one interactions with the patient in their home, responding to real-time diagnosis specific questions. Vital signs, oxygen saturation rates, and auscultation of heart and lung sounds using NASA technology stethoscopes is collected though the patient may be up to 50 miles away. The telehealth nurse is able to intervene at the right time to address disease-related issues, and to determine if a home visit is indicated. The telehealth nurse does all of this either from the office or from their home through a secure website. With a caseload of 40 patients, the telehealth nurse can monitor and do video visits on 12 patients a day as opposed to a home care nurse who averages five patients a day with a case load of 20 patients. Telehealth allows the nurse to intervene at the right time while the home care nurse may not know the status of patients until a home visit is conducted; by the time the home care nurse visits, the patient may already be back in the hospital. Today, over 900 Centura Health patients have received telehealth services. The number of hospital readmissions within 30 days of hospitalization for this group is 9.7 percent, compared to hospitals nationwide which have a readmission rate of over 20 percent for primary diagnosis of congestive heart failure. Three years of tracking of this program shows that 81 percent have remained without need for further hospitalizations. The intervention has successfully kept patients from being readmitted to the hospital, with tremendous savings (estimated $5.2 million) in health care dollars, showing that this technology is the future for home care agencies.

These examples demonstrate how nursing can provide the leadership and skills in addressing one of the nation’s top health care challenges—chronic disease. In order to continue and sustain these initiatives the following must occur:

• Establish solid local, state, and federal funding for nurse-led initiatives in chronic care.

• Support the development implementation and evaluation of innovative nurse-led models of care.

• Fund education initiatives to train nurse leaders in business, public policy, outcome monitoring, and quality improvement.

• Eliminate regulatory and oversight barriers that inhibit the ability of advance practice nursing to provide primary care.

Nursing is shaping health care of the future by creating innovative programs that are effective, low-cost, and reach the populations that most need the care.

Esperat, M.C., Feng, D., Owen, D., and Green, A. (2005). Transformation for Health: A framework for health disparities research. Nursing Outlook, 53:113–120