Effectiveness of a Nurse-Led Tele-Homecare Program for Patients With Multiple Chronic Illnesses: Appraisal Assignment, NTU, Singapore

Effectiveness of a Nurse-Led Tele-Homecare Program for Patients
With Multiple Chronic Illnesses and a High Risk for Readmission:
A Randomized Controlled Trial

Abstract

Purpose: Multiple chronic illnesses, such as those associated with advanced
age, are leading causes of poor health, disability, death, and high healthcare
expenditures. Tele-home care is a novel method for providing home care
to patients with chronic illnesses. The purpose of this study was to evaluate-
ate the effectiveness of an integrated nurse-led tele-homecare program for
patients with multiple chronic illnesses and a high risk for readmission.
Design: A randomized controlled trial.

Methods: Two hundred patients from a regional hospital who were sched-
uled to receive home care after discharge were randomly assigned to the
intervention group (n = 100) or the control group (n = 100). The patients
in the intervention group participated in an integrated tele-homecare pro-
gram. For outcome evaluation, primary outcomes included the number of
emergency department (ED) visits as well as readmittance and mortality.
Secondary outcomes included patients’ medication adherence, activities of
daily living, health status, and quality of life (QOL). Data were collected
at three time points: pretest baseline (T0), 3 months after intervention
(T3), and 6 months after intervention (T6). A generalized estimating equa-
tion model was used to compare changes and evaluate the effect of dif-
ferences between the two groups over time.
Findings: For primary outcome evaluation, we found that the tele-homecare
program significantly reduced mortality and ED visits, whereas no signifi-
cant effect on readmission was observed. For secondary outcome evaluation,
patients’ QOL indicated significant improvement.

Conclusions and Clinical Relevance: The nurse-led tele-homecare pro-
gram involves daily 24-hour remote monitoring and surveillance. In this
study, the system detected patients’ physical changes early and provided
timely and appropriate management, consequently reducing ED visits and
mortality. Additionally, it improved patients’ QOL. On the basis of our
findings, nurses’ independent roles, and functions revealed that the effec-
liveness of this nurse-led tele-homecare program strengthened the care of
patients with multiple chronic illnesses.