Clinical Effectiveness, Access to, and Satisfaction with Care Using a Telehomecare Substitution Intervention : A Randomized Controlled Trial

الملخص EN

Background.

Hospitalization accounts for 70% of heart failure (HF) costs; readmission rates at 30 days are 24% and rise to 50% by 90 days.

Agencies anticipate that telehomecare will provide the close monitoring necessary to prevent HF readmissions.

Methods and Results.

Randomized controlled trial to compare a telehomecare intervention for patients 55 and older following hospital discharge for HF to usual skilled home care.

Primary endpoints were 30- and 60-day all-cause and HF readmission, hospital days, and time to readmission or death.

Secondary outcomes were access to care, emergency department (ED) use, and satisfaction with care.

All-cause readmissions at 30 days (16% versus 19%) and over six months (46% versus 52%) were lower in the telehomecare group but were not statistically significant.

Access to care and satisfaction were significantly higher for the telehomecare patients, including the number of in-person visits and days in home care.

Conclusions.

Patient acceptance of the technology and current home care policies and processes of care were barriers to gaining clinical effectiveness and efficiency.