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Telehealth: The Future for Hospital Reduction of Readmissions
Student Name
NURS 6061: Transforming Nursing and Healthcare through Technology
Walden University
Instructor Name
Date of Submission
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Telehealth: The Future for Hospital Reduction of Readmissions
Telehealth is a clinical system that can help improve patient care when the patient is
transitioning from inpatient care to home care. Telehealth programs help patients engage in
their own health care. Providers can video conference with the patient without them having to
leave their home. Remote monitoring is also a form of telehealth that can be utilized. This
allows providers to see trends in patient’s biometrics which in-turn allows the providers to
implement new medications or follow up visits with the patient before an admission or
readmission occurs. The purpose of this paper is to evaluate how the utilization of a telehealth
program improves care by decreasing the number of 30-day readmissions to the hospital.
Annotated Bibliography
Bhatt, S. P., Patel, S. B., Anderson, E. M., Baugh, D., Givens, T., Schumann, C., Sanders, J.
G., Windham, S. T., Cutter, G. R., & Dransfield, M. T. (2019). Video telehealth
pulmonary rehabilitation intervention in chronic obstructive pulmonary disease
reduces 30-day readmissions. American Journal of Respiratory and Critical
Medicine, 200(4), 511-513. doi:10.1164/rccm.201902-0314LE
A study was performed to determine if a form of video telehealth would
decrease the all cause 30-day readmission of chronic obstructive pulmonary
disease (COPD) patients. This study was conducted due to the recognition that
pulmonary rehabilitation was successful in decreasing admissions by 56%, but
pulmonary rehabilitation programs have poor access. The authors
hypothesized that the use of an intervention of pulmonary rehabilitation early
via video telehealth after a discharge from an admission of an acute
exacerbation of COPD would then decrease the amount of all cause 30-day
readmissions. Eighty participants were enrolled in the telehealth video
pulmonary rehabilitation program and matched with 160 nonexposed
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participants. The groups had similar comorbidities and demographics. The
participants all received the same discharge plan to help reduce 30-day
readmissions. They all received a referral to traditional pulmonary rehab. The
telehealth participants received a smart phone during their visit that was to be
used for the video conferencing. A portable foot pedaler was received for the
exercise component of the video telehealth pulmonary rehabilitation program.
For safety a pulse oximeter and automatic sphygmomanometer were given to
the participants to use before and after exercise activity to test their blood
pressure, heart rate, and oxygen level. They telehealth pulmonary
rehabilitation program consisted of 36 sessions over 12 weeks, which is
consistent with a traditional program. The subjects that completed 20 sessions
were considered completers of the program. Sixty-six of the 80 participants
were completers of the program. Of the 160 nonexposed, only 42 were
referred to traditional pulmonary rehabilitation after discharge. Ten subjects
enrolled in traditional pulmonary rehabilitation within three months of
discharge, two of which were already participating. The study showed in the
participants within the telehealth program a reduction of 30-day all cause
readmissions, (6.2% vs. 18.1%). The study does have some limitations as the
study was not randomized and the participants were grouped by readmission
risk. There also could have been readmissions missed from other hospitals in
the control group. This study demonstrated a reduction in 30-day readmissions
for COPD patients with the use of a video telehealth based pulmonary
rehabilitation program.
