A funny thing happened on the way to expanding telehealth in northern Colorado.
Seems that one of the patients being monitored at home after congestive heart failure suddenly showed up in the statistics as 8 pounds heavier in one day. 这使康复中心的护士们感到困惑和惊慌 & 韦尔德和拉里默县探访护士协会.
心力衰竭后, rapid weight gain could mean malfunctioning kidneys that aren’t clearing fluids properly. 于是一个护士打电话来. The patient’s response surprised the nurse – the patient hadn’t yet weighed in on the remotely monitored scale that day.
They chatted some more and then realized that the patient’s sister had stepped on the scale during a visit and also tried the blood pressure cuff. 谜团解开了, marking another successful day in the promise of telehealth to help patients stay healthier and happier in their homes.
“很高兴知道你真的在看. 非常感谢，”病人对护士说.
更重要的是未来的趋势, the northern Colorado nurses’ group noticed remarkable results across a broad range of patients using their remote monitoring equipment, 是2013年十大菠菜靠谱老平台拨款购买的. Of 28 patients enrolled in the home-monitoring program with congestive heart failure, 高血压, 糖尿病, chronic obstructive pulmonary disease and other chronic illnesses, none was admitted to the hospital during the next year for their monitored condition.
尽管合并症因家庭护理人群而异, national averages show that about 29 percent of home health agency clients are admitted to the hospital in a given year. The difference made by the patient-centered aims of home monitoring is clear to 洛丽·福利特, 执行董事 of the northern nurses that have since merged with the Colorado Visiting Nurse Association. Follett hopes to update the telehealth equipment and expand the program.
“这确实有助于防止再入院. 我们的病人对此非常积极. They felt they were getting more attention to their health and had high satisfaction. 这让他们安心了。.
这是一种让他们更积极主动的方式. 远程医疗让他们觉得自己能有所作为.
Carla Cherry, 64, of Greeley, credits her home monitor with helping to save her life. She was living at home with congestive heart failure, COPD and asthma. The daily weight checks told her nurse one day she was massively retaining fluids, 这表明她的心脏跳动不正常, 她先是进了急诊室然后又进了重症监护室. 她最终减掉了20磅的额外水分.
她不再用同样的设备了, but has a machine checking in with a United Healthcare nurse for daily weight monitoring. She also answers a few routine questions, and if something’s wrong, the nurse calls. “这是我的独立性，”切里谈到监控设备时说. “如果我能得到额外的帮助，那么我就可以呆在家里. 这是我的归属.”
In a year where video medical appointments from a smartphone are quickly becoming commonplace in the consumer health world, 北科罗拉多州的远程医疗概念是适度的. But it was targeted carefully at a group of patients whose quality of life and costs could be greatly impacted by some simple technology.
The nursing association provides home care services that range from skilled nursing care to rehabilitation after injury or illness, 非医疗基本服务, 比如去杂货店购物, 差事, 打扫卫生或帮忙洗澡. “Keeping people in the least restrictive environment possible,” as Follett put it.
In 2013, they had about 90 employees and a daily census of 300 skilled nursing patients and 300 more nonmedical clients. “We really wanted to focus on reducing readmissions to hospitals and unnecessary ER visits,福莱特说, 那些已经病入膏肓的病人. “作为一家机构，我们有时会感到不安, and if we can visit people twice a week but do telehealth the other days of the week, 这让我们对那个人有了更好的了解.”
The grant was for boxy telehealth units and communications software that link to a regular phone line. (Newer versions link through cell technology as more homeowners give up their land lines.这个盒子连着一个血压袖带, 脉冲氧传感器, 体重秤，在某些情况下, 用体温计追踪可能与感染有关的发烧. 该装置还可以通过编程提出数百个问题, but the nurses kept questions to a simple few: Do you have shortness of breath? 你能给你的疼痛打分吗? 你的脚踝肿了吗??
A screen could also be programmed with modules adapted to the patient’s needs, 比如对糖尿病和心脏病患者的饮食教育和建议, 或者为心脏直视手术患者进行伤口护理自我检查.
The box could be programmed to give a voice prompt at a preset time every day, 提醒病人连接和测量每一个项目. All the information was transmitted to the nursing association offices for the case worker to monitor. If there were any troubling signs before the next in-person visit, the nurse could contact the patient and the patient’s primary care provider.
Providing the bridge between the primary care provider and the patient was one benefit of the technology, 福利特说. But it also became an unforeseen motivator of the patients themselves. “时代在变，”福莱特说. “It used to be that whatever the doctor said should happen would happen. Now we see patients doing their own research, wanting to be more proactive. 这是一种让他们更积极主动的方式. 远程医疗让他们觉得自己能有所作为.”
在拨款运行的这一年里, 虽然没有重新接纳原来的条件, 监测确实对患者进行了49次干预. Sometimes that just meant a high blood pressure reading and a call to the physician to check in. 没有监视器, a patient with high blood pressure from mere anxiety might go to the ER for fear of a heart problem, 福利特说. “The 49 interventions avoided much more potentially serious situations,” she said.
在下一次远程医疗的努力中, the northern Colorado nursing group will link with a local safety net clinic’s patients for home monitoring and interaction via sleek tablet technology.
“家庭护理是一个完美的结合，”福莱特说.
This article was originally published in the Fall 2016 issue of Health Elevations.