Virtual Clinic follow up of hip and knee joint replacement Helen [PDF]

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Helen Williams, Directorate Manager, T&O Nicola Fuller, Surgical Care Practitioner Dan Williams, Hip & Knee Consultant Co-founder, MyClinicalOutcomes @danhwilliams

Friday 17 May 2019

Virtual Clinic follow up of hip and knee joint replacement

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Virtual Clinic follow up (vFup)

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Newer, more expensive tests and treatments

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An ageing population with more chronic disease

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£30 billion p.a. funding gap by 2020

Healthcare

Cornish population aged 65-84

(2011 Census, 1st Release, July 2012, ONS)

ê Demand, é Funding or Improve efficiency

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Information revolution..

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Exponential growth in computer power / £

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Digitisation

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Layered innovation

Digital Health

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2016 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 NHS PROMs

Apr 09 - Present

NPfIT

Apr 05 – Mar 2013

Cost-effecOve health technology is a recent phenomenon

Digital Health

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Patient Reported Outcome Measures (PROMs)

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736 hip & knee replacement patients

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Validated PROMs

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Factors => return to sport 12mths post-op

Ø Age Ø Male sex Ø BMI Ø Pre-op UCLA activity §

Not operation or implant

Digital Health

Williams DH, Garbuz DS, Masri BA, Greidanus NV, Duncan CP. Predictors of pardcipadon in sport following hip and knee arthroplasty Clinical Orthopaedics and Related Research 2012;470(2):555-61

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Disclosure

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Disclosure

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Virtual Clinic follow up (vFup)

Hip (THR) & Knee (TKR) replacement

“Primary Total Hip Replacement: A Guide to Good Practice.” British Orthopaedic Association. First published 1999, revised Nov 2012

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Eng & Wales NJR THR / TKRs :

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160,000 p.a. when started

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208,364 p.a. 2016, ⬆ 3.7%

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1200 THR / TKR p.a. Cornwall

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Nadonal (BOA) guidelines <75yr padent follow up at:

§ 1yr, 7yr, 10yr + every 3yrs

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90-95% doing well at 10 years

..is there a beXer way?

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Virtual Clinic follow up (vFup)

Hip (THR) & Knee (TKR) replacement

“Primary Total Hip Replacement: A Guide to Good Practice.” British Orthopaedic Association. First published 1999, revised Nov 2012

VIDEO

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1. Locally taken x-ray film

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1. Locally taken x-ray film

Royal Cornwall Hospital

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2. Web based Oxford hip or knee score

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Patient-friendly interfaces ensure comprehensive data collection

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Understand current condition between clinical appointments using validated scores

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Receive personal feedback tailored to condition, change in score and stage of treatment

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Track improvement (or deterioration) over time

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2. Web based Oxford hip or knee score

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PaOent-friendly interfaces ensure comprehensive data collecdon

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Understand current condidon between clinical appointments using validated scores

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Receive personal feedback tailored to condidon, change in score and stage of treatment

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Track improvement (or deterioradon) over dme

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‘Related Information’ via NHS choices..

Patient-Side

PaOent and treatment specific content from NHS Choices Rich content improves engagement

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Virtual clinic

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Virtual clinic

Clinician-Side

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Virtual clinic

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Email report and plan to GP and patient Clinician-Side

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Virtual Clinic follow up (vFup)

Aim

§ Swap 2 face-to-face for 5 vFup § Target clinic capacity to those who need it most

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..no brainer..?!

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London growing faster than any other European city;

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Population 8.6 million => 10 million by 2030;

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London Infrastructure Plan 2050 predicts demand system to rise by 60%

An Interlude..

London Underground

Archie Bland, Guardian 16Jan16

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“We might be bad at dancing and expressing our feelings, but say this for the Bri=sh.. when we se@le on a conven=on of public order, we bloody well s=ck to it. We wait in line. We leave the last biscuit.. and when we take the escalator, we stand on the right. The leD is reserved for people in a hurry..”

An Interlude..

London Underground

Archie Bland, Guardian 16Jan16 Paul Stoneman and Celia Harrison, TfL strategic planners, at Holborn station

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31 more passengers could get on to the escalator each minute;

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An increase of 28%

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=> 3 week trial Holborn

An Interlude..

London Underground

Archie Bland, Guardian 16Jan16

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An Interlude..

London Underground

“I know how to use a bloody escalator!”

“terrible” “loopy” “crap” “ridiculous”

a “very bad idea”

..and in a one-hour session, 18 people called it “stupid”

Archie Bland, Guardian 16Jan16

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Result

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8.30 and 9.30am

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12,745 customers => 16,220

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Didn’t match theoretical numbers => it exceeded them..

An Interlude..

