Red alert rates and follow-up rates per 60-day episode of home care

The objective of this home health care study was to develop additional quantitative measures for documenting access to health care with tele-monitoring. Access has typically been measured by using numbers of patients who have tele-monitoring equipment placed in their homes; increases in these numbers are used to indicate increases in access to health care. We propose that access also be measured by rates of red alerts, and rates of follow-ups to red alerts, per 60-days of care. Tele-monitored patients used equipment to take their vital signs and transmit readings to a central station, where a trained nurse reviewed the readings, noted the red alerts, and determined whether there should be a follow-up action. Red alerts were generally indicated when readings fell outside of a range predetermined by health care providers for the individual patient. Follow-ups were with patients/caregivers, nurse care managers, or physicians. An episode of care, following Medicare payment protocols for home care services, may continue for a 60 day period of time. We present definitions of red alert, and follow-up, rates. We illustrate use of these rates with underserved rural and tribal homebound patients in three sparsely populated Montana counties. These measures document the rates at which rural homebound patients had abnormal physiological response to disease detectable by vital signs and thus were at increased risk of medical problems; as well as the rates at which the central station nurse subsequently followed up to mitigate these increased risks.