Chronic Disease Care

• By Jim McDonald, Clare Coleman
• Nov 01, 2000

Traditionally, health care in the United States has been reactive instead of proactive. But in today's marketplace, the high cost of health care is not due to the kid who breaks his arm at football practice, goes to the emergency room (ER), gets a cast and then goes home to recuperate. Nor are high costs due to the occasional flu victim who visits his primary care provider for an antibiotic.

Rather, the real cost in health care today comes from the chronically ill patient: it's the asthma, diabetes or congestive heart failure patient who is still treated and managed in the same reactive way that the occasional health care user is managed. That is, we wait until the chronically ill patient gets sick enough to visit the doctor's office or the ER, and then try to make them better. Once better, sending the chronically ill patient home from the hospital does not mean they won't be back, and in a short period of time.

Too often, chronically ill patients fall victim to the way health care is financed. Today's system does not do enough to encourage keeping patients out of the doctor's office, the ER or the hospital. In fact, it seems just the opposite. Payment is made only for patients who access health care. With the occasional user, that makes sense. With patients who have a chronic disease, it does not.

For example, congestive heart failure (CHF) effects an estimated five million people in America. While that number is dwarfed by the number of people with diabetes, CHF patients cost the health care system approximately $10 billion each year. With the baby boomers on the way to their golden years, that estimate could double or triple in a few years.

Telemedicine as a proactive alternative is just starting to grow in acceptance, but the debate about who is going to pay remains a major stumbling block to growth. However, we are already paying for the cost of reactive medicine with steadily increasing insurance payments and with the ever-growing number of people who have no health care coverage at all.

Proactive, daily monitoring of chronic diseases has been proven time and time again to significantly reduce doctor's office visits, trips to the ER and hospitalizations of the chronically ill. The HomMed Monitoring System, from HomMed LLC, Brookfield, Wis., was developed to furnish health care providers with real time, complete and accurate vital sign data, which helps medical professionals and patients work together to better manage chronic disease. The FDA-approved HomMed System is designed to be easy for both patient and clinician to use. The system is comprised of two components: the HomMed Sentry and the HomMed Observer. The Sentry is a light-weight, compact monitor, which collects and transmits data on patients' vital signs from the comfort of their home. The personal computer-sized Observer, located at the hospital, receives patient data, stores it and presents it to the clinical professional.

HomMed Sentry Gathers Accurate Clinical Data

The HomMed Sentry is easily installed in a patient's home. It is fast and easy to use. Dual communication modes guarantee transmission of patient data from any location. Unlike other systems that only use telephone communications, the HomMed Monitoring System also uses a digital two-way pager from Motorola so even patients without telephone service can access the service. The system requires no special installation of ISDN or DSL lines in a patient's home, nor do patients have to link up with a Web site to enter their vital signs.

At a set time each day, the Sentry's user-friendly voice announces to the patient that it's time to take vital signs. The system then guides the patient through data input using voice commands to ensure timely and complete vital sign measurements. As an added patient-friendly feature, the HomMed Sentry's voice command can be programmed to direct the patient in almost any language.

With three key strokes, the HomMed Sentry collects data on vital signs: heart rate, blood pressure, weight, oxygen saturation and temperature. The custom-designed blood pressure cuff can be easily positioned with one hand to accurately measure systolic, diastolic and mean blood pressure. A simple-to-use, non-invasive finger probe provides accurate heart rate and oxygen saturation measurements, while a digital thermometer provides the patient's temperature reading in five seconds. Finally, a digital scale measures the patient's weight for early detection of fluid retention. For those patients with diabetes or asthma, a glucose meter, or Spirometer, can be added to collect additional information.

Completed in the comfort of a patient's own home, the whole process takes less than three minutes each day. The resulting data is automatically transmitted to a health care facility for analysis in less than one minute. The current compliance rate of patients using the HomMed Sentry is 97.8 percent, indicating that not only can patients use the Sentry, but they like using it as well.

HomMed Observer Delivers Precise Patient Reports

Like the HomMed Sentry, the Observer is designed with ease of use in mind, so clinicians can focus on their patients instead of on a complicated system. Built around a Windows-based platform, the Observer is compatible with almost any system.

The HomMed Observer receives the patient's daily vital signs and displays them in a quick, easy-to-read format. The Observer can store information on 500 patients and can provide at-a-glance reports on 100 patients simultaneously. The Observer stores incoming data and can trend information for a period of up to six months. Ongoing results also can be easily correlated with current medications.

