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We have examined the hypothesis that home telemonitoring, when added to conventional home care in rural settings, results in less acute care hospitalization and more discharge to the community. Five US rural home health agencies of different types participated in the study. All agencies were not-for-profit and served low-income patients in designated health professional shortage areas or medically underserved areas/populations. A prospective treatment group was telemonitored daily in the home during the period 1 October 2006 to 31 May 2009 (n = 1419). An historical control group was selected sequentially backwards from 30 September 2006 (n = 1502). Both groups had home health services for approximately 50 days (P = 0.76). We used logistic regression modelling, with covariate data captured from the Outcome and Assessment Information Set (OASIS) data set, to assess the effect of group on outcome. Home telemonitoring was found to reduce the odds of any acute care hospitalization (OR = 0.59, P < 0.001) and to increase the odds of discharge to the community (OR = 1.36, P = 0.003).