Objective: Test the effects of tele-video and telephone follow-up on: 1) patients’ perceptions of health; symptom severity, knowledge and behavior related to medication, diet, and symptom management, 2) length of time to rehospitalization; and 3) number of hospital readmissions.
Design: Randomized clinical trial
Population, Sample, Setting, Years: Fifty-nine patients purposively drawn from patients admitted to the VNA of Greater Philadelphia from June 2000-March 2001. Eligibility criteria were: > age 65, CHF as a diagnosis or co-morbid condition, identified as high-risk using a score of >0.50 on the Pra instrument, English speaking with a phone, and able to see and hear the video and audio. Patients were randomly assigned to receive either tele-video visits or telephone calls in addition to home care.
Intervention and Outcome Variables: Video patients received two video visits per week via a tele-video computer that enabled measurement of vital signs and auscultation of heart and lungs. Telephone patients received two phone calls per week. In addition to home visits, video and phone calls included assessment for symptoms of CHF and weight, and teaching related to diet; symptoms, medication name, dose, and adherence to therapy. Outcome measures at 60 days included: patient’s knowledge and behavior related to medication, diet, and symptoms measured using the Omaha System Problem Rating Scale for Outcomes (PRSO). Symptom severity was scored using the New York Heart Association Scale (NYHA). Perception of health was measured with a single question asking patients to rate their health. The length of time patients to rehospitalization and numbers of rehospitalizations were collected from home care records.
Methods: Change in scores from admission to 60 days was compared for the tele-video versus the telephone group, adjusting for baseline score using analysis of covariance. Changes in scores from admission to discharge were assessed separately by group using paired t-tests. The time in days to the next hospital admission and total number of rehospitalizations were compared between groups using a logrank test and Wilcoxon test, respectively.
Findings: Mean patient age was 77.3. Two-thirds were female, one-quarter was Caucasian and three-quarters were African American. Eight-nine percent rated their health as fair or poor. At baseline, there were no significant differences between groups for age, gender, race, perception of health, NYHA classification, or PRA score. There were no significant differences (type-1 error a=.05) between groups at 60 days with respect to all study outcomes. The change from baseline to 60 days within groups from admission to discharge for perception of health was significant for both groups (video p=.002 and telephone p<.0001). Change in medication knowledge was significant for both the tele-video (p=.001) and the telephone groups (p<.001). Change in medication behavior was not significant for the tele-video group (p=.49) but was significant for the telephone group (p=.003). Change in diet knowledge was significant for both the televideo (p=.002) and the telephone groups (p<.0001).Change in diet behavior was not significant for the tele-video group (p=.46) but was for the telephone group (p=.002). Change in knowledge of symptoms was significant for both groups (video p=.001 and telephone p<.0001). Change in symptom management was not significant for the tele-video group (p=.18) but was for the telephone group (p=.002). Symptom severity was borderline significant for the televideo group (p=.06) but not for the telephone group (p=.82).The logrank statistic showed no significant difference between the groups for time in days to the next hospital admission (p=.60). A Wilcoxon test showed no significant difference between the groups with respect to the total number of rehospitalizations (p=.62).
Conclusions: Telephone or tele-video follow-up, along with home visits, were effective to improve patient’s knowledge about their diets, symptoms, and medications and they reported an improved perception of their health. Telephone patients had significant improvement in their behavior related to managing CHF treatment and symptoms. However, the effect of a single modality, telephone versus video, was not stronger than the other in producing improvement and neither resulted in decreased time to or number of rehospitalizations. Additional analysis is underway to compare these patients to those who received only home care.
Implications: Study findings suggest the modality of telephone follow-up may offer some advantage over tele-video in helping patients improve their health behavior. Both modalities led to improved knowledge suggesting their use for patient teaching. Further study is needed to explore how nurses and patients interact in a video versus a phone encounter and to further test the advantages of one modality over another. These patients were all at high risk for rehospitalization, so further study is needed of patients with varying levels of illness severity.
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