Going Low Tech Might Reduce Costly Hospital Admissions in Chronic Heart Failure
Any hospital dealing with significant numbers of congestive heart failure patients would want to reduce costly admissions with better management for people in their homes. And Inova Mount Vernon Hospital, a 237-bed facility in Northern Virginia, is no different.
That's why it promptly embraced an idea to monitor its CHF patients' daily weight and symptoms without having to see them in a healthcare setting. So it turned to a concept that uses surprisingly simple technology: a scale and a telephone, to learn the earliest signs of fluid buildup and treat those patients before their disease gets out of control.
The process, using Pharos Innovations' Tel-Assurance Remote Patient Monitoring Platform, takes only three minutes.
"We don't have firm metrics yet, but patient satisfaction is high, and initial results favorable in terms of decreased admission rates," and for those who were admitted, their lengths of stay and acuity were reduced, as well as their cost of care, says Harvey Sherber, a cardiologist and medical director of Inova's heart and vascular program.
The health system is so encouraged by the results, it is adopting the system in its four other Inova Health System hospitals: Inova Fairfax, Inova Alexandria, Inova Loudon, and Inova Fair Oaks, Sherber says.
The program began enrolling CHF patients last October. They were told to weigh themselves daily, and call in their weight to a special number. They would also report any symptom changes daily.
If they do report such symptoms, a case manager calls them back promptly to schedule a visit to see if a medication adjustment is necessary. And, the patients are reinforced on a daily basis to watch their sodium intake and make sure they are medication compliant.
"If there are any variances, their physician's practice is promptly notified," Sherber says.
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jeffrey Davis (8/27/2009 at 3:28 PM)
Dr. Sherber, The fairly low tech process of monitoring HF patients from their homes makes total sense. Probably the main proponent of this monitoring platform has been a company called LifeMasters Supported SelfCare, Inc, South San Francisco. Scales and BP cuffs would be provided for eligible HF patients, patients were then asked to monitor themselves at home daily or 2x-3x/week and send the results via phone to a nurse. The programmatic and operational question is whether to have a trained nurse as an intermediary to the physician or to have the results come directly to the personal physician. Given the fairly high false positive rate in the patient monitory/self reporting process, LM chose the business model of using a nurse. The other major choice is whether to include a wrap around personal coaching service with the remote monitoring program in order to educate/facilitate behavior change as part of a self-efficacy model. Alternatively, this leave this function to the physician. Unfortunately, we didn't find too many physicians who did this well and/or had the time to do it satisfactorily. Jeffrey Davis, MD
Mike Barrett (8/26/2009 at 5:08 PM)
CHF weight monitoring is a fairly routine disease management process. There several systems available from highly automated where the scale itself can make the call to more "human touch" systems. Either way, yes this process works not only reduce admissions but actually improve the health status of the patient. Reasonably sophisticated "Managed Medicare" plans have been operating this process for several years.