Cost Analysis of TeleHomecare

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Cost Analysis of TeleHomecare

• Kathryn H. Dansky, R.N., PhD
• Liisa Palmer, PhD candidate
• Dennis Shea, PhD
• Kathy Bowles, R.N., PhD

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Cost Analysis of TeleHomecare

• TeleHomecare Project
• Evaluation
• Cost analysis
• Lessons learned

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Partners

• Penn State University
• The Visiting Nurse Association of Greater
  Philadelphia (VNA)
• American TeleCare, Inc.

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Sponsor

• U.S. Department of Commerce
• National Telecommunications Information
  Administration (NTIA)
• Telecommunications and Information
  Infrastructure Assistance Program (TIIAP)

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Project Objectives

1. Evaluate health status and quality of life
2. Evaluate health care costs
3. Evaluate patient satisfaction
4. Extend TeleHomecare technology to other
   underserved populations

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System Description

• AVIVA 2020 (ATI)
• Patient station
• Clinician station
• Communication links

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Research Design

• Sample Homebound diabetics
• Randomization to experimental and control groups
• Pre- and post-testing
• (post-testing at 60 days or discharge)

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Patient Demographics

• Video Control
• Female 73.6 72.9
• Male 26.4 27.1
• Average Age 74.8 74.2
• Number 91 85

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Patient Health Status

• Video Control
• Mean Diabetes
• Severity Score 2.28 2.29
• Mean Number
• of Comorbidities 1.91 2.07

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Evaluation Indices

1. Health Status
2. Quality of Life
3. Self-Management of Diabetes
4. Patient Satisfaction
5. Health Care Costs

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Evaluation

• Health Care Costs
• Direct costs physician, hospital, home health,
  pharmaceutical
• System and training costs
• Indirect costs morbidity, mortality, QALYs

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Home Health Costs RN Care
(p lt 0.05)
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Home Health Costs RN Care
(p lt 0.001)
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Home Health Costs Project
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Project Costs Video Group

• Telehomecare units upgrades
• Peripherals
• Printer
• Carts and bins
• Equipment installation, maintenance
• and removal
• Education, training and meetings
• Unsuccessful video visits

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Considerations Costs

• Equipment discounted over 5 years, but no
  secondary market for equipment (salvage
  value 0)
• Bureau of Labor average hourly wage for
  Registered Nurses in Philadelphia (1998) used for
  labor costs

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Considerations Uncertainty

• Equipment
• - technical
• - operator
• Appropriate number of video visits
• - substitution versus supplementation
• Evaluation design

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Impact on Patients Discharge Status

• Video Control
• Discharged Home 63.7 39.0
• Recertified for HHA 23.1 25.6
• Hospitalized 11.0 26.8
• Other 2.2 8.5

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Lessons Learned Costs

• Technical support
• Staff buy-in
• Training
• Hidden costs
• Maximize potential

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TeleHomecare Project

• Caring, Journal of Healthcare Information
  Management
• http//www.hhdev.psu.edu/hpa