Using Tele-health to Affect Cardiovascular Outcomes in Rural Areas: The Case of Southern Appalachia

Southern Appalachia is a rural, medically underserved area with excess mortality and lack of access to care. Congestive Heart Failure (CHF) is a serious chronic condition and the leading cause of hospitalization for the elderly. Objectives: 1. To describe an innovative model using tele-health for CHF management in rural areas. 2. To delineate the components of a comprehensive evaluation framework for disease management programs. Methods: The Southern Appalachia Tele-Homecare (SATH) Program is a HRSA-funded disease management program that targets elderly CHF patients in Southwest Virginia. A program of Mountain States Health Alliance (MSHA), SATH seeks to improve CHF outcomes while reducing hospitalization and costs. SATH's model integrates patient participation and progressive self-care with tele-monitoring, home healthcare, and call center monitoring. A multidisciplinary team delivers care, and standardized physician orders enable nurses to provide immediate intervention for distressed patients. SATH employs a randomized control study design (with 300 patients) and a multi-pronged evaluation to assess quality of care, utilization outcomes, and cost-effectiveness. Results: A previous project of MSHA, after which SATH is modeled, included 88 patients in the pilot program in 2008. Of those, 90% reported satisfaction with the program. There was 69% reduction in 30-day CHF-related hospital readmissions, 67% reduction in CHF-related Emergency Department visits, and 48% reduction in all-cause inpatient admissions. Based on MSHA's experience and a HRSA grant, enrollment of patients in the three-year study is underway. Conclusion: Tele-homecare can be successfully implemented in rural communities. This model can be adapted to other chronic conditions and geographic locations.