US USING ING TE TELEH LEHEAL EALTH TH TO O ACHIEVE CHIEVE - - PowerPoint PPT Presentation

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Feb 09, 2023 354 likes •790 views

US USING ING TE TELEH LEHEAL EALTH TH TO O ACHIEVE CHIEVE THE THE TRIPLE TRIPLE AIM AIM TERRY YONKER, RN, MS, FNP-BC TELEMEDICINE CLINICAL CARE COORDINATOR FINGER LAKES COMMUNITY HEALTH Obje jectives 1. Discuss applications of

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US USING ING TE TELEH LEHEAL EALTH TH TO O ACHIEVE CHIEVE THE THE TRIPLE TRIPLE AIM AIM

TERRY YONKER, RN, MS, FNP-BC TELEMEDICINE CLINICAL CARE COORDINATOR FINGER LAKES COMMUNITY HEALTH

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SLIDE 2

Obje jectives

  • 1. Discuss applications of telehealth in primary care
  • 2. Identify how telehealth provides opportunities to

increase access to care

  • 3. List ways in which telehealth has tangible and

intangible cost benefits

  • 4. Explain how telehealth programs can improve

quality of care

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SLIDE 3

Dis isclosure

I have no financial relationship with a commercial entity producing health-care related products and/or services relative to the content I am presenting

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SLIDE 4

Who We Are…

  • Community/Migrant Health Center Program
  • Migrant Voucher Program in 42 Counties
  • Clinical Sites: 9 Health Center Sites
  • Administrative Office: Penn Yan, NY
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SLIDE 5

Where We Are…

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SLIDE 6
  • Transportation barriers
  • Language differences
  • Cultural beliefs
  • Cost of health care services
  • Uninsured/Underinsured
  • Lack of trust in health care

system

  • Poverty
  • Migrant lifestyle

Challenges in Providing Health Care to Rural Poor

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SLIDE 7

FINGER LAKES COMMUNITY HEALTH – HIT INFRASTRUCTURE DEVELOPMENT US USDA – Dist Distance Le Learnin ing an and d Telemedicin ine HRSA – Rura ural Ne Network De Development Fed ederal Co Communic icatio ions s Co Commissio ion – Rura ural Hea ealthcare Br Broadband Proj Project NY NYS DOH DOH

Tele lehealth th Pro rogram Develo lopment Funding Sources

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SLIDE 8

Teledentistry Telepsychiatry Telemental Health Tele-ENT TeleDiabetes (DRS) TelePeds Neurology TelePulmonolog y TeleAC TeleRD TeleMD TeleHCV

Telehealth Programs at FLCH

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SLIDE 9

Patients /Families Reduced travel Timely appointments Services in their community Additional support

Benefits of f Tele lehealth

Providers Direct patient interaction Expanded Services Access to other experts Access to CME Health Care Systems Improved access Improved outcomes Resources utilization Cost and Time efficient

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The Trip iple Aim im

1

  • IMPROVE ACCESS

2

  • IMPROVE QUALITY

3

  • DECREASE COST
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SLIDE 11

HOW TO ACHIEVE THE TRIPLE AIM PART 1 PROGRAM DEVELOPMENT

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GUIDING PRINCIPLES

#1 Telemedicine is a tool #2 Program Management can uncover strengths and weaknesses in operations #3 Quality Improvement is Forever #4 Management by facts = DATA #5 Need to see cost benefits from different perspective #6 Keep a sense of humor!

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TELEMEDICINE AS A TOOL

  • Identify gaps in service
  • Tap the resources
  • Champions are your best friend

IT’S NOT ABOUT THE GADGETS, IT’S ABOUT THE CARE

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PROGRAM PLANNING

  • Administration – IT – Clinical – Operations – Quality
  • Spend time with specialty provider
  • Pay attention to details
  • Document clinical workflow
  • Always do a pilot – start small, think big
  • Goal is to integrate into operations of a PCMH
  • Change Theory
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SLIDE 15

QUALITY IMPROVEMENT

  • Data Collection
  • Monitor and Report Outcomes
  • Continuous Quality Improvement (PDSAs)
  • Regularly Evaluate Program
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MANAGE BY FACTS

  • Data! Data! Data!
  • Facts can trump emotion
  • Facts = Outcomes

And remember:

A Vision Without a Plan is a Hallucination!

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SLIDE 17

COST BENEFIT IS NOT ALWAYS IN REAL $$$

  • Saved travel time/gas for families and enabling staff
  • Less lost work time for families
  • Increased volume of visits to PCMH
  • Relationships between primary care and specialty care
  • PCP job satisfaction and morale
  • Changing health care delivery system and policy
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KEEP A SENSE OF HUMOR

CHANGE THEORY HELPS!

  • Start Small, Think Big
  • Communicate for Success & Celebrate Victories
  • Pause Points: What is working? What is not working?

What could be done better?

