A Strategy of Home Telehealth for Management of Congestive Heart Failure(STARTEL)

• A composite of total all-cause hospitalizations and total mortality at one year.
  

• Heart failure morbidity and mortality
  
• Cardiovascular hospitalization
  
• Total number days in hospital
  
• Total outpatient physician visits
  
• Number of non-scheduled health visits outside the home
  
• Total inpatient and outpatient health care costs
  
• Kansas City Cardiomyopathy Quality of Life Score
  
• Total medication related costs
  
• Medication adherence(by prescription filling data)
  
• Patient satisfaction as measured on Likert scale(1-10)
  
• Primary care physician satisfaction (Likert scale)
  

We plan to implement and evaluate a Home Telehealth Care Management System designed to enhance clinical care for congestive heart failure patients who have difficulty with access to care. Unique in this model is that in addition to use of protocol driven interventions (evidence based), the primary care physician is intimately involved in follwo up of patients- with consequent reduction in the fracture of care seen in with attendance in multiple specialty clinics.

In this project, we will evaluate the delivery of care to heart failure patients in Nova Scotia and New Brunswick, with our intervention and the current standard of care, which is the heart failure clinic. Home Telehealth technology will allow patients to be contacted and regularly evaluated in a comprehensive way in their own home, and without the need for a clinic visit. While the Project Team (experienced in heart failure management) will monitor all data, the Family Physician will have first hand access to and right of first treatment when alterations in therapy are needed. This process will be facilitated by the use of protocol driven medical therapy, and delegated medical functions, as well as set-piece education. We hope, with this technology and care plan, to offer the benefits of disease management to this vulnerable patient population while at the same time firmly placing the Family Physician in their central role within the health care system. This program will enable a specific assessment of all aspects of the program, including outcomes, quality of life, professional satisfaction and cost.