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Heart Failure Disease Management

The Baystate Visiting Nurse Association's Heart Failure Disease Management Program is preventive and proactive, combining traditional skilled nursing visits with daily telephonic monitoring of key indicators such as blood pressure, heart rate, oxygen saturation, and weight. The daily process takes approximately three minutes to complete and transmit the data to the BVNAH Telehealth nurse. The nurse reviews the results to identify patient-specific trends and patterns early, Based on the results, actions may range from re-testing to having the home health nurse make an unscheduled visit to consulting with the physician to determine an alternate plan of care.

Early interventions and symptom management can help avoid re-hospitalization.

The program also encourages patient empowerment through better understanding of the disease processes and the importance of compliance with treatment plans.

Consider the BVNAH Heart Failure Disease Management Program for heart failure patients who qualify for home health care. Especially for patients where there is a desire to reduce emergency room visits and hospital admissions as well as to encourage patient education. The program may also help individuals who want to avoid admission to alternate living facilities by allowing them to be monitored in their homes. Patients with heart failure who have not had strong compliance with diet, medications, or self-monitoring may also benefit from this program.

Benefits to the Patient

  • Increased functional level
  • Increased self management
  • Decreased use of emergency room
  • Decreased hospitalizations

Benefits to the Health Care Team

  • Decreased hospitalization
  • Increased collaboration
  • Decreased urgent office visits

For more information or to make a referral, please call 800-249-8298