Facilitating Self-Management of Chronic Disease through Home Based Tele-Monitoring for Patients with CCF and COPD. Suzie Hooper August 2011

Transcription

1 Facilitating Self-Management of Chronic Disease through Home Based Tele-Monitoring for Patients with CCF and COPD Suzie Hooper August 2011

2 Acknowledgement Jo McLaren RN Emma Boston RN Belinda Smith RN Sue Rowe RN Carmel Bourne RN

3 Background Chronic Obstructive Pulmonary Disease (COPD) and Congestive Cardiac Failure (CCF) are two of the most prevalent chronic disease in Australia Difficult to accurately estimate prevalence Prevalence is increasing with the aging population Both are considered to be major public health issues in all Western countries AIHW (2005), Abhayaratna (2006)

4 Project Background Funding for the pilot was through the Medibank Private Special Purpose Fund. MBP and SJGHC wanted to collaborate to develop a home-based CDM program utilising emerging technology SJGHC investigated potential home monitoring systems Selected the Intel Health Guide Patients with current hospital cover with Medibank Private were eligible for participation in the project.

5 Target group Target group for the pilot: Patients with a diagnosis of CCF or COPD Recent hospitalisation for their condition and / or a history of multiple admissions for this condition Potential to reduce the likelihood of hospital admission Patients from both metropolitan and regional areas

6 St John of God Health Care Australia s largest Catholic not-for-profit private health care group. Established in 1895 in WA by the Sisters of St John of God. 15 hospitals in Australia and NZ, metropolitan and rural / regional

7 St John of God Health Choices Established in 2009 Reduction in hospital admission rates, bed days and associated hospitalisation costs Provides all levels of home-based nursing care: Community, PAC HITH Branches: Melbourne, Berwick, Geelong, Warrnambool, Bendigo, Ballarat Perth

8 Project Aims To determine the effectiveness of a home based telemonitoring system for patients with COPD and CCF Identification of an at risk cohort of Medibank Private members who would benefit from the program, following an admission to hospital for their condition Reduction in hospital admission rates, bed days and associated hospitalisation costs

9 Project Aims Improved self-management of the disease Provision of an integrated program of care between nurses, doctors, hospital and the community Improved member wellness (measured subjectively and objectively)

10 Program elements Pre-program assessment and recruitment if suitable Initial home visit by Health Choices nurse to set up system Daily home-based physiological tele-monitoring for 12 weeks

11 Program elements Daily monitoring of vital signs and physical symptoms Web-based data upload to central monitoring data centre. Interpretation of physiologic parameters by a skilled registered nurse centrally. Appropriate intervention as indicated. Weaning over 4 weeks. Data collection and analysis.

12 Equipment Intel Health-Guide (home based monitoring system). Peripherals: Sphygmomanometer Pulse oximeter (blue tooth) Scales (blue tooth)

13 Monitoring System Web-based central monitoring system (Intel Health Management Suite) On-line interface that allows nurses to securely monitor their patient s condition SJGHC developed EXCEL patient data base and patient record

14 Monitoring System

15 Monitoring System

16 Monitoring System

17 Possible interventions Telephone consultation by the RN Home visit by a member of the Health Choices nursing team (clinical or technical) Liaison with patient s GP/Specialist if indicated

18 Patient Enrolment 62 eligible 14 did not continue (no Special Purpose Fund form completed) 5 RIP 1 doctor refused 4 refused 4 other 46 Enrolled (Special Purpose Fund forms completed)

19 Patient Enrolment 46 approved by Medibank Private Special Purpose Fund Committee 32 Active clients 6 patients refused 4 RIP 4 other reasons

20 Current Activity 32 Active clients (July 2011) 9 monitoring daily 3 currently weaning 20 completed ceased monitoring 2 will be ongoing

21 Number of patients Patient Demographics SJGHC /MPL Tele-monitoring Pilot Program Age Range Total Age range

22 Number of patients Patient Demographics SJGHC /MPL Tele-monitoring Pilot Program Patient Gender Male Female Male Gender Female

