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Elizabeth A. Krupinski, PhD Arizona Telemedicine Program.

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Presentation on theme: "Elizabeth A. Krupinski, PhD Arizona Telemedicine Program."— Presentation transcript:

1 Elizabeth A. Krupinski, PhD Arizona Telemedicine Program

2  Recipe for Success: Skill Sets Home TH ◦ Leadership Potential Equation CriteriaDefinition Emotional StabilityTolerate stress & frustration, well adjusted, psychologically mature DominanceAssertive, competitive, decisive EnthusiasmOptimistic, energetic, flexible ConscientiousSelf-disciplined/motivated, high standards excellence Social boldnessSpontaneous risk takers Tough mindednessPractical, logical, to-the-point Self-assuranceSelf-confident, resilient CompulsivenessSocially aware, careful, abundant foresight

3  Recipe for Success: Skill Sets Home TH ◦ 5-Factor Personality Model FactorDefinition ConscientiousnessExtent to which hard-working, organized, dependable Emotional StabilityDegree calm, cool, self-confident ExtraversionExtent assertive, positively interacts with others OpennessCreative & curious AgreeablenessDegree cooperative & warm to co- workers

4  Recipe for Success: Skill Sets Home TH ◦ VA Skill Sets CriteriaCritical Ingredients Skill SetsClinical assessment, critical thinking, scientific process, communication, negotiation, collaboration, conflict resolution Core KnowledgeOrganizational structure, community resources, team building, service delivery, psychosocial support Personality TraitsFlexible, adaptable, optimistic, resourceful, self-motivated, persistent, intuitive, advocate, leader, compassionate

5  Technical feasibility  Provider & patient acceptance/satisfaction  Cost effectiveness  Outcomes = equivalent or better than traditional  H.R. 6331. = 1/1/09, skilled nursing facilities, in-hospital dialysis centers & community mental health centers = originating sites for Medicare reimburse

6  COPD HH vs TN ◦ Pare et al. 2006 ◦ 7.5 vs 4.2 home visits  46.6 min vs 57.5 min ◦ 40% vs 5% hospitalizations  7.3 days vs 13.5 days ◦ $2,779 vs $2,424 per patient over 6 mo ◦ Attitudes overall positive

7  Diabetes ◦ Chumbler et al. 2005 with VA ◦ Pre vs post TH enrolment ◦ 50% reduction hospitalizations ◦ 11% reduction ER use ◦ 3.0 fewer bed days of care ◦ Overall improvement QOL, pain reduction & social functioning ◦ Other studies show HbA1C improvement

8  Acute infections  Chronic respiratory failure  Lung transplant recipients  Stroke recovery  Asthma self-management  Cystic fibrosis  Chronic heart failure  Spinal cord injury  PTSD & TBI  Mental disabilities (schizophrenia, Alzheimer’s)  Pediatric, adult & geriatric populations

9  Cancer patients with ostomies being discharged earlier after surgery  Reduces time proficient in self-care  Increases need for education & support visits by nurses after discharge  Distance & time can be considerable  Shortage of nurses specializing in ostomy care

10  Achieving self-care is a process  Nurses guide patients from dependence to independence  Start with total care & conclude with education & support  Telemedicine can serve a role in this process at all stages

11  28 patients with ostomies resulting from treatment for cancer ◦ 14 HH =11 urostomy, 3 colostomy ◦ 14 TH/HH = 7 urostomy, 7 colostomy ◦ LOS = 8.86 days HH; 8.36 days TH ◦ 68% male, 32% female ◦ Mean age = 66.5 yrs (sd = 9.68) ◦ 89% Caucasian, 7% Hispanic, 4% AfAm

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13 HHTH Bladder Cancer (64%)17 Colorectal Cancer (28%)35 Cervical/Ovarian Cancer (8%)02 HHTH Spouse (78%)11 Daughter (11%)21 Sister (4%)10 Brother (3.5%)01 Parent (3.5%)01