  • Identify and Deal with Fears/Concerns
  • Keep Decision Makers in the Loop
  • Keep Process Moving Down the Track
  • Give Feedback (timelines, performance measures)

There is no such thing as a small problem

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HOW TO ACHIEVE THE TRIPLE AIM PART 2 FRONT LINE STAFF HOLD THE KEYS

Excellence in Patient Care Drives Everything

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MR # Last visit A1C Date Result B/P date Result LDL Date Result Malb Date Result DR Date Result Foot Exam Sm

  • ke

A07362500

10/20/11 10/20/11 7.3 10/20/79 124/79 4/11/11 71 7/26/11 <6 7/26 mild NPDR 6/21/11 N

A07343203

11/28/11 11/28/11 10.3 11/28/11 124/80 3/1/11 38 11/28/11 150 1/5 mild NPDR 3/3/11 N

A07317705

11/15/11 11/15/11 5.9 11/15/11 107/72 6/20/11 59 4/8/11 13 7/21 neg 4/8/11 N

3617386

11/01/11 9/8/11 14 11/1/11 106/66 9/25/11 231 9/8/11 <6 9/29 ?glauco ma 9/8/11 N

10002

12/06/11 12/6/11 6.4 12/6/11 126/83 12/6/11 ACE-I N

A07273833

10/25/11 8/25/11 7.3 10/25/11 129/80 6/2/11 85 8/25/11 16 8/25 neg 8/25/11 yes

A07228967

12/29/11 11/22/11 7.7 12/29/11 145/85 12/1/11 100 8/16/11 131 8/2 mild NPDR 11/22/11 N

Create a Registry

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*Scheduling *Pre-Visit Requirements *Concurrent Chart Review *Coordinate with PCMH Team/Specialty Team *Quality Assurance Reports *Lead Case Conferences *Quality Improvement PDSA

Care Coordination

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History Exam Treatment

Train Telepresenter

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  • Outreach
  • Insurance Access
  • Transportation
  • Language/Cultural Interpretation
  • Motivational Interviewing/Pt Centered Goals
  • Education

Relationships = Trust

Actively Decrease Barriers to Care

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Here are some examples……

The Finished Product…

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Finger Lakes Community Health

Eastman Institute for Oral Health

TeleDentistry

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EARLY CHILDHOOD CARIES IN MIGRANT CHILDREN

Early onset & increased severity due to cultural feeding practices

Prevalence: Migrant > Underserved urban > US general population

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Mobile Dental Services

**FLCH mobile dental teams and primary prevention strategy has decreased rate from 60% to 22%** ***For children with advanced decay, pediatric dentist and treatment under sedation or general anesthesia***

For those requiring treatment of ECC…..

15% COMPLETION RATE

  • * Lake Ontario ABCD * Red Creek ABCD
  • *Migrant Summer Schools (Sodus, North Rose, Red Creek)
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LIVE VIDEOCONFERENCING

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TELEDENTISTRY

Intraoral Camera Digital Images Real Time Images

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Bilingual/Bicultural Community Health Workers

Outreach Insurance Access Transportation Language/Cultural Interpretation Pediatric Dentistry Access Education Relationships = Trust

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Triaged Correctly = 88% Decreased travel costs Decrease in lost work time Improved access to care Decreased time to treatment Decrease no show rates Increased interaction between dental providers

94% COMPLETION RATE

4/10 – 4/14 N = 290 consults

54% require treatment under general anesthesia

TeleDentistry Outcomes

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Finger Lakes Community Health

URMC Child Neurology

TelePeds Neurology

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Site Visit – Create Remote Office – Registry – Care Coordination – IT Connectivity – Train PA in Neuro Exam – Use PCMH Team – Leverage HIT – Case Conference – Monitor Outcomes – Ongoing QI 2013 Pilot Outcomes:

*** Decreased time to treatment (38d vs 60d) *** Exceeded national averages on NCQA performance measures *** 75% had changes or additions to their med regimens *** 87.5% diagnosed with mental health co-morbidity *** 100% referred to behavioral health *** 63% showed improvement in function at school and home *** High provider and patient satisfaction

TelePeds Neurology

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Finger Lakes Community Health

Trillium Health

TeleAC (HIV/AIDS Care)

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TeleAC

Appointment Adherence

PCP 85%

57% 91%

AC 85%

86% 100%

HIV CARE

CD4 >500 50%

29% 64%

CD4 >200 85%

86% 91%

Negative viral load 50%

29% 67%

HAART > 95% 85%

71% 73%

OI PCP if indicated 100%

100% 100%

Prevention Screening TB Testing 85%

86% 80%

HCV Screening 85%

57% 100%

Cervical PAP 85%

66% 100%

Anal PAP 85% Colon cancer screening 85%

86% 50%

Annual Lipid Screen 85%

100% 100%

Annual urinalysis 85%

71% 60%

A1C 85%

71% 100%

STD Screen 85%

86% 92%

PHQ 9 85%

29% 80%

TeleAC Pilot Program Clinical Measures Indicator Goal Baseline 7/1/13 End Pilot 6/30/14

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Finger Lakes Community Health

FL Health & John D Kelly Behavioral Health Unit

TelePsychiatry

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  • 55% had decrease in PHQ9 scores
  • Mean time to consult = 19 days
  • Mean time to treatment = <24 hours
  • High patient and provider satisfaction
  • 39% lost to follow up
  • 0% referred to ED
  • 17% referred to higher level of care

(Article 31)

TelePsychiatry Outcomes 2010-2012

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Fundus Photography in Primary Care

Tel eleDia eDiabetes betes

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So Sodus us Com

  • mmun

unit ity Healt lth h Retinopa inopathy thy Pi Pilo lot Screeni eening ng Resul ults ts

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SODUS COMMUNITY HEALTH DIABETES QUALITY INDICATORS

FLCMH 1.2012

10 20 30 40 50 60 70 80 90 100 A1C < 7 B/P < 130/80 LDL < 100 Kidney check Foot Exam DRS May '11 March '12 June '12

National Committee on Quality Assurance(NCQA)

> 40% >25% >36% >80% >80% >60%

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USING TELEHEALTH TO ACHIEVE THE TRIPLE AIM

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THANK YOU! For more information: TerryY@flchealth.org 585-314-7548