Christian Care Home Health,

based in Mesquite, Texas, is a nonprofit home health agency serving about 105 patients daily. The agency serves patients who live on a 300-unit Christian Care Center retirement and assisted living campus in Mesquite, as well as, patients in suburbs of Dallas and Ft. Worth. Participating in the Honeywell HomMed National Telehealth Value Study allowed Christian Care Home Health to explore "better ways for nurses to have eyes on patients" and, if results proved positive, to demonstrate to its board of directors that telemonitoring is a venture worth pursuing. Director of Clinical Services, Doris Reynolds, Study and Equipment Manager, Leo Sanders, and Case Managers, Sharon Anderson, and Georgia Seyer, recently talked about what they have learned about telemonitoring and its role in patient care.

Q.How Has Your Hands-On Experience With Telemonitoring Changed Any Preconceptions You Had About The Technology?

The study didn't change our view. It cemented our notion about telemonitoring's potential. We had been looking at the technology since the 1990s. The idea of being able to tap into our patients and know how they are doing every day excited us. With telemonitoring, we thought we could help and teach patients daily. And that's what we have found. When a diabetic's glucose reading is up, we can see it right away via the monitor and ask what he ate the previous night. He can remember that he had pizza. If we had to wait three or four days to ask, the patient wouldn't remember - and a teachable moment would have been lost.

Q.What Have You Learned About The Use Of Telemonitoring As A Process To Improve Patient Care?

In addition to providing us with information, we can use it to help teach patients how to control their symptoms, and our case managers found that telemonitoring can help increase family involvement in the care of the patient. When family members are present in patient's home, or even when they are not, telemonitoring helps bring them into the process. Often a family member will call and say, "Dad's not feeling so good." By looking at the data, we can tell the son or daughter what's been going on.

Q.How Have Patients Responded To Telemonitoring?

Some of our patients have called telemonitoring a "security blanket." Having the monitor there and knowing that someone is looking after them makes them feel safe. At the other end of the spectrum, a very small percentage of patients are a little paranoid about the equipment and don't like it. But we had 92 percent compliance by patients doing their readings. We thought that was really good. We also have found that telemonitoring helps make the patient a partner in his or her health care. When a patient can look at her blood pressure and pulse readings and ask what they mean, it makes her a participant rather than an observer. Telemonitoring also forces accountability. Our patient population is older (average age of 80) and there are a lot of things they don't control any longer. There are some patients who don't want to think about taking an active role in their health, but there is also a good percentage that, if you give them the accountability, they will take and own it.

Q.Have Patients Complained That You're Not Visiting Often Enough?

No, we think they know that somebody checks on them every day and that they'll get a call if there is an alert. So, we're talking to them, but we're not invading their space. A lot of those we care for don't want people coming into their homes all the time.

Monitoring To Control Conditions

One of our best successes was a gentleman who had both CHF and diabetes. Both were out of control and he had been hospitalized a number of times. Over the period of time he had a monitor in his home, we helped him learn how to control and manage his conditions. He told

us he felt better than he had in many years. He's off the monitor now, but he's still complying and maintaining. The teaching we were able to do while he was being monitored stayed with him.

- Doris Reynolds, Director of Clinical Services

Source: Remington Report - August 2006