Just-in-time evidence-based e-mail "reminders" in home health care: impact on patient outcomes

• HIT Description: Decision support More info...
  
• Purpose of Study: To assess the impact and cost-effectiveness of two email provider reminder interventions to improvde self-care by heart failure patients
  
• Years of study: 2000-2001
  
• Study Design: Randomized controlled trial
  
• Outcomes: Impact on health care effectiveness and quality, Impact on efficiency, utilization, and costs
  

• Settings: Home health care agency in NYC
• Intervention: Nurses of HF patients were assigned to usual care on one of two intervention groups. The basic intervention was an email highlighting 6 HF-specific clinical guidelines. The augmented intervention included the emails, a laminated card focused on medication management, a prompter card to facilitate better MD-nurse communication, a self-care guide for patients, and follow-up outreach by a clinical nurse specialist
• Evaluation Method: Nurses were randomly assigned to usual care or one of the two intervention groups. Patient interviews were conducted 45 days after the start of the intervention Ð outcomes included self-care measures and quality of life. Utilization data for developing cost estimates was obtained through administrative data and patient self-report on medical care use.
• Description: Email reminders
• Financial Context: Low income urban population
• Extrinsic Factors in valuing cost and benefits: Heart failure is a high frequency, high cost disease that imposes a significant burden. It is the leading cause of hospitalization among the elderly.
• Costs: The average cost associated with administrative and direct home care was $2,814 for the usual care group, $3,371 for the basic intervention, and $3,425 for the augmented intervention
• Healthcare Utilization: Home-care related visits, which include nursing, therapy, and home health aide visits, were significantly higher for the intervention groups compared to usual care. Emergency department visits was not significant.
• Quality of Care and Patient Safety Outcome: Both interventions significantly increased patient recognition of HF medications. There was significant improvement in the mean Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score of patients treated by intervention nurses. Patients in the basic intervention group scored significantly higher than those in the control group on quality of life.
• Changes in healthcare costs: When all other medical costs are added, the mean overall medical costs were $4,996 for the control group, $5,869 for the basic intervention group, and $6,330 for the augmented intervention.
• Time needed to accrue benefit: Unclear