Cost Analysis of TeleHomecare
 Kathryn H. Dansky, R.N., PhD
 Liisa Palmer, PhD candidate
 Dennis Shea, PhD
 Kathy Bowles, R.N., PhD
Cost Analysis of TeleHomecare
 TeleHomecare Project
 Evaluation
 Cost analysis
 Lessons learned
Partners
 Penn State University
 The Visiting Nurse Association
of Greater Philadelphia (VNA)
 American TeleCare, Inc.
Sponsor
 U.S. Department of Commerce
National Telecommunications Information
Administration (NTIA)
Telecommunications and Information
Infrastructure Assistance Program (TIIAP)
Project Objectives
1) Evaluate health status and quality of life
2) Evaluate health care costs
3) Evaluate patient satisfaction
4) Extend TeleHomecare technology to
other underserved populations
System Description
AVIVA 2020 (ATI)
 Patient station
 Clinician station
 Communication
links
Research Design
 Sample: Homebound diabetics
 Randomization to experimental
and control groups
 Pre- and post-testing
(post-testing at 60 days or discharge)
Patient Demographics
% Female
% Male
Video
73.6
26.4
Control
72.9
27.1
Average Age
74.8
74.2
91
85
Number
Patient Health Status
Video
Control
Mean Diabetes
Severity Score
2.28
2.29
Mean Number
of Comorbidities
1.91
2.07
Evaluation: Indices
1. Health Status
2. Quality of Life
3. Self-Management of Diabetes
4. Patient Satisfaction
5. Health Care Costs
Evaluation
Health Care Costs:



Direct costs: physician, hospital, home
health, pharmaceutical
System and training costs
Indirect costs: morbidity, mortality, QALYs
Home Health Costs: RN Care
Video
Control
Mean Number
of RN visits**
23.88
17.5
Mean Hours
of RN care**
17.75
14.09
** (p < 0.05)
Home Health Costs: RN Care
Mean Length
of Episode
(in days)
Mean Cost
per Patient
Episode**
** (p < 0.001)
Video
Control
50.04
48.56
$1701.83
$388.89
Home Health Costs: Project
Administrative Costs
Cost per Patient
Video
Control
$76.33
$76.33
Equipment & Supplies $1231.63
$0
Video visits
$63.73
$0
$1371.69
$76.33
Total
Project Costs: Video Group
 Telehomecare units + upgrades
 Peripherals
 Printer
 Carts and bins
 Equipment installation, maintenance
and removal
 Education, training and meetings
 Unsuccessful video visits
Considerations: Costs
 Equipment discounted over 5 years, but
no secondary market for equipment
(salvage value =0)
 Bureau of Labor average hourly wage
for Registered Nurses in Philadelphia
(1998) used for labor costs
Considerations: Uncertainty
 Equipment
- technical
- operator
 Appropriate number of video visits
- substitution versus supplementation
 Evaluation design
Impact on Patients:
Discharge Status
% Discharged Home
% Recertified for HHA
% Hospitalized
% Other
Video
Control
63.7
23.1
11.0
2.2
39.0
25.6
26.8
8.5
Lessons Learned: Costs
 Technical support
 Staff buy-in
 Training
 Hidden costs
 Maximize potential
TeleHomecare Project
Caring, Journal of Healthcare
Information Management
http://www.hhdev.psu.edu/hpa