Home monitors improve health, behavior

After being treated at a hospital for life-threatening pneumonia and heart problems, Gerald Dombek had a choice.

He could stay in the secure environment of a hospital under the watchful eyes of nurses and doctors or return to his central Phoenix home with monitoring equipment and the responsibility of taking care of himself.

Dombek chose home.

"You really can't get rest in a hospital, so I said, 'Sure,'" said Dombek. "My big thing was: I'd do anything to get out of the hospital."

Banner Home Care installed a home-monitoring device that included a blood-pressure cuff, a pulse oximeter and a computer monitor that captures and sends data to a remote office where nurses monitor results.

Under the vigilant eye of the machine, Dombek soon discovered he was taking better care of himself. The results showed improved weight, pulse and blood-pressure readings. His healthier lifestyle helped keep his diabetes and other chronic conditions in check.

"A lot of it was a change in attitude," said Dombek, who lives by himself. "I wanted to get better and show them they did good, that helping me was worthwhile."

Hospitals such as Banner Health, the Veterans Health Administration and a handful of insurance companies have used home-monitoring programs to keep recovering patients out of hospitals and in the comfort of their own homes.

The program is geared to save the time and expense associated with lengthy hospitals stays. Banner officials said the program has proven effective over its first two years.

Nearly 18 percent heart-failure patients nationwide end up back in the hospital within 30 days. But just 3.5 percent of heart-failure patients do so under Banner's program, hospital officials said.

Other hospital groups have reported similar results, said Susan Salo, who oversees the Banner Home Health program.

Salo said the program works because it motivates patients to change their bad health habits.

"It helps develop behavioral changes," Salo said. "They see the value of the telehealth. They know if they don't send their data in, they will get a phone call from us."

Banner Home Care screens patients so that they are both healthy enough to go home and are capable of following daily instructions for monitoring.

The most common types of diseases the program is used with include heart failure, diabetes and chronic obstructive-pulmonary disease. Those three are among the most common diseases for triggering readmission to the hospital, Salo said.

After the Banner Home Health team installs a monitoring device at a patient's home, a nurse makes daily visits for the first week to make sure patients are handling the equipment correctly and to take care of them.

The nursing visits become less frequent after the first week. The health professionals then keep close tabs on the patient from a remote facility.

The patient is expected to keep up with daily checks of vital signs. Diabetes patients check their blood sugar.

If nurses notice even a slight change in a patient's readings, they call the patient for an explanation. They relay the information to doctors, who can immediately prescribe a new regimen of medications or gently prod the patient to try a little harder.

That was the case with Dombek. He added a few pounds after a Fourth of July cookout with the family.

He got a call as soon as he stepped on the scale at home.

"You get pretty depressed when all these (health) things are going on," he said. "So to have somebody watching after you, it makes you feel good."

Charlie Varin (right) examines Bernadine Strisdale during a home visit. Hospitals and insurers say letting people recover at home improves their behavior and reduces costs.