Effects of Telehealth
on the
Self Management of
Heart Failure
Brendon Colaco, M.B.B.S., M.H.A
Kathryn H. Dansky, PhD, RN
Kathryn H. Bowles, PhD, RN
Introduction

Study to look at the effects of telehealth on
home health patients with congestive heart
failure

Funded by the Robert Wood Johnson
Foundation through its Health E-Technologies
Initiative

Study undertaken by researchers at Penn State
in collaboration with the Pennsylvania Home
Care Association and 10 home health agencies
across the Commonwealth of Pennsylvania
Telehealth

Use of telecommunication technology to transmit
health information over a telephone line

Can transmit different types of health information
such as blood pressure, pulse oximetry, blood
glucose levels, heart sounds, breath sounds and
in some cases a direct visualization through a
camera
Types of telehealth

Asynchronous/ Monitor type: Transmits
clinical data only. The data are collected by
the machine and transmitted to a central
station once a day

Synchronous/ Video type: Transmits live data
and video through a camera. The
transmission occurs during the live event
Importance of study

Shift from institution centered care to patient
centered care

Patient involvement /participation and
empowerment

Preventative as opposed to therapeutic care

Era of chronic conditions-need for newer
modalities of disease management

Healthcare costs and limitations of resources –
capitol and human resources
Aims of study
To investigate the relationship between telehealth and
patient knowledge and behaviors specifically:
•
knowledge of heart failure (diet, exercise and
medications)
•
likelihood to adopt suggestions for healthy behavior
•
specific behaviors regarding symptom management,
physical activity and diet
Study Design


Randomized double blinded case control study
Sample
o Congestive Heart Failure patients
o
enrolled in home health care
o
patient/caregiver is cognitively intact
o
o
speaks English
phone line in home
Intervention

Three groups

Control group: regular home health care

Monitor group: receives monitor type
telehealth system + regular home health
care

Video Group: receives video type telehealth
system + regular home health care
Episode of home health care-60 days
Survey Instruments

Self Care Heart Failure Index

measures specific behaviors of patients
(diet, weight & activity)

measures the likelihood of patients to
perform healthy behaviors
Responses scored on Likert scale by research
assistants blinded to intervention
Survey Instruments

Omaha Problem Rating Scale (PRSO)

measures patients’ knowledge of diet,
activity, and medications
All responses scored on a Likert scale by
research assistants blinded to intervention
Patients interviewed at baseline, 60 days and
120 days from admission to study either on the
phone or via mail.
Descriptive Statistics
•
•
•
•
•
•
•
•
Sample: 212 patients
81 (38.2%) males
131 (61.8%) females
Mean age: 77 years ( 44-96)
Mean severity level for CHF:2.63 (1-4)
Control Group: 85 patients
Monitor Group : 90 patients
Video Group: 37 patients
Analyses

Univariate Analyses to determine that the
groups were equal at baseline

Reliability analyses for various summary scores

Repeated measures analyses or variance to
determine the between subjects and within
subjects effects over time
Findings & Limitations

Patients in both telehealth groups showed
greater improvement over time on knowledge
scores, likelihood to perform healthy behaviors
and specific behaviors than the control group

The time factor definitely had a significant effect

There was significant change within the groups;
however, the difference between the groups was
not statistically significant
Mean Scores
Knowledge Scores
15
14.5
14
13.5
13
12.5
12
11.5
11
10.5
10
9.5
9
Control
Monitor
Video
Baseline 60 days 120 days
Time
Likelihood to Perform Healthy
Behaviors
Means Scores
12
11. 5
11
Control
10. 5
10
Monitor
9. 5
9
8. 5
Video
8
7. 5
7
6. 5
6
Baseline
60 days
Time
120 days
Limitations and Challenges

Findings interpreted in light of small
sample size due to high attrition. Also
sample not complete, therefore these are
preliminary findings

Difficulty in enrolling patients and getting
three sets of data over 4 month period
Implications & Future
Direction






Telehealth an effective intervention through
knowledge and behavior?
Is one type of system better than the other, does it
vary with patient characteristics?
Policy Implications: adopt telehealth as standard of
care?
Reimbursement issues: Medicare reimbursement for
telehealth, insurance payers
Need for a cost analyses and effect of telehealth on
healthcare resources (nurse hours, hospitalizations,
ER visits)
Match telehealth with patient personalities and locus
of control to get better results