assisted home-based care to patients with chronic respiratory - - PowerPoint PPT Presentation

A partnership approach to delivering technology- assisted home-based care to patients with chronic respiratory disease

Vikas Wadhwa, Clinical Director Integrated Services, Eastern Health Rob Sutherland, Principal and Business Lead, ZEST Health Strategies

• Economic impact of Chronic

Obstructive Pulmonary Disease in 2008: $98 billion

Chronic Respiratory Diseases Hospital Admission Risk Programs (HARP)

• Second leading cause of

avoidable hospital admissions in Australia

• Promote independence
• Reduce risks of

hospitalisation

Background

• Resource intensive
• Regular home visits by

specialist nursing teams

EASTERN HEALTH

+

TELSTRA HEALTH

+

Patient recruitment, HARP service, Clinical governance Software and Technology

Consortium to develop EMOC

ZEST HEALTH STRATEGIES

+

SYMBION HOSPITALS

Collaboration, Expertise Service development & redesign, Research & Evaluation

Patient 1

Case Study

Patient 2

• Age 37, smoker
• Asthma preventer, occasional ventolin
• 2 hospitalisations previous 12 months, ICU
• HARP Respiratory Case Management
• Respiratory Connect home Project

Case Study

Study design and methodology

• 1. Reduce frequency of respiratory-

related hospital readmissions/ED presentations

• 2. Improve patient adherence to care

plan tasks

• 3. Reduce average no. of home visits
• 4. Reduce overall cost of home-based

care & support

Study Design

▪ 12 month trial: Aug 2018- Aug 2019 ▪ Quasi-experimental

:

Objectives

7

The App

• 1. Cross Platform (iOS & Android)
• 2. BYOD or provisioned devices
• 3. Zero rated data for Telstra

customers

• 4. TGA approved Bluetooth devices
• 5. SaaS model

Technology

• 1. Task reminders
• 2. Health Questionnaires/Surveys
• 3. Biometric data – Bluetooth and/or

manual data entry

• 4. Medication reminders – AMT

integration

• 5. Triage dashboard

Functionality

Co-design and change management

• Change management and implementation support tailored to

the local health service context Our approach: ✓ Shared governance model ✓ Co-design with the clinical team ✓ Process and patient journey mapping ✓ How-to-guides for patients and HARP staff ✓ Customisation of the technology (alerts for symptoms, Sp02)

• 77% female (n=61)
• Mean Age 65 years
• Age Range 21-96
• 23% male (n=18)
• Mean Age 65 years
• Age Range 20-85

Number of patients Demographics Principle referral source

• Acute Hospital (72%)
• Respiratory OPD (13%)
• Other (15%)

Eastern Health

• n=79

10

11

53 % 34 %

57% 66% 34%

Enhanced model of care: Preliminary Outcomes

>1

avoided ED presentations/ month

Healthcare Utilisation

15 Avoided ED presentations

87%

Tasks completed as scheduled

Care Plan Adherence Direct Cost Savings

>$23 000

Average cost of avoided events

Return on Investment

42%

Dollars saved in avoided events: Dollars Invested in technology

Enhanced model of care: Patient experience

Self-management of respiratory condition Health service-seeking behaviours Patient perceptions

• f care

“I feel more comfortable as I know the [nurses] are looking at my readings… that gives me confidence”

“Sometimes when you’re not well you doubt yourself. Many times I’ve been sick and should have called an ambulance and haven’t... with the technology if you get bad someone will ring and say you need to get an

• ambulance. Being told like this

means I’ll do it.” “You can see the days you're abnormal and normal... that's helpful as I could look back and say, Wednesday, Thursday, Friday my readings were abnormal, but this week it’s all

• good. What have I done

differently this week to last week?”

Patient 1

• Action plan, GP visit organised
• Only 1 respiratory presentation to ED 7 months; nil

admissions

• Reduction of carer stress
• Reduced anxiety
• Better recognition of symptoms and proactive in care

Case Study - Outcome

Patient 2

• No further ED presentations or admissions
• Reduced Ventolin
• Return to work fulltime whilst being monitored
• Activated Asthma Action Plan with Telephone Review

initiated through Telehealth Data

• Anxiety relieved

Case Study - Outcome

Learnings and future directions

Change management Software Optimisation Bluetooth pairing, PRN medications, further device integration Smartphone Access Scaling Up Hospital In The Home, Diabetes Palliative Care, Cardiology EMR/PAS Integration

17

Eastern Health

Acknowledgements

Suzanne Morony Rob Sutherland Nicola Man Sue Sinclair Frank Thien Mary West Vikas Wadhwa Dean Martin Tracey Hart William Grant Ryder Manson Vickie Irving Jim Darcy Zoltan Kokai

ZEST Telstra Health Symbion