Knowledge Session TeleCare Connection June 2, 2020 Noon-1:00pm - - PowerPoint PPT Presentation

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Knowledge Session TeleCare Connection June 2, 2020 Noon-1:00pm - - PowerPoint PPT Presentation

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Noontime Knowledge Session TeleCare Connection June 2, 2020 Noon-1:00pm onecarevt.org WebEx Details Please use Mozillas Firefox or Googles Chrome to access the WebEx application. If you do not have one of these browsers installed, you

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Noontime Knowledge Session

TeleCare Connection June 2, 2020 Noon-1:00pm

  • necarevt.org
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WebEx Details

Please use Mozilla’s Firefox or Google’s Chrome to access the WebEx application. If you do not have one

  • f these browsers installed, you will need to download
  • ne of them.

1. Open FireFox or Google Chrome 2. Enter: www.webex.com or click:

https://onecarevt.webex.com/onecarevt/j.php?MTID=m339 8fb421a11854e587c24ed245e0b69

3. Click on “Join” in the upper right hand corner 4. Enter Meeting Number: 479 414 085 5. Enter Meeting Password: OCVT 6. Enter Your Name 7. Enter Your Email Address 8. Call 1-415-655-0001 & Enter 479 414 085

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Monitoring Form Title of Program: OneCare Vermont Noontime Knowledge Session – TeleCare Connection Where: via WebEx Date: 06/01/2020 Please list speaker/moderator:

  • Dr. Norman Ward

Please list all planning committee members:

  • Dr. Norman Ward
  • Dr. Susan Shane

Emily Martin, RN Tawnya Safer, BS Jennifer Gordon, LICSW Cathie Buscaglia, Director of Innovation, Howard Center Jamie McKenzie, RN UVMHHH Purpose Statement/Goal of this activity: To provide education to attendees on the TeleCare Connection Program Learning objectives (do not use “understand”): By the end of this activity, the learners will be familiar with and will recognize the importance of having community supports in place for a successful transition of care for patients leaving an inpatient setting. Learners will gain knowledge on the collaborative project between the Howard Center and UVM Home Health & Hospice to provide 24 hour remote support for patients transitioning from the hospital to home. Do the speakers or any of the planners have anything to disclose?☐Yes ☒No If yes, please list all potential conflicts of interest: None If yes, were the potential conflicts resolved: ☐Yes ☐No ☒NA Did this activity receive any commercial support (grants or in-kind)?☐Yes ☒No If yes, please list all organizations and support type: N/A

In support of improving patient care, The Robert Larner College of Medicine at The University of Vermont is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. The University of Vermont designates this live activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This program has been reviewed and is acceptable for up to 1 Nursing Contact Hours. As a Jointly Accredited Organization, The Robert Larner College of Medicine at the University of Vermont is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. The University of Vermont maintains responsibility for this course. Social workers completing this course receive 1 social work continuing education credits.

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Important Reminder: All WebEx Participants will be muted during this session. During the Q&A portion you will be unmuted or you may use the chat box for that portion of the session.

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Welcome

Norman Ward, MD Chief Medical Officer

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Agenda

Presenter Time

Noon- 12:05pm

Norman Ward, MD Chief Medical Officer, OneCare Vermont Introduction & Innovation Fund Summary

15 Minutes 12:15pm- 12:45pm

Cathie Buscaglia, Director of Innovation, Howard Center Jamie McKenzie, RN UVMHHH

30 Minutes 12:45pm- 1:00pm

Q&A

15 Minutes

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Goal & Objectives of Innovation Fund

Goal: Improve quality, cost, and/or experience of care Objectives:

  • Rapidly test and evaluate innovative programs/

interventions (i.e. short speed to scale)

  • Ensure funded projects have potential to be

sustainable without relying on ongoing ACO funding

  • Ensure funded projects are scalable to other settings
  • r communities
  • Develop a portfolio of projects that, over time,

address different populations (e.g. age, socio- economic risk, geography, conditions)

