Empowering heart failure patients
Telehealth programme by CGH and Philips gives patients more confidence and reduces hospital stay.
The positive one-year results of a Heart Failure Telehealth programme, piloted by Changi General Hospital (CGH) and Royal Philips, showed a 67 percent reduction in length of hospital stay for heart failure-related readmissions, a 42 percent reduction in costs of care, and an enhanced quality of care. The heart failure patients enrolled in the telehealth programme benefitted from increased knowledge of their condition and improved self-care abilities, resulting in a greater confidence in managing their heart condition.
The experience obtained from this pilot contributes to the design and development of the national telehealth vital signs monitoring (VSM) project initiated by the Ministry of Health. Following the pilot, CGH will be participating in the national VSM project to enable CGH patients to receive care after discharge from hospital, as they return to their homes and the community.
There were 150 heart failure patients from CGH enrolled in the programme between November 2014 and March 2016. They received tele-monitoring support for one year and their results were compared against a group that received support only via phone calls.
Reduced length of stay for heart failure-related readmission
As a result of the telehealth programme, patients had improved knowledge, improved confidence and ability to maintain their heart failure condition. In addition to the timely detection of changes in their clinical condition, the average length of stay for heart failure-related readmission over 12 months was reduced by 67 percent for heart failure patients under tele-monitoring support compared to the group that only received support via phone calls (2.2 days vs 6.6 days).
With reduced heart failure related readmission, this translated to cost savings for both patients and hospitals. The bill size for heart failure related admissions in a year for heart failure patients in the tele-monitoring group was 42 percent (S$2,514) lower compared to patients that received support via telephone calls.
“It is important for patients with chronic conditions to feel that they are empowered and in control of their own health as it increases their capacity to take action,” said Dr Sheldon Lee, programme director and consultant, cardiology, CGH. “Patients with greater knowledge of their conditions are more confident about self-care, and are more likely to comply with treatment plans. This naturally leads to reduced risk of complications that may necessitate readmission to CGH. We are delighted to see these encouraging results in the pilot and will continue to look into enhancing the programme further so as to provide sustainable benefits for our patients in the long run.”
Improved care compliance with self-management
Patients in the tele-monitoring group were highly engaged in taking care of their own health. Ninety-three percent of the respondents in the tele-monitoring group felt that they were more involved in their own care. After going through the programme, 68 percent of the patients were more confident and able to maintain their condition versus 34 percent and 32 percent respectively before the programme.
Results also suggest that patients on the programme felt more empowered to engage with their healthcare providers. Ninety-four percent of respondents reported that submitting their weight and blood pressure readings helped them to talk more about their condition during their doctor’s visit.
“This programme has helped me understand how to take better care of my health,” shared 76-year-old Gan Hwee Sun, who was enrolled in the programme. “I am now more conscientious about healthy eating and being active. I am also very grateful to my tele-carer for her concern and regular follow-ups with me. She has shared useful knowledge about heart failure, which has given me more confidence to manage my condition at home. I have been following her advice, and now have more energy and am able to walk more without feeling breathless easily.”
The telehealth programme
The Heart Failure Telehealth pilot programme was launched in November 2014 by CGH and Philips to help heart failure patients learn how to better manage their heart condition at home; reduce the risk of readmission and premature death. The programme integrated three elements of care – tele-monitoring, tele-education and tele-care support via tele-nurses from CGH Health Management Unit.
Heart failure patients in the tele-monitoring group were provided a weighing scale and blood pressure monitor to assist them in the daily measurement of their weight, pulse and blood pressure upon discharge from CGH. They also received a personal tablet to wirelessly capture these key vital parameters and to upload it to a central system for monitoring. Tele-nurses then remotely monitored participants’ vital readings and intervened when signs of deterioration were detected. To teach patients how to manage their diseases and ensure care compliance, there were also educational videos, e-quizzes and follow-up calls from tele-nurses.
“To meet the long-term demand for chronic care, we need to start shifting chronic disease management beyond hospital walls and into our patients’ home,” said Diederik Zeven, general manager, Health Systems, Philips ASEAN Pacific. “Telehealth, where patients are remotely monitored at home, is a sustainable and scalable model that bridges the care delivery gap. At the same time, this care model also shows positive impact in treatment compliance which results in better quality of life for patients. Staying connected with patients in between their check-ups, ensuring that they remain healthy, thereby reducing hospital readmission rates and healthcare costs are the optimal goals in patient care.”