1. The Pathways Program “Bridging your way to better breathing” Advocate Health Care, Advocate Home Health Services, Cardio-Pulmonary Rehabilitation, and Physicians collaborating to provide positive outcomes for patients with chronic obstructive pulmonary disease. Connie Polke Advocate Home Health Services

2. Goals:  Decrease Frequency and Duration of Hospitalizations  Improve Patient Outcomes  Return Patient to Self Management  Improve Patient Satisfaction  Improve Physician Satisfaction  Provide Necessary Home Health Services  Reduce Symptomatic Complaints

3. Program Activities:  The Pathways Newsletter  Quarterly Patient Support Groups  Respiratory Therapist 1:1 educational sessions  Telehealth via Telephonic Assessments and support  Respiratory Therapist ongoing evaluation of progress and condition  Coordination with other care providers to standardize education  Program Coordinator Case Management and Clinical Interventions

4. Program Criteria:  Physician order  Pulmonary Diagnosis  Secondary Diagnosis Shortness of breath Deconditioning Decrease in ADL’s Decreased Functional or Neurological Capacity  FEV1 < 60%

5. Measures:  Dyspnea as measured using Borg and ADL Scales  Strength and Endurance as measured by the Six Minute Walk  Health Status as measured by SF-36 Health Survey  Number and Length of Hospitalizations

6. Telehealth Phone Monitoring via TouchPointCare, data collected included:  Weight  Shortness of Breath  Sputum Production Color and Amount  Oxygen Change in Liter Flow  Hospitalization Number of Days  Medication

7. Why We Chose Phone Monitoring:  Focus on the data to be collected, not on methodology  Choose easiest method patients  Patients like real voice connection  Much cheaper than other telehealth approaches

8. Quality of Life Scale

9. Results of Six Minute Walk Results of Perceived Exertion and Dyspnea

10. Weight Change

11. Number of Days Hospitalized

12. Data Interpretation  One year data indicative of improvement in the majority of measures  Increase the number of patients in program and continue ongoing assessment  Interpretation of data indicates need for increase in communication and education regarding program goals

13. Technology Issues for Web Based Phone Monitoring Telehealth:  Hosting eliminates IT hassles  Available 24/7  Secure Server  Robust security  Daily back-ups  HIPAA compliant  Easy to interface

14. Project Summary:  Telehealth via TouchPointCare phone monitoring facilitates patient data collection  RN not needed for data collection, (only assessment of data)  Improved productivity  Improved patient outcomes  Phone monitoring a cost effective solution

15. Contact:  Advocate Healthcare: Connie Polke Connie.Polke@advocatehealth.com 630-368-6581  TouchPointCare: David Anderson danderson@touchpointcare.com 866-713-6590