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Facilitating self management of chronic disease through home based tele monitoring for patients with ccf and copd
The document outlines a pilot project aimed at facilitating self-management of chronic diseases, specifically Congestive Cardiac Failure (CCF) and Chronic Obstructive Pulmonary Disease (COPD), through home-based tele-monitoring. The initiative involves daily physiological monitoring of patients using the Intel Health Guide and aims to reduce hospital admission rates and improve patient wellness. Feedback indicates increased patient confidence and a significant decrease in hospitalizations among participants.
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Facilitating self management of chronic disease through home based tele monitoring for patients with ccf and copd
- 1. Facilitating Self-Management of ChronicDisease through Home Based Tele-Monitoring for Patients with CCF and COPD Suzie Hooper August 2011
- 2. Acknowledgement • Jo McLarenRN • Emma Boston RN • Belinda Smith RN • Sue Rowe RN • Carmel Bourne RN
- 3. Background • Chronic ObstructivePulmonary 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 • Fundingfor 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 groupfor 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 ofGod 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 ofGod 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 • Todetermine the effectiveness of a home based tele- monitoring 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 • Improvedself-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-programassessment 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 • Dailymonitoring 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-basedcentral 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
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- 17. Possible interventions • Telephoneconsultation 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 • 62eligible • 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 • 46approved by Medibank Private Special Purpose Fund Committee • 32 Active clients – 6 patients refused – 4 RIP – 4 other reasons
- 20. Current Activity • 32Active clients (July 2011) – 9 monitoring daily – 3 currently weaning – 20 completed – ceased monitoring • 2 will be ongoing
- 21. Patient Demographics SJGHC /MPLTele-monitoring Pilot Program Age Range 2011 0 5 10 15 20 25 30 35 51-60 61-70 71-80 81-90 91-100 Total Age range Numberofpatients
- 22. Patient Demographics SJGHC /MPLTele-monitoring Pilot Program Patient Gender 2011 0 2 4 6 8 10 12 14 16 18 Male Female Gender Numberofpatients Male Female
- 23. Patient Demographics SJGHC /MPLTele-monitoring Pilot Program Region 2011 0 5 10 15 20 25 Bendigo Berwick Nepean Region Numberofpatients Bendigo Berwick Nepean
- 24. Patient Demographics SJGHC/MPL Tele-monitoringPilot Project Diagnosis 2011 31% 63% 6% CCF COPD CCF/COPD
- 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 ofAdmissions 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 - Goodsystem 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 - Connectivityissues 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 • COPDpatient 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 ourcollaborators • 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 Instituteof 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) 151-154 3. 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) 147-148 5. Australian Institute of Health and Welfare (2004) Heart, Stroke and Vascular Disease – Australian Facts 2004 6. 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 2006 7. 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 362. 759-766