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Summary of Selected Proposals, 1st Round

Proposal Youth Psychiatric Urgent Care Model Community Embedded Well Child Care Ocular Telehealth in Primary Care

Description An intensive behavioral support program that will serve as an alternative to the ED for children presenting with an urgent mental or behavioral health issue. Clinic for 0- to 5-year-old well child care. The clinic will be in the Janet Munt Family Room, which serves members of refugee and immigrant communities. Automated retinal cameras to be placed in Addison Co. primary care clinics. Images will be interpreted by a UVMMC retinal specialist. Lead Applicant United Counseling Services UVM Children's Hospital UVMMC Co-Applicant(s) Southwestern Vermont Medical Center Janet Munt Family Room; Center for Behavioral Integration UVMHN: Porter Medical Center Geographic area

  • f impact

Bennington HSA Burlington HSA Middlebury HSA

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Proposal Wellness Plus TeleFriend Pilot Child Pysch. Consult Clinic

Description Program to improve the health of individuals and to slow the incidence of chronic disease for patients at risk for developing cardiovascular and pulmonary disease. Will provide 60 individuals with serious mental illness with a personalized tablet- based tele-health intervention during first 30 days post-discharge from inpatient psychiatric treatment. CHCB will conduct psychiatric evaluation and consultation for the patients

  • f VT pediatricians and
  • ther PCPs, and provide

diagnostic evaluation and treatment recommendations. Lead Applicant Brattleboro Memorial Hospital The Brattleboro Retreat Community Health Centers

  • f Burlington

Co-Applicant(s) n/a n/a n/a Geographic area

  • f impact

Brattleboro HSA Statewide Burlington HSA; Statewide potential

Summary of Selected Proposals, 2nd Round

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Proposal TeleCare Connection Telemedicine and Home Health for ALS Patients

Description Integration of Howard Center's

  • vernight tele-support solution and

UVM HHH Tele-monitoring Program. 24-hour remote monitoring with in- person support for transitioning from hospital to home. Home telemedicine and collaboration with home health providers for high risk ALS patients to reduce the burden of traveling to clinic for both the patient and caregiver. Lead Applicant Howard Center UVMMC – Neurology Co-Applicant(s) UVMHN Home Health & Hospice UVMHN Home Health & Hospice Geographic area of impact Burlington HSA Statewide

Summary of Selected Proposals, 2nd Round

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2019 Innovation Fund Areas of Interest

OneCare is particularly interested in proposals concerning the following:

  • Improving access to care
  • Improving mental health and/or substance used disorder

prevention, screening and/or treatment

  • Advancing care coordination for high risk individuals through

innovative programs addressing the social determinants of health

  • Improving the health of individuals with multiple chronic conditions
  • Slowing the incidence of chronic disease
  • Improving patient experience of care
  • Transforming systems of care by aligning or integrating care across
  • rganizational boundaries
  • Using technology to provide care in new and different ways
  • Eliminating inequalities in health
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Presenter Bios

Cathie Buscaglia, Director of Innovation, Howard Center

Cathie Buscaglia is the director of innovation at Howard Center and is responsible for developing client centered solutions that are sustainable and meet the needs of the most vulnerable Vermonters in a changing and challenging funding environment. She has strong leadership, strategic planning, and program development skills. Cathie has established professional relationships with people across a variety of human service disciplines throughout Vermont. She joined Howard Center in 1994 as a program manager in Developmental Services and acted in a number of capacities before accepting the role as the Director of Children and Family Services in

  • 2006. It was during this period that Cathie helped to establish Safety Connection and other

innovative programs that rely on successful community collaborations to provide enhanced independent living opportunities for adults with disabilities.

