Heart Failure Telelink: Expanding the Reach using Interactive Voice Response Technology to Improve Patient Outcomes
Technology: e-Solutions and Telemedicine
Heart Failure (HF) Telelink became a UOHI program in 2014 and expanded to 4 regional partner hospitals in 2015. Lessons learned from these early adopters will lead to broader implementation. The automated call/IVR system highlights issues that can be assessed by a cardiac nurse and communicated to the cardiologist and primary care physician as needed ensuring continuity and coordination of care. Ease of use with voice or touch pad responses using phones ensures a broad reach requiring minimal resources.
Heart failure (HF) is often not recognized by patients and clinicians due to the multiple symptoms and disease complexity. Many exacerbations of HF are avoidable, often linked to poor self-care and limited access to cardiac services after discharge. IVR technology uses speech recognition to deliver phone calls day 2 after discharge and every 2 weeks to assess HF symptoms, offer self-care information, and track outcomes after 3 months. The system highlights issues that require additional assessment and intervention by a expert nurse . From September 2015 to 2016, 195 patients (average age 73yrs; 98 females) were followed by IVR (129 community referrals). These best practice medications were captured: betablocker (76%) & ACEI/ARB (60%). The system delivered 1076 calls of which 40% had no issues “complete”, 29% required a call from the nurse “callback”, and 24% could not be reached by the system “no contact”. Symptom screening at 7 days revealed assessment for dizziness (21%), and nocturnal dyspnea (14%). The following self-care information was mailed out as requested: eating out (64%), , reading a food label (35%), starting a walking program (34%). The majority (75%) of patients were satisfied with this follow-up technology. The UOHI has gained experience in the use of IVR follow-up of ACS, cardiac surgery and HF patients. There is preliminary evidence that with a well executed implementation plan this program can be expanded to other hospitals and sectors. The technology is easy to use, allows for system delivered re-education and has a broad reach into remote rural communities. The algorithm of questions can be adapted to include diabetes assessment and/or depression screening.