Use of a homecare electronic health record to find associations between patient characteristics and re-hospitalizations in patients with heart failure using telehealth

Data from homecare electronic health records were used to explore the association of patient characteristics with re-hospitalizations of patients with heart failure (HF) during a 60-day period of telemonitoring following hospital discharge. Data from 403 Medicare patients with HF who had used telehealth from 2008 to 2010 were analysed. There were 112 all-cause (29%) and 73 cardiac-related (19%) re-hospitalizations within 60 days of the start of telemonitoring. In adjusted analyses, the patients’ number of medications and type of cardiac medications were significantly (P < 0.05) associated with an increased risk of re-hospitalization. After stratifying the sample by illness severity, age and gender, other significant (P < 0.05) predictors associated with an increased risk of all-cause and cardiac re-hospitalization were psychiatric co-morbidity, pulmonary and obesity co-morbidities within gender, beta blocker prescription in females and primary HF diagnosis in the oldest age stratum. The study's findings may assist homecare agencies seeking to allocate resources without compromising patient care.

[1]  Dawn Nelson,et al.  Impact of the implementation of telemanagement on a disease management program in an elderly heart failure cohort. , 2007, Progress in cardiovascular nursing.

[2]  R. Pekmezaris,et al.  The impact of remote patient monitoring (telehealth) upon Medicare beneficiaries with heart failure. , 2012, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[3]  S. Scalvini,et al.  Effect of home-based telecardiology on chronic heart failure: Costs and outcomes , 2005, Journal of telemedicine and telecare.

[4]  Kathryn H. Dansky,et al.  Impact of Telehealth on Clinical Outcomes in Patients With Heart Failure , 2008, Clinical nursing research.

[5]  B. Riegel,et al.  Self care in patients with chronic heart failure , 2011, Nature Reviews Cardiology.

[6]  A. Wu,et al.  Chronic Medical Illness, Depression, and Use of Acute Medical Services Among Medicare Beneficiaries , 2004, Medical care.

[7]  M. Naylor,et al.  Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized, Controlled Trial , 2004, Journal of the American Geriatrics Society.

[8]  M. Pfisterer,et al.  Drug Treatment of Chronic Heart Failure in the Elderly , 2007, Drugs & aging.

[9]  Kathryn H Bowles,et al.  A comparison of in-person home care, home care with telephone contact and home care with telemonitoring for disease management , 2009, Journal of telemedicine and telecare.

[10]  Stephen Morris,et al.  A randomized trial of home telemonitoring in a typical elderly heart failure population in North West London: results of the Home‐HF study , 2009, European journal of heart failure.

[11]  Piotr Ponikowski,et al.  Home telemonitoring in heart failure patients: the HHH study (Home or Hospital in Heart Failure) , 2009, European journal of heart failure.

[12]  B. Avitall,et al.  Outcomes of chronic heart failure. , 2003, Archives of internal medicine.

[13]  J. McMurray,et al.  Heart failure and chronic obstructive pulmonary disease the quandary of Beta-blockers and Beta-agonists. , 2011, Journal of the American College of Cardiology.

[14]  Sangeeta C. Ahluwalia,et al.  Impact of Comorbidity on Mortality Among Older Persons with Advanced Heart Failure , 2012, Journal of General Internal Medicine.

[15]  P. Armstrong,et al.  Renal Insufficiency and Heart Failure: Prognostic and Therapeutic Implications From a Prospective Cohort Study , 2004, Circulation.

[16]  B. Wakefield,et al.  Outcomes of a home telehealth intervention for patients with heart failure , 2009, Journal of telemedicine and telecare.

[17]  P Baiardi,et al.  Multicenter randomised trial on home-based telemanagement to prevent hospital readmission of patients with chronic heart failure. , 2009, International journal of cardiology.

[18]  B. Tabachnick,et al.  Using Multivariate Statistics , 1983 .

[19]  C. Steiner,et al.  Comorbidity measures for use with administrative data. , 1998, Medical care.

[20]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2012 update: a report from the American Heart Association. , 2012, Circulation.

[21]  Nilay D Shah,et al.  Medication adherence among community-dwelling patients with heart failure. , 2011, Mayo Clinic proceedings.

[22]  A. Morguet,et al.  Impact of Telemedical Care and Monitoring on Morbidity in Mild to Moderate Chronic Heart Failure , 2008, Cardiology.

[23]  Gianfranco Parati,et al.  Impact of telemonitoring at home on the management of elderly patients with congestive heart failure , 2008, Journal of telemedicine and telecare.

[24]  Kathryn H. Bowles,et al.  Clinical Effectiveness, Access to, and Satisfaction with Care Using a Telehomecare Substitution Intervention: A Randomized Controlled Trial , 2011, International journal of telemedicine and applications.

[25]  William T. Abraham,et al.  Risk stratification for in-hospital mortality in acutely decompensated heart failure. Classification and regression tree analysis , 2005 .

[26]  J. Spertus,et al.  Depression-related costs in heart failure care. , 2002, Archives of internal medicine.

[27]  J. Strain,et al.  Congestive heart failure and depression in older adults: clinical course and health services use 6 months after hospitalization. , 2003, Psychosomatics.

[28]  M. Volpe,et al.  The challenge of polypharmacy in cardiovascular medicine , 2010, Fundamental & clinical pharmacology.

[29]  Harlan M. Krumholz,et al.  Recent National Trends in Readmission Rates After Heart Failure Hospitalization , 2010, Circulation. Heart failure.

[30]  Cynthia S. Jacelon,et al.  Perceptions on the Use of Telehealth by Homecare Nurses and Patients With Heart Failure , 2012 .

[31]  Amanda H. Salanitro,et al.  Risk prediction models for hospital readmission: a systematic review. , 2011, JAMA.