"Health care is moving out of acute-care facilities and into the community", stated Martha Sheely, RN, Clinical Research Director at Mercy Home Health. "We are looking at the role of telemedicine in helping us to provide health care for CHF patients and others with chronic conditions." Mercy Home Health Services President and CEO Carol Quinn pointed out, "As insurance companies, HMOs and Medicare shift toward flat-rate payments for a patient's entire cost of care, the health care industry is challenged to find ways to reduce costs while maintaining quality of care. Home health care is one way to accomplish this and adding telemedicine to home health care is being examined to determine the nature and extent of benefits."
CHF is a chronic condition that accounts for a high proportion of the health care expenditures in the United States. "Patients with CHF are the number one diagnosis for readmission to the hospital", Martha Sheely explained. "They are often elderly and, because it may be difficult for them to get to the doctor, they wait a few days after symptoms appear. By the time they decide to call 911, their condition has worsened such that they require admission to the Critical Care Unit (CCU). This is very expensive care", she added.
Patients in the Mercy Home Health research study will receive an equipment package which includes a Spacelabs monitor to assess a number of non-invasive parameters, including ECG, blood pressure, temperature and pulse oximetry. The package equally includes a digital stethoscope for monitoring heart rate and lung sounds. Mercy Home Health will provide patients with the necessary training and instructions to use the equipment package. All of the data are digitally transferred to the central monitoring station at Mercy Home Health, using the patient's existing phone line. A two-way video hook-up provides communication between the patient and nurse.
The research protocol also calls for evaluation of the health care application method itself, such as the acceptance of telemedicine technology by medical personnel as well as patients; the level of training or skill that is necessary to operate the equipment to ensure that accurate assessments can be obtained; the validity of the data collected from a video visit as compared to data which is collected from an actual on-site visit; and the financial impact of providing telemedicine technology in the home health setting.
The grant was awarded and administered by the US Army Medical Research Acquisition Activity at Fort Detrick. According to LTC John Albano, MC, who is the grant officer representative, the military is interested in telemedicine as a way to provide medical care when faced with the recent down-sizing of the military forces and the tactical requirement to have a smaller medical "footprint" in the far, forward areas. John Albano stated that if the US Army can effectively use telemedicine to monitor injured soldiers, it would give the health care provider a greater geographic distribution of the monitoring capability without having to be physically present.
The US Army Medical Department is closely watching Mercy's evaluation of the utility of the Spacelabs equipment. "If it is sufficiently simple to have the subjects in this study operate it, then it is likely that a soldier can operate it under the severe stressors of a harsh field environment or urgency of patient evacuation from a combat zone", according to Bob Leitch, Senior Research Associate. He is with the US Army's Casualty Care Research Center (CCRC), whose focus is on telemedicine for use in trauma care. CCRC is providing hands-on training to the Mercy Home Health nurses.
Mrs. Sheely emphasised that the test programme will not replace the home visits these patients currently receive. "As a whole we strongly believe that telemedicine will be adjunctive to the care they are now receiving." Mercy Home Health Services is a JCAHO-accredited affiliate of Mercy Health System, a health care ministry of the Sisters of Mercy, which serves patients in Philadelphia and surrounding areas of southeastern Pennsylvania, New Jersey and Delaware. The Spacelabs equipment has been rigorously tested earlier this month. Read all about it in this month's VMW article Spacelabs monitoring equipment stands tall in disaster telemedicine tests organised by NASA.