Congressmembers Kathy Hochul and Brian Higgins joined leaders from the Visiting Nursing Association of Western New York to announce a $250,000 grant from the U.S. Department of Health and Human Services, Health Resources and Services Administration through its Telehealth Network Grant Program to implement a "Diabetes Telehomecare Program for Rural Western New York."
The project will commence immediately for a one-year period with future HRSA funding recommended in the amount of $250,000 annually over the next three years for a total four-year award of $1,000,000. Each year, 75 diabetes patients in Chautauqua and Genesee counties are targeted to participate in the program.
The VNA, a Kaleida Health subsidiary, provides services to residents in all eight Western New York counties including Erie, Niagara, Orleans, Genesee, Chautauqua, Cattaraugus, Allegany and Wyoming.
The VNA offers a full range of services including pediatric and adult skilled nursing and therapies, chronic disease management, home infusion therapy, mental health care, obstetrical services and care as well as personal response systems.
Diabetes is highly prevalent in the targeted counties and nationally with the CDC reporting that 25.8 million people in the United States have diabetes equating to 8.3 percent of the total population. In Chautauqua County, the diabetes prevalence age adjusted rate per 100 adults from 2008-2009 was 11.2 and 13.2 in Genesee County, while the NYS rate was 9.0 (NYSDOH, Expanded BRFSS Report, 2008-2009).
In addition to a diagnosis of diabetes, the individuals targeted for this project experience significant barriers to care. Access to transportation for these rural-based individuals who are often elderly and living with chronic health conditions such as diabetes can be especially challenging. Poverty and lack of adequate health insurance also play a role. Home-based care through telehealth monitoring and care coordination will work to overcome these barriers and improve the lives of Chautauqua and Genesee county residents living with diabetes.
Unique to this project is the increased physician participation and involvement in the telehealth patient care management process. Participating physician groups are Robert Berke, MD and Albert Persia, MD of Family Health Services in Mayville for Chautauqua County.
The proposed project will provide reimbursement to the participating primary care physicians for monthly patient interventions resulting from telehealth data review and communication with the VNA provider team. Physicians are not currently reimbursed for this level of care for diabetes patients. A VNA telehealth nurse will provide daily telehealth monitoring of patient progress and will provide ongoing updates to the partnering physician group as to patient progress and to reconcile medication issues, blood glucose levels, diet and other concerns. The program will be further supported by an initial evaluative home visit by a VNA home health nurse with subsequent visits as needed every two months and in rotation with a VNA registered dietician, as well as monthly teleconferences between patients and a VNA diabetes educator.
The VNA will oversee the program and facilitate daily telehealth monitoring of the participating patients, home care, other consultation services and case conferencing with the partnering physician offices. County specific outreach, education, telemonitoring placement and home care support will be facilitated through the VNA's branch offices in Jamestown. The physician partners for this project will refer patients with diabetes who meet the assigned criteria for participation and will work with the VNA to facilitate ongoing telehealth monitoring, the sharing of clinical information and data and the testing and follow-up of patients as to their progress.
The goal of this collaborative telehealth program is to improve diabetes management through telehealth technology as evidenced by the measurement of blood glucose - bg - and physician directed measurement of HbGA1c - Glycosylated hemoglobin or A1C - values of the participating patients and to promote patient self-management of the disease through outreach and education. The program is intended to reduce the risk of complications and unnecessary emergency room visits and hospitalizations, thereby lowering the cost of care and improving health outcomes for Western New York residents.
The VNA has successfully operated its telehealth program since 2005. In 2011, the VNA provided telehealth services to nearly 500 urban and rural Western New York residents. The VNA regularly surveys discharged telehealth patients and consistently achieves 98 to 100 percent overall satisfaction rates. This includes 96 percent of patients who agreed or strongly agreed "the monitoring system is useful in assisting me to manage my health."