Eligibility
Inclusion criteria were (a) a start of care (SOC) OASIS, completed by a registered nurse (RN), with a SOC beginning October 1, 2007, through September 30, 2009; (b) SN care by this HHA for no less than 21 days in a single home health episode of care; (c) a primary, secondary, or tertiary diagnosis of ICD-CM-9 code categories 390–519, which includes HF, chronic obstructive pulmonary disease, and pneumonia; and (d) a transfer/discharge OASIS for the same home health episode of care. If during the same episode of care, the patient transferred to the hospital and this HHA resumed care posthospitalization, or if care did not resume and the patient was discharged, the patient remained eligible for the study. An episode of care was defined as a time period for a single SOC and an OASIS transfer or transfer/discharge.
Patients with a primary diagnosis category code of 430–438 were excluded, as the plan of care focused primarily on rehabilitation services provided by therapists, not nurses. Patients may have received services in addition to SN, such as physical therapy, occupational therapy, speech therapy, medical social services, and/or home health aide services or a combination of these services.
Patients were grouped into one of three groups, defined by SOC date and telehealth use (see Table 1). A baseline group (Group 1) was established to determine the agency's base rate for ACH and ED visits in the year before implementation of telemonitoring and also if a temporal trend in patient characteristics occurred. Group 2 served as the control group as telemonitoring was available but not implemented for these patients. Patients in Group 3 received telemonitoring.