In addition to monitoring and tracking patients, the HomMed Observer also establishes an intervention system to identify and react to potential problems. Each patient is given a baseline of appropriate vital sign measurements with minimum and maximum alarm limits. In the event that a vital sign falls outside the alarm parameters, the clinician is notified immediately upon data transmission by a flashing red alert. Monitoring personnel also may be alerted if vital signs are not transmitted at the assigned time. In both instances, the Observer provides an information screen with call back information, the patient's current drug regimen, and any other emergency contact information necessary to effectively and efficiently work with the patient.

HomMed Helps Professionals, Patients Better Manage Care Together

Via daily monitoring, health care professionals can make clinical interventions at the onset of problems rather than dealing with a much sicker patient when they arrive in the ER. Further, doctors can titrate medications (determine their concentration) based on daily vital signs rather than requiring an office visit to make adjustments. The daily readings effectively fill in the blanks between patient visits and allow doctors to evaluate the effectiveness of a treatment regimen daily, monthly and over an extended period. Additionally, the HomMed Monitoring System can reduce hospital and HMO costs, costing as little as $5 per patient, per day.

Home health care agencies also can benefit from use of the HomMed Monitoring System. Not only can home health care providers reduce costs, but also they now can provide efficient daily monitoring of patients scattered across miles. As a result, home health agencies can expand their range of coverage and take on more patients, while providing quality care for less money.

In addition to CHF, the HomMed Monitoring System can help health care professionals and patients manage a range of chronic illnesses including high blood pressure, diabetes, asthma and chronic obstructive pulmonary disease.

Beyond cost savings, the HomMed System enhances the quality of life for patients with chronic diseases. Daily monitoring helps patients increase their awareness and understanding of their disease, empowering them to better manage their chronic condition. HomMed's proactive system also reduces or eliminates hospital visits, meaning patients spend more time at home. Finally, daily monitoring by a health care professional provides patients and their families with a sense of comfort and security.

Monitoring System Backed By Proven Results

The effectiveness of the HomMed Monitoring System in helping professionals and patients better manage chronic conditions is supported by a recent study reported in the May/June issue of Congestive Heart Failure, the research and education journal of the Heart Failure Society of America. The study showed that the HomMed Monitoring Systems improves CHF patient outcomes in terms of reduced hospitalization rates and emergency room visits even at major teaching institutions with sophisticated CHF programs. For smaller, community-based institutions, treating CHF patients is likely to present even more dramatic results. Specifically, the study showed that used as an adjunct to multidisciplinary specialty intervention in chronic heart failure, the HomMed System "is clinically feasible, is associated with high compliance rates, demonstrates trends in improved hospitalization rates, and decreases the need for crisis-triggered emergency room visits."

The study included 53 patients with CHF who used the HomMed Monitoring System over a three-month period and another group of 60 CHF patients who did not. The study involved patients from Ochsner Clinic in New Orleans, Vanderbilt University in Nashville, Waukesha Memorial Hospital in Wisconsin and the University of Iowa Hospitals and Clinics in Iowa City.

The study results showed 95 percent of the trial group complied with the daily home monitoring program, and patients using the HomMed System had 7 percent, per month hospitalization rate, compared to 11.7 percent for the non-monitored group. Thirteen of the 21 hospitalizations for the unmonitored group were preceded by an emergency room visit, compared to only two of 11 hospitalizations for the group using the HomMed Monitoring System (see Figure 1).

In another study, Waukesha Memorial Hospital reported that use of the HomMed Monitoring System over a 15 month period had totally eliminated ER visits and hospitalizations for 15 of the hospital's "frequent flyer" patients (those patients who had previously experienced numerous trips to the ER and related hospitalizations).

"Early intervention proved to be a key factor in preventing hospital re-admissions," said Maurice Espinoza, a cardiovascular clinical nurse specialist and manager of the Congestive Heart Failure Clinic at Waukesha Memorial Hospital. "If a patient is concerned about something, we can ask them to take more vital signs, rather than having them come immediately to the medical facility."

According to Espinoza, this has equaled high patient satisfaction. "Daily monitoring gives patients peace of mind, and early intervention allows them to spend more time in their home instead of in the hospital."

The HomMed Monitoring System is currently being used in teaching institutions and progressive home care agencies across the country. The system has been used with patients for 18 months totaling more than 10,000 patient days.

The advent of telemedicine is gaining more and more converts as health care providers see the possibilities it holds for improving the quality of care for patients with chronic diseases, and helping doctors and patients work together to better manage the chronic conditions. Telemedicine and products like the HomMed Monitoring System can make health care more about people and less about money.

This article appeared in Home Health Products, November/December 2000 issue, Vol. 8, #10, pg. 18-19.

This article originally appeared in the November 2000 issue of HME Business.