With the aging of the baby boom generation the prevalence of congestive heart failure, already the most common cause of readmission to hospitals, is expected to nearly double over the next 40 years and could become a major drain on health care resources. Congestive heart failure patients often require several hospitalizations, each costing around $10,000.
But a physician at the University of Illinois at Chicago Medical Center has an innovative solution to this looming health care problem. Dr. Boaz Avitall, director of cardiac electrophysiology has developed a system called the Home Health Monitor that closely monitors congestive heart failure patients in their homes several times daily, resulting in fewer readmissions to the hospital and substantially lower health-care costs.
In a pilot study conducted by Avitall, the hospital readmission rate for 35 congestive heart failure patients using the system was just 14 percent over a six-month period, compared to the national readmission average of 42 percent over a three-month period. Patients reported the system was easy and convenient to use.
The Home Health Monitor includes a computerized central monitoring station at the UIC Medical Center staffed 24 hours a day by cardiology nurses and technicians, with cardiology fellows and attending physicians on call. The system's hardware in the patient's home consists of a small, portable monitor, a scale for body weight, an automatic blood pressure cuff, a finger probe to measure blood-oxygen levels and pulse rate and a glucose meter. When the patient takes his or her measurements, the monitor storesthe data and then automatically transmits it over the patient's existing telephone line to the station for review. Any patient who does not transmit data within 24 hours is contacted by telephone.
"The Home Health Monitor provides rapid and early detection of any complications before they become severe and require hospitalization," says Avitall. "It also makes patients feel more secure in their home environment by having continous contact with the Medical Center.
"For example, the system detects increases in body weight or changes in blood pressure, common indicators of problems in congestive heart failure patients," explains Avitall. "Any time the system picks up a deviation in a patient's vital sign from a pre-set level, an alarm will sound at the Medical Center station, prompting a follow-up call to the patient. In cases of elevated body weight or blood pressure, the patient's physician can adjust the patient's medication."
Avitall says the Home Health Monitor teaches patients to comply with diet and medication requirements. "Non-compliance and ignorance of their disease are often the causes for patient readmissions," says Avitall. "We call our patients every week to discuss their vital signs and let them know if they are doing well or make suggestions on how they can do a better job of following their diet and medication regimens."
Congestive heart failure is the primary diagnosis for more than 750,000 hospital admissions annually in the United States, requiring a total of nearly six million hospital in-patient days. A 1994 study concluded that the total cost of avoidable, unncessary hospital readmissions for congestive heart failure in the United States was more than $600 million a year.