Research and Projects: AHRQ THQIT and SRD Portfolio

Montana

Home Heart Failure (HF) Care Comparing Patient-Driven Technology Models

Description:  Assesses the impact of health IT on clinical and financial outcomes for patients with symptomatic congestive heart failure living in a rural area, including telemonitoring of vital signs and symptoms, evaluation of Technology Supported Case Management, and Technology Support Self Management.

Abstract:  DESCRIPTION (PROVIDED BY APPLICANT): This is a study is to assess the impact of health information technologies (HIT) on clinical and financial outcomes for patients with symptomatic heart failure (HF). Nearly 5 million Americans have HF (the leading cause of hospitalization) with an estimated $40 billion annual cost. The information technologies we will use include remote monitoring (telemonitoring) of vital signs and symptoms, an electronic health record system and clinical decision support systems. We will test a reproducible model for technology-supported HF management and assist purchasers, payers and policy makers in selecting HIT to improve clinical and financial outcomes. Patients will be recruited from rural and urban primary care practices. We will evaluate two different configurations of HIT. One is Technology Supported Case Management, a combination of telemonitoring and telephone nurse case management. The other is Technology Supported Self Management, a novel combination of telemonitoring plus an expert system that assesses vital signs and symptoms for risk of decompensation and guides patients through an individually-tailored self-care algorithm. The study will use a two-stage, randomized, open-label, multi-site, controlled trial design. In Stage 1, the incidence of hospitalization and/or ER visits with Standard Care will be compared to the incidence with Case Management to test the hypothesis that Case Management will have a lower incidence of ER visits and/or hospitalization than Standard Care. In Phase 2, Case Management will be compared to Self Management to test the hypothesis that both interventions are equivalent in reducing ER visits and/or hospitalization. Secondary outcomes will include total cost of HF care, functional and psychosocial status and satisfaction with care. We hypothesize that both interventions will produce better secondary outcomes than Standard Care, and that Self Management will have lower cost than Case Management because it does not require skilled nurse case managers.

Year 1 Funding:  $488,426

Estimated Total Funding:  $1,454,568

Principal Investigator:  Lee Goldberg

Applicant Institution:  St. Vincent Healthcare Foundation

City/Town:  Billings, Montana

State:  Montana

Grant Number:  R01 HS15459

Category:  Value Grants (THQIT)

Thesaurus Terms:  bioinformatics, computer system design /evaluation, health care cost /financing, heart failure, information system, information system analysis, outcomes research, automated medical record system, computer assisted medical decision making, emergency care, geographic difference, hospital utilization, patient care management, rural health, socioeconomics, telemedicine, urban area, clinical research, health services research tag, human subject

Project Start Date:  Sep 30, 2004

Project End Date:  Sep 29, 2007