Managing Chronic Illness: Telemonitoring vs Telephone

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Telehealth (the monitoring of a patient's vital signs and condition using telecommunications equipment) is seeing a great deal of growth in the homecare industry as a cost-effective means to closely monitor patients. Home health agencies are seeking alternatives to care that reduce their costs and make them more efficient while maintaining or improving the quality of patient care. However, no studies have directly evaluated the value of this additional technology over the more commonly tested telephone disease mangement programs. This proposed randomized field study will address this gap in knowledge and attempt to demonstrate how patients with a primary diagnosis of heart failure, diabetes or hypertension respond to evidence based disease management protocols provided using telemonitoring and in-person home care versus just telephone and in-person home care. The aims of this study are to, 1) compare the effects of these two disease management modalities on health outcomes such as patients' subjective health status rating, sell care knowledge and behavior, and resource utilization. 2) examine the advantages and disadvantages of delivering disease management protocols via telemonitoring versus telephone during an episode of home care. One group will receive the protocols via a telemonitoring unit that provides peripheral devices for physiological monitoring. A second group will receive the disease management protocols over a standard telephone. Both groups will be enrolled in traditional skilled home care. Study outcomes will be measured upon admission into the study and at discharge (typically 45-60 days later). Nurses from the four participating home health agencies will be trained in using the disease management protocols. All of the agencies currently conduct telemonitoring of heir patients but no disease management. Patient outcomes will include: self-care knowledge and behavior related to diet and medications, health status, and health care utilization. Data analysis will include mixed model ANOVA for continuous variables, non-parametric analogues of ANOVA for ordinal variables, Fisher's exact test for discrete endpoints, and survival analysis for time to first readmission. Findings regarding health outcomes and advantages and disadvantages of the two interventions will guide the design of a larger clinical trial to compare telemonitoring to telephone disease management.