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Heather Sherrard VP Clinical Services University of Ottawa Heart Institute Telehomecare: Outcomes and Patient Experiences 2012.

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Presentation on theme: "Heather Sherrard VP Clinical Services University of Ottawa Heart Institute Telehomecare: Outcomes and Patient Experiences 2012."— Presentation transcript:

1 Heather Sherrard VP Clinical Services University of Ottawa Heart Institute Telehomecare: Outcomes and Patient Experiences 2012

2 Only tertiary cardiac service provider for the region Over 50 % of our patients come from outside the Ottawa area High disease rates outside of the urban areas

3 Telehealth Framework Strategies using technology to improve the care delivered to patients –Enhances care –Improves access –Assists patients to stay in their communities –Improves patient satisfaction –Efficient use of resources

4 Telehealth Technologies Broadband connection in the region Monitoring of patients in their home Interactive voice response using automated calling to care for patients

5 Why home monitoring The majority of patients live outside the Ottawa area Majority of HF care is not in the hands of HF specialists HF is a chronic condition characterized by episodic clinical deterioration interspersed with periods of apparent stability HF remains the most common diagnosis that brings a patient to hospital for medical admission Readmission rates can be as high as 25% at 1 month and 50% within the first year Congestion is one of the main causes of readmission Self-care strategies have a positive impact on decreasing readmission Multidisciplinary approach has produced + outcomes

6 Telehome Monitoring Technology

7 Outcome Evidence AuthorsStudyOutcomes Goldberg, A. et al ( 2002) Wharf Trial RCT n=280 6 month f/u mortality ED visits QOL Cleland, J. et al (2005)RCT n=426 8 month f/u mortality LOS Antonicelli, R. et al (2008) RCT n=57 12 month f/u mortality readmission compliance, BB & statin use, health perception Woodend, K. et al (2008) RCT n=249 ACS & HF 12 month f/u readmission (ACS) QOL & functional status

8 Outcome Evidence Cochrane Review (August 2010) Structured Telephone Support or Telemonitoring Programs for Patients with Chronic Heart Failure 25 peer reviewed RCT + 5 published abstracts 16 evaluated structured telephone support (n=5613) 11 evaluated telemonitoring (n=2710) 2 tested both interventions Telemonitoring reduced all cause mortality (P<0.0001) Both interventions reduced CHF-related hospitalization, QOL, reduced costs & improved NYHA

9 Heart 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=244) showed no difference in # of medication adjustments, # of calls, monitoring duration, or outcomes (ER visits, admission, death) between the 2 groups

10 Innovation Diffusion Program started 7 years ago as a research initiative Nurse managed with medical lead available for issues 1 APN + 20 monitors (only from the Institute) 5 day operation, with support from Nursing Coordinators for off hour coverage No home visits, Greyhound bus used for returns Non physician referrals accepted Intake letter to all HCP Monitoring duration 3-4 months on average with lots of flexibility

11 Operations-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 region 158 monitors & scales, GPRS bridge modems for digital lines or no land lines, 35 pocket ECG, 20 glucose cables, 20 INR units Transitional Care framework adopted

12 Regional Program Montfort TOH-Civic, OGH QCH UOHI

13 THM

14 Funding 75 % of initial equipment funded through grants & research Permanent staff funded through operations Leverage to improve bed $1000/day, decrease wait time for admission, improve provider capacity Cost avoidance model

15 Lessons 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 & EHR The technology can be adapted to meet individual patient needs: volume, language, frequency of transmissions, clinical questions Infrastructure promotes collaborative care model No billing issues

16 Doing the right thing, at the right time, in the right place!


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