This is a study is to assess the impact of health information technologies (HIT) on clinical and financial outcomes for patients with symptomatic heart failure (HF). Nearly 5 million Americans have HF (the leading cause of hospitalization) with an estimated $40 billion annual cost. The information technologies we will use include remote monitoring (telemonitoring) of vital signs and symptoms, an electronic health record system and clinical decision support systems. We will test a reproducible model for technology-supported HF management and assist purchasers, payers and policy makers in selecting HIT to improve clinical and financial outcomes. Patients will be recruited from rural and urban primary care practices. We will evaluate two different configurations of HIT. One is Technology Supported Case Management, a combination of telemonitoring and telephone nurse case management. The other is Technology Supported Self Management, a novel combination of telemonitoring plus an expert system that assesses vital signs and symptoms for risk of decompensation and guides patients through an individually-tailored self-care algorithm. The study will use a two-stage, randomized, open-label, multi-site, controlled trial design. In Stage 1, the incidence of hospitalization and/or ER visits with Standard Care will be compared to the incidence with Case Management to test the hypothesis that Case Management will have a lower incidence of ER visits and/or hospitalization than Standard Care. In Phase 2, Case Management will be compared to Self Management to test the hypothesis that both interventions are equivalent in reducing ER visits and/or hospitalization. Secondary outcomes will include total cost of HF care, functional and psychosocial status and satisfaction with care. We hypothesize that both interventions will produce better secondary outcomes than Standard Care, and that Self Management will have lower cost than Case Management because it does not require skilled nurse case managers. ? ?
