How providers can tailor HF home monitoring to prevent readmissions

Heart monitor

Telehomecare by itself may not be enough to prevent hospital readmissions among heart failure patients, according to new research from the University of Pennsylvania School of Nursing.

The study, published online in the journal Telemedicine and e-Health, refers to telehomecare as daily remote monitoring of factors such as vital signs and weight. It involved 526 patients who received such care from Jan. 1, 2011 to Aug. 31, 2013, using data analysis of the Centers for Medicare & Medicaid Services-mandated assessment, the Outcome and Assessment Information Set (OASIS)-C.

The research identified four factors associated with readmissions:

  1. Moderately frail health status
  2. Severe pain
  3. Skin problems
  4. Independence in dressing the lower body

These factors, they said, could help providers tailor interventions to help prevent further hospitalization.

For instance, the odds of a moderately frail person being readmitted were 1.65 times greater than the odds for stable or mildly frail patients. Therefore, these patients might need more in-person visits

And pain has not typically been considered a primary symptom the way shortness of breath, fatigue and edema have, the researchers said. Pain, however, could be correlated with fatigue and depression, and may restrict daily activity and self-management.

The authors also found that patients with dermatologic problems, such as pressure ulcers, skin lesions, or open wounds, were more at risk for rehospitalization.

The researchers were surprised to find a patient’s higher ability to dress the lower body associated with readmission. They speculated that such patients might also be able to independently weigh themselves and seek help before experiencing clinical deterioration.