Home-Based Preventative Care in High-Risk Dialysis Patients: A Pilot Study
TELEMEDICINE and e-HEALTH MAY 2011 Steven J. Berman, M.D.,1,2 Cherisse Wada, R.N.,1 Dayna Minatodani, Ph.D., R.N.,3 Timothy Halliday, Ph.D.,4 Robin Miyamoto, Psy.D.,2 Jaclyn Lindo, M.A.,4 and Patricia J. Jordan, Ph.D.1,5 1John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii.2St. Francis Healthcare Foundation, Honolulu, Hawaii. 3University of Hawaii—Leeward Community College, University of Hawaii—West Oahu, Honolulu, Hawaii. 4Department of Economics and 5Social and Behavioral Health Sciences Program, Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, Hawaii.
Objective: Most dialysis patients have multiple comorbidities with complex healthcare needs and consume a disproportionate share of medical resources. We conducted a pilot study employing telehealth technology to determine whether home-based preventative care can improve healthcare outcomes, impact quality of life (QOL), and be cost effective by proactively managing underlying chronic conditions that place the patient at risk. Materials and
Methods: Forty-four patients (19 in the remote technology group [RT] and 25 in the usual care group [UC]) participated in this study. The mean age was 57 for those in the RT group (7 females and 12 males) and 62 for those receiving UC (11 females and 14 males). Health outcome measurements included hospitalizations, emergency room visits, and the number of days hospitalized. Economic analysis included total hospital and
emergency room charges. QOL was measured using the medical outcomes survey instrument 36-Item Short Form Health Survey (SF-36).
Results: Hospitalizations (RT 0.0018 and UC 0.0056 per study day), hospital days (RT 0.008 and UC 0.036 per study day), emergency room visits (RT 0.0003 and UC 0.0019 per study day), and associated charges (RT $114 and UC $322 per study day) were significantly less in the RT group of the study compared with patients receiving UC. The perceived QOL remained the same in the UC group from outset to midpoint of the study (59.1, 59.5), whereas it decreased slightly in the RT group (63.9, 60.76).
Conclusions: The results suggest that remote telehealth technology can play an important role in improving health outcomes and the cost of care of patients with end-stage renal disease who have complex healthcare needs.