London Underground

Archie Bland, Guardian 16Jan16

..we’re still standing on the right L

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Virtual Clinic follow up (vFup)

Results: 12 months

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300 patients followed up;

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520 additional patients choosing the new service for future follow up;

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Only 21% of slots filled

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Virtual Clinic follow up (vFup)

Results: 12 months

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High levels of sadsfacdon; padents finding it effecdve

n=72

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Virtual Clinic follow up (vFup)

Results: 12 months

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High levels of satisfaction; patients finding it effective, quick

n=72

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Virtual Clinic follow up (vFup)

Results: 12 months

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High levels of sadsfacdon; padents finding it effecdve, quick and easy;

“ easy to follow and no concerns” n=72

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Virtual Clinic follow up (vFup)

Results: 12 months

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All survey respondents reported having an x-ray at a location of their choice

n=75

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Virtual Clinic follow up (vFup)

Results: 12 months

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All survey respondents reported having an x-ray at a locadon of their choice;

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70% saved dme

n=61

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Virtual Clinic follow up (vFup)

Results: 12 months

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All survey respondents reported having an x-ray at a location of their choice;

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70% saved time, 79% saved money

n=61

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Virtual Clinic follow up (vFup)

Results: 12 months interviews

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8 purposively selected padent interviews; 2 qualitadve researchers

§ based on age, employment status, educadon and sadsfacdon of the virtual clinic experience § using topic cards, recorded, transcribed => simple descripdve themadc analysis §

2 consultant surgeons

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Google => ‘BMJ Virtual Clinic’

https://bmjopenquality.bmj.com/content/8/1/e000502

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Virtual Clinic follow up (vFup)

Results: 12 months interviews

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Patients who were trouble free liked the “click and go approach”

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Time and money: “Well, it’s probably half to three quarters of an hour each way and then you have got to pay for parking, haven’t you? It’s a chunk of your day, isn’t it?”

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Virtual Clinic follow up (vFup)

Results: 12 months interviews

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Self management: “I found it really interesting because when I first went on it was before the

peration so it would have been very

low then, just to see it jump right up after the operation, …..”

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Virtual Clinic follow up (vFup)

Results: 12 months interviews

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Altruism: satisfaction that the virtual clinic was freeing up the consultant’s time to see those in need

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Using technology: most found straight forward

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Virtual Clinic follow up (vFup)

Results: 12 months interviews

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Recognise that people value face- to-face interaction

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Clear pathways of communication are essential

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Virtual Clinic follow up (vFup)

The challenges

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Clinician engagement

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An operadonal project lead

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Our organisadon is a barrier to innovadon

§ “We are too busy to improve” § Leadership

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Virtual Clinic follow up (vFup)

What worked well..

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Project administrator

§ Single point of contact §

Pending list

§ Track engaged padents §

Behavioural Insights (BI) workshop

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Padent sadsfacdon

§ Technology is seen as a route to improve healthcare; elderly group

CQUIN + Tariff

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Virtual Clinic follow up (vFup)

1127 patients ‘seen’ | 25 patients per month

Update: 4 years

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Staff moved

CQUIN £216,000 Ongoing £45 tariff agreed Band 8 nurse appointed

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What’s possible..?

www.danhwilliams.com

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What’s possible..?

www.danhwilliams.com

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What’s possible..?

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What’s possible..?

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What’s possible..?

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1. Get going!

Invest in..

hXp://techhub.ichom.org

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Arthroplasty care practitioner + admin support

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Chose tech supplier (ICHOM)

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Leaflets + letters (use ours!)

https://www.dropbox.com/home/Virtual%20clinic

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2. Early commissioner involvement

National tariff

hXps://improvement.nhs.uk/resources/naOonal-tariff/

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Helen Williams, Directorate Manager, T&O Nicola Fuller, Surgical Care Practitioner Dan Williams, Hip & Knee Consultant Co-founder of MyClinicalOutcomes @danhwilliams

Friday 17 May 2019

Thank you

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n “Every hospital should follow

every pa=ent it treats, long enough to determine whether or not the treatment has been successful, and then to inquire, ‘if not, why not?’ with a view to preven=ng similar failures in the future.”

n Dr Ernest Amory Codman, c. 1911 n Orthopaedic surgeon n 1869 - 1940

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Patient empowerment

64F listed for Uni Knee Replacement

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Patient empowerment

64F listed for Uni Knee Replacement
Completed a score and read informaOon

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Patient empowerment

64F listed for Uni Knee Replacement
2 stone weight loss
OKS 10/48 to 33/48, deferred surgery

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Patient empowerment

64F listed for Uni Knee Replacement
2 stone weight loss
OKS 10/48 to 33/48, deferred surgery