Clinical Effectiveness, Access to, and Satisfaction With Care Using a Telehomecare Substitution Intervention: A Randomized Controlled Trial

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School of Nursing Departmental Papers
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Critical Care Nursing
Geriatric Nursing
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Bowles, Kathryn H
Hanlon, Alexandra L
Glick, Henry A
Naylor, Mary D
O'Connor, Melissa
Shih, Nai-Wei
Weiner, Mark G
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Background. Hospitalization accounts for 70% of heart failure (HF) costs; readmission rates at 30 days are 24% and rise to 50% by 90 days. Agencies anticipate that telehomecare will provide the close monitoring necessary to prevent HF readmissions. Methods and Results. Randomized controlled trial to compare a telehomecare intervention for patients 55 and older following hospital discharge for HF to usual skilled home care. Primary endpoints were 30- and 60-day all-cause and HF readmission, hospital days, and time to readmission or death. Secondary outcomes were access to care, emergency department (ED) use, and satisfaction with care. All-cause readmissions at 30 days (16% versus 19%) and over six months (46% versus 52%) were lower in the telehomecare group but were not statistically significant. Access to care and satisfaction were significantly higher for the telehomecare patients, including the number of in-person visits and days in home care. Conclusions. Patient acceptance of the technology and current home care policies and processes of care were barriers to gaining clinical effectiveness and efficiency.

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2011-08-31
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International Journal of Telemedicine and Applications
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