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Background. Hospitalization accounts for 70% of heart failure (HF) costs; readmission rates at 30 days are 24% and rise to 50% by 90 days. Agencies anticipate that telehomecare will provide the close monitoring necessary to prevent HF readmissions. Methods and Results. Randomized controlled trial to compare a telehomecare intervention for patients 55 and(More)
Meaningful use has become ubiquitous in the vocabulary of health information technology. It suggests that better healthcare does not result from the adoption of technology and electronic health records, but by increasing interoperability and informing clinical decisions at the point of care. Although the initial application of meaningful use was limited to(More)
This study demonstrates that telehomecare is an effective way to improve patient education and self-management outcomes. The cost effectiveness of this technology makes it an attractive medium for reaching patients who require close monitoring, reinforced teaching, and reassurance. telehomecare can also support caregivers and connect socially isolated(More)
OBJECTIVES Describe the characteristics of hospitalized older adults who were not referred for home care, compare the referral decisions of hospital clinicians with those of nurses with expertise in discharge planning and transitional care, and compare the characteristics of hospitalized older adults who did not receive a home care referral with patients(More)
The demand for home health care has skyrocketed in recent years. The aging population and the push for more efficient delivery of hospital services have fueled this growing demand. However, health care financing reforms have constrained the industry's growth. Home health agencies struggle to deliver high-quality services while staying within the financial(More)
Telemedicine is the use of technology to provide healthcare over a distance. Telehomecare, a form of telemedicine based in the patient's home, is a communication and clinical information system that enables the interaction of voice, video, and health-related data using ordinary telephone lines. Most home care agencies are adopting telehomecare to assist(More)
OBJECTIVE To evaluate the impact of translating into a large US health plan, the Transitional Care Model (TCM), an evidence-based approach to address the needs of chronically ill older adults throughout acute episodes of illness. METHODS A prospective, quasi-experimental study of 172 at-risk Aetna Medicare Advantage members in the mid-Atlantic region who(More)
BACKGROUND Anticipating post-acute needs and making referrals for follow-up care are crucial for quality discharge planning. Several studies reveal serious gaps in quality for these common and important processes. OBJECTIVES Compare experts' and hospital clinicians' discharge referral decisions for the same elderly patients, and examine 12-week outcomes(More)