Outcomes of the Kaiser Permanente Tele-Home Health Research Project

CONTEXT: Level of acuity and number of referrals for home health care have been escalating exponentially. As referrals continue to increase, health care organizations are encouraged to find more effective methods for providing high-quality patient care with cost savings. OBJECTIVE: To evaluate the use of remote video technology in the home health care setting as well as the quality, use, patient satisfaction, and cost savings from this technology. DESIGN: Quasi-experimental study conducted from May 1996 to October 1997. SETTING: Home health department in the Sacramento, Calif, facility of a large health maintenance organization. PARTICIPANTS: Newly referred patients diagnosed as having congestive heart failure, chronic obstructive pulmonary disease, cerebral vascular accident, cancer, diabetes, anxiety, or need for wound care were eligible for random assignment to intervention (n = 102) or control (n = 110) groups. INTERVENTION: The control and intervention groups received routine home health care (home visits and telephone contact). The intervention group also had access to a remote video system that allowed nurses and patients to interact in real time. The video system included peripheral equipment for assessing cardiopulmonary status. MAIN OUTCOME MEASURES: Three quality indicators (medication compliance, knowledge of disease, and ability for self-care) ; extent of use of services; degree of patient satisfaction as reported on a 3-part scale; and direct and indirect costs of using the remote video technology. RESULTS: No differences in the quality indicators, patient satisfaction, or use were seen. Although the average direct cost for home health services was 1830 in the intervention group and 1167 in the control group, the total mean costs of care, excluding home health care costs, were 1948 in the intervention group and 2674 in the control group. CONCLUSIONS: Remote video technology in the home health care setting was shown to be effective, well received by patients, capable of maintaining quality of care, and to have the potential for cost savings. Patients seemed pleased with the equipment and the ability to access a home health care provider 24 hours a day. Remote technology has the potential to effect cost savings when used to substitute some in-person visits and can also improve access to home health care staff for patients and caregivers. This technology can thus be an asset for patients and providers.