14 HHTH Education Some College (55%)88 Some High School (26%)34 Grade School (19%)32 Marital Status Married (77%)11 Widowed (4%)10 Divorced (4%)10 Never Married (14%)13 Religion Protestant (39%)65 Catholic (25%)43 Other (11%)12 No Affiliation (25%)34

15 No significant differences MeanSDRange HH6.294.251 – 17 TH FTF5.433.031 – 13 TH3.571.282 - 6

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17  Surgery: t = 0.304, p = 0.7632  Discharge: t = 0.170, p = 0.8666 MeanSD HH Surgery15.07 days8.42 HH Discharge6.79 days7.49 TH Surgery13.71 days14.39 TH Discharge6.14 days12.04

18  Ostomy surgery explained = 100%  Enterostromal nurse participated care = 96%  Family of support during surgery = 100%  Received United Ostomy Association visitor during hospital stay = 38%  Who helped adjust to surgery ◦ Family = 36% ◦ Ostomy nurse = 36% ◦ Doctor or nurse = 22% ◦ Other = 6%

19 Agree HH Agree Both Disagree HH Disagree Both Neutral HH Neutral Both Future hopeless0%15%91%77%9%8% Take care self70%77%30%15%0%8% Easily talk @ ostomy100%92% 0%8%0% Feel helpless18%8% 82%84%0%8% Activity limited36%38%64%62%0% Feel angry28%30%63%62%9%8% Prevents relationships 28%24%72%76%0% Odor18%31%73%61%9%8% Look at stoma without depressed 82%84%18%16%0% Colostomy Significantly > Urostomy

20 Agree HH Agree Both Disagree HH Disagree Both Neutral HH Neutral Both Dress same clothes72%54%19%38%9%8% Avoid situations now18%34%64%66%18%0% Ostomy is a disability45%38%54%55%0%8% Travel is no problem81%77%10%8%9%15% Physically active45%54%55%38%0%8% Socially active72%62%28%30%0%8% Sexually active30%18%70%82%0% Sex relationship worse55%54%45%37%0%9% Would visit other ostomy patients 45%62%28%23%27%15%

21 HHTHSig Nurse understands problem 11% disagree0% disagreeX 2 p < 0.01 Comfortable with what nurse said about ostomy 11% disagree0% disagreeX 2 p < 0.01 Overall satisfaction81% satisfied93% satisfiedNS Camera embarrassed15% agree TH care more accessible 100% agree Prefer TH instead of waiting 87% agree Prefer FTF70% agree TH as good as FTF85% agree

22 HHTH A) Mean # visits6.295.43/3.57 B) Mean cost nursing visits$63 salary* + 0.34/mile @ 12 miles HH = same TH = $18.90** C) Average cost pouches used$123.22/pt$70.73/pt D) Final cost (A x B)$444.52$377.31 HH $67.50 TH*** $444.81 total *Set fee for HH visit **30 min 0.04/min airtime = $1.20 + $17.70 salary *** TH only vs HH t = 5.05 p = 0.0001

23 Pereira et al. IMEDIR in Spain ICU filled with info Need to organize

24  Avera eICU (South Dakota; Pat Herr)

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26  Sutter Health eICU (CA; Teresa Rincon) ◦ Onsite intensivist coverage 12 hrs/day = $43,810 ◦ RN resource for APACHE & se[sis data collection = $11,700 ◦ Licensing fees for risk adjusted data collection = $1800 ◦ Total costs per bed onsite = $57,310 ◦ Total costs per bed eICU = $42,000

27  Remote monitoring & wearable devices  Wellness & prevention devices  Call-centers & automatic monitoring  Smart homes  Business-based programs  All have TH Nursing component  Need to be evaluated further for impact & health outcomes

28  Telenursing occurs on a variety of levels & in many environments  Clear cost & outcome benefits have been demonstrated  Opening avenues for reimbursement & new care settings  Providers & patients will continue to benefit from telenursing expansion

29 THANK YOU!


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