An Evaluation of Home-telemonitoring Influence on Heart Failure Readmission at a Veterans Administration Medical Center

Abstract
Purpose: Heart Failure (HF) remains the leading cause of hospitalization in the United States. Despite the development of guidelines for appropriate medication use and lifestyle management, the rate of readmission has remained constant. In an effort to reduce the number of readmissions for HF and other chronic illnesses, the Veterans Administration (VA) has developed a Home Telemonitoring (HT) program to monitor Veterans in their home settings and to allow for earlier intervention. The purpose of this quality improvement study was to evaluate the effectiveness of HT on HF readmissions in a Veteran population.
Study Questions: In Veteran patients admitted with Heart Failure, did the addition of Home Telemonitoring to usual care compared to usual care alone, influence heart failure admissions and total bed days of care in the two years following initial study enrollment?
Methods: One hundred fifteen charts were identified for Veterans admitted with HF in FY 2010. Subjects were followed through the end of FY 2012 to determine the number of HF specific admissions. Veterans were placed into one of two groups: enrolled in HT or not enrolled in HT at the time of admission. Mann-Whitney U Tests were performed to evaluate the significance of HT on HF specific readmissions and bed days of care (BDOC). Additionally, one hundred twenty-seven charts were identified for Veterans admitted with HF in FY 2017 to provide updated data. These were followed through the end of FY 2018 following the same criteria as the FY 2010 sample.
Results: In the FY 2010 sample, the Mann-Whitney U Test revealed no significant difference in readmission rates between HT (Md =0.5, n =10) and UC (Md = 1.0, n =105), U = 467.00, z = -.605, p = .545. The Mann-Whitney U Test revealed no significant difference on BDOC between HT (Md =10.0, n =10) and UC (Md =10.0, n =105), U = 477.50, z = -.472, p = .637.
In the FY 2017 sample, the Mann-Whitney U Test revealed no significant difference in readmission rates between HT (Md = 1.0, n = 38) and UC (Md = 1.0, n = 89), U = 1578, z = -.626, p = .531. The Mann-Whitney U Test revealed no significant difference on BDOC between HT (Md = 9.5, n = 38) and UC (Md = 12.0, n = 89), U = 1614, z = -.406, p = .685.
Nursing Implications: HT has been shown to be beneficial in preventing short term readmissions, but has not sustained the benefit over time. The quality improvement program evaluation results support similar findings within the literature and provides an opportunity for Advanced Practice Nurses and other clinicians to re-evaluate the underlying causes of HF readmission within the VA.