UTILIZING TELEHEALTH SERVICES TO IMPROVE ACCESS TO QUALITY CARE IN RURAL SETTINGS

Transcription

1 UTILIZING TELEHEALTH SERVICES TO IMPROVE ACCESS TO QUALITY CARE IN RURAL SETTINGS Charles Gizara, MS, BSN, RN, CCM Director Integrated Care Management Jennifer Light, RN Telehealth Coordinator

2 Goals / Objectives Goals Gain an understanding of the infrastructure required to support telehealth services in various clinical settings. Identify opportunities to improve access to healthcare services in a rural area utilizing telehealth services. Gain insight into tele-coordination, decreased utilization and increasing patient engagement. The Capable Patient

3 Atlantic General Hospital History Demographics Located in Worcester County, MD Opened in Bed Acute Care Hospital 7 Primary Care Offices Located in MD and DE Patient-Centered Medical Home 2 Walk-in Clinics Acute Care Services: - 19 bed ER - General surgery - Medical surgical services - 8 Bed ICU Hospitalists program: 10 Physicians 5 Mid - Level Providers

4 2020 Vision Atlantic General Hospital

5 Most Wired - Advanced

6 Infrastructure Telehealth committee Sr. Leadership support Provider relations Information Technology Health information management Malpractice assessment Provider credentialing / risk management Technology: equipment / software

7 Telehealth Services Services Berlin Nursing & Rehabilitation Center Maryland ecare Intensive Care Shephard Pratt Kennedy Krieger Institute University of Maryland Pulmonary/ Cancer Care Remote Patient Monitoring / Supportive Care Medication Therapy Management

8 Atlantic General Hospital Telehealth Project A collaborative effort between Atlantic General Hospital and Berlin Nursing & Rehabilitation Center with the focus of implementing telehealth services to prevent avoidable transfers, admissions and readmissions.

9 Project Goals Goals Prevent unnecessary inpatient admissions / readmissions from BNRC to AGH for patients with COPD, CHF, DM, and HTN. Reduce all transfers from BNRC to AGH. Utilize telemedicine physician consultations as part of pre-transfer protocols. Reduce readmissions from BNRC to AGH for patients initially discharged from AGH.

10 Clinical Algorithm Nursing Home Resident Condition Changes Clinical Algorithm RN Notifies Nursing Home On-Call MD Algorithm and Clinical Condition Drive Next Steps YES Consider Transfer to AGH NO BRNC Provider Initiates call & Implements Telehealth Consultation with AGH Hospitalist Telehealth conference confirmed Continue to monitor or Transfer to AGH Continue to Monitor Patient Remains at Nursing Home 10

11 Results/ Outcomes %BRNC Patients Admitted to AGH

12 Results/ Outcomes Reduction in Total Transfers from BNRC to AGH Reasons for Transfers include: ER Visits, Hospital Observation, Acute Care Admission, etc

13 Results/ Outcomes Re-Admissions to the Acute Care Hospital

14 Equipment Me

15 Maryland ecare Services A partnership between Maryland ecare, LLC (that includes Atlantic General Hospital) and University of Maryland Medical Center with the focus of improving patient outcomes, reducing mortality rates and decreasing costs for patients admitted to the critical care / intensive care unit.

16 Maryland ecare is a group of non-profit, independent hospitals committed to improving patient care and safety for the communities they serve. Participating hospitals include; Atlantic General Hospital MedStar St. Mary s Hospital Calvert Memorial Hospital Union Hospital of Cecil County Peninsula Medical Regional Center Meritus Medical Center

17 Advantages: * Immediate availability of consultation * Immediate intervention and * Prevention of delay in lifesaving treatment * Continuous monitoring *Decreased mortality rates *Efficiency / cost-effectiveness Zero VAPS since 2008 Zero CLAPSI since 2014

18 Sheppard Pratt Atlantic General Hospital Behavioral/ Mental Health Telemedicine Services First successful telemedicine program at AGH. Psychiatric Evaluations performed at the Atlantic Health Center. FY 2016: 2932 visits performed. FY 2017: 1778 visits performed to date. Next Steps: Focus on pediatric mental health evaluations.

19 Kennedy Krieger Atlantic General Hospital Development, Learning and Autism Spectrum Telemedicine Developed in 2014 through a Grant Opportunity: Carefirst BlueCross Blue Shield. Focus: Expanding Access to Care of Pediatric Developmental Learning and Autistic Spectrum Disorders via Telemedicine. Accessible Specialty Healthcare saving families additional stress of round-trip travel, gas and added expenditures.

20 Budgeted for 120 visits per year FY 2016 FY Visits 117 Visits The child is able to respond to the evaluation in the same way as in a conventional office visit. Decreased sensory overload Visits time: 45 minutes Provides a safe play environment allowing parents to focus on the provider. Child specific technology.

21 University Of Maryland Atlantic General Hospital Dr. Joseph Friedberg Dr. Peter Costantini University of Maryland Atlantic General Hospital

22 Specialty Pulmonary and Thoracic Surgery Consultation from University of Maryland. Multi-disciplinary Team approach. Less Stress for our patients in the community. Increased compliance in care. Cost Effective

23 Technology

24 Expansion of Services Physician Engagement

25 Remote Patient Monitoring/Transitional and Supportive Care Services

26 Equipment Samsung Tablet: Wi-Fi; 3G/4G Peripheral Devices: BP, SPO2, Scale Compatible Glucometers Daily Monitoring Ease of Use

27 Patient Perspective Remote Patient Monitoring Philips eclinical Care Companion (eccc) Symptom and health literacy assessments Icon-based user interface Health literacy development through education videos

28 The Patient Experience Remote Patient Monitoring gh

29 Philips Call Center Remote Patient Monitoring Nurse Triage Center Escalation Patient Centered Medical Home/ Community Care Coordination

30 Patient Success Remote Patient Monitoring Pulmonary Clinic Care Coordination Diabetes Education Medication Therapy Management Nutrition

31 Medication Therapy Management

32 AGHRx Rediscripts Pharmacy Concierge Program. Medication Therapy Management Clinic. Medication Education, Adherence, Compliance, Financial Assistance Delivery of medications Specialty Packaging Reduction in Utilization Care Coordination

33 Readmissions from MTM Population Patient population= 41 patients Readmissions year prior to MTM Clinic Readmissions while in MTM Clinic ED Visits year prior to MTM Clinic ED Visits while in MTM Clinic Total Readmissions Avoided= 8 Total ED Visits Avoided= 80 Readmission Rate= 2.4% Estimated cost avoidance $7920 Estimated cost avoidance $40,000 33

34 Go Forward Strategy Approved as a FTE program expansion expected to manage up to 100 patients Patients from outside PCMH can now be referred to MTM Clinic Outcome measures to be tracked will be readmissions and ED visits Explore billing for services.

35 Resources

36 QUESTIONS / COMMENTS