Predictors of attrition in older users of a home-based monitoring and health information delivery system

The present study examined the predictors of discontinuation from a home telehealth program designed to provide a patient centered approach to symptom management for older adult veterans.;Data from 132 veterans were collected and analyzed through the Care Coordination/Home Telehealth program at the Salt Lake City Veterans Affairs Medical Center. The criteria established for participant inclusion required that the veteran reported using four or more active prescription medications, was 50 years of age or older, and reported patterns of high utilization of health care services during the year prior to enrollment. Veterans were provided with a telehealth device and oriented to the program through an in person or telephone meeting.;Over a 4-year period, results demonstrated that 73 of the 132 (55.3%) participants discontinued enrollment in the program. When a veteran participant discontinued, the reason for discontinuation was recorded. There were three reasons that a veteran could be classified as discontinued including the following: (1) the veteran chose to discontinue the program; (2) the veteran no longer qualified for participation in the program therefore, discontinued; or (3) the veteran did not engage in the program beyond the initial orientation session.;Logistic regression was employed to determine whether demographic, health care utilization, program enrollment orientation method, and responses to the telehealth device predict discontinuation within each of the categories. Results demonstrated that low frequency of responses to the telehealth device within the first 30 days of enrollment was the only significant predictor of program discontinuation for both veterans who chose to discontinue and for veterans who discontinued due to no longer qualifying for participation. For participants who failed to engage in the home telehealth program following orientation, results revealed the number of emergency room visits in the year prior to enrollment and veteran enrollment through a telephone orientation meeting were significant predictors of discontinuation.;These results provide a direction for future home telehealth participant selection and reveal that irrespective of the reason for discontinuation, early experiences in the program and technology adoption are the most predictive variables of ongoing program engagement.