Growing numbers of older veterans, combined with an emphasis on decreasing hospital and nursing home admissions and lengths of stay, have increased the demand for home care services. At the same time, VA home care programs have had to cope with reductions in resources for staffing and support and are faced with the need to develop effective and efficient services for older veterans. One potentially useful home care service is tele-home health care, which provides for video-based home interactions between home-based older veterans and home care staff members.

The purpose of this research is to examine the effectiveness of telemedicine technology in delivering home care services to VA patients. The primary objectives are to determine if patients receiving tele-home health care services, compared with patients receiving usual care: 1) have higher levels of health related quality of life and satisfaction with home care services; 2) have lower levels of health care resource use, in terms of number and duration of inpatient hospital and nursing home stays, and number of outpatient and emergency room visits; and 3) have higher levels of access to home care services, in terms of the total number of contacts between home based primary care (HBPC) clinicians and patients, and the total time devoted to home care patients.

This study will involve a randomized design. Patients will be assigned to the telemedicine intervention or to the control group. Intervention group patients will have a video telemedicine unit installed in their home, and VA staff members will communicate with patients using this technology for the purpose of monitoring the patient’s condition, encouraging self-care practices, and reviewing medication use. Control group patients will receive the usual home care services available to them and will not receive telemedicine services. Self-administered baseline and six month follow up surveys will be distributed to all study participants and will ask questions concerning health related quality of life and satisfaction with home care services. Multivariate analysis will be used to compare intervention and control group members in terms of changes in health related quality of life, resource utilization, and satisfaction with home care services over the six-month study period, controlling for baseline factors and treatment team membership.

Ages Eligible for Study:  18 Years and above,  Genders Eligible for Study:  Both

Accepts Healthy Volunteers

Criteria

Patients must be enrolled in the home care program at the Indianapolis Veterans Affairs Medical Center (VAMC) and have at least:

• 6 outpatient visits, one hospitalization, or 2 or more emergency room visits in the last twelve months,
• a care plan specifying two or more skilled nursing visits per month,
• an expected need for future home care visits for at least one month.