Contributors to frequent telehealth alerts including false alerts for patients with heart failure: a mixed methods exploration.
BACKGROUND
Telehealth data overload through high alert generation is a significant barrier to sustained adoption of telehealth for managing HF patients.


OBJECTIVE
To explore the factors contributing to frequent telehealth alerts including false alerts for Medicare heart failure (HF) patients admitted to a home health agency.


METHODS
A mixed methods design that combined quantitative correlation analysis of patient characteristic data with number of telehealth alerts and qualitative analysis of telehealth and visiting nurses' notes on follow-up actions to patients' telehealth alerts was employed. All the quantitative and qualitative data was collected through retrospective review of electronic records of the home heath agency.


RESULTS
Subjects in the study had a mean age of 83 (SD = 7.6); 56% were female. Patient co-morbidities (p<0.05) of renal disorders, anxiety, and cardiac arrhythmias emerged as predictors of telehealth alerts through quantitative analysis (n = 168) using multiple regression. Inappropriate telehealth measurement technique by patients (54%) and home healthcare system inefficiencies (37%) contributed to most telehealth false alerts in the purposive qualitative sub-sample (n = 35) of patients with high telehealth alerts.


CONCLUSIONS
Encouraging patient engagement with the telehealth process, fostering a collaborative approach among all the clinicians involved with the telehealth intervention, tailoring telehealth alert thresholds to patient characteristics along with establishing patient-centered telehealth outcome goals may allow meaningful generation of telehealth alerts. Reducing avoidable telehealth alerts could vastly improve the efficiency and sustainability of telehealth programs for HF management.
University of Texas - Austin, School of Nursing , Austin, Texas, United States.
K
K
Radhakrishna
University of Pennsylvania School of Nursing, School of Nursing , Philadelphia, Pennsylvania, United States.
K
K
Bowles
VNACare Network & Hospice, Telehealth Program , Worcester, Massachusetts, United States.
A
A
Zettek-Sumner
D000369:Aged, 80 and over; D015897:Comorbidity; D057286:Electronic Health Records; D005189:False Positive Reactions; D005260:Female; D006040:Goals; D006333:Heart Failure / Q000175:diagnosis* / Q000628:therapy*; D018574:Home Care Agencies; D006801:Humans; D008297:Male; D005791:Patient Care; D012189:Retrospective Studies; D017216:Telemedicine; D055986:Vital Signs
Telehealth alerts; false alerts; heart failure; home health nursing