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1Telehealth: The Future for Hospital Reduction of ReadmissionsStudent NameNURS 6061: Transforming Nursing and Healthcare through

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Telehealth: The Future for Hospital Reduction of Readmissions

Student Name

NURS 6061: Transforming Nursing and Healthcare through Technology

Walden University

Instructor Name

Date of Submission

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Telehealth: The Future for Hospital Reduction of Readmissions

Telehealth is a clinical system that can help improve patient care when the patient is

transitioning from inpatient care to home care. Telehealth programs help patients engage in

their own health care. Providers can video conference with the patient without them having to

leave their home. Remote monitoring is also a form of telehealth that can be utilized. This

allows providers to see trends in patient’s biometrics which in-turn allows the providers to

implement new medications or follow up visits with the patient before an admission or

readmission occurs. The purpose of this paper is to evaluate how the utilization of a telehealth

program improves care by decreasing the number of 30-day readmissions to the hospital.

Annotated Bibliography

Bhatt, S. P., Patel, S. B., Anderson, E. M., Baugh, D., Givens, T., Schumann, C., Sanders, J.

G., Windham, S. T., Cutter, G. R., & Dransfield, M. T. (2019). Video telehealth

pulmonary rehabilitation intervention in chronic obstructive pulmonary disease

reduces 30-day readmissions. American Journal of Respiratory and Critical

Medicine, 200(4), 511-513. doi:10.1164/rccm.201902-0314LE

A study was performed to determine if a form of video telehealth would

decrease the all cause 30-day readmission of chronic obstructive pulmonary

disease (COPD) patients. This study was conducted due to the recognition that

pulmonary rehabilitation was successful in decreasing admissions by 56%, but

pulmonary rehabilitation programs have poor access. The authors

hypothesized that the use of an intervention of pulmonary rehabilitation early

via video telehealth after a discharge from an admission of an acute

exacerbation of COPD would then decrease the amount of all cause 30-day

readmissions. Eighty participants were enrolled in the telehealth video

pulmonary rehabilitation program and matched with 160 nonexposed

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participants. The groups had similar comorbidities and demographics. The

participants all received the same discharge plan to help reduce 30-day

readmissions. They all received a referral to traditional pulmonary rehab. The

telehealth participants received a smart phone during their visit that was to be

used for the video conferencing. A portable foot pedaler was received for the

exercise component of the video telehealth pulmonary rehabilitation program.

For safety a pulse oximeter and automatic sphygmomanometer were given to

the participants to use before and after exercise activity to test their blood

pressure, heart rate, and oxygen level. They telehealth pulmonary

rehabilitation program consisted of 36 sessions over 12 weeks, which is

consistent with a traditional program. The subjects that completed 20 sessions

were considered completers of the program. Sixty-six of the 80 participants

were completers of the program. Of the 160 nonexposed, only 42 were

referred to traditional pulmonary rehabilitation after discharge. Ten subjects

enrolled in traditional pulmonary rehabilitation within three months of

discharge, two of which were already participating. The study showed in the

participants within the telehealth program a reduction of 30-day all cause

readmissions, (6.2% vs. 18.1%). The study does have some limitations as the

study was not randomized and the participants were grouped by readmission

risk. There also could have been readmissions missed from other hospitals in

the control group. This study demonstrated a reduction in 30-day readmissions

for COPD patients with the use of a video telehealth based pulmonary

rehabilitation program.

O’Connor, M., Asodornwised, U., Dempsey, M. L., Huffenburger, A., Jost, S., Flynn, D., &

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Norris, A. (2016). Using telehealth to reduce all-cause 30-day hospital readmissions

among heart failure patients receiving skilled home health services. Applied Clinical