Jamie McKenzie, RN UVMHHH

The University of Vermont Health Network - Home Health & Hospice in Colchester has utilized telemonitoring technology to assess, triage and treat patients for nearly 15 years. The program continues to evolve during the COVID-19 pandemic, which is bringing the technology and other eHealth options to more patients and families than ever before. Jaimie McKenzie, RN, BSN, Telemonitor Nurse Coordinator, joined the Home Health & Hospice team as a nurse case manager 16 years ago. During her time making in-home visits, McKenzie came to appreciate the benefits telemonitoring provided for patients and families — not only as a second set of eyes and ears on patients in between home visits, but also as an important patient education tool. About five years ago, McKenzie transitioned from in-home field work to the Telemonitor Nurse Coordinator role with goals of increasing utilization and increasing patient and field clinician engagement. These goals have been realized in that the average daily census has more than doubled along with increased referrals directly from field clinicians. To learn more, visit https://www.uvmhomehealth.org/speciality-programs/telemonitoring- services/.

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Session Objectives

At the conclusion of the session participants will be able to:

  • 1. Recognize the importance of having community supports in

place for a successful transition of care for patients leaving an inpatient setting.

  • 2. Gain knowledge on the collaborative project between the

Howard Center and UVM Home Health & Hospice to provide 24 hour remote support for patients transitioning from the hospital to home.

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Accreditation Designation Statement In support of improving patient care, The Robert Larner College of Medicine at The University of Vermont is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. The University of Vermont designates this live activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This program has been reviewed and is acceptable for up to 1 Nursing Contact Hours. As a Jointly Accredited Organization, The Robert Larner College of Medicine at the University of Vermont is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. The University of Vermont maintains responsibility for this course. Social workers completing this course receive 1 social work continuing education credits.

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Important Reminder: All WebEx Participants will be muted during this session. During the Q&A portion you will be unmuted or you may use the chat box for that portion of the session.

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Noontime Knowledge Session June 2, 2020 TeleCare Connection

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TeleCare Connection

An Innovative Approach to Supporting the Transition from Hospital to Home

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 To understand the importance of having community supports in place for a successful transition of care for patients leaving an inpatient setting.  To gain knowledge on the collaborative project between Howard Center and UVM Home Health and Hospice to provide 24 hour remote support for patients transitioning from hospital to home.

Learning Objectives

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Daytime Telemonitoring Service Overnight Check-In and Independent Living Support

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Home-Based Care Peace of Mind

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TeleCare Connection delivers 24 hour remote support to patients transitioning from the hospital to home.

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The Benefits of TCC

 Supports healthy routines and wellness  Home-based care and recovery  Provides a Community of Care that focuses on individual needs  7 days/week health monitoring and

  • vernight check-in

service

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Patients Eligible for TCC

 Use the hospital and Emergency Room frequently  Stable Housing  Requires short term (60-90 day) supports for best healthcare

  • utcome

 Can benefit from telemonitoring support  Receive Home Health Services

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TCC Patient Profile

 Individual feels isolated and lonely and would benefit from a routine check-in.  Individual experiences anxiety and is concerned about health and wellbeing.  Individual is interested in supports that may prevent or delay higher level of care.  Individual could benefit from knowing support is available overnight when needed.  Does not require routine overnight medical intervention/medication prompting.  Does not engage in behaviors that may put others in danger.

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TCC Disqualifying Factors

  • Physically unable to use the monitor and does not have a

caregiver to assist.

  • Cognitive, behavioral, or safety issues with no caregiver

support.

  • History of non- adherence due to active ETOH or drug

abuse.

  • Homeless, or environmental issues such as hoarding.
  • No access to a phone.
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How It Works

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 60-90 day TeleCare Connection Support

  • UVM HHH Telemonitoring Support

 Access to Triage RN 24/7  8:00 am – 2:00 pm Telemonitor Nurse support  Patient’s condition is monitored daily through vitals and Q&A transmitted by tablet to nurse.  Easy in home set up and use  Coordination with Care Team for best outcomes

  • HC Safety Connection Overnight Monitoring Support

 8:00 pm – 7:00 am  Nightly check-in with Safety Connection Operator  Community of Care Responder support  After-hours Emergency Care Coordination

TCC Service Includes

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Telemonitoring

 Monitoring for blood pressure, heart rate, SPO2, weight, glucose, temperature.  Individualized prompts for biometric checks.  Customized medication reminders.  Evidence based survey questions support early identification

  • f complications.

