HOME-MONITORING FOR CHF PATIENTS 8
Impact of In-Home Monitoring for CHF Patients
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Impact of In-Home Monitoring for CHF Patients
Introduction
Disease management entails the exploration of the best means of managing chronic diseases. Patients know about their input in handling their conditions, things to avoid, and the preferred practices through disease management. Disease management is instrumental in reducing re-hospitalization rates while improving a patient’s quality of life. In the face of the COVID-19 pandemic, disease management has stood out as a critical concept of curtailing the spread of infections to patients with underlying conditions. The virus is fatal to patients with chronic diseases such as heart failure and various types of cancers. Some of the disease management programs are such as telemedicine and home monitoring. While these programs may not be 100% effective in improving a patient’s health condition, they improve their quality of life; reduce the stress associated with hospital visits, and relatively lower re-hospitalization rates.
Cardiovascular heart disease (CHF) is a life-threatening disease accounting for a significant percentage of deaths worldwide. According to Brahmbhatt and Cowie (2019), there is a tremendous increase in the prevalence of heart disease globally, with the aftermath being the high mortality rates and health costs. Renee et al. (2018) noted that there are 5.8 million people with heart failure in the United States. The disease is one of the commonly diagnosed chronic diseases, with most of the patients being 62 years and older. Renee et al. (2018) outline that by 2013, there would be approximately 8 million older adults with heart failure disease. The disease’s burden due to its financial aspects affects not only the patients but also the professionals and the country’s economy. Numerous heart failure management programs have been effective in the reduction of re-hospitalization rates. However, socioeconomic, geographic, among other factors, hinder the participation of some patients. Technological advancements have resulted in the evolution of the programs to improve home monitoring for heart failure patients. Home monitoring mechanisms for heart failure patients range from remote monitoring, self-care, telemonitoring, telemedicine, and implantable devices.
Rationale
The frail state is one of the reasons for high hospitalization rates among CHF patients. Brahmbhatt and Cowie (2019) observed that within a year, 10% of heart failure patients are admitted with emergency cases. The authors added mortality rates ranging between 5 to 10%. The readmission rates are as high as 25% in a single month. Over a year, the readmission rates could be so high, resulting in the burden of disease on the health care system and the nation at large. The economic state of countries is uncertain of the high prevalence of heart failure is something to go by. As such, there is a need to devise mechanisms that would translate to lower mortality rates. Characteristically, new developments should improve patients’ quality of life while lowering readmission rates. Lower readmission rates translate to lower costs incurred by the health care system in managing the disease. The home monitoring programs ensure the patient’s participation in disease management. A patient is bound to be more responsible, knowing that their output influences the quality of life. These programs would also be sensitization to other people. The research aims at studying home monitoring among CHF patients to reduce re-hospitalization rates.
Problem Discussion
Telemonitoring, telemedicine, and remote monitoring are some of the home monitoring interventions for heart failure patients. The interventions lower re-hospitalization rates that would burden the health care system, making it impossible to admit needy patients in medical facilities. Self-care is the foundation for any home monitoring intervention. Under self-care, patients are tasked with noting changes in their bodies due to their condition. In most situations, home monitoring would apply for patients that had been admitted as an emergency case. Characteristically, the intervention could apply to patients that are out of danger as a means of precaution.
Kristian and Mie Borch Dahl (2018) pointed out several countries and international institutions as embracing telemedicine and telemonitoring as a means of dealing with the demographic challenges faced by their health care systems. These challenges are such as the increasing number of patients with chronic disease. The authors discussed home monitoring using technology as being part of telemedicine. According to studies, as cited by Kristian and Mie Borch Dahl (2018), these interventions could help in reducing the number of bed days and the frequency of admitting emergency cases. One could think home monitoring as being all about self-care. However, the intervention stretched further to include telemedicine and remote monitoring using implantable devices.
Tieh-Cheng et al. (2017) highlighted the complexities associated with transitioning patients from hospitals to homes. With readmission rates acting as a measure of quality, facilities with unfavorable rates find themselves facing financial penalties. Lauren et al. (2018) outlined the implementation of home monitoring interventions with some turning out unsuccessful. Nevertheless, the change in technology has resulted in the changes in monitoring technologies with early developments faced out by new ones. Gensini (2017) defined telehealth as a combination of telematics in medicine that enables remote diagnosis and treatment through a set of communication tools with the example of phones and mobile wireless devices. The authors observed that some years back, medical practitioners relied on the information from the electronic health records (EHR). The expansion of technology has resulted in the development of new devices that could relay on-time data on a patient’s condition. Gensini et al. (2017) discussed the sensor tools used in home monitoring. These tools can detect and respond to the inputs coming from a particular setting through their connection with mobile devices. Tieh-Cheng et al. (2017) listed periodic breathing as some of the elements that the devices measure.
