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KAISER PERMANENT TELE-HOME CARE HEALTH RESEARCH PROJECT SHOWS POSITIVE RESULTS

Participants in the study
Data collection
Costs
Patient satisfaction
Results

By Lisa Remington, Publisher
Reprinted with permission from The Remington Report(underline), March/April 2000, pp. 9-10.

The long-awaited outcomes of the tele-home health study conducted at the Home Health Department at Kaiser Permanente Medical Center in Sacramento, Calif., from May 1996 through October 1997, have been published in the January 2000 issue of the American Medical Association's Archives of Family Medicine(underline).

This research study was significant to the home-care industry because, to this point, there have not been enough major case studies of telemedicine's use in home care, its responsiveness by patients and its potential cost savings. The research project conducted by Kaiser evaluated the use of remote video technology in a home care setting and the use, patient satisfaction and cost savings from this technology.
Barbara Johnston, R.N., M.S.N., M&L, a Hospice Home Health nurse, headed up the project, and was originally interviewed in The Remington Report's(underline) September/October 1997 issue. Ms. Johnston had commented during the interview how tele-home health reduced home-care visits and reduced trips to the emergency room. These results are certainly timely for home-care agencies preparing for the prospective payment system (PPS) approaching in October 2000, and further supports a key strategy under PPS of reducing expenses while maintaining quality of care.

PARTICIPANTS IN THE STUDY

Participants in the study were newly referred patients diagnosed with congestive heart failure, chronic obstructive pulmonary disease, cerebral vascular accident, cancer, diabetes, anxiety or the need for wound care. These patients volunteered to be randomly assigned into either the intervention or the control group. The intervention group had 1,003 in-person home healthcare visits and 416 remote video visits, and the control group had 1,197 in-person home healthcare visits.

During the study, the control and intervention groups received routine home health care (home visits and telephone contact). The intervention group also had access to a remote video system that allowed nurses and patients to interact in real time. This allowed the nurse and the patient to see each other and to talk in real time. The video system included peripheral equipment for assessing cardio-pulmonary status.
Ms. Johnston said that outcome measures were an important part of the study. Three quality indicators (medication compliance, knowledge of disease and ability for self-care); extent of use of services; degree of patient satisfaction as reported on a three-part scale; and direct and indirect costs of using the remote video technology were outcomes measured.

DATA COLLECTION

Data for this study was collected from patient interviews and surveys, from medical record audits and from Kaiser's computer databases. To evaluate homogeneity of the control and intervention groups, they collected information about initial health status, prior use of services (visits to the emergency department, urgent care clinic or physician's office; days in a skilled-nursing facility; previous healthcare interventions at home; and days in the hospital), referral source and demographic characteristics.

The computer databases included information about health plan membership, demographics, use of services, direct costs for Kaiser inpatient and outpatient services, claims for services received outside the Kaiser system (e.g., visits to non-Kaiser emergency departments, days in skilled-nursing facilities and days in non-Kaiser hospitals). The data used to derive costs included direct costs for pharmacy services, laboratory, physician visits, emergency department visits and inpatient treatment. Home healthcare costs included direct costs for payroll, benefits, travel and cellular-phone usage. In the intervention group, additional costs included capital equipment and telecommunication charges.

COSTS

The mean length of time was 45 minutes to provide an in-person visit and 18 minutes for a remote video visit. The current productivity standards allow one nurse to visit five to six patients per day. Although not demonstrated, a time study indicated that remote video visits allow 15 to 20 video visits per day. For home health services, the average direct costs, including cost for purchase of capital equipment and telecommunication expenses, were $1,830 in the intervention group and $1,167 in the control group. The total mean cost of care, excluding home healthcare costs were $1,948 in the intervention group and $2,674 in the control group. This reduction in total mean costs, excluding home healthcare services, was most attributable to hospitalization costs, which were $1,087 in the intervention group and $1,940 in the control group. Outpatient costs did not vary materially between the two groups.

PATIENT SATISFACTION

The survey results regarding the intervention group's satisfaction with the remote video visit showed more than ninety percent of the intervention group agreed or strongly agreed that they appreciated the care provided at the remote video visits, were confident in the assessment received, were comfortable discussing personal problems, believed they received an appropriate level of care, found the remote visit convenient and appreciated receiving timely access to care. Both groups responded similarly regarding their satisfaction with in-person caregiver visits, even though the intervention group received 194 fewer in-person visits.

RESULTS

The results of the study indicated no differences in the quality indicators, patient satisfaction or use. Even though the average direct cost for home health services was $1,830 in the intervention group and $1,167 in the control group, the total mean costs of care, excluding home healthcare costs were $1,948 in the intervention group and $2,674 in the control group.

Results of the remote video technology research project in a home healthcare setting were shown to be effective, well received by patients, capable of maintaining quality of care, and showed potential for cost savings. Patients seemed pleased with the equipment and the ability to access a home healthcare provider 24 hours a day. The study supported that remote technology has the potential to effect cost savings when used to substitute some in-person visits, and can also improve access to home healthcare staff for patients and caregivers.

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