Successes and Failures in Telehealth 2017

Transcription

1 How the VST Program works Transitioning from a single-site pilot project to a state-wide regional telehealth service: the experience from the Victorian Stroke Telemedicine program Stroke symptom onset < 4.5 hours Paramedics notify hospital Regional Hospital Rapid triage and assessment CT brain and CTA Phone 1300 TELEMED Dr Acute stroke therapies delivered within acceptable timeframe -tpa, ECR - Video consultation with family and regional clinician Rapid review of brain imaging remotely Assessment by VST stroke specialist D. Cadilhac, J. Kim, M. Vu, M. Savage, L. Bolitho, G. Howlett, J. Rabl, H. Dewey, P. Hand, S. Denisenko, G. Donnan, C. Bladin, on behalf of the VST program consortium Successes and Failures in Telehealth, 30 October 2017 Mildura Victorian Stroke Telemedicine Program Swan Hill Pilot site Total sites, N=1 Live during 2011 Horsham Echuca Albury-Wodonga Wangaratta Shepparton Hamilton Warrnambool Ballarat Bairnsdale Warragul Sale Traralgon Wonthaggi Mildura Mildura Swan Hill Pilot site Total sites, N=1 Live during 2011 Swan Hill Pilot site Total sites, N=1 Live during 2011 Echuca Scale-up 1 Total sites, N=4 Live during 2014 Horsham Echuca Shepparton Albury-Wodonga Wangaratta Scale-up 1 Total sites, N=4 Live during 2014 Ballarat Hamilton Warrnambool Warragul Bairnsdale Sale Traralgon Wonthaggi Scale-up 2 Total sites, N=16 Live during

2 Aim To describe the factors that facilitated the transition of the VST program from a short-term, single-site pilot project to an ongoing, state-wide regional service. Method Design: Naturalistic case study Data Sources: Project reports - 16 stakeholder, 13 funder 10 protocols, 3 collaborative agreements Meeting minutes from 12 Steering and 26 Management, 55 Working Groups Interviews with VST Program Leads and Manager Field notes Thematic analysis, inductive 5 categories 1. Political, financial and technological environment Government focus on digital / technology Technology available Skype, mobiles, laptops used in medical settings Pilot site had a telemedicine cart Technology, health and philanthropic funding In kind support Figure of available cart published in Nagao et al, Evidence-based Stroke distribution in Victoria isochrone map from Ambulance Victoria Clinical need Stroke Foundation Audit / Victorian Stroke Strategy Evidence-based solution Telemedicine successful elsewhere 3 hour drive time to Melbourne 1 hour drive time to regional centre Implementation strategies Behaviour change techniques Sustainability 2

3 Medical Steering Management Florey Hospital programme programme support coordinators Communicatio IT Research and ns and Evaluation education Financial Sustainability 3. Stakeholders, leadership, team Steering Florey-based team Operations/research team together Range of skills, expertise, FTE; change over time Management Local level at hospital Executive sponsor, champions, site co-ordinator Embed into policy Program level Multi-disciplinary, multi-organisations Medical IT Florey programme support Communications and education Hospital programme coordinators 16 hospitals Research and Evaluation Financial Sustainability 4. Iterative evaluation Provide interim results, ongoing monitoring Site-based for each hospital, comparisons Program-level for other stakeholders Clinical and process/implementation evaluation Benefits to patients, but also clinicians/hospitals/funders identified Financial sustainability Pilot and interim VST results, publically available data 5. Dissemination activities Early successes & interim results Tailored to audience Individualised hospital reports Program Governance quarterly meetings Stakeholder meetings and reports National Stroke and Data Workshops Media local papers, social media Conferences, papers Conclusions Various funding sources, pilot data, cost-effectiveness Evidence-based clinical need, solution, implementation Stakeholders identified and engaged Leadership and teamwork established Iterative evaluation and dissemination conducted VST Acknowledgements Project Leads: Christopher Bladin, Dominique Cadilhac Steering and Management members including Chair of Steering : Geoff Donnan Members of the VST Working Groups: Medical, Communication & Education, IT, Financial Sustainability, Research & Evaluation VST Neurologists: Chris Bladin, Bruce Campbell, Helen Dewey, Richard Gerraty, Amanda Gilligan, Peter Hand, Matt Lee-Archer, Poh-Sien Loh, Tom Oxley, Marion Simpson, Vincent Thijs, Hans Tu, Teddy Wu, Nawaf Yassi, Philip Choi, Jorge Zavala, Henry Zhao Hospitals: Health, Echuca Regional Health, Mildura Base Hospital, Swan Hill District Health, Goulburn Valley Hospital, Northeast Health Wangaratta, Albury Wodonga Health, Wimmera Health Care Group, Latrobe Regional Hospital, Central Gippsland Health Service, Bairnsdale Regional Health, Ballarat Health Services, West Gippsland Healthcare Group, South West Healthcare, Bass Coast Health, Western District Health Service Site co-ordinators: Lisa Howard, Julie Stevens, Ashley Murray, Pat Groot (Former: Sharan Ermel, Jo Cottrell, Lisa Peters, Lauren Arthurson, Maria Fox, Emma Marino, Justin Rabl, Trudi Hill, Anne van Berkel, Casey Hair, Mick O Shea, Janette McCabe, Catharina de Muelenaere, Janet May ) Project Staff : Michelle Vu, Kathleen Bagot, Joosup Kim, Sally Berger, Nancy Pompeani, Karen Biddiscombe, AuSCR Economic evaluation: Lauren Sheppard, Marj Moodie (Deakin University) Analysis Assistance: Leonid Churilov, Monique Kilkenny Funding: Victorian Government, Health and Hospitals Fund Department of Health (Commonwealth) Victorian Department of Health and Human Services National Health and Medical Research Council 3

4 What s next Papers available for scaling up VST Australian Telestroke Network Thank you @dominiquecad Additional slides Photos 4

5 Preliminary data Comparable thrombolysis rates Thrombolysis National Stroke Foundation Audit 2009 Australia Regional Australia National Stroke Foundation Audit 2015 Size (75-199) VST Program All Ischaemic 8% 2% 8% 5% 14% Ischaemic < 4.5 hrs not reported 24% 16% 32% Preliminary VST data Faster clinical processes Treatment delivered safely Ischaemic strokes and received thrombolysis Reduction in time (median minutes) Pre-VST N=105 VST N=174 Median mins (Q1, Q3) ED Door to CT time 8 mins 33 (18, 74) 25 (13, 45) Confirmed stroke & received stroke thrombolysis Pre-VST N=105 n (%) VST N=174 n (%) TEMPiS 2006 (Germany) sich (bleed) 16 (15%) 9 (5%) 9% ED Door to thrombolysis time 31 mins 103 (77, 128) 72 (55, 96) Stroke onset to needle time 38 mins 210 (170, 245) 169 (133, 210) Deceased (in hospital) 19 (18%) 32 (13%) 10% Preliminary VST data Preliminary VST data 5

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