Evaluation of a Virtual Home Health Heart Failure Program: Mixed Methods Study

Abstract

Background: Heart failure is a prevalent and debilitating condition, affecting millions globally and imposing a significant burden on patients, families, and health care systems. Despite advancements in medical treatments, the gap in effective, continuous, and personalized supportive care remains glaringly evident. To address this pressing issue, virtual health care services delivered by interdisciplinary teams represent a promising solution. Understanding the outcomes and experience of remote monitoring-enabled interdisciplinary chronic disease management programs can inform resource allocation and health care policy decisions.

Objective: The purpose of this study was to evaluate the clinical and behavioral outcomes of patients undertaking a Virtual Home Health Heart Failure Program (VHHHFP) and explore the experiences of patients and health care practitioners (HCPs).

Methods: The VHHHFP is a virtual postdischarge support service for patients with heart failure that includes an intensive 3-month period followed by a maintenance period delivered by an interdisciplinary team. A mixed methods study was conducted with patients and HCPs. Self-reported outcome data (KCCQ-12 [Kansas City Cardiomyopathy Questionnaire-12], PHQ-4 [Patient Health Questionnaire-4], PAM-13 [Patient Activation Measure-13], and PREMs [Patient Reported Experience Measures]) were obtained from the records of patients (N=49) who completed the intensive phase of the VHHHFP, and interviews were conducted with patients (n=9) and HCPs (n=6). A paired t test was used to compare quantitative data before and after the 3-month intervention, and a thematic qualitative analysis was undertaken of interview data.

Results: Thirty-one of the 55 (77.5%) patients completed the baseline and 3-month follow-up KCCQ-12 assessment. The mean KCCQ-12 summary score at 3 months was 72.20 (SD 20.2), which was significantly higher than the mean summary score at baseline of 50.51 (SD 17.59; P<.001). These findings were similar for the KCCCQ-12 subscales: physical limitations (mean 47.09, SD 29.7 and mean 69.43, SD 22.6; P<.001), quality of life (mean 43.75, SD 21.7 and mean 62.91, SD 25.7; P<.001), symptom frequency (median 60.40, IQR 1-100 and median 91.70, IQR 35.40; P<.001), and social limitation (median 50.0, IQR 1-100 and median 82.50, IQR 32.50; P<.001). The PHQ-4 measure of psychological health was completed by 32 (80%) patients. The median scores at baseline and follow-up for total distress (median 1.50, IQR 0-7 and median 0.0, IQR 0-8; P<.02), and the anxiety subscale (median 1.0, IQR 0-6 and median 0.0, IQR 0-4; P<.02) reduced over time. Six hospital admissions were recorded (10.2% of 49 patients) within 30 days. Nine patient interviews aligned with the value-based health care (VBHC) Capability, Comfort, and Calm (CCC) framework. Three themes were identified, which are as follows: (1) enhanced patient capability, (2) improved patient comfort, and (3) positive influences on calm. Six health care professionals shared experiences of the VHHHFP, with three emerging themes: (1) improved patient capability through shared decision-making, (2) improving capability through care practices, and (3) promoting comfort and calm through virtual coordination and collaboration.

Conclusions: The use of technologies to support the management of HF is an area of growth. This study contributes to the understanding of how remote patient monitoring with interdisciplinary chronic disease support, integrated into an existing system, can improve clinical outcomes for patients.

Keywords: Australian; healthcare systems; heart failure; mixed methods study; monitoring support program; patient care team; quality of life; supportive care; telemedicine; value-based healthcare; virtual health; virtual healthcare.

Figure 1.. The patient journey through the Virtual Home Health Heart Failure Program (a 3-months intensive phase followed by a maintenance period). GP: general practitioner.