J. Med. Internet Res. - Clinical outcome and cost-effectiveness of a synchronous telehealth service for seniors and nonseniors with cardiovascular diseases: quasi-experimental study.

Tópicos

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Resumo

CKGROUND: Telehealth based on advanced information technology is an emerging health care strategy for managing chronic diseases. However, the cost-effectiveness and clinical effect of synchronous telehealth services in older patients with cardiovascular diseases has not yet been studied. Since 2009, the Telehealth Center at the National Taiwan University Hospital has provided a range of telehealth services (led by a cardiologist and staffed by cardiovascular nursing specialists) for cardiovascular disease patients including (1) instant transmission of blood pressure, pulse rate, electrocardiography, oximetry, and glucometry for analysis, (2) mutual telephone communication and health promotion, and (3) continuous analytical and decision-making support.OBJECTIVE: To evaluate the impact of a synchronous telehealth service on older patients with cardiovascular diseases.METHODS: Between November 2009 and April 2010, patients with cardiovascular disease who received telehealth services at the National Taiwan University Hospital were recruited. We collected data on hospital visits and health expenditures for the 6-month period before and the 6-month period after the opening of the Telehealth Center to assess the clinical impact and cost-effectiveness of telehealth services on cardiovascular patients.RESULTS: A total of 141 consecutive cardiovascular disease patients were recruited, including 93 aged =65 years (senior group) and 48 aged <65 years (nonsenior group). The telehealth intervention significantly reduced the all-cause admission rate per month per person in the nonsenior group (pretelehealth: median 0.09, IQR 0-0.14; posttelehealth: median 0, IQR 0-0; P=.002) and the duration (days per month per person) of all-cause hospital stay (pretelehealth: median 0.70, IQR 0-1.96; posttelehealth: median 0, IQR 0-0; P<.001) with increased all-cause outpatient visits per month per person (pretelehealth: median 0.77, IQR 0.20-1.64; posttelehealth: mean 1.60, IQR 1.06-2.57; P=.002). In the senior group, the telehealth intervention also significantly reduced the all-cause admission rate per month per person (pretelehealth: median 0.10, IQR 0-0.18; posttelehealth: median 0, IQR 0-0; P<.001) and the duration (days per month per person) of all-cause hospital stay (pretelehealth: median 0.59, IQR 0-2.24; posttelehealth: median 0, IQR 0-0; P<.001) with increased all-cause outpatient visits per month per person (pretelehealth: median 1.40, IQR 0.52-2.63; posttelehealth: median 1.76, IQR 1.12-2.75; P=.02). In addition, telehealth intervention reduced the inpatient cost in the nonsenior group from $814.93 (SD 1000.40) to US $217.39 (SD 771.01, P=.001) and the total cost per month from US $954.78 (SD 998.70) to US $485.06 (SD 952.47, P<.001). In the senior group, the inpatient cost per month was reduced from US $768.27 (SD 1148.20) to US $301.14 (SD 926.92, P<.001) and the total cost per month from US $928.20 (SD 1194.11) to US $494.87 (SD 1047.08, P<.001).CONCLUSIONS: Synchronous telehealth intervention may reduce costs, decrease all-cause admission rates, and decrease durations of all-cause hospital stays in cardiovascular disease patients, regardless of age.

Resumo Limpo

ckground telehealth base advanc inform technolog emerg health care strategi manag chronic diseas howev costeffect clinic effect synchron telehealth servic older patient cardiovascular diseas yet studi sinc telehealth center nation taiwan univers hospit provid rang telehealth servic led cardiologist staf cardiovascular nurs specialist cardiovascular diseas patient includ instant transmiss blood pressur puls rate electrocardiographi oximetri glucometri analysi mutual telephon communic health promot continu analyt decisionmak supportobject evalu impact synchron telehealth servic older patient cardiovascular diseasesmethod novemb april patient cardiovascular diseas receiv telehealth servic nation taiwan univers hospit recruit collect data hospit visit health expenditur month period month period open telehealth center assess clinic impact costeffect telehealth servic cardiovascular patientsresult total consecut cardiovascular diseas patient recruit includ age year senior group age year nonsenior group telehealth intervent signific reduc allcaus admiss rate per month per person nonsenior group pretelehealth median iqr posttelehealth median iqr p durat day per month per person allcaus hospit stay pretelehealth median iqr posttelehealth median iqr p increas allcaus outpati visit per month per person pretelehealth median iqr posttelehealth mean iqr p senior group telehealth intervent also signific reduc allcaus admiss rate per month per person pretelehealth median iqr posttelehealth median iqr p durat day per month per person allcaus hospit stay pretelehealth median iqr posttelehealth median iqr p increas allcaus outpati visit per month per person pretelehealth median iqr posttelehealth median iqr p addit telehealth intervent reduc inpati cost nonsenior group sd us sd p total cost per month us sd us sd p senior group inpati cost per month reduc us sd us sd p total cost per month us sd us sd pconclus synchron telehealth intervent may reduc cost decreas allcaus admiss rate decreas durat allcaus hospit stay cardiovascular diseas patient regardless age

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