Reducing the cost of frequent hospital admissions for congestive heart failure: a randomized trial of a home telecare intervention.
BACKGROUND
The high cost of caring for patients with congestive heart failure (CHF) results primarily from frequent hospital readmissions for exacerbations. Home nurse visits after discharge can reduce readmissions, but the intervention costs are high.


OBJECTIVE
To compare the effectiveness of three hospital discharge care models for reducing CHF-related readmission charges: 1) home telecare delivered via a 2-way video-conference device with an integrated electronic stethoscope; 2) nurse telephone calls; and 3) usual outpatient care.


METHODS
One-year randomized trial.


METHODS
English-speaking patients 40 years of age and older with a primary hospital admission diagnosis of CHF.


METHODS
Our primary outcome was CHF-related readmission charges during a 6-month period after randomization. Secondary outcomes included all-cause readmissions, emergency department (ED) visits, and associated charges.


RESULTS
Thirty-seven subjects were randomized: 13 to home telecare, 12 each telephone care and 12 to usual care. Mean CHF-related readmission charges were 86% lower in the telecare group ($5850, SD $21,094) and 84% lower in the telephone group ($7320, SD $24,440) than in the usual care group ($44,479, SD $121,214). However, the between-group difference was not statistically significant. Both intervention groups had significantly fewer CHF-related ED visits (P = 0.0342) and charges (P = 0.0487) than the usual care group. Trends favoring both interventions were noted for all other utilization outcomes.


CONCLUSIONS
Substantial reductions in hospital readmissions, emergency visits, and cost of care for patients with CHF might be achieved by widespread deployment of distance technologies to provide posthospitalization monitoring. Home telecare may not offer incremental benefit beyond telephone follow-up and is more expensive.
Jerant
A F
AF
Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento 95817, USA. afjerant@ucdavis.edu
Azari
R
R
Nesbitt
T S
TS
D000328:Adult; D000359:Aftercare / Q000379:methods*; D000368:Aged; D000704:Analysis of Variance; D002140:California; D003363:Cost Control / Q000379:methods; D017281:Cost of Illness; D005260:Female; D006333:Heart Failure / Q000191:economics* / Q000628:therapy; D018575:Home Care Services, Hospital-Based; D017722:Hospital Charges; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data; D010865:Pilot Projects; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D013690:Television