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Virtual house calls: In-home computer-based system optimizes patient care

Photo of project collaborators: Brennan, Sebern, and Burke

Industrial and Systems Engineering Professor Patricia Brennan (right), Visiting Nurse Association Director of Quality Education and Care Management Marge Sebern (left) and Aurora Health Care Metro Region Director of Nursing Laura Burke collaborated on a project to implement a computer-based in-home support system for Aurora's heart patients. (22K JPG)

For many people who suffer from chronic congestive heart failure conditions, the months of home recovery after a hospital stay often are more difficult than the time they spend in the hospital. Their illness can leave them without the strength to leave the house, and they can suffer from depression or be confused about how to manage their condition at home.

Patient education in the Milwaukee-based Aurora Health Care system includes daily home-care activities: recording weight, adhering to a prescribed diet and taking medication. Patients begin this education in the hospital and visiting nurses often continue it after patients return home. The nurses frequently assess, evaluate and treat heart-care patients, and teach them and their families how to manage their illness.

But 20 to 30 percent of Aurora's heart patients are readmitted to the hospital within 30 days of their discharge — and that number is too high, says Laura Burke, director of nursing research for Aurora's metro region. "The patients go home and for whatever reason — social reasons, lack of family support, continuing deterioration of their physiological condition — they will have more symptoms of heart failure," she says.

Aurora is a community-owned health-care system that serves thousands of people in more than 20 eastern Wisconsin counties. Like similar organizations nationwide, it faces a nursing shortage that will worsen as baby-boomer nurses retire or take on less strenuous tasks. "So the question is, 'How are we going to deliver care with fewer nurses and better outcomes?'" asks Burke.

The answer: develop an in-home computer-based system that optimizes patients' care by creating 24-hour help managing their illness. To start, Burke and Marge Sebern, director of quality education and care management at Aurora's Visiting Nurses Association, sought Industrial and Systems Engineering Professor Patti Brennan's expertise. "She brings technological knowledge and how to apply technology to the nursing practice," says Burke.

About 330 Aurora patients could benefit from such a system each year. It would enable them to log on to a secure computer server and daily enter health information. They could access educational web pages and monitor their health through run charts — graphical "pictures" of the medical information they submit. Patients also could E-mail their doctor or nurse with questions or concerns.

The system not only should be easy for patients to use, but also must comply with stringent restrictions on health-record sharing, says Brennan. With UW-Madison's schools of Nursing and Pharmacy, its Medical School and the Division of Information Technology (DoIT) she is proposing a regional health-information technology architecture that can securely transmit and store clinical information. "We're testing ways to basically put an envelope around electronic mail to make sure it's doubly secure, and this will allow the nurses to interact with patients on a level that's secure," Brennan says.

The group also is studying how implementing such a technology in heart patients' homes affects the nurse-patient relationship and how it might shift nurses' duties. "Visiting nurses are only in the home at the most maybe an hour a day, and the patient has to manage their illness 24 hours a day, seven days a week," says Sebern. "I believe the most exciting thing is expanding that role to the nurse using technology to really create an environment where the patient can self-manage."

The three hope to extend funding from the National Institute of Nursing Research and the National Institute of Health's national library of medicine to develop and implement the system at Aurora.

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