Overview
Henry Ford e-Home Care Reduces Readmissions, Extends Care with Telehealth
Henry Ford e-Home Care is part of the Henry Ford Health System, a non-profit healthcare organization serving patients in the Detroit area. In keeping with the health system’s population health focus, Henry Ford e-Home Care launched their telehealth program in 2010 to address barriers within their community that prevent patients from successfully transitioning from hospital to home.
Challenge
In Michigan, nearly 60% of the adult population suffers from a chronic condition, with the Detroit metro area seeing significantly higher rates of chronic disease than the national average.
Across the health system, including the e-Home Care program, providers were in search of a technology platform that would enhance their remote monitoring of patients and leverage predictive analytics to identify at-risk patients.
With the assistance of telehealth, Henry Ford aimed to prevent unnecessary hospitalizations and emergency department (ED) visits among their most vulnerable, chronic disease patients.
Solution
In 2016, Henry Ford re-launched their telehealth program in partnership with Health Recovery Solutions. Focusing initially on chronic care patients, Henry Ford enrolled COPD, CHF and hypertension patients, later expanding to monitor other high-risk patients such as cardiothoracic surgery, transplant and cancer patients. Henry Ford’s nursing team monitors for variances in patient data, including biometric readings, medication adherence, and symptom surveys. To triage patients, provide more in-depth assessments and prevent hospitalizations, Henry Ford leverages video conferencing.
If a patient’s readings indicate their condition has become exacerbated, a nurse will conduct a virtual visit to assess the patient's immediate needs. To streamline communication and clinical documentation, Henry Ford’s EHR is integrated with the HRS telehealth platform. Henry Ford providers are able to monitor telehealth patients directly in the health system’s EHR. The integration enables home health clinicians, referring physicians, and other Henry Ford providers to access a patient’s biometric readings, clinical documentation and visit notes.
We see a future in which patients are comfortable with and proficient at utilizing mobile devices to communicate with clinicians, manage their healthcare, and be more knowledgeable about their own health, as well as the health of their loved ones.Mary Hagen, BSN, RN
e-Home Care Manager
Results
Nearly 800 patients were monitored by the e-Home Care Telehealth Program in 2019. During that time, Henry Ford averaged a 30-day hospital readmission rate of 10.5%. Through exceptional patient education, Henry Ford achieved daily patient adherence rate over 86%. Patient engagement and adherence have been key elements to Henry Ford’s reduced readmissions as they allow the clinical monitoring team to assess individual patient risk and identify patients in need of care. In response to risk alerts, Henry Ford’s nursing team performed over 1,000 virtual visits to triage patients and prevent adverse outcomes over the one year period.
