Telehealth Research Across The Community (TRAC): An evaluation of telehealth home monitoring of home care clients with chronic obstructive pulmonary disease or chronic heart failure compared to usual care.

INTERVENTION: Remote home monitoring of client’s vital signs by a nurse will be undertaken. The monitoring equipment is installed in the client’s home. The client is trained in the use of the equipment to measure their vital signs which will include: a) Blood Pressure b) Weight c) Heart Rate d) Oxygen Saturation Levels In addition, clients’ response to questions regarding their general state of health or specific to their condition, such as the type of cough they are experiencing or the colour of their sputum. Readings take approximately 20 minutes for the client to complete and occur on a daily basis for a period of 6 months. Readings are transmitted to a central point where any deviations from the norm are reviewed by a nurse and interventions introduced where required. Those interventions can be a telephone call by the clinician to retake the tests or a recommendation that the patient visit their General Practitioner. CONDITION: Chronic Heart Failure (CHF) PRIMARY OUTCOME: Number of emergency department visits. ; Emergency department visits recorded by client in a diary Number of hospital admissions. ; Hospital admissions recorded by client in a diary. SECONDARY OUTCOME: Cost savings of home monitoring compared to usual care accounting for equipment, telephone costs, monitoring costs, hospital admissions, emergency department visits, other medical visits. First, average unit costs for equipment, hospital separations, accident and emergency occasions of service, general practitioner visits, specialist visits and post acute community care services using West Australian Department of Health and Australian Department of Health and Ageing reported figures and Silver Chain unit costs. Unit costs for monitoring and liaising will be similarly derived. Next, the data collected for the control and intervention groups will be used to estimate service utilisation that can be averaged for various sub‐groups defined in terms of, inter alia, age, gender and Quality of Life (QoL). The incidence of monitoring and liaising for the intervention group will be averaged across the number of clients. Finally, unit costs will be applied to the service utilisation figures for the control and intervention groups to estimate total average costs for each group. The total costs of monitoring and liaising will be added to the total cost of services for the intervention group. A sensitivity analysis that refers to parameters used to estimate the savings in other studies identified in the literature review will be undertaken. Health related quality of life. As measured by the Chronic Respiratory Questionnaire (COPD) and Minnesota Living with heart Failure Questionnaire (CHF) INCLUSION CRITERIA: Have a confirmed diagnosis of COPD and are currently receiving oxygen services OR diagnosis of CHF; Do not have a diagnosis of dementia; Can communicate in English; Are not receiving palliative care; and Their specialist or GP has agreed for their inclusion and will take clinical governance