Jun 14, 2011 - TeleHome Monitoring Goals. 6 ... A home monitoring unit will typically monitor 4 patients a year. ie. ...
TeleHome Monitoring a BC Perspective
Margarita Loyola, Manager Telehealth, VIHA Loretta Zilm, Coordinator Telehealth, IHA 2011 BCATPR Workshop June 14, 2011 Slide 1
Heart Failure is the leading cause of hospitalization for people over the age of 65 with a six-month readmission rate as high as 50% and one-year mortality rates as high as 40% after diagnosis.
Arnold, et al., 2006; Deaton & Grady, 2004; Ravel & Arnold, 2002
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British Columbia - 89,345 HF Clients
Interior Health Authority Population: 741,709 17,869 HF clients Vancouver Island Health Authority Population: 768,000 15,965 HF clients Slide 3
Next Steps
High rate readmission
Percentage decrease in Hospital readmissions
Reduction in the # of Hosp readmissions
Increase Self Management
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Sustainable and integrated Healthcare
Business Drivers • • • • •
Limited support for primary care physicians supporting CDM clients Increasing CDM client population Increased pressure on acute & complex care facilities Limited support and self-care education for clients living with CDM Emergency room utilization by clients living with CDM
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TeleHome Monitoring Goals Reduce: • emergency room visits • hospital admissions • length of stay
Extend • system capacity • geographic reach
Enhance • acute care discharge planning • access to care • continuity of care • quality of life • self management 6
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TeleHome Monitoring Service Model Target Patients: Diagnosis of Heart Failure VIHA • Home & Community Care nurse • Nurse installs device and trains in clients home
IH • Heart Function (acute care) nurse • Patient is trained at a Heart Function Clinic and installs own device
• Both nurses - monitor and respond to client data • Provide necessary support and self-care education Slide 7
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TeleHome Monitoring in BC - Costs
BC VIHA
BC IHA
BC IHA Expansion
Project Scope # of Units Target Population Patients managed to date
2008 CHI funded 50 200 patients per year 140
2006 – pilot 40 120 patients per year
2008 CHI funded expansion 20 60 patients per year 510
Project Costs
$336,350
$317,750
$204,215 $160,000
Annual Operational
$105,000
A home monitoring unit will typically monitor 4 patients a year. ie. 50 units will manage 200 patients per year Initial program implementation costs lay the groundwork required for building the capacity for future expansion The program costs include hardware, deployment, project management and exclude one time setup and ongoing network costs VIHA expansion of THC has started IHA has continued to expand. In 2010, another 90 units were purchased and implemented. Approximate annual operational costs are projected to be between $350,000 and $400,000 Slide 15
TeleHome Monitoring - Results Impact
BC VIHA 2009
BC IHA 2006
1) 100% strongly 2)100% agreed
1) 90% strongly agreed 2) 84% strongly agreed
3) 87% strongly agreed
3) 90% strongly agreed
Patient satisfaction and quality of life
1) Overall satisfaction 2) Confidence in managing condition 3) Ability to self manage
↓ 47% in home visits Ç116% increase in phone calls
Reduction in Homecare nurses in field
Number of patients monitored per nurse
25
29-34
Patients managed to-date
172 +
795 +
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TeleHome Monitoring - Results Impact
BC - VIHA
BC - IHA
Hospital Admissions
↓ 61%
↓56%
Cost per HF hospitalization $8,575
$7,240
↓ 65%
↓ 64%
Emergency Dept Visits
Client Level: Fewer Complications Program Level: Increased Efficiency (increased caseload) System Level: Decreased Acute Care Utilization (cost avoidance) 17
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Evidence CHF RN acted in a timely basis, thus avoiding exacerbation of the client condition (e.g. weight gain and diuretic) “By following her instructions I have lost 20+ pounds of fluid and have a lot less swelling. I believe that my health has improved a lot”. “I have been able to pick up early on signs of pneumonia & heart failure in my dad and I have been able to prevent it from getting worse”. Slide 18
Lessons Learned • Improve communication to referral sources • Potential clients should be identified in hospital prior to discharge. • PM 101 course for stakeholders • PIA - most complex deliverable • Infoway reporting challenges (e.g. timesheets) • Sharepoint was a good tool • Process integration into clinical practice • Wrapping the services around the client, regardless of program Slide 19
Success Factors • Collaborative partnership between GP, RN and client • Case management model • Navigation skills • Consistent self-management support & follow up • Boundary spanning information sharing: GP, Specialists, ER, Health Care Providers • Physician champion to promote program • Clearly defined roles and responsibilities
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Next Steps - VIHA • VIHA Board approved Telehealth Strategic Plan which targets Telehome monitoring expansion • CHF • COPD • Additional 125 monitors purchased to deploy • Project in the charter and early planning phase
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Next Steps – Interior Health • Identify opportunities for expanded use of monitors • Identify opportunities for use of supplementary technologies (ie. IVRS) in conjunction with HF and CDM programs
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Conclusions • Electronic home monitors enable Health Care providers to work effectively with complex clients in assisting them to better manage their illness and stabilize their health, regardless of where they live. • Use of electronic home monitors facilitates early intervention by the health care provider, thus preventing unnecessary hospital visits and enabling early discharge.
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The End
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