Date of Award

6-2008

Degree Name

Doctor of Philosophy

Department

Interdisciplinary Health Sciences

First Advisor

Dr. Nickola W. Nelson

Second Advisor

Dr. Daryle Gardner-Bonneau

Third Advisor

Dr. Debra Lindstrom Hazel

Fourth Advisor

Dr. Michael R. Stoline

Abstract

Telemonitoring is the remote monitoring of patients' health status using telecommunications and information processing technologies. This pilot study analyzed data collected through a parent study that randomized 46 home health patients to either standard care (SC) or standard care with the addition of telemonitoring (TM). The telemonitoring device used in this study provided daily transmission of physiologic data and patients responses to questions about their disease and symptom management. Data analysis was completed to address the question whether telemonitoring, as part of standard home care for patients with chronic obstructive pulmonary disease (COPD) and patients with heart failure (HF), has an effect on patients' perception of self-efficacy (confidence) for managing their disease, overall emotional well-being, and clinical outcomes. Independent variables were diagnosis (COPD or HF) and treatment group (SC or TM). Dependent variables for this pilot study were measures of self-efficacy (SE); emotional well-being (EWB); and data collected on mortality, emergency room use, and hospitalization. Data also were analyzed to identify significant relationships among 3-month variables.

By 3 months, patients in COPD-TM showed greater improvement in SE to evaluate effectiveness of strategies to relieve symptoms and a significant positive relationship between EWB and SE when compared to patients in COPD-SC. There were no differences between the groups on the other measures. Patients in HF-SC showed greater improvement on EWB and a significant positive -relationship between EWB and SE, and a significant negative relationship between EWB and hospitalization, and EWB and emergency room use, when compared to the HF-TM patients. Patients in HF-TM reported more hospitalization than patients in HF-SC. There were no differences between the HF groups on the other measures.

For patients with COPD, TM was associated with improved SE for evaluating strategies used to relieve symptoms, and a positive relationship between SE and EWB. For patients with HF, TM did not have an effect other than an association with greater patient-reported hospitalization.

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Dissertation-Open Access

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