Why Vanderbilt nurses check in on chronic disease patients via telehealth

Nashville, Tenn.-based Vanderbilt University Medical Center checks in on high-risk chronic disease patients with telehealth calls from a registered nurse to try to keep them out of the hospital.

Vanderbilt Home Care Services' chronic disease management program treats patients with heart failure, COPD, diabetes and pneumonia and after coronary artery bypass surgery or heart attacks. The telehealth visits complement in-person appointments and traditional home health services.

"Our hope is that someday we can provide these telehealth services across our entire home health agency," program leader Kristina Niehoff, PharmD, said in a June 15 news release. "In the future, we also hope we can be reimbursed for these telehealth services. Many home health patients can benefit from check-in calls from a nurse to address their health goals, management of their chronic conditions, and to ensure they have the appropriate medicines, supplies and education to successfully manage their health at home."

During its first year, the program followed 296 chronic disease patients for an average of 32 days. Hospital readmission rates have been lower for those patients than Vanderbilt's general home care population.

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