TEC4Home Heart Failure

Heart Failure in the Emergency Department in BC: In 2014-2015, VGH and SPH saw close to 900 heart failure (HF) patients presenting to the emergency department. Of the 900, 79% were admitted to hospital and had an average length of stay of more than 11 days resulting in a high resource intensity weight (RIW) (VGH at 1.9, St. Paul’s at 2.6). The cost of each patient is estimated to be $10,000 or higher per admission. While some patients do require admission due to the severity of their symptoms, others may be able to be safely discharged with the appropriate support. TEC4Home can provide that support.

What is TEC4Home? TEC4Home is patient-centred home health monitoring solution designed for the safety and quality of care during the patient’s transition from hospital to home, bridging the gap between acute and community care. The solution uses sensors supplied by TELUS Health to collect biometric measurements (i.e., weight, blood pressure, pulse, and oxygen saturation) from patients daily as a way of remotely monitoring symptoms to detect deterioration sooner, avoiding unnecessary ED readmissions and hospitalizations.

How does TEC4Home work? Using remote patient monitoring technology provided by TELUS Health, upon discharge from the hospital, HF patients enrolled in the TEC4Home project will be provided with the monitoring equipment. The equipment includes a touchscreen tablet, blood pressure cuff, weight scale, and pulse oximeter. Patients will be asked to submit their measurements daily for 60 days. They will also be asked to answer questions about their other HF signs and symptoms (ex. shortness of breath, coughing, dizziness, etc). All data is automatically sent to the TEC4Home monitoring nurse.

The TEC4Home monitoring nurse will review the submitted patient data and provide one-on-one evidence based self-management education to the patient. Data is reviewed daily, Monday through Friday. In reviewing the patient data, if deterioration is detected, the monitoring nurse will follow up with the patient and his/ her family doctor and care team for early intervention (e.g. medication titration, visit to the family doctor, visit to the ED, etc.).

What do we want to achieve? Our project hypothesis is that TEC4Home will be a cost-effective strategy to decrease 90-day ED revisits and hospital admission rates, and improve comfort and quality of life for HF patients.

To investigate the effectiveness of TEC4Home we conducted a feasibility study in VCH in 2016-17 and a will be implementing a larger, cross health authority randomized controlled trial (RCT) in early 2018.

The purpose of the feasibility study was to assess implementation and research procedures and to identify areas of quality improvement. The RCT will use the findings from the feasibility study to guide the implementation of TEC4Home into other sites and health authorities across BC. The RCT design will allow us to evaluate the effectiveness of the HHM solution against the selected primary and secondary outcomes (i.e. reduction in ED revisits and hospital admission rates; and improvements in patient quality of life and self-management).

The results from the TEC4Home study will inform the scale and spread of the use of HHM technology in BC.

About TEC4Home: TEC4Home is a four year initiative funded by the Canadian Institute of Health Research and Michael Smith Foundation for Heath Research, with matching funding from the BC Ministry of Health and an industry partnership with TELUS Health.

Project Principal Investigators: Dr. Kendall Ho, Professor, UBC Department of Emergency Medicine; Dr. Chad Kim-Sing, Department Head and Medical Director, Emergency Medicine Vancouver Acute Community of Care VCH (VGH, UBCH, GF Strong); Ms. Mary Ackenhusen, President and CEO, VCH.

The TEC4Home Healthcare Innovation Community is made up of researchers, ED physicians, family physicians, nurses, cardiologists, patients, technology partners, and healthcare administrators.

For more information: Jennifer Cordeiro, Research Coordinator, UBC Digital Emergency Medicine Jennifer.c@ubc.ca.