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M. Jaana

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    OS21 - Advancing Telehealth: The Next Wave of Opportunities (ID 33)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 1
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      OS21.03 - Rural-Urban Comparison of Telehomecare for Patients with Heart Failure (ID 529)

      M. Jaana, Telfer School of Management, University of Ottawa; Ottawa/CA

      • Abstract
      • Slides

      Purpose/Objectives: To assess the differential benefits of telehomecare for patients living in rural versus urban environments and suffering from chronic heart failure.

      Methodology/Approach: A cross-sectional design was used to examine the differences in process and outcomes care measures between rural and urban patients enrolled at a major specialized hospital. Chart review of all patients enrolled in the program in 2014 was conducted to extract data on relevant indicators. Rural status indicated a patient’s home residence in a geographic area with < 30,000 habitants. Descriptive analysis provided an overview of the sample; bivariate analyses examined the relationship between rural/urban status (R/U) and patient characteristics, and process/outcomes measures. Multivariate analysis was conducted with the variables that demonstrated significant relationships at the bivariate level.

      Finding/Results: Table 1 presents an overview of the sample that included 240 patients (137 urban and 103 rural). Analysis of differences in their characteristics revealed a significantly higher proportion of rural patients living with someone and diagnosed with diastolic heart failure. In addition, a significantly higher number of emergency room visits was observed for male patients and when living alone. Patients who were seen by a specialist and a regular GP had the longest telehomecare duration, and the highest number of diuretic adjustments, nurse calls and emergency visits. A preliminary examination of the relationship between R/U and process/outcomes measures did not reveal any significant association, although more rural patients had undocumented reason for emergency visits compared to urban patients (Table 2a). The multivariate analysis controlling for significant patients’ characteristics further confirmed the absence of any significant differences between rural and urban patients on process/outcomes measures related to telehomecare. Interestingly, a posthoc analysis of correlation between process of care (e.g., frequency of changes of diuretic doses, calls) and outcomes measures (e.g., emergency visits, admissions) demonstrated significant positive relationships (Table 2b). table 1.jpg table 2a and 2b.jpg

      Conclusion/Implications/Recommendations: Telehomecare is equally beneficial for urban and rural patients with chronic heart failure. The improved process of care attributed to this patient management approach was associated with more emergency visits and hospital admissions. This is an indication that timely interventions are done, when needed, especially that the emergency visits appear to be correlated with hospital admissions.

      140 Character Summary: There are no differential benefits associated with the use of telehomecare for rural versus urban patients with chronic heart failure.

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