Until recently, home health care agencies had absorbed an increasing demand for caring for older Americans. While demographic characteristics remain unchanged for our aging society, since 1997 thousands of home health agencies have closed. With the advent of prospective payment, thousands more are at risk of closure. Unless alternatives can be developed or workable solutions can be identified for home care, the health care of aging Americans may be at risk. Applied Home Telemedicine (AHT) has spent two years piloting a system that stands to serve as a model for home care. Using chronic wounds as the first focus, AHT has: (1) assembled technology that allows remote assessment and guidance, thus potentially leveraging resources; (2) proven that "expert" clinicians can utilize the technology to benefit more patients than would otherwise be the case; and (3) produced remarkably promising clinical and financial results. However, pilot work has also resulted in the identification of barriers to broad scale access and utilization, which, if left un-addressed, will threaten commercial viability and sustainability. This Phase I proposal is directed toward assembling the components to address each of those barriers and evaluating the results in terms of increased within-agency utilization and clinical outcomes. Phase II will assemble these components into a management module to add to existing clinical and technological modules. To address generalization, the resulting comprehensive system will be evaluated in a range of agencies and the content will be expanded to two additional clinical conditions. There is already considerable interest from potential strategic alliances for Phase II expansion and commercialization. PROPOSED COMMERCIAL APPLICATION: This research will investigate the potential for deeper and broader applications of a telemedicine-based expert approach to caring for home health patients. If successful, it has the potential to revolutionize the home health industry by proving the viability of a new delivery model capable of generating substantially improved patient outcomes while utilizing resources far more efficiently and effectively.