Home Care NetWork
Home Care Literature Reviews 2003
Clinical Management:
Cardiovascular Surgery:
Ghanayem NS, Hoffman GM, Mussatto KA, Cava JR, Frommelt PC, Rudd NA, Steltzer MM, Bevandic SM, Frisbee SS, Jaquiss RD, Litwin SB, Tweddell JS. Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg. 2003;126:1367-77.
This case series of infants undergoing a two stage cardiac procedure compared 63 patients discharged before initiation of a home surveillance program that included an infant scale and pulse oximeter with 24 patients discharged after initiation of the program. Parents in the program maintained a daily log of weight and arterial oxygen saturation according to pulse oximetry and were instructed to contact their physician in case of an arterial oxygen saturation less than 70%, an acute weight loss of more than 30 gm. in 24 hours, or failure to gain at least 20 gm. during a 3-day period. There was no interstage mortality among infants surviving the first stage surgery who were discharged compared to nine deaths in the 57 patients in the control group (15.8%). The program detected instability in 13 of the 24 program patients leading to early bidirectional superior cavopulmonary connection (stage 2 palliation). This uncontrolled series suggests that relatively simple home technology can be lifesaving
Congestive Heart Failure:
Louis AA, Turner T, Gretton M, Baksh A, Cleland JG. A systematic review of telemonitoring for the management of heart failure. Eur J Heart Fail. 2003;5:583-90.
This systematic review of the literature on the application of telemedicine in the management of heart failure found 18 observational studies and six randomised controlled trials published between 1966 and 2002. The literature supported good patient acceptance and compliance with telemonitoring. Among the benefits suggested by this literature were a reduction in hospital bed-days, early detection of deterioration with reduced readmission rates and reduced length of hospital stay. The fact that most of these studies were observational argues for caution in evaluating the literature but the results of this review were encouraging and support well designed clinical trials of telemonitoring for heart failure.
Goldberg LR, Piette JD, Walsh MN, Frank TA, Jaski BE, Smith AL, Rodriguez R, Mancini DM, Hopton LA, Orav EJ, Loh E; WHARF Investigators. Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure: the Weight Monitoring in Heart Failure (WHARF) trial. Am Heart J. 2003;146:705-12.
This multicenter, randomized, controlled trial involving 280 patients (mean age 59 ± 15 years, 68% male) who were hospitalized with New York Heart Association class III or IV heart failure with a left ventricular ejection fraction < or =35% compared outcomes from a standard heart failure disease management program to outcomes from the same heart failure program care plus the AlereNet system (Alere Medical, Reno, Nev), a technology-based daily weight and symptom-monitoring system. There was a 56.2% reduction in mortality (P<.003) for patients randomized to the AlereNet group. This interesting, well designed study supprots the use of this technology in the context of a heart failure management program.
Infectious Disease:
Wong BB, Ko GJ. Neutropenia in patients receiving long-term cefepime therapy for osteomyelitis. Am J Health Syst Pharm. 2003;60:2229-32.
This case-controlled review compared the frequency of neutropenia in 12 patients receiving long-term cefepime therapy for osteomyelitis with that in 120 patients treated with other antimicrobials over a two year period. The usual duration of prescribed therapy was approximately six weeks. Eight (62%) of the cefepime courses resulted in neutropenia, compared with none in the courses of other antimicrobials. Neutropenia was detected after 17-30 days of cefepime therapy. Blood counts returned to normal within one week of cefepime discontinuation in all cases. An interesting problem in a drug commonly used to treat fever in patients with neutropenia.
Oncology:
Cherny NI, Catane R; European Society of Medical Oncology Taskforce on Palliative and Supportive Care. Attitudes of medical oncologists toward palliative care for patients with advanced and incurable cancer: report on a survey by the European Society of Medical Oncology Taskforce on Palliative and Supportive Care. Cancer 2003;98:2502-10.
This survey was conducted by the European Society of Medical Oncology to determine its members' involvement in and attitudes toward palliative care in patients with advanced cancer. Of 895 members who responded (82.5% European and 12.1% North American) only 38% reported collaborating regularly with a palliative home care service. The vast majority (88.4%) of respondents endorsed the belief that medical oncologists should coordinate the end-of-life care for their patients but almost half (42%) felt that they were trained inadequately for this task. There is a great deal in information on other aspects of oncologists' attitudes towards managing palliative care in their terminal patients. The fact that 60% of responding oncologist rarely collaborated with home care services for end-of-life care indicates a significant lost opportunity for patients.
Orthopedic Surgery:
Rivard A, Warren S, Voaklander D, Jones A. The efficacy of pre-operative home visits for total hip replacement clients. Can J Occup Ther. 2003;70:226-32.
