True or False

• In 2010, the estimated direct and indirect annual cost of heart failure was $39 billion. True or False

• Literature shows significant risk reduction of 28% in CHF hospitalization with home telehealth versus usual care. True or False


ObjectivesObjectivesObjectivesObjectives

1. By the end of this session, participants will be able to describe at least two ways that CHF impacts patients in the US.

2. By the end of this session, participants will be able to describe at least to ways to manage CHF through telehealth outreach programs.

3. By the end of this session, participants will be able to describe at least two ways telehealth programs can impact CHF treatment plans.


What is What is Chronic Heart FailureChronic Heart Failure

What is What is Chronic Heart FailureChronic Heart Failure

• Heart failure is a common chronic disease marked by frequent exacerbations often resulting in hospitalization and death.

• Heart failure is the leading cause of hospitalization for Americans over age 65.

• Approximately 50% of CHF patients are re- hospitalized within 6 months of discharge.


National Measure National Measure National Measure National Measure

• National Veterans Health Administration (VHA) – to reduce hospital readmissions of the CHF patient as a way of improving quality and reducing costs.

• A CHF Readmission is defined by patients who had an initial hospitalization for CHF & were readmitted at least once to acute care in the hospital within 30 days of discharge for CHF


AHA Policy AHA Policy StatementStatementAHA Policy AHA Policy StatementStatement

• By 2030, you - and every U.S. taxpayer could be paying $244 a year to care for heart failure patients


Projected Cost of Projected Cost of CHFCHF

Projected Cost of Projected Cost of CHFCHF


CHF Arkansas CostCHF Arkansas CostCHF Arkansas CostCHF Arkansas Cost

• Average cost for inpatient stay is $16,641

• Or• $3,390 per BDOC


CHF ArkansasCHF ArkansasCHF ArkansasCHF Arkansas


CHF CAVHS COSTCHF CAVHS COSTCHF CAVHS COSTCHF CAVHS COST

• 235 discharges in FY15 – Average cost per discharge $13,864– Total expense $3,258,241

• 356 discharges in FY14

• 388 discharges in FY13


Home Telehealth at Home Telehealth at CAVHSCAVHS

Home Telehealth at Home Telehealth at CAVHSCAVHS

• Is defined as a program into which Veterans are enrolled that applies care and case management principles to coordinate care using health informatics, disease management and Home Telehealth (HT) technologies to facilitate access to care and to improve the health of Veterans with the specific intent of providing the right care in the right place at the right time.


Home Telehealth Home Telehealth Home Telehealth Home Telehealth

• The goals of Home Telehealth (HT) – improve clinical outcomes and access to

care – reduce complications, hospitalizations, clinic

and/or emergency room visits


Home TelehealthHome TelehealthHome TelehealthHome Telehealth

Four components to the HT program: 1. Disease Management 2. Care/Case Management 3. Self-Management of Chronic Disease 4. Telehealth technologies used to deliver these components.


Telehealth Telehealth TechnologiesTechnologies


• Device-Based Telemonitoring

• Interactive Voice Response System

• Web-Based Telemonitoring


Telehealth Telehealth Technologies Technologies

Telehealth Telehealth Technologies Technologies

• Device-Based Telemonitoring– Electronically submitted vital

sign data and symptom responses using attached peripheral devices

– Includes modems, broadband or landline




• Interactive Voice Response System-manual input of data using

telephone keypad to send information concerning vital signs and symptoms to healthcare provider




• Web-Based Telemonitoring– manual input of data using internet

access, allowing patient to gain secure access to web-based portal to enter their vital signs obtained through stand-alone peripheral devices


Who Could BenefitWho Could Benefit

∙ Diabetes∙ Chronic Obstructive Pulmonary Disease (COPD)∙ Hypertension (HTN)∙ Congestive Heart Failure (CHF)∙ Bipolar Disorder∙ Depression∙ Schizophrenia∙ Substance Abuse∙ Post-Traumatic Stress Disorder (PTSD)

May be a combination of above diagnosisMay be a combination of above diagnosis


Why Participate?Why Participate?Why Participate?Why Participate?

• Use every day at home• Gain confidence &

improves independence at home

• Links Veteran directly to RN Care Coordinator

• Alerts health care team before problems occur

• Personalized and individualized care

• Prevents unnecessary clinic, hospital or ER visits

• Helps Veteran follow prescribed plan of care

• Provides daily knowledge of health status

• Improves quality of life• Provides peace of mind


TelehealthTelehealthTelehealthTelehealth

• There is a trend to the way health care is being delivered due to:– Increased age of population– Needs of returning service members from conflicts in

Iraq & Afghanistan– Limited access to care in rural/remote areas

• MAKES THE HOME AND COMMUNITY THE PREFERRED SITE OF CARE


Telehealth PerformanceTelehealth

Performance• It’s been shown that the recording of data & answering of symptom

related questions could reduce mortality risk by 34% & the risk of CHF-related hospitalization by 15%.

• By adding the monitoring of HR, mortality could be reduced by 40% & CHF-related hospitalizations by 43%.

• Studies have shown it significantly reduces all-cause mortality by an average of 24%, CHF-related hospitalization by 28% and CHF-related LOS by 1.4 days.


Home Telehealth Home Telehealth StoriesStories

Home Telehealth Home Telehealth StoriesStories

http://vaww.telehealth.va.gov/resources/video/mlmhmc.asf


QuestionsQuestionsQuestionsQuestions


Post-testPost-testPost-testPost-test

• Approximately 10% of CHF patients are re- hospitalized within 6 months of discharge. True or False

• In 2010, the estimated direct and indirect annual cost of heart failure in the US was $39 billion. True or False

• Literature shows significant risk reduction of 28% in CHF hospitalization with home telehealth versus usual care. True or False


ReferenceReferenceReferenceReference

• American Heart Association Policy Statement (2013). American Heart Association: Direct, indirect costs to treat heart failure could more than double in 2030.

• 2012 Arkansas Department of Health, Chronic Disease Prevention & Control Branch Heart Disease & Stroke Prevention Section. www.healthy.arkansas.gov

• 2010 VHA Facility Quality and Safety Report, Dept. of Veterans Affairs, VHA October 2010; p. 20-21

• Spyros, K., Pare, G., & Jaana, M. (2015). Effects of home telemonitoring interventions on patients with chronic heart failure: An overview of systematic reviews. Journal of Medical Internet Research, 17(3), e63. doi: 10.2196/jmir.4174

• Varon, C., Alao, M., Minter, J., Stapleton, M., Thomson, S., Jaecques, S., Brunner-La Rocca, H.P., & Van Huffel, S. (2015). Telehealth on heart failure: Results of the Recap project. Journal of Telemedicine and Telecare, 0(0), 1-8. doi: 10.1177/1357633X15577310

• Xiang, R., Li, L., & Liu, S.X. (2013). Meta-analysis and meta-regression of telehealth programmes for patients with chronic heart failure. Journal of Telemedicine and Telecare, 19(5), 249-259. doi: 10.1177/1357633X13495490

cavhs—where veterans come first disclosuredisclosure 1. no planner, presenter, faculty, authors,...

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