Effects of a telehealth program on the functional status and rehospitalization rates of patients after coronary artery bypass grafts
Keywords:
Telehealth program, functional status, rehospitalization, coronary artery bypass graftAbstract
Background: Patients with coronary artery bypass graft (CABG) exhibit a decrease in functional status during the postoperative period. The rehospitalization rate within the first month is 8.0% - 21.0%. Therefore, during the first month after discharge, most patients require help from health care teams. Telehealth programs promote health monitoring and share health information remotely during transitional stages, encouraging awareness, increasing cardiac rehabilitation and physical function. As a result, the number of rehospitalizations is also reduced.
Objectives: This quasi-experimental research aimed to study the effects of a telehealth program on the functional status and rehospitalization rates of patients with CABG.
Methods: Thirty-two patients who had undergone CABG surgery at two university hospitals in Bangkok were randomly assigned to the telehealth program, and 32 patients received the usual care. Data were collected using the Demographic Data, Functional Status and Rehospitalization questionnaires.
Results: The results showed that the functional status of the telehealth group was significantly higher than that of the control group at 2 weeks and 4 weeks (P = 0.03 and 0.007, respectively). In addition, the rate of rehospitalization within 28 days was significantly lower in the telehealth group than in the control group (P = 0.026). Moreover, the rehospitalization and revisitation rates in the telehealth group were significantly less than those in the control group (P = 0.048).
Conclusions: The telehealth program effectively increases patients’ functional status and reduces rehospitalization rates. It may be reasonable to consider implementing a telehealth program using a multidisciplinary team after discharge from the hospital to improve the recovery process.
Downloads
References
World Health Organization. Cardiovascular diseases (CVDs) [Internet]. 2017 [cited 2017 Jun 19]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).
Information and Communication Technology Center, Ministry of Public Health. (Draft) eHealth Strategy, Ministry of Public Health (2016 - 2020) [Internet]. 2017 [cited 2018 Jan 20] Available from:https://ict.moph.go.th/upload_file/files/e3f8b9a43f0751fe4fa60c68a1d75. pdf.
Amouzeshi A, Hosseini SM, Javadi A, Norozian F, Zamanian N, Mohammadi U, et al. Depression and associated factors in patients undergoing coronary artery bypass grafting in Imam Reza Hospital of Mashhad in 2013. J Surg Trauma 2015;3:51-6.
Nesami MB, Shorofi SA, Jafari A, Khalilian AR, Tabari SZ. The relationship between stressors and anxiety levels after CABG in Sari, Iran. Iran Red Crescent Med J 2016;18:e25407
https://doi.org/10.5812/ircmj.25407
Pourafkari N, Pourafkari L, Nader ND. Depression following coronary artery bypass grafting surgery revisited. Turk Kardiyol Dern Ars 2016;44:524-9.
Fredericks S, Yau T. Clinical effectiveness of individual patient education in heart surgery patients: a systematic review and meta-analysis. Int J Nurs Stud 2017;65:44-53.
https://doi.org/10.1016/j.ijnurstu.2016.11.001
Pietrzyk E, Gorczyca-Michta I, Michta K, Nowakowska M, Wożakowska-Kapłon B. Depression in patients after coronary artery bypass grafting. Psychiatr Pol 2014;48:987-96.
https://doi.org/10.12740/PP/24426
Fox JP, Suter LG, Wang K, Wang Y, Krumholz HM, Ross JS. Hospital-based, acute care use among patients within 30 days of discharge after coronary artery bypass surgery. Ann Thorac Surg 2013;96:96-104. https://doi.org/10.1016/j.athoracsur.2013.03.091
Price JD, Romeiser JL, Gnerre JM, Shroyer AL, Rosengart TK. Risk analysis for readmission after coronary artery bypass surgery: Developing a strategy to reduce readmissions. J Am Coll Surg 2013;216: 412-9. https://doi.org/10.1016/j.jamcollsurg.2012.11.009
Hannan EL, Zhong Y, Lahey SJ, Culliford AT, Gold JP, Smith CR, et al. 30-Day readmissions after coronary artery bypass graft surgery in New York State. JACC Cardiovasc Interv 2011;4:569-76.
