The Advantages and Disadvantages of Heart Failure Disease Management When Randomly Assigned To Be Delivered by Telehealth or Telephone

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Introduction: Disease management is most often delivered via telephone or in person in the outpatient setting. This study compared the delivery of disease management protocols for heart failure and diabetes via telephone or telehealth technology in home care. Hypothesis: Patients receiving disease management using telemonitoring will have improved self rated health, increased knowledge and behavior related to diet and medication, improved depression scores, and decreased health care utilization compared to telephone or usual care. Methods: The study was a randomized, field study comparing the health and resource utilization outcomes among three groups of chronically ill adults who are receiving home care and evidence based disease management delivered by three different modalities. A usual care group (N=112) received traditional in-person home care guided by evidence based disease management protocols; One intervention group (N=93) received home care guided by evidence based disease management protocols and telephonic intervention, and a second intervention group (N=98) received home care guided by evidence based disease management protocols and telemonitoring with telehealth technology. The protocols included the latest evidence for managing heart failure and diabetes. The nurses were educated to use the protocols to compare the plan of care for their patient in relation to the protocols and to discuss any discrepancies with the patients' physician and adjust the plan of care. Patients received the intervention over a home care episode which is typically 45–60 days and included home care with at least 4 phone calls or 4 telehealth encounters. Results: There were no significant differences by group for any of the study outcomes. Knowledge and behavior related to medication and diet management significantly improved across all groups from baseline. In qualitative interviews nurses identified several advantages and disadvantages of delivery by telehealth compared to telephone or without technology. Nurses also reported great difficulty in collaborating with physicians on the disease management protocols. Conclusions: The delivery of disease management protocols via varying levels of technology had no differential effect on patient outcomes. Based on qualitative findings from the nurses, the procedures, policies and communication methods in home care do not facilitate evidence based disease management.