An evidenced-based home telehealth monitoring model for high-risk patients

Objective: A three-year randomized control pilot study showed that home telehealth monitoring with nurse clinician support improved health outcomes and reduced cost of care in an ethnically diverse, underserved population of high-risk dialysis patients. Additional research was conducted to examine the specific therapeutic components of nurse clinician support and patient self-monitoring. This systematic approach to investigating the feasibility, cost-effectiveness, and patient's subjective experience, informed the planning of an evidenced-based home telehealth model of care for high-risk patients newly discharged from hospital.

Methods: The pilot study was comprised of very high-risk dialysis patients with end-stage renal disease on chronic dialysis (N=101). Nurse clinicians monitored health data daily and contacted patients in the event of outliers and suggested interventions as needed. Next, a mixed methods approach was employed (n=33) to explore barriers and facilitators to using telehealth technology, and the impact of nurse clinician support on program adherence and health care behavior change.

Results: Results from the programmatic investigation of high-risk dialysis patients showed reduced hospitalizations, emergency room visits, and frequency of nurse/patient contacts over time. Particularly, patients were empowered to change their health behavior, reported high level of perceived acceptability, utility, and satisfaction of nurse clinician support and home telehealth monitoring.

Conclusions: Telehealth technology with nurse clinician support shows promise in promoting disease self-management. An evidenced-based home telehealth model is proposed to improve patient care, reduce cost of care, promote self-management skills, and train new skilled workers using telehealth home monitoring technology for high-risk patients.