Telehealth for Emergency-Community Continuity of Care Connectivity Via Home-Telemonitoring

Overview

Modern technology like computers, smartphones and the Internet enable patients to measure certain health indicators, like blood pressure and body weight, from the comfort of their own homes. This information can also be shared electronically with doctors and other healthcare providers to monitor remotely. This is called home health monitoring. In TEC4Home, we are developing a home monitoring solution for patients with heart failure to support their care and recovery at home after a visit to the emergency department. We hope to show that this solution decreases revisits to the emergency department and increases quality of life for patients.

Full Title of Study: “TEC4Home: Telehealth for Emergency-Community Continuity of Care Connectivity Via Home-Telemonitoring”

Study Type

  • Study Type: Interventional
  • Study Design
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Supportive Care
    • Masking: None (Open Label)
  • Study Primary Completion Date: May 2017

Interventions

  • Device: Telus Health Remote Patient Monitoring

Arms, Groups and Cohorts

  • Experimental: Home Telemonitoring

Clinical Trial Outcome Measures

Primary Measures

  • Emergency Department Revisit, hospital administrative data, questionnaire
    • Time Frame: 90 days
    • Hospital administrative data will be reviewed to determine if the patient visited an emergency department for a heart-failure-related health issue during the 90-day follow-up period. Participants will also be asked to self-report emergency department visits during the follow-up period.
  • Hospitalization, hospital administrative data
    • Time Frame: 90 days
    • Hospital administrative data will be reviewed to determine if that patient was admitted to hospital during the 90-day follow-up period. Participants will also be asked to self-report hospitalizations during the follow-up period.
  • Mortality
    • Time Frame: 90 days

Secondary Measures

  • Reduction in Cost as Compared to Usual Care
    • Time Frame: Through study completion, approximately 9 months
  • Improvement in Communication, questionnaire
    • Time Frame: 90 days
    • Improved communication between acute and community care during transition from hospital to home, to be assessed by questionnaires of health care providers
  • Quality of Life, KCCQ,
    • Time Frame: 90 days
    • Disease-specific health-related quality of life
  • Patient Experience of Care, questionnaire
    • Time Frame: 90 days
  • Reductions in Morbidity
    • Time Frame: 90 days
  • Improvement in Communication, interview
    • Time Frame: 90 days
    • Improved communication between acute and community care during transition from hospital to home, to be assessed by interviews with health care providers
  • Quality of Life, VR-12
    • Time Frame: 90 Days
    • Generic health-related quality of life.

Participating in This Clinical Trial

Inclusion Criteria

PATIENT PARTICIPANTS:

  • Have one or more typical symptoms of Heart Failure (i.e. dyspnoea at rest or minimal exertion (includes orthopnoea, reduced exercise tolerance)) AND
  • Have one or more typical signs of Heart Failure (i.e. elevated jugular venous pressure, pulmonary crepitations, pleural effusions, peripheral oedema) AND
  • Have one or more objective measures of heart failure:

Radiological congestion.

  • Elevated BNP ≥ 400 pg/mL or NT-proBNP ≥ 1000 pg/mL.
  • Reduced left ventricular ejection fraction <40% (or <45%) in previous 12 months.

Diastolic dysfunction including tissue Doppler E/e' ratio > 15 in previous 12 months.

  • Pulmonary capillary wedge pressure >20 mmHg.
  • Diuretic therapy. The additional value of diuretic therapy (IV or oral) is debatable, as presumably unlikely (or unsafe) that patient with genuine HF will be discharged without diuretic.

CLINICIAN PARTICIPANTS:

To be eligible to participate, clinician participants (i.e. ED physicians, family physicians and monitoring nurse(s)) must have referred or have a patient enrolled in the TEC4Home monitoring service.

Exclusion Criteria

PATIENT PARTICIPANTS:

  • Physical barriers e.g. unable to stand on scales.
  • Cognitive impairment (e.g. MMSE <20), unless suitable caregiver support.
  • Language (must be able to read and understand English), unless suitable caregiver support.
  • Documented history of current and active substance misuse (within 3 months).
  • Lack digital connectivity or landline phone connection.
  • No regular care provider e.g. GP, or at least regular walk-in clinic.
  • Existing intensive system of care: LVAD, transplant, dialysis.
  • Anticipated improvement due to revascularization (PCI/CABG) or valve intervention during index hospitalization.
  • Anticipated survival <90 days. Active palliative care, less-than level III care, disseminated malignancy.

CLINICIAN PARTICIPANTS:

Clinicians who do not have patients enrolled in the TEC4Home service or who themselves are not involved in the implementation or operation of the TEC4Home monitoring service will not be eligible to participate.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University of British Columbia
  • Provider of Information About this Clinical Study
    • Principal Investigator: Kendall Ho, Lead, Digital Emergency Medicine; Professor, Department of Emergency Medicine, Faculty of Medicine, UBC – University of British Columbia

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