Delnor Hospital
Reduces Emergent Care Episodes for
Cardiac Patients with well@home
With chronic
diseases on the rise, telemedicine has
emerged as an innovative, cost-effective
way for home care agencies to help
patients manage their own conditions, in
the privacy of their own homes.
Congestive Heart Failure (CHF) is one of
several long-term ailments which can
worsen very rapidly, and without regular
surveillance, can often land its
sufferers in the ER. Delnor Community
Hospital (Geneva, IL) is helping many of
its patients handle the complications of
CHF, while staying out of the hospital
longer, with Patient Care Technologies' (PtCT)
comprehensive telemanagement solution,
well@home.
"well@home is a device the size of a
shoe box which is placed in the patient's
home, programmed with the physician's
orders and the patient's individual needs,"
says Reidun Juszczak, RN, Home Care
Information System and Billing
Coordinator for Delnor. "It's an
interactive, easy-to-use tool that helps
those patients who struggle most with
self-management of their conditions. It's
really taking health care convenience and
quality to a whole new level for
chronically-ill patients."
Tackling the Problem of
Re-Hospitalizations
Like many health care organizations,
Delnor had previously struggled with
frequent readmissions for patients with
CHF. "It was the number one reason
our patients had to be readmitted,"
says Juszczak. "Knowing that, and
knowing that heart failure is the most
common reason for hospitalization among
people with Medicare, we began to gather
statistics on re-hospitalizations and
emergent care for our agency, and compare
that data to our benchmarks. It became
evident to us that we really needed to
focus on patients with CHF, for both
clinical and financial reasons."
Once Delnor set its goals, it didn't take
long for the organization to choose PtCT's
well@home product, due to its
revolutionary telemanagement
functionality and integration with the
MEDITECH HCIS. "It was important for
us to find a solution which integrates
seamlessly with our home health medical
record, and well@home certainly fit the
bill," says Juszczak.
well@home is simple to use, guiding
patients through their daily assessments
such as blood pressure, weight, blood
sugar levels, and more. The data
populates the electronic patient record
through a phone or Ethernet line. "Our
clinicians are able to view the data
through the patient's clinical record or
through the well@home Web application
from their point-of-care notebooks, as
quickly and easily as they view their own
clinical notes," says Juszczak.
"It's allowed some of our highest
risk patients to successfully manage and
maintain their health, while minimizing
unpleasant and expensive trips to the
hospital."
Securing Support from
Staff and Patients Alike
After selecting the right technology for
their cause, Delnor then had the
challenge of securing buy-in from key
staff members and patients. "Our
telehealth committee presented the
benefits of the telehealth program to our
leadership team, physician practices, and
various referral sources in the community,"
says Juszczak. "We also began
conducting education sessions for the
home care clinicians, all hospital
patient care departments, and discharge
and case management staff."
The team also brought their message out
to those patients with CHF, who needed to
be monitored on a regular basis. "We
went out to each patient's home to
install the device, show them how to use
it, and most importantly, make them feel
comfortable with having the well@home
device in their homes," says
Juszczak.
Some patients who were unfamiliar with
telehealth were nervous about what the
new technology entailed, and how much
monitoring it could really do. "We
reassured patients that the device was
not invading their privacy; it was not a
hidden camera," says Juszczak.
"Tackling the misconceptions and
talking about how it could improve their
health and keep them out of the hospital
were enough to convince CHF patients that
this was a great solution." 
Seeing the Benefits of
Daily Home Monitoring
Once Delnor started prescribing
telehealth to CHF patients, Juszczak and
her team immediately started seeing the
benefits. One CHF patient, an 84-year-old
patient with a history of frequent
readmissions to the hospital, was
experiencing chronic episodes of
anxiousness, elevated and irregular pulse,
weight gain from fluid retention, and
problems adhering to her medication
schedule. By monitoring her cardiac
status using the well@home
electrocardiogram (ECG) feature, and
assessing her daily blood pressure and
weight for abnormal trends as well as
symptom reporting, the clinical staff was
able to manage her cardiac status by
medication adjustments. There was ongoing
communication with the patient's
physician with faxed up-to-date results
of her well@home data, and the monitor
was set up to alert the patient to notify
the home care office if her values went
higher or lower than preset parameters.
The data collected from the assessments
on well@home, together with an alert to
the patient and clinical staff, helped
the physician diagnose the patient with
an abnormal heart rhythm that required
the patient to have a pacemaker inserted.
The close monitoring from well@home has
also led to increased medication
compliance and weight control for many of
Delnor's CHF patients. "The well@home
system enables clinicians and physicians
to intervene before the patient's health
deteriorates to the point where they need
to visit the ER, thereby lowering the
number of multiple readmissions,"
says Juszczak. "In the year since
implementing well@home, we've
successfully lowered our re-hospitalization
rate from 24.5% to 21.9%."
Keeping an Eye Toward
the Future
In addition, Delnor experienced an
unexpected financial benefit from well@home.
While well@home does not take the place
of a nurse's physical assessment in the
patient's home, nurses are able to
decrease their number of visits because
they are better able to manage the
patient by looking at the data to
determine when the patient really needs a
visit. Because of the decreased number of
these visits, Delnor has saved
tremendously on travel reimbursement. In
the past year alone, the organization has
saved $13,000 in reduced expenditures.
Juszczak expects that the savings will
grow as more patients are able to take
advantage of the well@home initiative.
"Telehealth really is the way of the
future," she says. "The more
individualized care we can offer outside
of the hospital with telehealth
management for chronic disease patients,
the greater their chance for leading
healthier lives."