Evaluation of a Disease Management System for Chronic Heart Failure Patients

Paper in proceeding, 2008

Approximately 2 % of the western population (about 250 000 people in Sweden and 5 million people in USA), most of them elderly, suffer from Chronic Heart Failure (CHF) and the numbers are increasing. This results in huge costs for the healthcare sector and a loss in quality of life for the individual. Typical for CHF patients is poor treatment compliance; something that could be captured and partly prevented through daily monitoring of the patients. Patient monitoring can allow the personnel to catch signs of deteriorating health, e.g. due to low adherence, and act before the situation becomes acute. Information gathered through the monitoring could also aid the personnel in decision making, thereby improving quality of life for the patient, as well as reducing costs. Since the patient group is elderly, the design of a home monitoring system becomes very important, motivating extensive design and usability evaluations of such system. Therefore, a doctoral project, Care@Distance, at Chalmers University of Technology has been developed where the aim is to introduce a patient centered, disease management system into the health care sector using easy-to-apply measurements, such as body weight and blood pressure. Measurements are combined with questionnaires focusing on how the patients perceive their health. The research is focused on implementation procedures and acceptance by both healthcare personnel and patients, and the evaluation described in this paper is a first step. In order to evaluate if an eHealth system of this kind could be implemented in the home of a CHF patient, a prototype system has been developed. The system consists of a blood pressure monitor, a personal scale, and a tablet PC with proprietary software guiding the patients through a number of physiological measurements and questions. Measurement sessions are scheduled twice a day in order to get a good picture of their health progress, and questions on experienced tiredness and dyspnea are asked at each session. When a session is completed the results are stored in a database which can then be accessed by the health care personnel. Following the system development, a field test was conducted in the homes of two patients during the fall 2007. The aim of these tests was to gain initial experience on patients’ attitude and response to having the system in their home, and also to get an idea of the design and usability aspects of the system. Two CHF patients were selected by the heart failure clinic at Östra Hospital in Gothenburg to participate in the one month long field test, and during this period the patients used the system daily in their homes. The trial was evaluated with semi-structured interviews where each patient was asked about their experiences using the system. Results from the interviews show that the computer with software is user friendly and that the personal scale is easy to operate. It can also be concluded that the system is stable enough to be used in a home environment. However, both of the patients had difficulties with the blood pressure monitor, raising the question whether that type of measurement equipment is suitable in a home environment. Furthermore, to get more reliable information, a more extensive trial involving a larger number of patients is required. Future work includes developing a web based solution, resulting in a system which can be used on any computer with an internet connection. Considering that about 46 % of the Swedish population between 65 and 74 years of age have access to internet at home, this can have a major influence on the possibility to conduct a larger trial to determine whether the system has a positive effect on treatment compliance and healthcare costs.