 Customizable surveys, reminders, patient education Provides patients the comfort of knowing a nurse continues to monitor their health condition once home, while engaging them in learning how to better manage their chronic illness

  • r recovery after an acute illness or surgery.
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Monitoring Equipment

 User-friendly, intuitive design  State of the art technology  Bluetooth enabled  No landline required  Easy installation

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Patient-Friendly Interface

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Medication Checks and Reminders

 Support medication adherence for best recovery outcomes  Manage refills  Track program success

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Individualized Survey Questions

 Provide direct feedback to telemonitoring nurse  Build a comprehensive picture of patient health  Adapt to reflect patient needs

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Video Chat Enabled

 F2F Patient check-in with nurse  “Eyes on” assessment  Ability to conference in multiple members of Care Team with patient  Person-centered

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Telemonitoring Benefits

 Monitoring between clinician home visits  Develops daily routine for health management.  Reinforces education on health management.  Provides trend data available for field clinicians and MD as needed  Promotes greater patient engagement  Results in high patient satisfaction

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Safety Connection delivers overnight, person- centered independent living support to people who want to live on their own.

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Personal Emergency Reporting System (PERS) Technology

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✔ Advanced fall detection ✔ Array of personal help buttons ✔ Hands-free, two-way voice ✔ Universal-design, easy to use ✔ Smoke and freeze detection ✔ Landline or cell alarm signaling

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Safety Connection Service Model

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Monitoring Service Participant Community of Care Response Team

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  • Experienced clinicians
  • Employ person-centered care practices
  • Skilled in emotional/behavioral support

strategies

  • Provide problem-solving guidance and

support based on a relational approach

  • Ready to deliver OTA outreach or in-person

response when needed

Community of Care Response Team

Community of Care

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Social Isolation and Loneliness

  • Since 1980 the number of adults who report feeling

lonely has doubled from 20% to 40%

  • Lack of social connection increases health risks: Equal

to 15 cigs/day or alcohol use disorder

  • Social isolation and/or loneliness is a major concern for

people living alone

  • Feeling lonely is connected to Generalized Anxiety

Disorder

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Safety Connection Brightens Up the Night

 Nightly Check-In Routine  Community of Care Responder Outreach  Help when needed most  Emergency Response Coordination  Supportive Relationship

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Safety Connection Makes a Difference

83% of Safety Connection users report satisfaction with their living situation 90% feel safe at home during the night 88% Safety Connection meets my needs even when they change 95% I can always get help at night when I need it

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Mission

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  • Support patient recovery at home
  • Empower participants to live their best

lives

  • Provide social and emotional support
  • Combat loneliness and

isolation

  • Avoid unnecessary use of higher levels of care
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Questions

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Questions & Answers *please use chat box for questions

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UVM CME/CEU

________________________________________________________________________________________________

In support of improving patient care, The Robert Larner College of Medicine at The University of Vermont is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. The University of Vermont designates this live activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This program has been reviewed and is acceptable for up to 1 Nursing Contact Hours. As a Jointly Accredited Organization, The Robert Larner College of Medicine at the University of Vermont is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. The University of Vermont maintains responsibility for this

  • course. Social workers completing this course receive 1 social work continuing education credits.

If you are interested in claiming 1.0 Credit for attending this session, please use the following or scan the QR code below.

http://www.highmarksce.com/uvmmed/index.cfm?do=ip.claimCreditA pp&eventID=13831

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Survey Monkey Session Evaluation Link:

https://www.surveymonkey.com/r/TeleCareConnection

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Who to Contact with Questions: Emily Martin, RN Clinical Education Coordinator OneCare Vermont emily.martin@onecarevt.org Tawnya Safer Clinical Program Specialist OneCare Vermont tawnya.safer@onecarevt.org

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Thank You!

  • necarevt.org