Content area
Full text
To meet the health needs of an aging population, Congress and the U.S. Department of Veterans Affairs (VA) prioritized noninstitutional care services with The Veterans Millennium Health Care and Benefits Act of 1999. A central component of noninstitutional care is the care coordination/home telehealth (CCHT) program implemented in 2003. Based on the Chronic Care Model (Wagner et al., 2001 ), the initial rationale for the CCHT program was to expand benefits of the VA's Community Care Coordination service. Program goals now extend beyond chronic care to include acute care management, health promotion, and disease prevention (Darkins, 2006 ; Darkins et al., 2008 ).
Coordinated care involves various stakeholders, so components of the program vary to meet the changing needs of a given patient. The three common elements are the care coordinator (CC), the telehealth technology, and the patient. The care coordinator is typically an RN who serves as a single point of contact for enrolled patients. The care coordinator typically manages between 100 and 150 general medical patients (Darkins et al., 2008 ). The home telehealth technology used depends on the needs and capabilities of the patient and may consist of messaging devices, monitoring and measuring devices, videophones, or personal computers. The patient may require indefinite enrollment (as with heart failure and pulmonary disease) or limited enrollment (as with diabetes mellitus) (Knoefel, 2009 ), but the goal of self-managed care remains the same.
Home Telehealth
Home telehealth benefits health care organizations by reducing resource utilization and decreasing costs (Finkelstein, Speedie, & Potthoff, 2006 ; Jia, Chuang, Wu, Wang, & Chumbler, 2009 ; Noel, Vogel, Erdos, Cornwall, & Levin, 2004 ; Rojas & Gagnon, 2008 ). Patients benefit because they are monitored more closely and make fewer trips to hospitals and clinics. For example, the 48.4% of veterans enrolled for diabetes management used VA hospital facilities 20.4% less after home telehealth enrollment than before (Darkins et al., 2008 ). Because the mean age of a CCHT program patient is 66.5 and 39% live in rural or highly rural areas (Darkins et al., 2008 ), the reduction in travel is also a substantial patient benefit.
Whereas usual care typically relies on unidirectional provider-to-patient communication, home telehealth facilitates patient-provider collaboration and...