A healthcare advance comes into the home

When Irving Gould returned home from the hospital after a heart attack last fall, his wife was on pins and needles every time he looked tired or was out of breath.

Doctors were conflicted about how to treat the 80-year-old Natick resident, who was diagnosed with congestive heart failure.

So while Gould waited for his doctors to decide what to do next, the Natick Visiting Nurses Association set up Gould with a small machine that he could use to check his vital signs at least once a day. The machine sent the readings via a telephone line to a VNA computer, where a nurse would monitor the results and call if something didn't look right.

''We were led to believe Irving was on the brink of death, so if anything happened we'd be scared to death," said Gould's wife, Jean, speaking about the VNA line. ''There is such a concern at the other end. We really feel like we're not alone."

The Natick VNA, which serves 20 communities in the suburbs west of Boston, started the telemonitoring program in September with 31 patients, said Betsy Wadland, the organization's director of development.

The program has been so successful that the agency will soon add 70 more, she said.

The monitors put patients at ease because they know they're being checked on a daily basis. They free up nurses to see more patients, and they allow nurses to identify problems before they become serious, Wadland said.

Some patients who might formerly have needed to be checked in person three times a week can now be seen once a week. While the patients may have less face time with a nurse, they are being monitored more closely. And nurses and doctors have more data to assist in patients' care, Wadland said.

''The most important benefit we're expecting to see is that patients will be healthier," Wadland said. ''You're able to catch anything that's a major problem before they have to go to the emergency room, before they have to be hospitalized."

Sometimes it can be as simple as reminding a patient to take his or her medicine, Wadland said. And the program has shown good results.

Since last fall, about 10 percent of the VNA's congestive heart failure patients who use monitors were hospitalized, compared with 38 percent of those not on monitors, Wadland said. About 25 percent of the agency's chronic obstructive pulmonary disease patients on monitors have been hospitalized, compared with 75 percent of those not on monitors, she said.

After having open-heart surgery in November, Framingham resident Barbra MacPhee was in and out of the hospital every two weeks.

MacPhee, 78, hasn't returned to the hospital since she was placed on a monitor in February.

Through the monitoring, the VNA has been able to identify when MacPhee's oxygen level is low or whether she's had any weight gain indicating fluid in her lungs, said MacPhee's nurse, Robyn Smith.

If her oxygen level is low, nurses will call and ask MacPhee if she remembered to wear her oxygen.

''Sometimes she gets busy and forgets," Smith said. ''You can become confused, dizzy, and it puts stress on the heart. By reminding her, it wards off a problem. It's been very successful."

Each day at the same time, MacPhee is prompted by an automated voice within the machine to check her vital signs -- her oxygen level, blood pressure, and weight. The voice walks her through the entire process, explaining exactly what needs to be done. The voice will then ask her a series of questions that have been selected based on her needs.

MacPhee's machine asks her whether she's had any chest pain, whether her ankles are swollen, and whether she's had trouble breathing or any difficulty standing. It also reminds her to take her medication.

''There isn't anything I have to do to it other than press a button now and again," MacPhee said. ''I feel very comfortable with it."

In all, 51 different questions can be programmed into the machine.

Sometimes there's a simple explanation when the nurses receive unusual data. For example, Gould checked his weight one day just before going outside. The recording was high, the nurse discovered, because he had an overcoat on.

But sometimes the information indicates a problem and a nurse is sent over to check on the patient. In some cases, the VNA will call the patient's doctor or even 911.

Each week, the VNA prints up a report showing trends that are sent to each patient's doctor.

Smith sees the machine as a temporary crutch for her patients, not a long-term solution. She looks at it as a teaching tool to help patients better understand how to take care of themselves.

She expressed hope that eventually, the patients won't need to be reminded to check their ankles for swelling or take their blood pressure.

''Hopefully they'll get used to the questions we're asking so they know what to ask themselves," Smith said. ''The primary purpose is to teach independence and keep people out of the hospital."

The monitors are used primarily for patients with heart or respiratory conditions. Wadland said it costs the VNA about $125 a month to monitor one person. And because it's still a fairly new technology, the VNA does not get reimbursed by insurance plans.

The VNA received a grant from the MetroWest Community Health Care Foundation to pay for the pilot program and is applying for additional grants to pay for the expansion project, Wadland said.

''We really see it as the future of home healthcare," she said.

It might seem that the ''visiting" is being taken out of the Visiting Nurses Association. But, said Wadland,''nurses are still making visits -- just not unneeded visits."