1. THE APPLICATION OF TELECARE FOR PATIENTS WITH CARDIOVASCULAR DISEASE
Feipei Lai
National Taiwan University
3/22/2010

2. OUTLINE Why do we need telehealthcare service? Previous experiences
Infrastructure for Continuous Care Service
Case Study
Conclusion

3. Why do we need telehealthcare service?
Top 5 high cost diseases:
Dialysis, Dentistry, Cold/Flu, High blood pressure, Diabetes
4 billion US dollar annually
1/3 of Taiwan National Health Insurance Expenditure
Average hospital visit (2008) : 15 times/year (population: 23 M)

4. Between January 2004 and December 2004, chronic heart failure patients who were followed up by specialist nurse-led telephone visiting regularly were enrolled.
Clinical and financial data half a year before enrollment were collected as control.
A total of 247 patients (168 males, 79 females; mean age, 60 ± 17 years) were enrolled.
J Formos Med Assoc 2007;106(4):313–319

5. J Formos Med Assoc 2007;106(4):313–319

6. J Formos Med Assoc 2007;106(4):313–319

7. before
after
change (%)
Cost (US$)
Inpatient cost
624,020
362,722
-41.8
Non-Heart Failure cost
541,800
184,136
-66.0
ED cost
6,528
6,101
-6.5
OPD
90,783
94,855
4.4
Duration
Inpatient
2,127
1,042
-51.0
Non-Heart Failure
1,729
556
-67.8 ED 66 45
-31.8
ICU
327
160
-51.1
Visit
Admission
109 73
-33.0
Non-HF Inpatient 82 26
-68.3 43 27
-37.2 35 12
-65.7
1,085
1,352
24.6

8. EFFECTIVENESS
The previous study confirmed that home-based intervention with nursing specialists improved the clinical outcome and provided cost-savings for Taiwanese patients with systolic heart failure.

9. INFRASTRUCTURE FOR CONTINUOUS CARE SERVICE
National Taiwan University Hospital (NTUH) established a telehealthcare center in 2009, to provide a continuous healthcare service, while the patients stay at home
Normal Discharge
Before
Admission
Virtual OPD Service
Home Care Service
After
Early Discharge

10. INFRASTRUCTURE FOR CONTINUOUS CARE SERVICE

12. Telehealthcare equipment-Patient site
Gateway
plug & play
store and transfer

13. Telehealthcare equipment-Patient site

14. Telehealthcare equipment-Patient site

15. Telehealthcare equipment-Patient site

16. Telehealthcare equipment-Patient site

17. Telehealthcare equipment-Patient site

18. Telehealthcare equipment
Video Conference

19. Telehealthcare equipment-Hospital site

20. Telehealthcare equipment-Hospital site

21. Telehealthcare equipment SpO2-Hospital site

22. Telehealthcare equipment-Hospital site

24. CASE STUDY
87 year old female, with history of atrial fibrillation, arrhythmia
2009/10/06 discharged after bone fracture operation

25. CASE STUDY 2009/10/12 Symptoms of respiratory distress SPO2 75%
Case manager immediately contacted cardiology surgery, emergency treatment

26. CASE STUDY
pulmonary embolism → operation

27. INITIAL RESULT Year/Month 2009/10 2009/11 2009/12 2010/01 2010/02
Patient 65 81 51 62 57
Signout 2 5 6
Average Admission Stay
8.26 8
9.39
8.4
8.2
14 Day Emergency Department Visit
13 (21%)
10 (13%)
7 (14%)
6 (10%)
5 (9%)
14 Day Readmission Rate
8 (12%)
6 (7%)
5(10%)

28. Enrollment Follow-up Patient No. 65 81 51 62 57 Stay 8.26 8 9.39 8.4
2009/10
2009/11
2009/12
2010/1
2010/2
Follow-up
Patient No. 65 81 51 62 57
Stay
8.26 8
9.39
8.4
8.2
control 96 98
107 93 -
11.17
10.53
10.04
10.6 56

29. CONCLUSION
The Department of Health of Taiwan has been establishing a national health insurance that includes continuous care service.
A new service infrastructure is needed to support post- hospital community service, and provide continuous and comprehensive care service
Our project demonstrates an infrastructure to enabling integrated personal healthcare service. (to be effective on 2011)