Kobb R et al. 2003 "Enhancing elder chronic care through technology and care coordination: report from a pilot."

Reference
Kobb R, Hoffman N, Lodge R, et al. Enhancing elder chronic care through technology and care coordination: report from a pilot. Telemed J E Health 2003;9(2):189-195.
Abstract
"The Rural Home Care Project is one of eight clinical demonstration pilots in an initiative of the Veterans Health Administration (VHA) Sunshine Network in Florida and Puerto Rico. In this project three care coordinators consisting of two nurse practitioners and a social worker collaborate with primary care providers in the management of high-risk, high-cost veterans with multiple chronic diseases such as diabetes and heart failure. The project staff uses home telehealth devices to monitor and educate patients to prevent health crises. The evaluation methodology is a quasiexperimental design that uses a nonequivalent control group of usual care veterans. Data were gathered through personal interviews with patients and providers, and statistical analysis was based on a series of repeated-measure of covariance modeling designed by a research team from the University of Maryland. Findings demonstrate that care coordination enhanced by technology reduces hospital admissions, bed days of care, emergency room visits, and prescriptions as well as providing high patient and provider satisfaction. Veterans also had improved perception of physical health as evidenced by a standardized functional status measure."
Objective
"To evaluate rural health acre project in terms of resource utilization and user satisfaction."
Type Clinic
Primary care
Size
Large
Geography
Rural
Other Information
Patients at home communicate with primary care providers.
Type of Health IT
Telemedicine
Type of Health IT Functions
The home telehealth equipment included an in-home messaging device, the Health Buddy, telecare audio-video units, vital sign monitoring system, videophone, and telephone to monitor and educate patients on how to prevent health crises.
Context or other IT in place
Electronic medical records (EMR) and a decision support system were already in place.
Workflow-Related Findings
Medication, immunization, and usage adherence among patients increased.
"Project patients showed a greater improvement in healthcare resource consumption than the usual care group." Hospital admissions, bed days of care, emergency room visits, and prescriptions in the experimental groups decreased as compared to the control group.
A satisfaction survey was administered to patients (N=281) and providers (N=57). "Patients reported high levels of satisfaction with both project team members and technology. They reported the technology to be "easy to use" and "helpful" in managing their chronic conditions. Providers also responded very positively."
Study Design
Pre-postintervention (no control group)
Study Participants
The study participants included 1,401veterans: 1,120 usual care patients (nonrandomized control group) and 281 rural home care patients (experimental group).