The overall objective of this proposed research is to determine the impact of a telemedicine program on outcomes of African Americans with high-risk congestive heart failure in combination with hypertension and diabetes. Specifically, the study will compare outcomes of two outpatient management methods currently used for chronic congestive heart failure - traditional outpatient clinic and home care (from herein referred as a clinical management, (CM) compared to the home telemonitoring and telemanagement method (TM). The TM method incorporates a physiologic home monitor providing transtelephonic patient data to a multidisciplinary health care team. We hypothesize the outcomes in the proposed study would be improved more effectively and efficiently via the TM method. A randomized design using a sample of 60 patients with 30 patients managed in each group will be employed. Primary outcomes will include: outpatient and overall mortality, heart failure hospital admissions, length of stay, admission costs, care delivery costs, blood pressure reduction, and glucose control. Additionally, provider time, quality of life, self-efficacy, anxiety, depression and patient satisfaction will be analyzed and compared. If the stated hypothesis is realized as true, TM will provide the clinicians with a powerful tool to improve care in a cost effective manner. PROPOSED COMMERCIAL APPLICATION: AvidCare, working in conjunction with UICMC and Advocate Home Health Care Services is developing and optimized method of outpatient CHF care: the Home Health Monitoring Service. This research process will result in the creation of a computerized CHF patient record with integral clinical protocols for "telemanagement" and transtelephonic physiologic monitoring. The culmination of these works will tie together into the development of a sercice and hardware package that will be offered by AvidCare to hospitals, managed care organizations, and integrated delivery system