Informatics, 7(2). doi:10.4338/ACI-2015-11-SOA-0157

An article was written to describe the impact of a telehealth program that was

directed to decrease the amount of 30-day all-cause readmissions in heart

failure (HF) patients in a Medicare-certified home health agency. Penn Care at

Home launched their telehealth program in September of 2010. Inclusion

criteria was the participants had to speak English, have a classification of II-IV

by the New York Health Association, or be a high risk for readmission, be able

to utilize the monitoring equipment safely and step on a scale with or without

caregiver assistance, willing to utilize the home monitoring equipment, and the

participant had to have a home environment that was conducive to safely

accommodate the monitoring equipment. The telehealth equipment was a

wireless tablet that collected patient’s blood pressure, heart rate, weight, and

blood oxygen level. The tablet also provided instructional videos on HF that

the patients could utilize. The health data was collected daily and transmitted

real-time to the telehealth team via a secure web portal daily including

weekends. When additional teaching needs to occur, nurses telephone the

patient and coach them in whatever needs to be coached additionally. If

changes occur in patient’s biometrics the nurse practitioner or physician are

contacted to make changes in the patient’s medications or diet. Follow up

appointments are made if needed. In 2011 data was analyzed and the 30- day

all-cause readmission rate for HF patients within this study was 19.3%. Three

years into this program the 30-day all-cause readmission rate decreased to

5.2%. This program was successful in keeping patient’s out of the hospital. A

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limitation to the study was that it only used data from one home health agency

and it did not adjust for varying demographics of the participants. infections.

Noel, K., Messina, C., Hou, W., Schoenfield, E., & Kelly, G. (2020). Tele-transitions of care

(TTOC): a 12-month, randomized controlled trial evaluating the use of Telehealth to

achieve triple aim objectives. BMC Family Practice, 21(27).

A study was performed to determine whether telehealth after discharge would

decrease 30-day readmissions versus patient’s being discharged with the

normal standards of care. Standard of Care included, discharge instructions

with discharge summary, scheduling of specialist appointments, and

encouragement to follow-up with primary care within 7-14 days. One hundred

two patients were randomly chosen to be in either the standard of care (SOC)

group or the telehealth group (TTOC). The telehealth group received a smart

phone with Bluetooth-enabled devices of a blood pressure cuff, a scale to

measure weight, and a pulse oximeter. The patients used these devices daily to

submit data and had weekly virtual visits with a teledoc. The patients

consented to participate in this for 30 days after discharge. Forty-five patients

were randomly chosen for the TTOC group and 57 received the standard of

care. This study showed that with the use of telehealth, the patient within the

TTOC group adhered to their medications after discharge and be engaged in

their health care. The authors reported that the study was underpowered to

determine a decline in hospital readmissions, but with the utilization of

telehealth it is promising on the reduction of readmissions.

Bernocchi, P., Wcdalvini, S., Galli, T., Paneroni, M., Baratti, D., Turla, O., La Rovere, M. T.,

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Volterrani, M., & Vitacca, M. (2016). A multidisciplinary telehealth program in

patients with combined chronic obstructive pulmonary disease and chronic heart

failure: study protocol for a randomized controlled trial. Trials, 17(462).

A study was conducted to determine how telehealth would affect patient that

have combined diagnosis of chronic obstructive pulmonary disease and

congestive heart failure. Participants were recruited from three different

hospitals. Patients were selected randomized into either the control group or

the intervention group. The intervention group were monitored by remote

cardiorespiratory parameters and telephone contact by nurses. They also

participated in a home-based rehabilitation with contact made with a

physiotherapist. The intervention group received a pulse oximeter and a one-

lead portable electrocardiograph. The control group received standard of care

for discharge. The study revealed with the use of telehealth these patients had

an increase in exercise tolerance. Secondary outcomes included a decrease in

hospital readmissions for all-causes and a decrease in readmissions for

cardio/respiratory diseases.

Conclusion

Utilization of a telehealth program is an essential clinical system to have within an

organization. The use of telehealth can reduce the 30-day readmission at facilities which will

improve patient outcomes and quality of care. Evidence has been shown in studies that have

been conducted with CHF and COPD patients, that the utilization of telehealth with home

monitoring equipment, calls from health care professionals, and educational materials

presented on a tablet can reduce hospital readmissions. Telehealth is essential in transitional

care and will improve patient outcomes.

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