title: Association of comorbidities with home care service utilization of patients with heart failure while receiving telehealth.
abstract: BACKGROUND
  Comorbidities adversely impact heart failure (HF) outcomes. Telehealth can assist healthcare providers, especially nurses, in guiding their patients to follow the HF regimen. However, factors, including comorbidity patterns, that act in combination with telehealth to reduce home care nursing utilization are still unclear.
  
  
  OBJECTIVE
  The purpose of this article was to examine the association of the comorbidity characteristics of HF patients with nursing utilization along with withdrawal from telehealth service during an episode of tele-home care.
  
  
  METHODS
  A descriptive, correlational study design using retrospective chart review was used. The sample comprised Medicare patients admitted to a New England home care agency who had HF as a diagnosis and had used telehealth from 2008 to 2010. The electronic documentation at the home care agency served as the data source, which included Outcome and Assessment Information Set data of patients with HF. Logistic and multiple regression analyses were used to analyze data.
  
  
  RESULTS
  The sample consisted of 403 participants, of whom 70% were older than 75 years, 55% were female, and 94% were white. Comorbidities averaged 5.19 (SD, 1.92), ranging from 1 to 11, and nearly 40% of the participants had 5 or more comorbidities. The mean (SD) nursing contacts in the sample was 9.9 (4.7), ranging from 1 to 26, and 52 (12.7%) patients withdrew from telehealth service. For patients with HF on telehealth, comorbidity characteristics of anemia, anxiety, musculoskeletal, and depression were significantly associated with nursing utilization patterns, and renal failure, cancer, and depression comorbidities were significantly associated with withdrawal from telehealth service.
  
  
  CONCLUSIONS
  Knowledge of the association of comorbidity characteristics with the home care service utilization patterns of patients with HF on telehealth can assist the home health nurse to develop a tailored care plan that attains optimal patient outcomes. Knowledge of such associations would also focus home care resources, avoiding redundancy of resource utilization in this era of strained healthcare resources.
authors.affiliation: School of Nursing, University of Pennsylvania, Philadelphia 19104, USA. rkavita@nursing.upenn.edu
authors.forename: Kavita
authors.initials: K
authors.lastname: Radhakrishnan
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Jacelon
authors.forename: Carol
authors.initials: C
authors.lastname: Bigelow
authors.forename: Joan P
authors.initials: JP
authors.lastname: Roche
authors.forename: Jenna L
authors.initials: JL
authors.lastname: Marquard
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Bowles
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000451:nursing*; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009511:New England; D010342:Patient Acceptance of Health Care; D010352:Patient Dropouts / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D055817:Telenursing