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No Place Like Home: Testing Out Telehealth

Illustration of hand holding cell phone that has image of doctor on it.

Written by Stacey Elza
Illustrated by Lindsey Estep

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No one, upon being discharged from the hospital, ever said, “You know what? I want to stay an extra day.” Even if patients bask in watching TV all day and having meals delivered bedside, the hospital never really feels like home. Yet, once at home, and without the luxury of 24/7 care, there’s always a risk of having to be readmitted.

West Virginia University researcher Steve Davis is exploring how telehealth — the use of technology to provide healthcare remotely — can keep people from reentering hospitals and long-term care facilities once they’ve been released.


“We looked at Medicaid claims data to see what some of the top reasons were for these individuals going back to an emergency department or a hospital,” said Davis, associate professor of health policy, management and leadership in the School of Public Health. “We designed the program based on what we were seeing.”


The data revealed that the exacerbation of chronic illnesses — such as emphysema flare-ups or blood pressure spikes — were common reasons people returned to the hospital. So were infections, pain, mental illness and substance misuse. 


Davis and his team, which includes members of the School of Public Health, School of Nursing, School of Medicine and West Virginia Bureau for Medical Services, will enroll about 30 rural West Virginians in their pilot program. Enrollment is slated to begin by the spring of 2020. To qualify, participants must receive services through Medicaid “traumatic brain injury” or “aged and disabled” waiver programs. They must also have been recently discharged from a long-term care facility, such as a nursing home or an inpatient rehabilitation center. 


“While in a long-term care facility, a nurse will assess a participant and determine the risk of future adverse outcomes,” said Jennifer Mallow, School of Nursing associate professor who is part of the project. “Based on this assessment, an individualized care and tele-monitoring plan will be developed and put into place once the participants return to their own independent living space in the community.”


Depending on the patient’s conditions, he or she will receive a scale, a thermometer, a fall monitor and devices to measure blood oxygenation, pressure and glucose. Every day for six months, participants will use the equipment to keep tabs on their biometrics. How much do they weigh? Do they have a fever? Is their blood sugar too high? What about their blood pressure?


Some of the equipment will transmit readings directly to nurses who will observe the data and, if necessary, consult with primary care providers or contact the patient. 


In other cases, patients will use telehealth platforms to send the data. 

“These platforms include a tabletop interactive hub or a tablet device, depending on the participant’s circumstances,” he said. 


By checking in with clinicians daily — rather than waiting weeks between healthcare visits — participants may be able to address health issues as soon as they arise. That could keep them out of the emergency room — and out of long-term care.


“For example, a participant with high blood pressure will be asked to monitor their blood pressure using the in-home blood pressure monitor,” Mallow said. “Often, without a blood pressure reading, the only symptom that a patient may have of high blood pressure is a headache, a late symptom sometimes occurring after damage has been done. The benefit of more frequent monitoring is that nurses will be able to assess the participant’s blood pressure readings over time and intervene earlier to prevent a complication of uncontrolled high blood pressure, such as stroke or heart attack.” 


According to the Centers for Disease Control and Prevention, rural Americans are more likely than their urban counterparts to die prematurely from the five most common killers: heart disease, cancer, unintentional injury, chronic lower respiratory disease and stroke. Telehealth is an emerging way to combat these trends. 


Programs like these could also be especially valuable for rural residents who spend hours driving on narrow, winding and — sometimes — snowy and icy roads to reach their doctor’s offices. Factor in the reality of recuperating from a medical crisis, and staying home starts to seem even more attractive. Someone recovering from spinal surgery, for instance, might find every bump in the road excruciating.


Davis has seen the potential benefits of telehealth up close. One of his friends has a congenital birth defect that left him disabled. 


“He has lived alone since the death of his mother 17 years ago and has developed multiple chronic health conditions that may lead to institutionalization,” Davis said. 


Because his friend can’t drive, getting to a doctor’s office is complicated. 


“Telehealth services would directly mitigate these transportation difficulties, promote care continuity and allow him to remain at home where he enjoys entertaining guests with his amazing musical abilities,” Davis said.


Once the six-month trial is over, the researchers plan to demonstrate the program’s effectiveness and cost-efficiency. Their goal is to expand the program to encompass other home- and community-based participants throughout the state.


The West Virginia Department of Health and Human Resources and the U.S. Department of Health and Human Services have funded the project.


“Can telehealth be used to help people who are in some kind of institution — and are getting ready to bedischarged — to prevent them from being re-institutionalized?”Davis asked. “Being from West Virginia myself, I appreciate how important that is: that connection to the community, that connection to our families, being able to live and thrive at home.”