This Canadian case series compared the outcomes of 208 patients receiving a total hip replacement at two acute care hospitals, one that used home-based pre-operative teaching and the other using the pre-admission clinic for teaching. There was no significant difference in discharge disposition and length of hospital stay. It seems that if patients can walk into clinic, it is reasonable to assume they can learn in clinic as easily as they can learn at home.
Palliative Care:
Brumley RD, Enguidanos S, Cherin DA. Effectiveness of a home-based palliative care program for end-of-life. J Palliat Med. 2003;6:715-24.
This case series compared 161 Kaiser Permanente patients who died in a Kaiser palliative care program involving a multidisciplinary care management approach with home-based treatment designed for end-of-life care with 149 patients receiving Kaiser's usual care over a two year period. The palliative care program's patients expressed increased satisfaction with services at 60 days after enrollment and had significantly fewer emergency department visits, hospital days, skilled nursing facility days, and physician visits than those in the comparison group. The cost of care for the program's patients was 45% less than for the usual care patients. This well organized, targeted program for home-based end-of-life care appeared to be cheaper and better than usual care in this managed care organization.
Pediatrics:
Hahn RA, Bilukha OO, Crosby A, Fullilove MT, Liberman A, Moscicki EK, Snyder S, Tuma F, Schofield A, Corso PS, Briss P; Task Force on Community Preventive Services. First reports evaluating the effectiveness of strategies for preventing violence: early childhood home visitation. Findings from the Task Force on Community Preventive Services. MMWR Recomm Rep. 20033;52:1-9.
This systematic review of the literature by the Task Force on Community Preventive Services of the Center for Disease Control's National Center for Injury Prevention and Control found insufficient evidence to determine the effectiveness of early childhood home visitation in preventing violence by visited children, violence by visited parents (other than child abuse and neglect), or intimate partner violence in visited families. The authors correctly point out that insufficient evidence to determine effectiveness should not be interpreted as evidence of ineffectiveness. Clearly further research is needed.
Respiratory Disease:
Tuggey JM, Plant PK, Elliott MW. Domiciliary non-invasive ventilation for recurrent acidotic exacerbations of COPD: an economic analysis. Thorax. 2003;58:867-71.
This British case series evaluated the economic consequences of non-invasive ventilation (NIV) in patients with chronic stable COPD who suffer recurrent acidotic exacerbations. Thirteen patients who tolerated and responded well to NIV were identified. Home NIV resulted in a mean (95% CI) saving of £8254 (£4013, £12,495) per patient/year, hospital days fell from a 78 ± 51 (mean ± SD) to 25 ± 25 (p=0.004), number of admissions from 5 ± 3 to 2 ± 2 (p=0.007), and ICU days fell from a total of 25 to 4 (p=0.24). This is a small number of highly selected patients, none the less; the findings are interesting and may have implications for the use of home NIV in this country .
Doherty LS, Kiely JL, Lawless G, McNicholas WT. Impact of nasal continuous positive airway pressure therapy on the quality of life of bed partners of patients with obstructive sleep apnea syndrome. Chest. 2003;124:2209-14.
This Irish survey of 55 bed partners of patients with obstructive sleep apnea being treated with continuous positive airway pressure (CPAP) found that the bed partners reported significant improvements in sleep, anxiety, role limitation due to physical problems, role limitation due to emotional problems, social functioning, mental health, and energy/vitality (all p < 0.05). CPAP benefits the whole family.
Kirk VG, Bohn SG, Flemons WW, Remmers JE. Comparison of home oximetry monitoring with laboratory polysomnography in children. Chest. 2003;124:1702-8.
This Canadian prospective cohort study compared the accuracy and reliability of a portable home oximetry monitor with a laboratory-based automated sleep analysis for the diagnosis of obstructive sleep apnea in children presenting to a sleep clinic. While the test-retest reliability of the portable monitor-based desaturation index between 2 nights at home and between laboratory and home were high, the sensitivity and specificity of the home monitor for recognizing moderate sleep apnea (i.e., polysomnography Apnea Hypoxia Index > 5/h) were only 67% and 60%, respectively. Home oximetry was not comparable to laboratory-based automated sleep analysis in these children.
Poels PJ, Schilder AG, van den Berg S, Hoes AW, Joosten KF. Evaluation of a new device for home cardiorespiratory recording in children. Arch Otolaryngol Head Neck Surg. 2003;129:1281-4.
This Dutch case series of 53 eligible children scheduled for adenotonsillectomy to treat habitual snoring and/or apneas at otorhinolaryngology clinics evaluated a single-night unattended home cardiorespiratory recording device. Technically acceptable recordings were obtained in only 18 of the 24 children who completed the testing and only 7 recordings were classified as accurate. Another disappointing result from home monitoring in children.
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