title: Unsustainable Home Telehealth: A Texas Qualitative Study.
abstract: Telehealth has emerged as an innovative approach to aid older individuals in managing chronic diseases in their homes and avoid hospitalizations and institutionalization. However, the sustainability of home telehealth programs remains a major challenge. This qualitative study explored the reasons for the initial adoption and the eventual decline of a decade-long home telehealth program at a Texas home health agency (HHA). Barriers to and facilitators for sustaining home telehealth programs were also explored.
  
  
  
  Semistructured interviews of 13 HHA nursing staff and administrators, 1 physician, and 9 patients aged >55 years and their informal caregivers who used telehealth were conducted in summer 2013. Interview transcripts were analyzed using conventional content analysis.
  
  
  
  Data analysis generated 5 themes representing the decline of the Texas home telehealth program: its impact on patient-centered outcomes, its cost-effectiveness, patient-clinician and interprofessional communication, technology usability, and home health management culture. Lack of significant impact on patient outcomes, in addition to financial, technical, management, and communication-related challenges, adversely affected the sustainability of this home telehealth program.
  
  
  
  A home telehealth program that attains patient-centered outcomes, improves cost-effectiveness of managing chronic diseases, improves quality of communication among patients and clinicians, is user-friendly for older adults, and involves end users in decision making is likely to be sustainable.
authors.affiliation: School of Nursing, University of Texas at Austin. kradhakrishnan@mail.nur.utexas.edu.
authors.forename: Kavita
authors.initials: K
authors.lastname: Radhakrishnan
authors.affiliation: School of Nursing, University of Texas at Austin.
authors.forename: Bo
authors.initials: B
authors.lastname: Xie
authors.affiliation: School of Nursing, University Massachusetts Amherst.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Jacelon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D017028:Caregivers; D002908:Chronic Disease; D003142:Communication; D005260:Female; D018574:Home Care Agencies; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D015279:Organizational Culture; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D010820:Physicians; D015397:Program Evaluation; D036301:Qualitative Research; D012648:Self Care; D017216:Telemedicine; D013781:Texas
keywords: Chronic disease; Home health; Self-management; Sustainability; Telehealth