The stakeholders impacted by the concern are the heart failure patients and health care professionals. The increase in the depiction of the home –monitoring would result in a relative reduction of the re-hospitalization case, especially those involving patients with emergency cases. The intervention would reduce the severity of patients arriving on health care for assistance. As such, there would be lower cases where medical practitioners recommend admission. The available cases would be of patients that require much assistance due to the deterioration of their situation.
The study’s purpose is to explore home monitoring and interventions for CHF patients that would reduce the re-hospitalization rates. The different interventions could be embraced in line with their suitability to heart failure patients. The interventions help in the early adoption of measures to improve the patients’ standard of living. Among older adults, traveling to seek medical assistance is such an inconvenience. Therefore, the intervention would help eliminate the difficulties of moving from their homes to the medical centers. The main rationale behind the intervention is the seriousness of the disease. Heart failure records high numbers of patients suffering from the disease with the number bounds to go higher in the coming years. Among older adults, many of them are suffering from heart failure. The seriousness of the disease in terms of the mortality rates means that the health care system needs to make adequate management measures that translate to the utilization of huge cash utilization. Thus, considering the presence of their chronic diseases, home monitoring interventions help in disease management without concentrating so much on one disease while ignoring the others.
PICO Question and Literature Search Process
The PICO question is, do old aged patients with CHF receiving in-house monitoring experience lower re-hospitalization rates than when routinely visiting the doctor? The completion of the comprehensive electronic database search was through the following;
Cochrane Central Register of Controlled Trials
CINAHL
Medline
Cochrane Database of Systematic Reviews
The search comprised of the English authored scholarly articles authored within the last five years. Some of the keywords used in the search were such as;
Home monitoring
Cardiovascular heart failure (CHF)
Remote monitoring
Telemedicine
Re-hospitalization rates
Disease management
The search yielded close to 25 results. However, only six were relevant to home monitoring, telemedicine, remote monitoring, older aged CHF patients, re-hospitalization rates.
Theoretical Framework
The theory of use in the EBP question is the complex adaptive systems (CAS) theory. According to Penney et al. (2018), CAS provides a theoretical approach to understand and describe the interventions in use. The authors added that the CAS theory helps comprehend the complexity surrounding the care transitions and the challenge of determining the approaches that would yield the most results. The theory highlights the uncertainties associated with clinical tasks and systems. The suggestions as per this theory are that to be successful, theories need to align with the uncertainties and the differences in contexts that people encounter during care delivery. This theory has been successfully used to explore the heterogeneity in effectiveness involving the reduction in readmissions.
Penney et al. (2018) highlighted the importance of the CAS theory in unearthing the importance of the interdependencies created between the different parts of the systems. In the use of home monitoring to reduce the re-hospitalization rates among the older patients with CHF, the theory shall help highlight the differences aspects that stand out depending on the demographic characteristics of the patients. Characteristically, the theory shall help understand the theory in use and its alignment to the situation at hand, which is the older patients with CHF. Through this theory, there shall be the realization of means of improving the patients’ quality of life while also reducing the readmission rates.
References
Brahmbhatt, D. & Cowie, M. (2019). Remote Management of Heart Failure: An Overview of Telemonitoring Technologies. Cardiac Failure Review, 5(2): 86-92. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6545972/
Gensini, G., Alderighi, C., Rasoini, R., Mazzanti, M. & Casolo, G. (2017). Value of Telemonitoring and Telemedicine in Heart Failure Management. Cardiac Failure Review, 3(2): 116-121. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5739893/
Kristian, K. & Mie Borch Dahl, K. (2018). A Scoping Review of Economic Evaluations Alongside Randomised Controlled Trials of Home Monitoring in Chronic Disease Management. Applied Health Economics & Health Policy, 16(2): 167-176. https://doi.org/10.1007/s40258-017-0351-9
Lauren, P., Nahid, M., Luci, L., Lanham, J., & Polly, N. (2018). Interventions to reduce readmissions: can complex adaptive system theory explain the heterogeneity in effectiveness? A systematic review. BMC Health Services Research, 18. https://doi.org/10.1186/s12913-018-3712-7
Penney, L., Nahid, M., Leykum, L., Lanham, H., Noël, P., Finley, E. & Pugh, J. (2018). Interventions to reduce readmissions: can complex adaptive system theory explain the heterogeneity in effectiveness? A systematic review. BMC Health Services Research, 18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260570/
Renee, P., Leanne, T., Myia, W., Vidhi, P. & Amgad, M. (2018). Home Telemonitoring In Heart Failure: A Systematic Review And Meta-Analysis. Health Affairs, 37(12). https://doi.org/10.1377/hlthaff.2018.05087
Tieh-Cheng, F., Wen-Chen, L., Jong-Shyan, W., Chao-hung, W., & Chun-tien, C. (2017). Detection of exercise periodic breathing using thermal flowmeter in patients with heart failure. Medical and Biological Engineering and Computing, 55(8): 1189-1198. https://doi.org/10.1007/s11517-016-1581-y
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