A small study aiming to reduce hospital admissions among underserved individuals provided gratifying results.
Technology to help people age in place is a hot research and development topic these days. For the most part, such studies involve sophisticated technologies that hold promise for those on one side of the digital divide—those in a position to access, afford, learn and use the new tools. That leaves out the large segment of older Americans who don’t have or understand digital devices.
Enter WSU Vancouver researchers Cory Bolkan and Renee Hoeksel, with their modest project titled “Technology to Support Aging in Place (TSAP): A Community-Based Partnership for Older Adults with Heart Failure.”
“Usually the fancy whistles and gadgets and industry go toward higher-income, higher-educated populations,” said Bolkan, associate professor of human development at WSU Vancouver. “This was the first time local private industry had expressed interest in an underserved, near- or at-risk population.” In addition, while much of the remote health monitoring research is clinically based, this study was community-based and focused on a social service agency that addresses social determinants of health as well as physical.
The social service organization was the Area Agency on Aging & Disabilities of Southwest Washington. The agency provides home- and community-based services for people aged 60 and older and people with disabilities. Bolkan had been working with the agency in other research projects to support older adults’ well-being in the community. AAADSW developed a partnership with a technology company, HealthSaaS, which is based in Beaverton, Ore, to create TSAP.
Area Agencies on Aging are often a state’s best-kept secret. They are a network of federally designated entities all over the country that help people age in place and provide information and referral in every community. They connect people with local resources, including nutrition, family caregiver support, health and wellness and case management. Most of their work is with people who are “dual-eligible,” which means eligible for both Medicaid and Medicare.
Aims of the TSAP program were to reduce hospital readmissions, enhance self-management of a chronic illness (in this case heart failure), encourage aging in place and improve quality of care.
“This program is unique in key ways,” the study authors write in a fact sheet: “(1) it targeted low-income older adults who were in poor health, at high risk of hospital readmissions, and who often required intensive clinical services; and (2) it was implemented by a community-based organization in consultation with local health care providers and hospitals.”
Needing clinical expertise, Bolkan reached out to Renee Hoeksel, professor in the WSU College of Nursing on the Vancouver campus. Hoeksel helped bring on members of the medical community, including Legacy Health and PeaceHealth.
In developing the partnership, Bolkan and Hoeksel and the other members faced enormous hurdles, from ethical (who has the training to monitor the health data provided by patients; what happens in an emergency?) to practical (the amount of time it took to tailor devices to each patient, for patients to use them and for care coordinators to monitor them), and much more. But ultimately they were gratified with the results.
The technology is sophisticated but easy to use. HealthSaaS provided remote monitoring devices to each of 43 individuals, who each had completed a personalized heart failure care plan with their cardiologists. Over six months, patients incorporated these devices into their daily lives, monitoring their weight, blood pressure, medicines and how they felt. The devices sent data to an online portal, and if anything was amiss, care coordinators at the AAA received HIPPA-compliant secure notices so they could contact the patient to determine if clinical care was needed.
“At the end of the day, there were a lot of lessons learned, and a lot of bumps in the road,” Bolkan said. Nevertheless, she added, “We were surprised that we saw some statistically significant reduction in the number of hospitalizations for that small trial.”
Hospital admissions among participants were reduced by 54 percent, and days in the hospital by 57 percent. In interviews, many participants reported encouraging changes in their health behaviors. One said, “Doing this helped to improve my routine so that I did not forget anything.”The study was self-funded, with everyone involved pitching in their time and expertise. Bolkan and Hoeksel say that this kind of partnership-based study has particular value in helping to move research from the lab to a community setting. “You can show things work over and over in a controlled educational lab setting,” Bolkan said, “but that’s not where people live and work, so doing this messy kind of study where people really live is how you can find out what is really effective.”