O’Connor, M., Asodornwised, U., Dempsey, M. L., Huffenburger, A., Jost, S., Flynn, D., &
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Norris, A. (2016). Using telehealth to reduce all-cause 30-day hospital readmissions
among heart failure patients receiving skilled home health services. Applied Clinical
Informatics, 7(2). doi:10.4338/ACI-2015-11-SOA-0157
An article was written to describe the impact of a telehealth program that was
directed to decrease the amount of 30-day all-cause readmissions in heart
failure (HF) patients in a Medicare-certified home health agency. Penn Care at
Home launched their telehealth program in September of 2010. Inclusion
criteria was the participants had to speak English, have a classification of II-IV
by the New York Health Association, or be a high risk for readmission, be able
to utilize the monitoring equipment safely and step on a scale with or without
caregiver assistance, willing to utilize the home monitoring equipment, and the
participant had to have a home environment that was conducive to safely
accommodate the monitoring equipment. The telehealth equipment was a
wireless tablet that collected patient’s blood pressure, heart rate, weight, and
blood oxygen level. The tablet also provided instructional videos on HF that
the patients could utilize. The health data was collected daily and transmitted
real-time to the telehealth team via a secure web portal daily including
weekends. When additional teaching needs to occur, nurses telephone the
patient and coach them in whatever needs to be coached additionally. If
changes occur in patient’s biometrics the nurse practitioner or physician are
contacted to make changes in the patient’s medications or diet. Follow up
appointments are made if needed. In 2011 data was analyzed and the 30- day
all-cause readmission rate for HF patients within this study was 19.3%. Three
years into this program the 30-day all-cause readmission rate decreased to
5.2%. This program was successful in keeping patient’s out of the hospital. A
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limitation to the study was that it only used data from one home health agency
and it did not adjust for varying demographics of the participants. infections.
Noel, K., Messina, C., Hou, W., Schoenfield, E., & Kelly, G. (2020). Tele-transitions of care
(TTOC): a 12-month, randomized controlled trial evaluating the use of Telehealth to
achieve triple aim objectives. BMC Family Practice, 21(27).
A study was performed to determine whether telehealth after discharge would
decrease 30-day readmissions versus patient’s being discharged with the
normal standards of care. Standard of Care included, discharge instructions
with discharge summary, scheduling of specialist appointments, and
encouragement to follow-up with primary care within 7-14 days. One hundred
two patients were randomly chosen to be in either the standard of care (SOC)
group or the telehealth group (TTOC). The telehealth group received a smart
phone with Bluetooth-enabled devices of a blood pressure cuff, a scale to
measure weight, and a pulse oximeter. The patients used these devices daily to
submit data and had weekly virtual visits with a teledoc. The patients
consented to participate in this for 30 days after discharge. Forty-five patients
were randomly chosen for the TTOC group and 57 received the standard of
care. This study showed that with the use of telehealth, the patient within the
TTOC group adhered to their medications after discharge and be engaged in
their health care. The authors reported that the study was underpowered to
determine a decline in hospital readmissions, but with the utilization of
telehealth it is promising on the reduction of readmissions.
Bernocchi, P., Wcdalvini, S., Galli, T., Paneroni, M., Baratti, D., Turla, O., La Rovere, M. T.,
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Volterrani, M., & Vitacca, M. (2016). A multidisciplinary telehealth program in
patients with combined chronic obstructive pulmonary disease and chronic heart
failure: study protocol for a randomized controlled trial. Trials, 17(462).
A study was conducted to determine how telehealth would affect patient that
have combined diagnosis of chronic obstructive pulmonary disease and
congestive heart failure. Participants were recruited from three different
hospitals. Patients were selected randomized into either the control group or
the intervention group. The intervention group were monitored by remote
cardiorespiratory parameters and telephone contact by nurses. They also
participated in a home-based rehabilitation with contact made with a
physiotherapist. The intervention group received a pulse oximeter and a one-
lead portable electrocardiograph. The control group received standard of care
for discharge. The study revealed with the use of telehealth these patients had
an increase in exercise tolerance. Secondary outcomes included a decrease in
hospital readmissions for all-causes and a decrease in readmissions for
cardio/respiratory diseases.
Conclusion
Utilization of a telehealth program is an essential clinical system to have within an
organization. The use of telehealth can reduce the 30-day readmission at facilities which will
improve patient outcomes and quality of care. Evidence has been shown in studies that have
been conducted with CHF and COPD patients, that the utilization of telehealth with home
monitoring equipment, calls from health care professionals, and educational materials
presented on a tablet can reduce hospital readmissions. Telehealth is essential in transitional
care and will improve patient outcomes.
