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.
Lynne Weir, physical therapist and the Inova cardiac program's clinical coordinator who works with the program, says the patients answer five questions on the phone:
- Are they short of breath more than usual?
- Did they notice swelling or bloating more than usual?
- Did they wake up with shortness of breath?
- Did they have to sleep in a chair or propped up with pillows?
- Were they light-headed or dizzy?
If the patients don't call the designated number by noon, a case worker calls them back directly. During the first six months of the program, 47 patients complied consistently.
Also, if they don't own a scale and don't have the means to buy one, Inova will take care of that too.
Compared with another set of patients who were not enrolled in the program or who were enrolled but for some reason dropped out, the CHF project reduced rehospitalizations as well as the cost of each hospitalization, from $10,305 to $6,536.
"We avoided a lot of panic calls to doctors offices, too," Weir says.
Also compared with another set of patients with CHF seen by the health system a year earlier, the hospital was able to reduce all-cause admissions by 31%.
The return on investment is favorable as well, Weir says. With an average cost of $50 per patient per month, the savings were worth it, even considering start-up costs, she says.
The program's cost was estimated at $74,300 for the first six months, with an estimated saving from avoided hospitalizations, or avoided more acute hospitalizations, of $99,291.
Now, the health system has expanded the program 150 patients.
Sherber says that for these patients, who tend to be older with multiple medical issues, taking the time to weigh themselves daily and monitor their symptoms may be something they otherwise would not want perform.
"This is an example of an implementation of a program that not only helps patients, but also helps physicians deliver care they want to give and helps the hospital to decrease unnecessary utilization at the same time," Sherber says. He adds that a similar call-in template is now being developed for patients with diabetes.
"A year from now, we'll be enrolling a lot more patients in this program," he says.