For more information about the final programme, speakers or the EHFG conference please contact us directly!

Transcription

1 For more information about the final programme, speakers or the EHFG conference please contact us directly! SAVE THE DATE! 18th EHFG: 30 September 02 October 2015

2 COPD service in Renewing Health Claus Duedal Pedersen Odense University Hospital, Denmark

3 Content 1. Conclusion 2. The Renewing Health telemedicine project: Objective and methods 3. A long journey 4. Results from the evaluation

4 Conclusion NT + OO = COO 03/10/2014 4

5 The aim Produce evidence and decision support for EU health policies regarding the future deployment of innovative telemedicine services in those fields where they can lead to improved care and reduced cost.

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7 Objective of Renewing Health To implement mature telemedicine services In 9 European regions For patients with diabetes, COPD, CVD Assessment of outcomes by use of MAST Austria Denmark Finland Germany Greece Italy Norway Sweden Spain

8 End of a long journey? 2005: Clinical problem: Better treatment options for COPD patients 2006: OUH and GiTS collaborate to develop a mobile solution to offer monitoring in own home after discharge. End product: A 'briefcase' with only three buttons; Power, Connect and Volume: : Pilot project: Patients and staff reported satisfaction, initial evaluation was good : To obtain solid documentation of the service, it was rolled out on small scale and included in a large European research project and a PhD project (incl. Randomised Control Trial). 2012: The service is implemented in the daily operations at OUH for the benefit of patients and staff. 2013: Expansion in use of briefcase: COPD rehabilitation (live demo later), heart patients, other areas 8

9 Methods MAST Model for Assessment of Telemedicine - HTA-based framework Domain 1. Health problem and characteristics of the application Domain 2. Safety Domain 3. Clinical effectiveness Domain 4. Patient perspectives Domain 5. Economic aspects Domain 6. Organisational aspects Domain 7. Socio-cultural, ethical and legal aspects Design: 18 pragmatic RCTs - Broad inclusion criteria - Many stakeholder relevant outcomes - Complex intervention - Tested in normal practice Sample size: 7148 patients in total 03/10/2014 9

10 Example of data collection (RCT, n=266) Safety Clinical effectiveness Patient perspectives Economic aspects Organisational aspects Technical reliability Readmissions Mortality FEV1, SAT, MRC, BMI SF-36 Exercise WSD acceptability questionnaire Qualitative interviews Investments Number of telemedicine consultations Use of staff Number of readmissions Number of outpatient visits Number of home nurse visits Use of emergency ward Interview with nurses

11 Days to first admission within 26 weeks

12 Days to death within 26 weeks

13 Patient satisfaction Because of the TVC the patients felt safe or more safe with discharge Yes No? % Used the equipment without help from anyone* Could easily or with little difficulty make the TVC measurements work 98 2 The measurements made the patients feel more safe or no difference 93 7 Found the number of consultations suitable** Will recommend that the TVC should be the usual care *5 % some times with help; **5 % wants more consultations; ***20 % preferred both telemedicine and telephone calls

14 Economic results COPD Country DK ES I A GR Cost of TM intervention Total cost per TM pat Total cost per C. pat Difference % Difference 6% 61% 20 % -21 % - 32% Results: Mean difference: + 7% No. of studies estimating savings: 2 of 5 No. of studies with statistically significant difference: 0 of 5 Mean costs of telemedicine intervention: 690

15 Overall results 1. Telemedicine increases costs per patient in 12 of 18 RCTs Main reason: Cost of telemedicine intervention is per patient Generally, use of health care is not reduced 2. Methodological interpretation: RCT of mature interventions Economics: Trials follow checklist by Drummond et al. (2005) 3. Comparison with existing studies? Whole Systems Demonstrator (Henderson et al. 2013) Costs of telemedicine intervention: 1847 per patient Increase in total costs per patient by +15% 03/10/

16 But did we get it right? Is RCT the right tool for telemedicine services? RCTs kill the business case! Did we actually measure at the right time? New services and no change management! What if we look at the setup in daily production? Is the market ready? No change in reimbursement systems, no large scale deployment! 03/10/

17 NT + OO = COO New Technology + Old Organizations = Costly old organizations

18 Thank you Chief Innovation Officer Claus Duedal Pedersen Chief Innovation Officer CIMT Centre for Innovative Medical Technology Odense University Hospital