The purpose of this study is to conduct a multi-level evaluation of the Telehomecare intervention offered to patients diagnosed with Heart Failure (HF) or Chronic Obstructive Pulmonary Disease (COPD) across 8 local health integration networks (LHINs) in Ontario in comparison with the ‘usual care’.

Research Questions


1. What is the impact of the Telehomecare on disease-specific hospitalization and ED visits in comparison with ‘usual care’ for COPD and HF patients followed up to 18 months?


2. What is the impact of the program on all-cause hospitalization/ ED visits and other uses of the healthcare system including primary care, specialists, long-term facility and medication use in comparison with ‘usual care’?
3. What are the costs associated with the program and its cost-effectiveness in comparison with the ‘usual care’?
4. What are the program’s patterns of use and the perceived impact on patient quality of life, self-management, satisfaction with care and informal caregiver strain?
5. What are the perceptions and experiences of program users (patients, informal caregivers, technicians, healthcare providers, administrators, decision-makers) as well as the overall adoption, integration and sustainability of the program?

Inclusion Criteria


A patient that has:

  • A documented diagnosis of HF or COPD (with or without co-morbid conditions)
  • Classified as a ‘heavy user’ of the health care system, characterized by any of the following:
    • A minimum of one hospitalization for a respiratory or cardiac complaint in the past six months
    • A minimum of two emergency department/urgent care center visits for a respiratory or cardiac complaint in the past six months
    • Currently receiving nursing services via CCAC
    • Frequent visits to primary care provider in the past year
  • Patient/informal caregiver (if applicable) is an adult (over 18 years), able and willing to provide informed consent
  • Patient/informal caregiver (if applicable) is fluent in English
  • Patient/informal caregiver is able and willing to operate the Telehomecare equipment
  • Patient lives in a residential (private home or retirement home) setting with an active landline

In addition to the program eligibility criteria, the following criteria for the intervention evaluation study apply to the recruitment of patients:

  • Patient must have a documented consent for participating in Telehomecare 
  • Patients enrolled in the Telehomecare program must have agreed to share their contact and health information for evaluative purposes 
  • Patients must provide informed consent before participating in observations, interviews and surveys as part of the program evaluation study

Healthcare Provider

A healthcare provider that has:

  • Referred a patient that has been previously enrolled in the Telehomecare program, and/or
  • Provided primary care to a patient enrolled in the evaluation study
  • Previously or currently participated in delivering Telehomecare as a provider or care administrator
    • For observations, interviews and surveys: nurses/physicians must have at least 2 months experience in providing care using Telehomecare

Technicians, Administrators and/or Decision Makers

The following are eligible for inclusion in the study:

  • Technicians involved in the set-up of Telehomecare equipment in the patient home.
  • Administrators and/or decision makers of the Telehomecare program as a larger network of care such as Healthcare Program Managers, key members of the LHINs, OTN etc.

Exclusion Criteria


  • Less than 18 years of age;
  • Individuals without an established diagnosis of COPD or HF
  • Unable or unwilling to provide verbal informed consent
  • Demonstrated non-adherence to the THC program
    • The Telehomecare Nurse works with each patient on a case-by-case review to assess willingness to partner in their own care, and if the number of missed consultation appointments and reasons for demonstrate overall non-adherence with the program;
  • Inability or unwillingness to use Telehomecare equipment, and/or;
  • Do not have a regular caregiver to assist in the use of the equipment (if assistance is required)

Healthcare Provider

  • Is not a practicing healthcare provider in any of the participating LHINs

Technicians, Administrators and/or Decision Makers

  • Unable or unwilling to provide verbal informed consent

Design and Methods

The evaluation of the Telehomecare intervention is a mixed-methods study comprising of four components (sub-studies).

1. Comparative Effectiveness Study is a propensity matched cohort study that will evaluate patient clinical outcomes using administrative data (ICES) in comparison with the ‘usual care’. The main outcomes of interest focus on health services utilization (i.e. hospital admissions, ED visits, primary care visits).

2. Economic Evaluation Study consists of two sub-studies:

1. Descriptive Costing Study will evaluate costs associated with the Telehomecare and the ‘usual care’, including patient level clinical outcomes (e.g. hospitalization, ED visits) using administrative data (ICES).
2. Cost-effectiveness Matched Cohort Study will evaluate cost-effectiveness of the Telehomecare in comparison with the ‘usual care’.

3. Evaluation study of Telehomecare use consists of two sub-studies:

1. Quantitative Descriptive Study uses administrative data (PMMS database that contains patient information such as: medication use, blood pressure etc.) to comprehensively evaluate the program, its implementation, patterns of use and its efficacy.
2. Longitudinal Surveys Study will capture patients’and informal caregivers’ quality of life, disease management skills, as well as satisfaction with care. Surveys will be conducted over the phone.

4. Adoption Study – by conducting ethnographic observations, in-depth semi-structured interviews, documentation collection and review, this study will explore perceptions and experiences of program users (patients, informal caregivers, healthcare providers, technicians, administrators, and key decision makers) as well as the overall adoption, integration and sustainability of the program.

Study Timeline

The study duration is expected to take 2-3 years.

Research Team

Valeria Rac, MD, PhD (Principal Investigator)
Murray Krahn, MSc, MD (Co-Principal Investigator)
Lusine Abrahamyan, MD, MPH, PhD
Morgan Slater PhD
William Wong PhD
Michael Hillmer MSc, PhD
Heather Ross MHSc, MD, FRCPC
Petros Pechlivanoglou MSc, PhD
Nicholas Mitsakakis Msc, PhD
Nida Shahid, HBSc
Yeva Sahakyan, MD, MPH
Gemma Hunting HBHSc, MA
Farah Mawani Msc, PhD (Candidate)
Aleksandra Stanimirovic MPH, PhD (Candidate)
Yelena Petrosyan, MD, MPH, PhD(Candidate)
Welson Ryan


Ontario Ministry of Health and Long-Term Care