November 30, 2009

Technology brings at-home nursing care to inner-city Baltimore

Congestive heart failure patients in Baltimore City will be using a new FDA-approved electronic health monitoring device to help manage their heart disease at home as part of a new study by the Johns Hopkins School of Nursing.

With funding from the National Institutes of Health, lead investigator Patricia Abbott will measure whether having an Intel Health Guide—which allows patients to monitor their conditions, participate in learning modules and connect with clinicians online—in the homes of congestive heart failure patients can improve their health. “We need to find ways to reach the medically underserved, and I think technology is one way that we can begin to build those bridges,” said Abbott, an associate professor in Nursing Systems and Outcomes.

With “telehomecare” devices provided by Intel Corp., this is the first study to use the technology in community-dwelling African-American congestive heart failure patients. It is also the first such study to form a unique partnership with Clearwire Corp., which will support the Internet connectivity requirements of the Health Guide by providing access to its 4G WiMAX wireless connection, which is now live in Baltimore.

According to Abbott, wireless technology may be an important tool as telehomecare for chronic disease management becomes more commonplace. “Not having to pull cables or wires into a patient’s home or require telephone lines is a critical step in the battle to reduce barriers to access to health care services, particularly in underserved populations,” she said.

As part of a larger NIH-funded study led by JHU School of Nursing Professor Miyong Kim, Abbott’s pilot study will involve 60 inner-city home-dwelling African-American patients. Half the patients will receive the Health Guide, while the others will receive usual care.

Researchers want to find ways to accelerate the use of technology to keep patients in their homes rather than the hospital, Abbott said. “Our goal is to gain a deeper understanding of how to work more efficiently with patients who have chronic disease, utilizing newer technological approaches. The research shows us that an informed and engaged patient may have fewer complications and has higher levels of satisfaction with the health care system.”

Using the simple touch-screen device, patients will be able to take their own blood pressure, weight and other measurements. Patients can connect with researchers through video and voice-over Internet protocol and access a library of educational videos about chronic diseases. An important component of this study is in the construction and testing of intelligent branching logic, which creates an interactive session for the patient while taking measurements and answering health questions. The device also will be programmed to remind patients about medications, the basics of sodium and fluid management, and medical appointments.

The outcomes of the study will demonstrate the impact of such interactivity on heart failure knowledge and disease self-management.