23 Number of patients Patient Demographics SJGHC /MPL Tele-monitoring Pilot Program Region Bendigo Berwick Nepean 5 0 Bendigo Berwick Nepean Region

24 Patient Demographics SJGHC/MPL Tele-monitoring Pilot Project Diagnosis % 31% CCF COPD CCF/COPD 63%

25 Health Service Utilisation Number of Admissions to hospital - 6 Number of admitted days to be determined Days between hospitalisation for the chronic condition to be determined Number of unscheduled home nursing visits Clinical - 3 Technical (system management) - 21

26 Hospitalisation Number of Admissions to hospital - 7 Reason for admission 1. Worsening disease palliative 2. Cardiac complications full time care 3. Chest Infection 10 day stay recommenced monitoring (had commenced weaning) 4. Blood transfusion (leukaemia) 1 day stay recommenced monitoring 5. Back surgery currently in hospital 6. Pneumonia 7 day stay recommenced monitoring (had not commenced weaning) 7. Chest infection 10 day stay home with PICC line and recommenced monitoring

27 Clinician Feedback Successes - Good system that is very easy for the patients to use - Currently assessing patient and carer satisfaction - Comprehensive system of data that provides the whole picture that usually indicates when intervention is needed (some exceptions) - Minimal requirement for phone follow up related to clinical issues

28 Clinician Feedback Difficulties - Connectivity issues in outer-metro and regional areas related to wireless internet - Issues with firewall protection within SJGHC (unable to use videoconferencing) - Clinicians need reasonable computer skills - Complexities related to multiple clinicians monitoring patients knowledge of patients reduces necessity for patient contact

29 Patient Feedback COPD patient who has had 6 hospital admissions in the last half of 2010 has now stayed out of hospital for 10 months and feels he is in control of his health remains out of hospital and wife went on overseas for a holiday. COPD / CCF patient admitted monthly prior to monitoring and rehab program feels more in control of her health - remains out of hospital 14 weeks.

30 Patient Feedback COPD / CCF patient remained out of hospital increased confidence has taken a trip to Sydney to meet her first great grand child. CCF patient remained out of hospital severe CCF monitoring provides reassurance regarding condition. Many patients and carers express general sense of increased confidence in managing their condition.

31 Issues for consideration Need for broadband internet to facilitate consistent monitoring and utilise video capability Need the formal data analysis to determine quantitative and qualitative outcomes Develop proposals to access funding more broadly

32 Thanks to our collaborators Steve Hall (CEO, St John of God Health Choices) Rebecca Redpath (Medibank Private) Dianne Paynter (Medibank Private) Dr Steve Bunker (Medibank Private) Anthony Fanning (Healthe Tech Pty Ltd) Scott Moller-Neilson (Healthe Tech Pty Ltd) George Margellis (Care Innovations an Intel GE Company)

33 References 1. Australian Institute of Health and Welfare (2005) Chronic Respiratory Disease in Australia. Their prevalence, consequences and prevention. 2. Abhayaratna, Smith, Becker, Marwick, Jeffery and McGill (2006) Prevalence of heart failure and systolic ventricular dysfunction. MJA 184(4) Australian Bureau of Statistics (2001) National Health Survey 4. Krum H. and Stewart S. (2006) Chronic Heart Failure; time to recognise this major public health problem. MJA 184(4) Australian Institute of Health and Welfare (2004) Heart, Stroke and Vascular Disease Australian Facts Krum H., Jelinek M., Stewart S., Sindone A., Atherton J., Hawkes A., (2006) Guidelines for the prevention, detection and management of people with chronic heart failure in Australia Pfeffer M.,Swedberg K., Granger C., Held C, McMurray J., Michelson, Olofsson B., Östergren J., Yusuf S., for the CHARM Investigators and Committees (2003). Effects of Candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM- Overall programme. The Lancet, Vol