Telehealth Research Across the Community (TRAC)

Funding body
State Health Research Advisory Council (SHRAC) ($140, 000) and the Commonwealth Department of Health and Ageing ($250, 000).

Project description
Silver Chain's analysis of its clients' hospital admissions show that clients with diagnoses of Chronic Obstructive Pulmonary Disease (COPD) or Chronic Heart Failure (CHF) are frequently admitted to hospital and identified as the frequent flyers of hospital usage (Smith & Lewin, 2008).  AIHW (2008) recently reported that 9.6% of all hospital admissions for diagnoses of these and other chronic conditions are preventable.  The use of Telehealth, or the remote monitoring of patients vital signs by a nurse using equipment that has been installed in the patient's own home, is seen as one way in which Silver Chain can assist in reducing such preventable hospitalisations.

In order to determine the applicability and the potential savings to the health system of Telehealth devices in an Australian context, Silver Chain is undertaking a randomised controlled trial of Telehealth self-monitoring.

The objectives of this research are:

  • To implement and evaluate a model of chronic disease self-management using Telehealth equipment with remote monitoring.
  • To determine if the Telehealth monitoring results in a measurable reduction in hospital admissions and emergency department visits and is therefore cost saving.
  • To determine whether there are any measurable changes in clients' self-assessed quality of life as a result of the Telehealth monitoring.
  • To determine participants' and GPs'/Respiratory Consultants' satisfaction with the Telehealth equipment and monitoring.

Two hundred participants will be recruited to take part in the randomised controlled trial.  They will include 80 (40 intervention, 40 control) Silver Chain clients who have a confirmed diagnosis of COPD and who are currently in receipt of oxygen services from Silver Chain.  In addition 120 people (60 intervention, 60 control) who have a diagnosis of CHF and have had at least one hospital admission or emergency department visit within the previous 12 months will be recruited. 

Following recruitment, clients allocated to the Intervention group will be visited by the Telehealth Nurse to collect baseline health information as well as to train them in the use of the equipment. Both baseline measurement and the monitoring equipment will measure the following:

  • blood pressure
  • weight
  • heart rate
  • oxygen saturation levels
  • ECG
  • questions relating to their general state of health, cough and other symptoms

The Telehealth Nurse will also provide instructions and a calendar for recording any hospital admissions, emergency department visits and GP visits. Clients will measure vital signs everyday for six months and the results will be transmitted automatically via telephone to Silver Chain's Customer Centre.  Each client's data will be monitored daily by the Telehealth Nurse and changes in the vital signs indicating deterioration in health will be managed using protocols developed.

Clients randomised to the control group will be visited by the Telehealth Nurse who will collect baseline health information, provide them a calendar and an educational book on either COPD or CHF.

Project update

Data collection and analysis have now been completed for the COPD trial with a final report submitted to the Commonwealth Department of Health and Ageing in September. The results of the trial were very positive and showed that the number of COPD related emergency department presentations, hospitalisations and length of stay of the Telehealth group were half that of the information group. Although these results were not statistically significant the differences between the Telehealth and information groups were still large enough to produce substantial cost savings for those in the Telehealth group ($2,931 per person annualised). Importantly, participants have also enjoyed using the Telehealth technology, with many describing a range of benefits, including: increased sense of security, improved confidence in self-managing their condition and helping them to identify when they may have been getting sick earlier.

Data is still being collected for the CHF trial, which is due to be completed in April 2011.

A summary version of the COPD Final Report can be accessed by clicking here