NEW MODEL OF HEALTHCARE DELIVERY - TELEHOMECARE PROGRAM FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND HEART FAILURE PATIENTS IN ONTARIO, CANADA
The purpose of the quantitative descriptive study included providing descriptive analysis of the program volume, program duration and patient characteristics for Telehomecare in the Central West (CW), North East (NE) and Toronto Central (TC) Local Health Integrated Network (LHINs).
Data stored and managed by the Ontario Telemedicine Network for COPD and HF patients was extracted from July 2012 to March 2015. The authors described continuous variables with median and interquartile range and compared across the three LHINs using a one-way analysis of variance ANOVA or Kruskal-Wallis test. The categorical variables were described using contingency tables and compared using Chi-square test.
Since 2007, 4751 patients had been referred to the program out of which 3093 enrolled. The highest enrollment rate was reported in CW (78.3%), followed by NE (64.1%) and TC (58.8%) LHINs. As per program definition, 456 (56.1%) in CW, 423 (51.4%) in NE and 487 (46.0%) patients in TC LHINs had ‘successfully discharged’. Approximately 20-25% patients asked to leave before program completion with a majority leaving within the first two months of enrollment. No significant differences in program duration were found based on patient condition, however median duration was reported significantly longer in CW LHIN (median=179; q1-q3=67-211 days), followed by NE (median=159; q1-q3=66-185 days) and TC (median=149;q1-q3=33-212 days). The average age of patients was 74.5±11.2, with 52% being women and a slight predominance of HF patients (55.6%) found. Overall, 42 – 45 % patients had diabetes and 50-75% living with hypertension. Majority of patients (77-94%) were taking five or more medications with 50% of NE LHIN patients taking 10 medications or more.
Telehomecare program users are elderly with high prevalence of diabetes and hypertension that are taking five or more medications. Considering the low proportion of patients successfully completing the program, a careful examination is underway of process outcomes that may reduce drop-out rates and improve successful program completion.