House Calls
Remote monitors can be lifesavers for chronic disease patients
An extra pound doesn't seem like much. But for George Grande, that little quiver on the bathroom scale could signal that his heart is drowning. Grande, 82, has heart failure, and what used to be a strong, muscular pump now lets blood and fluid pool in his lungs, adding an extra pound or two. More fluid and he'll end up unable to breathe, fighting for his life.
That's the last thing he wants. "I've been to the hospital so many times," says Grande, who lives in the small town of Boxford, Mass., about 20 miles from Boston. His voice sounds tired as he recites the litany: "Three open-heart surgeries, an aorta problem, a leaky heart valve." To keep him safe at home, any weight change needs to be spotted quickly.
It is. About three months ago, Grande's nurse gave him a little device called a monitoring station, which let him input his vital signs. "Every morning it reminds me to check myself," says Grande. "I plug in a blood pressure cuff and a scale, and it sends that stuff over the phone, right to my nurse. A few weeks ago, it picked up a weight gain, and they called me right away and told me to adjust the dose of my medication. That's very reassuring, to know someone is always watching out for me."
Daily care. More healthcare professionals are watching out for patients with chronic conditions like Grande using this kind of remote monitoring. Heathcare agencies spent about $55 million in 2003 on telehealth and expect to spend $260 million in 2010. The key is the daily check of vital signs, a drill that can catch problems much faster than a monthly clinic visit. The technology is easy to use for senior citizens and for kids and adaptable to a wide range of illnesses. Study after study has shown that it helps keep people healthy and out of the hospital and allows scarce medical resources to be stretched over a wider area for a longer period. "It's been great for our patients and great for our agency," says Rhonda Chetney, director of clinical operations for Sentara Home Care Services in Chesapeake, Va. "These are very brittle patients who go in and out of the hospital a lot. With these units in the home, that stops."
Partners HealthCare, Grande's health plan, has placed American TeleCare Monitoring Stations in hundreds of homes and cut hospital readmissions for its heart failure patients by 33 percent. In Brooklyn, N.Y., Coney Island Hospital gave similar devices to 69 asthmatic kids who had been hospitalized at least once a month during the previous winter, and during the next winter all but one avoided the hospital completely. Across the country, the Department of Veterans Affairs has been testing these appliances in the homes of patients with diabetes and lung diseases as well as heart failure; it has found a 35 percent reduction in readmissions and a 60 percent drop in emergency visits. "Plus we get 90 percent patient satisfaction ratings," says physician Adam Darkins, the VA's chief consultant for care coordination. "That's why we'll have these devices in 12,500 homes by the end of this year."
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