Contributors to frequent telehealth alerts including false alerts for patients with heart failure: A mixed methods exploration

Summary

Background: Telehealth data overload through high alert generation is a significant barrier to sustained adoption of telehealth for managing HF patients.

Objective: To explore the factors contributing to frequent telehealth alerts including false alerts for Medicare heart failure (HF) patients admitted to a home health agency.

Materials and Methods: A mixed methods design that combined quantitative correlation analysis of patient characteristic data with number of telehealth alerts and qualitative analysis of telehealth and visiting nurses’ notes on follow-up actions to patients’ telehealth alerts was employed. All the quantitative and qualitative data was collected through retrospective review of electronic records of the home heath agency.

Results: Subjects in the study had a mean age of 83 (SD = 7.6); 56% were female. Patient co-morbidities (p<0.05) of renal disorders, anxiety, and cardiac arrhythmias emerged as predictors of tele-health alerts through quantitative analysis (n = 168) using multiple regression. Inappropriate tele-health measurement technique by patients (54%) and home healthcare system inefficiencies (37%) contributed to most telehealth false alerts in the purposive qualitative sub-sample (n = 35) of patients with high telehealth alerts.

Conclusion: Encouraging patient engagement with the telehealth process, fostering a collaborative approach among all the clinicians involved with the telehealth intervention, tailoring tele-health alert thresholds to patient characteristics along with establishing patient-centered telehealth outcome goals may allow meaningful generation of telehealth alerts. Reducing avoidable tele-health alerts could vastly improve the efficiency and sustainability of telehealth programs for HF management.

Citation: Radhakrishnan K, Bowles K, Zettek-Sumner A. Contributors to frequent telehealth alerts including false alerts for patients with heart failure: A mixed methods exploration. Appl Clin Inf 2013; 4: 465–475

http://dx.doi.org/10.4338/ACI-06-RA-0039

Keywords

Telehealth alerts - false alerts - heart failure - home health nursing

 

Conflicts of interest

The first and the second author, Drs. Radhakrishnan and Bowles, do not report any conflict of interest in conducting this study. The third author, Ms. Zettek-Sumner, RN MS, is an employee at the home health agency where this study was conducted.

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