Citizens
Doing Well at Home
Citizens Memorial Healthcare brings its expertise into the home
care arena, using MEDITECH's well@home technology to help chronic
disease patients better manage their conditions.
Citizens
Memorial Healthcare (Bolivar, MO) is an enterprise known for its
extraordinary achievements. As the first rural health system and
nonacademic medical center to receive the Nicholas E. Davies Award
of Excellence in 2005, and the first MEDITECH customer to achieve
Stage 7 EMR Adoption recognition from HIMSS Analytics, Citizens
Memorial is always raising the bar on quality health care.
But while Citizens' claim to fame is its inpatient facility, leaders
also have reason to be proud of its home care agency, a "small
but mighty" group of home health and hospice staff that treats
about 120 patients a day. Citizens' home care team has been using MEDITECH's
Home Health product, to
provide efficient care to its home and hospice patients since 2002.
But more recently, they also wanted to implement telehealth
technologies, specifically MEDITECH's well@home telemonitoring
technology, to reach out to the growing number of patients with one
or more chronic diseases.
"Our goal in home care is to keep patients out of the
hospital," says Valerie Noblitt, director of home care services
for Citizens Memorial. "In adopting well@home, we were really
focused on helping those patients with chronic diseases to manage
their conditions, and avoid ER visits whenever possible."
Establishing a Telehealth Network Program
To accomplish these objectives, Citizens created a telehealth
network program called Project Infocare: In-Home Telemanagement,
which was funded by the U.S. Department of Health and Human Services
Health Resources and Services Administration.
"The purpose was to integrate in-home telemanagement into our
existing Project Infocare Electronic Medical Record network, which
incorporates data from across all of our facilities--including the
hospital, home care agency, five long-term care buildings, and 16
physician clinics," says Noblitt. "But most importantly,
this project was initiated to measure the impact of telemanagement
technology on our home care population."
A study measured key results among three groups: 1) patients without
in-home telemanagement, 2) patients with in-home telemanagement
monitored by a nurse, and 3) patients with in-home telemanagement
actively monitored by a physician. Citizens' goal was not only to
evaluate whether or not in-home telemanagement in an EMR environment
improved quality of care and outcomes, but also to gauge the
potential impact of having a physician or nurse monitor that data on
a daily basis.
"The well@home devices enabled patients to self-report
prescribed assessments such as weight and blood pressure, learn more
about their diseases, view tutorials on how to properly perform
physiologic measurements and their prescribed treatments, and
receive reminders to take their medications," says Jennifer
Earl, IS specialist for Citizens Home Care. "Those assessments
were then electronically submitted to our EMR. And we soon saw that
telemanagement does work, and having nurses monitor the data was
equally as helpful as having physicians doing that."
Beating the Benchmarks
One major improvement shown was in the reduction of hospital
re-admissions among the telehealth group: just 9% of those patients
were readmitted after discharge, far lower than the national
benchmark of 29%. Furthermore, Citizens continues to experience
improvements in emergent care episodes, admission rates,
re-hospitalizations, and home care visits from the Project Infocare
initiative, as well as a reduction in home care-related costs. As a
result, Citizens has been named to the OCS
Home Care Elite list, a
compilation of the most successful Medicare-certified home health
care providers in the U.S., for the past two years.
"Telehealth has made a such big impact on our community,"
says Earl. "We are looking forward to using this technology
even more, with some different patient populations. We figured, why
not use home care to bring convenient care to more patients? There's
no reason not to."