The study is the first to identify the specific costs associated with the new technology and to show that while the new approach imposes additional initial expenses for care delivery, it contributes substantial savings without compromising quality. It is also the first comprehensive study to link patient outcomes with the use of telehomecare.
Dr. Kathryn Dansky, associate professor of health policy and administration, who led the study, says "Video visits are not a complete substitute for in-home nursing care. You are always going to need home visits because patients benefit from the personal touch."
However, the team found that over a typical 60 days of care, savings of $300 per patient could be achieved by substituting video visits for seven in-home visits and $700 per patient was saved if half of the visits were made via advanced communication technology.
"As the number of nursing visits increase, you can substitute more and more video visits if the purpose is to monitor the patient's health status," Dansky adds. "Substituting an equal number of video and home visits can produce a major difference in the cost of the care."
The sources of savings include less travel time and travel costs, fewer travel accidents, less car theft and the ability to see more patients in the same amount of time.
The researchers published their results in the current (fall) issue of the Telemedicine Journal and e-Health. The authors are Dansky, Dr. Liisa Palmer, who earned her doctorate in health policy and administration at Penn State, Dr. Dennis Shea, professor of health policy and administration, and Dr. Kathryn H. Bowles, assistant professor of nursing at the University of Pennsylvania.
Skilled nursing care in the home requires a registered nurse to drive to the patient's residence, conduct examinations and assessments, provide patient care and education, and then drive to the next patient's house. The process is time-consuming, dangerous at times for the nurse and expensive.
To see if new technology could help both patients and nurses without incurring additional costs, the Penn State researchers initiated a 24-month evaluation of the use of telecommunications as a supplement to skilled nursing visits for people with diabetes. Called the TeleHomecare Project, the effort was a partnership of Penn State, American Telecare Inc., and the Visiting Nurses Association of Greater Philadelphia (VNAGP), a large, urban, home health agency.
A group of 171 diabetic patients discharged from the hospital and referred to the VNAGP participated in the study. Half of them were randomly assigned to receive a patient telecommunication station in their homes while the remaining patients received traditional in-home nursing visits. The patient station included a computer and monitor equipped with two-way voice capability and a video camera. A blood pressure cuff and stethoscope were also attached to the computer.
Using the patient station, which works over ordinary phone lines, the patient could see and talk with the nurses. The system also allowed the nurses to see and hear the patients and to take temperature and blood pressure measurements, listen to heart and lung sounds and discuss diet and blood sugar results.
Patients who used the telecommunications system scored higher on positive outcomes of treatment, had fewer re-hospitalizations and fewer visits to hospital emergency rooms.
Dansky notes that, in general, the patients liked working with the telecommunications equipment. The stations gave patients a sense of security because they could keep in touch with their nurse at all times. Some patients even prepared for the video visits by fixing their hair and dressing up. Far from frivolous, such interest in self-care is an important indicator of vitality and personal responsibility.
The nurses, too, responded favorably to the technology although three generations of telehomecare machines were introduced and tested during the study period. Dansky notes that the nurses found ingenious ways to deal with equipment failures. For example, if a patient didn't respond, they'd hold up a sign that said, "Nod your head if you can see and not hear me."
The nurses also used laundry baskets to take the equipment into homes so that thieves wouldn't see what they were doing. There were no thefts during the project and no break-ins despite the fact that some patient's homes were located in crime-ridden areas of the city.
Dansky sees many possibilities for broader application of the telecommunications systems. She is currently working with Sun HomeHealth to study whether the systems can aid nurses in helping patients manage their medications especially when there is a danger of drug interactions. She also sees the possibility of physical therapists using the system to supervise family members or aides who are helping patients exercise in the home. Dieticians could also use the system to supervise meal planning and preparation.
Journal
Telemedicine Journal