Clinical effectiveness, access to, and satisfaction with care using a telehomecare substitution intervention: a randomized controlled trial

Abstract

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.

Figure 1

Consort diagram.

Figure 2

Kaplan-Meier survival curve of time to first all-cause readmission or death for telehealth group versus control usual care group (LR P-value = 0.585).

Figure 3

Kaplan-Meier survival curve of time to ED use for telehealth group versus control usual care group (LR P-value = 0.699).