Presentation on theme: "Telehomecare: Outcomes and Patient Experiences"— Presentation transcript:
1Telehomecare: Outcomes and Patient Experiences Heather Sherrard VP Clinical Services University of Ottawa Heart Institute2012
2Only tertiary cardiac service provider for the region Over 50 % of our patients come from outside the Ottawa areaHigh disease rates outside of the urban areas
3Telehealth FrameworkStrategies using technology to improve the care delivered to patientsEnhances careImproves accessAssists patients to stay in their communitiesImproves patient satisfactionEfficient use of resourcesDefine, give objectives, include knowledge transfer.
4Telehealth Technologies Broadband connection in the regionMonitoring of patients in their homeInteractive voice response using automated calling to care for patients
5Why home monitoringThe majority of patients live outside the Ottawa areaMajority of HF care is not in the hands of HF specialistsHF is a chronic condition characterized by episodic clinical deterioration interspersed with periods of apparent stabilityHF remains the most common diagnosis that brings a patient to hospital for medical admissionReadmission rates can be as high as 25% at 1 month and 50% within the first yearCongestion is one of the main causes of readmissionSelf-care strategies have a positive impact on decreasing readmissionMultidisciplinary approach has produced + outcomes
7Outcome Evidence Authors Study Outcomes Goldberg, A. et al ( 2002) Wharf TrialRCT n=2806 month f/u↓ mortality↓ ED visits↑ QOLCleland, J. et al (2005)RCT n=4268 month f/u↓ LOSAntonicelli, R. et al (2008)RCT n=5712 month f/u↓readmission↑compliance, BB & statin use, health perceptionWoodend, K. et al(2008)RCT n=249 ACS & HF↓readmission (ACS)↑QOL & functional status
8Outcome EvidenceCochrane Review (August 2010) Structured Telephone Support or Telemonitoring Programs for Patients with Chronic Heart Failure25 peer reviewed RCT + 5 published abstracts16 evaluated structured telephone support (n=5613)11 evaluated telemonitoring (n=2710)2 tested both interventionsTelemonitoring reduced all cause mortality (P<0.0001)Both interventions reduced CHF-related hospitalization,QOL, reduced costs & improved NYHA
9Heart Institute Outcomes Heart failure cohort of 121 patients (2008): 69.4% had 1-2 admissions for HF in previous 6 months prior to THM versus 14.8 % in 6 months post THM (each admission has LOS of 7 days at $1000/day)Case-matched cohort (2009): 91 THM patients matched by EF, age (average 70 yrs.) & gender to usual care showed significant difference in the 6 month readmission rate in THM group (p<0.001)THM & the elderly (2010): 594 HF patients divided into 2 cohorts <75 (n=350) & >75 (n=244) showed no difference in # of medication adjustments, # of calls, monitoring duration, or outcomes (ER visits, admission, death) between the 2 groups
10Innovation DiffusionProgram started 7 years ago as a research initiativeNurse managed with medical lead available for issues1 APN + 20 monitors (only from the Institute)5 day operation, with support from Nursing Coordinators for off hour coverageNo home visits, Greyhound bus used for returnsNon physician referrals acceptedIntake letter to all HCPMonitoring duration 3-4 months on average with lots of flexibility
11Operations-now… 1500 patients have been followed to date 1 RN for ~100 patients/day (40-50 monitors)Monitoring duration 3-4 months with plan to transitional to less intensive HF IVR follow-up (q 2 weekly automated calls)Hub and spoke model for the region158 monitors & scales, GPRS bridge modems for digital lines or no land lines, 35 pocket ECG, 20 glucose cables, 20 INR unitsTransitional Care framework adopted
14Funding 75 % of initial equipment funded through grants & research Permanent staff funded through operationsLeverage to improve bed $1000/day, decrease wait time for admission, improve provider capacityCost avoidance model
15Lessons Learned Using regular phone lines is easy & cost effective Patients are successful at connecting equipment in their homes. Equipment return by bus is feasible. No distance barriers.The technology is reliable, producing valid patient data & EHRThe technology can be adapted to meet individual patient needs: volume, language, frequency of transmissions, clinical questionsInfrastructure promotes collaborative care modelNo billing issues
16Doing the right thing, at the right time, in the right place!