WVU researchers use telehealth to prevent hospitalizations and emergency visits

According to the Centers for Disease Control and Prevention, rural Americans are more likely than their urban counterparts to die prematurely of the five leading causes of death: heart disease, cancer, unintentional injury, lower respiratory tract disease, and stroke. . Telehealth – the use of technology to provide distance health care – is an emerging way to combat these trends. And its popularity is increasing.

Steve Davis, a researcher at West Virginia University, is piloting a telehealth intervention program to connect rural residents of western Virginia with nurses who can help them manage – and even prevent – such conditions. The program will focus on people coming out of long-term care facilities while they return home.

"Can telehealth be used to help people who are in some kind of institution – and who are about to be discharged – to prevent them from being re-institutionalized so that they can live and prosper in their community, close to their families? " said Davis, an badociate professor of health, management and executive policy at the School of Public Health.

Her research team includes Jennifer Mallow of the School of Nursing, Margaret Jaynes of the School of Medicine, Nathan Pauly and Lindsay Allen of the School of Public Health and Marcus Canaday of the West Virginia Medical Services Bureau.

The one-year program will begin accepting participants this fall. The approximately 30 people who will register will be rural residents of western Virginia who will receive services through Medicaid's "Traumatic Brain Injury" programs or through "seniors and disabled ". They will have recently left a long-term care facility, such as a retirement home or an inpatient rehabilitation center. And they will probably have a range of illnesses they have to deal with at home, including diabetes, hypertension and obesity.

"We looked at Medicaid's claims data to determine the main reasons for returning these people to an emergency department or hospital," Davis said. "We designed the program based on what we saw."

Each patient will receive a ladder; a thermometer and devices to monitor glucose levels, blood pressure and blood oxygenation. Those who risk falling will also receive a fall monitor. The patient's medical team will help them install the equipment and tell them how and how often to use it.

All devices will transmit data to nurses responsible for monitoring patient health 24 hours a day, 7 days a week. If a measurement departs from a healthy range – or, if there is a risk of a fall, if a patient falls – a nurse will be notified of it day or night.

Learn more about a medical problem as soon as it arises can help avoid what Davis calls a "cascade" of events that may lead again to a person in a long-term care facility . For example, if the blood sugar level of a diabetic patient is moderately high, a nurse can call, remind him to take his insulin and try to prevent future spikes by identifying the food that caused this increase. In this way, the patient can quickly control his glucose level before it reaches a very high level requiring a move to the emergency room.

In addition, Davis and his team plan to implement bi-weekly nurse calls to monitor patients' pain and mental health. "If mental health deteriorates, it can lead to the reinstitutionalization of someone," he said.

At the end of the pilot program, the researchers will evaluate its cost-effectiveness based on, among other things, the number of hospitalizations, readmissions to long-term care facilities and emergency department visits or a referral center. emergency care. . The team expects telehealth to reduce these numbers.

"We know that telehealth can reduce health care costs and emergency room visits, among other things, but it also makes nurses more accessible to patients and creates an opportunity for an adequate amount of care with fewer patients." There is currently a mbadive shortage of nurses nationwide, "said Mallow, badociate professor at WVU's Department of Adult Health. "Thanks to telehealth, we are able to spend more time with patients – time that we would otherwise spend traveling, taking notes or running from one patient to another on the spot."

This is especially true for home-based nurses who serve rural populations and can spend hours on the road visiting a patient. "In West Virginia, we call it" windshield hour, "said Mallow." Telehealth can give us more meaningful contacts with patients while reducing travel times. "

Once the pilot program is complete, researchers will also interview patients and health care providers to determine their satisfaction with the service and ways to improve it.

"Telehealth itself – once it's operational – is quite easy to use, from the end-user's point of view, but its design and implementation can prove to be very effective. complicated, "said Davis. "You have opposing visions and goals, coping with co-morbidities, all types of technologies, a range of devices, and providers, and we believe that telehealth is the only way to do this. has not yet reached its generalized potential – especially in rural areas. "

What the study reveals may suggest ways to overcome these logistical hurdles and deliver on the promise of telehealth.

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CONTACT: Jessica Wilmoth

WVU School of Public Health

304.293.0404; [email protected]

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