title: Impact of a Telehealth and Care Management Program on All-Cause Mortality and Healthcare Utilization in Patients with Heart Failure.
abstract: BACKGROUND
  Telehealth has the potential to improve chronic disease management and outcomes, but data regarding direct benefit of telehealth in patients with heart failure (HF) have been mixed. The objective of this study was to determine whether the Health Buddy Program (HBP) (Bosch Healthcare, Palo Alto, CA), a content-driven telehealth system coupled with care management, is associated with improved outcomes in Medicare beneficiaries with HF.
  
  
  METHODS
  This was a retrospective cohort study of 623 Medicare beneficiaries with HF offered HBP enrollment compared with a propensity score-matched control group of Medicare beneficiaries with HF from the Medicare 5% sample. Associations between availability of the HBP and all-cause mortality, hospitalization, hospital days, and emergency department visits were evaluated.
  
  
  RESULTS
  Beneficiaries offered enrollment in the HBP had 24.9% lower risk-adjusted all-cause mortality over 3 years of follow-up (hazard ratio [HR] = 0.75; 95% confidence interval [CI], 0.63-0.89; p = 0.001). Patients who used the HBP at least once (36.9%) had 57.2% lower mortality compared with matched controls (HR = 0.43; 95% CI, 0.31-0.60; p < 0.001), whereas patients who did not use the HBP had no significant difference in survival (HR = 0.96; 95% CI, 0.78-1.19; p = 0.69). Patients offered the HBP also had fewer hospital admissions following enrollment (Δ = -0.05 admissions/quarter; p = 0.011), which was primarily observed in patients who used the HBP at least once (Δ = -0.10 admissions/quarter; p < 0.001).
  
  
  CONCLUSIONS
  The HBP, a content-driven telehealth system coupled with care management, was associated with significantly better survival and reduced hospitalization in Medicare beneficiaries with HF. Prospective study is warranted to determine the mechanism of this association and opportunities for optimization.
authors.affiliation: 1 Division of Cardiology, Department of Medicine, University of Colorado School of Medicine , Aurora, Colorado.
authors.forename: David P
authors.initials: DP
authors.lastname: Kao
authors.affiliation: 1 Division of Cardiology, Department of Medicine, University of Colorado School of Medicine , Aurora, Colorado.
authors.forename: JoAnn
authors.initials: J
authors.lastname: Lindenfeld
authors.affiliation: 2 Analysis Group, Inc., New York, New York.
authors.forename: Dendy
authors.initials: D
authors.lastname: Macaulay
authors.affiliation: 3 Analysis Group, Inc., Boston, Massachusetts.
authors.forename: Howard G
authors.initials: HG
authors.lastname: Birnbaum
authors.affiliation: 3 Analysis Group, Inc., Boston, Massachusetts.
authors.forename: John L
authors.initials: JL
authors.lastname: Jarvis
authors.affiliation: 3 Analysis Group, Inc., Boston, Massachusetts.
authors.forename: Urvi S
authors.initials: US
authors.lastname: Desai
authors.affiliation: 4 Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences , Aurora, Colorado.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Page
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009026:Mortality; D011446:Prospective Studies; D012189:Retrospective Studies; D013534:Survival; D017216:Telemedicine / Q000379:methods* / Q000706:statistics & numerical data*; D014481:United States
keywords: Medicare; heart failure; outcomes; survival; telemonitoring