1. © 2010 Center for Technology and Aging1 Consumer Digital Health: Technology Assessment and Outcomes Measurements Lynn Redington, DrPH, MBA Sr. Program Director Center for Technology and Aging techandaging.org vital: the consumer digital health event San Francisco, 6 October 2010

2. © 2010 Center for Technology and Aging2 Center for Technology and Aging  Established in 2009 with funding from The SCAN Foundation, located at the Public Health Institute  Accelerate diffusion of proven technologies (ADOPT) that help older adults remain healthy and independent  CTA initiatives  Technology Diffusion Grants Program  Independent, non-profit resource—research briefs, advocacy, tools and lessons learned (ADOPT toolkit)  Older adults: A large, growing population with high medical and social service needs

3. © 2010 Center for Technology and Aging3 Technology Assessment Factors --CTA’s Selection Criteria for Grant Program Focus Areas-  Population Applicability  Large, growing, high-need, high-burden population segments  Health Outcomes  Control existing health conditions, prevent exacerbations/adverse events  Economic Outcomes  Health service use—reduce use per patient, or increase overall efficiency  Caregiver/Workforce Relief  “Downshifting”--from high-acuity/skilled to low acuity/unskilled care  Technology Viability  Rogers DoI Theory: Relative advantage, compatibility, complexity, etc.  Stakeholder Readiness  Ready or resistant? Note: technology viability/stakeholder readiness tradeoff  Policy Relevance  “Authority-driven” adoption: QI/Cost Savings Initiatives, Subsidies

4. © 2010 Center for Technology and Aging4 Promising Technology Focus Areas --Focus of CTA’s first 3 Grant Programs-- 1. Medication Optimization Technologies  Medication adherence  Medication reconciliation  Medication monitoring 2. Remote Patient Monitoring Technologies  Chronic disease monitoring  Safety, falls monitoring 3. Technologies for Post-Acute Care Transitions/Readmissions

5. © 2010 Center for Technology and Aging5 Focus AreaMedication Adherence, Remote Patient Monitoring PopulationVets with CHF, hospitalized within past year Technology Health Buddy using POTS, Med Adherence Algorithm, weight scale, BP cuff Outcomes Reduce hospital/ED visits; improve patient activation, QOL & satisfaction (randomized, controlled trial) Workforce Relief Patient Self-Support, Care coordinator (RN), MD oversight, Automated clinician alerts ReadinessVHA: world’s largest telehealth user, rural health = telehealth Policy Relevance VHA mandated to efficiently change from acute care provider to a chronic care/preventive care provider Veterans Health Administration (Central CA) --Example CTA Grantee Project--

6. © 2010 Center for Technology and Aging6 Technology Intervention Outcomes Measures -- Examples from CTA Grantees-- Medication Adherence Morisky scale, Beliefs about Medicines, Meds possession ratio Medical service utilization # of hospitalizations, ED visits; cost comparisons between usual care and technology-enabled care Technology adoption Surveys regarding adoption process, points of resistance, barriers/drivers, clinician satisfaction, organizational readiness Patient Patient QOL: SF 12, SF 36, Lorig Patient Activation: PAM, other empowerment surveys Caregiver Burden Zarit scale ClinicalWeight, BP, A1c, other condition-specific indicators Study Design Issues RCT is gold standard Validity of pre-post & cohort comparisons?

7. © 2010 Center for Technology and Aging7 Center for Technology and Aging www.techandaging.org