Innovative Home Monitoring Initiative Reaches 1,000-Patient Milestone

February 18, 2011

The Heart Institute’s highly successful telehome monitoring program is marking the participation of its 1,000th patient. The unique program for managing heart failure care substantially reduces hospital readmissions and saves on unnecessary health care costs.

Heart failure refers to a complex of conditions that includes heart attack, compromised heart function, high blood pressure and other contributing factors. Patients suffering from this chronic disease must be managed for the rest of their lives under close medical supervision.

Telehome monitoring enables the Heart Institute to intervene with remedial action before a small problem develops into a larger medical issue.

Due to their compromised health, heart failure patients face many potential trips to the hospital under both emergency and non-emergency circumstances. The health care system is already seeing a greater demand for medical resources for patients with congestive heart failure. Mortality and readmission rates for the condition are high and will only increase with an aging population.

Telehome monitoring enables the Heart Institute to intervene with remedial action before a small problem develops into a larger medical issue. Nurses can promptly address a range of problems, from compliance with medication or daily salt and fluid restrictions to symptom management and arrangements for lab work. This strategy improves the quality of life of heart failure patients and provides effective management of health care costs.

Ongoing research into the effectiveness of the program shows telehome monitoring has cut hospital readmissions for heart failure by 54%. The program has also been shown to save up to $20,000 for each patient safely diverted from an emergency department visit, readmission or hospital stay.

The Heart Institute started the program with 20 monitoring systems, which patients took home following discharge. Today, 158 monitors are available for distribution in nearly every hospital in the region.

“These are known formally as point-of-care systems, although we call this home monitoring. Essentially, we can keep an eye on the patients electronically each day. We can stay connected with these patients, who are taught to measure and report their own vital signs every day,” said Christine Struthers, advanced practice nurse for heart failure and manager of the program. “Patients participate in their own care, and we are showing them how to have a good measure of control over their own well-being.”

Each day, patients transmit medical data, such as weight and vital signs, to the Heart Institute where it is analyzed by a team of nurses. Any data that indicate a potential problem or issue, or a need for more information, is flagged. The patient is contacted immediately by a cardiac care nurse, who assesses the situation and recommends changes to the patient’s care routine—anything from an adjustment in medication to a new instruction for nutrition management. Physicians are contacted as needed and are provided with updates on patient progress.

A second part of the telehome program involves interactive voice response (IVR) technology. IVR is an automated calling system that proved to be successful in the Heart Institute’s smoking cessation program for connecting regularly with patients who had quit smoking. The system is used to reach out to patients for surgical follow-up, heart failure and coronary conditions ranging from chest pain to heart attack. For heart failure patients, IVR kicks in where home monitoring leaves off, usually after three to four months.

IVR takes over to check in with the patient every two weeks for a period of several months.

The use of interactive voice response (IVR) to contact patients at home via automated calling keeps them engaged in their own care, answers their questions and flags potential problems once they have left the Heart Institute.

Patients answer a series of carefully designed questions related to their condition. Their answers are monitored, and a nurse follows up personally if there are any signs of a problem. Equally important, IVR helps to educate patients about their condition by providing them with more information.

“We know that compliance falls for many patients when they get home, and we can address this quickly,” said Struthers. “They stop taking their medication for several reasons—because they don’t fill out a new prescription after running out or the medication received on discharge differs from the new prescription or they have questions about side effects they can’t find answers for.”

Heart Institute researchers have evaluated home monitoring in several ways. From 2007–2008, 121 heart failure patients were followed over a one-year period. Patients received telehome monitoring only during the second six months. Readmission rates in that period fell by 54% compared to the first six months.

An earlier study, in 2006, showed no readmissions due to congestive heart failure for 78 patients followed over an average of 117 days. Another investigation looked at Francophone patients from Ontario—a population that exhibits an increased risk for heart disease. The three-month study examined 47 patients who received a total of 125 automated calls. Of these, 58 requests were made to the call system to hear more information about heart failure medication. A total of seven “events” or “possible events” involving adverse effects of medication were captured by the system. No unavoidable hospital readmissions were reported.

Other types of remote home monitoring services operate elsewhere in the country. The Heart Institute program differs by providing daily remote nursing supervision for people with severe conditions who need close medical attention. First developed for regional use, the Heart Institute’s cardiac telehealth services now support nearly 1,200 patients from British Columbia to Newfoundland and Labrador, with satellite sites in 13 hospitals in the Ottawa region.