https://doi.org/10.1016/j.jcin.2011.01.010
Alahyari E, Izadpanah IM, Sharifzadeh G, Moghadam HRM. The effects of phase III cardiac rehabilitation on the quality of life of patients undergoing coronary artery bypass graft. Mod Care J 2015;12:e8665. https://doi.org/10.17795/modernc.8665
Bikmoradi A, Masmouei B, Ghomeisi M, Roshanaei G. Impact of tele-nursing on adherence to treatment plan in discharged patients after coronary artery bypass graft surgery: a quasi-experimental study in Iran. Int J Med Inform 2016;86:43-8. https://doi.org/10.1016/j.ijmedinf.2015.12.001
Varnfield M, Karunanithi M, Lee C-K, Honeyman E, Arnold D, Ding H, et al. Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial. Heart 2014;100:1770-9. https://doi.org/10.1136/heartjnl-2014-305783
Nabagiez JP, Shariff MA, Khan MA, Molloy WJ, McGinn JT. Physician assistant home visit program to reduce hospital readmissions. J Thorac Cardiovasc Surg 2013;145:225-31.
https://doi.org/10.1016/j.jtcvs.2012.09.047
Turk-Adawi K, Grace SL. Smartphone-based cardiac rehabilitation. Heart 2014;100:1737-8.
https://doi.org/10.1136/heartjnl-2014-306335
Aranki D, Kurillo G, Yan P, Liebovitz DM, Bajcsy R. Real-time tele-monitoring of patients with chronic heart-failure using a smartphone: lessons learned. IEEE Trans Affect Comput 2016;7:206-19.
https://doi.org/10.1109/TAFFC.2016.2554118
Kleinpell RM, Avitall B, Catrambone C, Johnson T, Fogg L, Moore S, et al. Randomized trial of a discharge planning and telehealth intervention for patients aged 65 and older after coronary artery bypass surgery. Int J Clin Cardiol 2015;2:4. https://doi.org/10.23937/2378-2951/1410044
Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc 2004;52:675-84.
https://doi.org/10.1111/j.1532-5415.2004.52202.x
Train the Brain Forum Committee. Thai mental state examination (TMSE). Siriraj Hosp Gaz 1993;45:359-74.
O'Connor M, Asdornwised U, Dempsey ML, Huffenberger A, Jost S, Flynn D, et al. Using telehealth to reduce all-cause 30-day hospital readmissions among heart failure patients receiving skilled home health services. Appl Clin Inform 2016;7:238-47. https://doi.org/10.4338/ACI-2015-11-SOA-0157
Barnason S, Zimmerman L, Nieveen J, Hertzog M. Impact of a telehealth intervention to augment home health care on functional and recovery outcomes of elderly patients undergoing coronary artery bypass grafting. Heart Lung 2006;35:225-33. https://doi.org/10.1016/j.hrtlng.2005.10.003
de Waure CD, Cadeddu C, Gualano MR, Ricciardi W. Telemedicine for the reduction of myocardial infarction mortality: a systematic review and a meta-analysis of published studies. Telemed J E Health 2012;18:323-8. https://doi.org/10.1089/tmj.2011.0158
Sawatzky JA, Christie S, Singal RK. Exploring outcomes of a nurse practitioner-managed cardiac surgery follow-up intervention: a randomized trial. J Adv Nurs 2013;69:2076-87.
https://doi.org/10.1111/jan.12075
Fiogbé E, de Vassimon-Barroso V, Takahashi ACDM. Exercise training in older adults, what effects on muscle oxygenation? A systematic review. Arch Gerontol Geriatr 2017;71:89-98.
https://doi.org/10.1016/j.archger.2017.03.001
Schopfer DW, Forman DE. Cardiac rehabilitation in older adults. Can J Cardiol 2016;32:1088-96.
https://doi.org/10.1016/j.cjca.2016.03.003
Rawstorn JC, Gant N, Direito A, Beckmann C, Maddison R. Telehealth exercise-based cardiac rehabilitation: a systematic review and meta-analysis.Heart 2016;102:1183- 92.
https://doi.org/10.1136/heartjnl-2015-308966
Eller P, Russell L. Acute care readmission reduction initiatives: major program highlights. Ann Arbor, MI: Center for Healthcare Research & Transformation (CHRT); 2013.
Ghashghaei FE, Sadeghi M, Marandi SM, Ghashghaei SE. Exercise-based cardiac rehabilitation improves hemodynamic responses after coronary artery bypass graft surgery. ARYA Atheroscler 2012;7:151- 6.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Chulalongkorn Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
