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Tele-Health Monitoring by Maureen Ideker
This document discusses tele-home monitoring programs for patients with conditions like heart failure and diabetes. It provides examples of programs that have used daily video visits and monitoring of vitals to save costs on long-term care for an elderly diabetic woman and reduce heart failure readmission rates. Research studies are summarized that found tele-home monitoring reduced hospitalizations and emergency room visits while improving outcomes when combined with care coordination. The document concludes by outlining the financial benefits to counties from keeping patients healthy at home and reducing long-term care costs through remote monitoring programs.
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- 1. Tele-Home Monitoring Blandin FoundationWeb- X December 14, 2017 Maureen Ideker, RN, BSN, MBA Senior Advisor for Telehealth Essentia Health, Duluth
- 2. Objectives • Provide basicson Tele-Home monitoring with examples of use in heart failure & diabetes. • Describe the equipment needed at home, broadband & resources needed for services. • Describe potential savings to counties and citizens.
- 5. Example 1: ElderlyDiabetic Lady • Maintained at home over 3 years • Daily video visit for insulin injections • Saved 36 months at $6,000/Month to the county for LTC MA - $216,000
- 6. Example 2: Acommon Disease - Heart Failure? Prevalence – Affects 5.8 million in the U.S. – Over 650,000 new patients annually – The lifetime risk of developing HF is 20% for Americans ≥40 years of age. – HF is the most frequent cause of hospitalization in elderly (> 65 y/o) Prognosis – 1/2 of people who develop HF die within 5 years of their diagnosis – Less than 25% are alive at 10 years
- 7. • HF isnot always treated correctly • Patients do not adhere to diet and medication regime • Projections show the prevalence of HF will increase 46% from 2012 to 2030, resulting in >8 million people ≥18 years of age with HF Heart Failure Progression is Inevitable AHA Heart Disease & Stroke Statistics 2014 Update
- 8. What will itCost? • Estimated lifetime cost per each individual HF patient is $110,000/year • In 2012, total cost for HF was estimated to be $30.7 million • Projections show that by 2030, the total cost of HF will increase almost 127% to $69.7 billion from 2012
- 9. Summary % Readmissionsfor Heart Failure Within 30 Days • National – 24% • Essentia Health – Duluth – 9% • Essentia Health with Tele-Home Monitoring Scales – 2%
- 10. Tele-Home Monitoring Research •Kaiser-Permanente- conducted the foundational research in mid-1990s(4) • University of MN replicated it with similar results in 1998 • VA in Florida experienced greater impact in 2004 by adding care coordination • Ascension Health conducts research under Beacon Grant in 2012 with similar results and adds self management education
- 11. U of MNResearch: 1998 & 2004 • The impact of using home monitoring devices on transfers to higher levels of care….1998 • Patients ability to use and acceptance of tele-home monitoring equipment………2004
- 12. MN Telehealth NetworkResearch 1998 – Telehomemonitoring N = 150 U of MN
- 13. Research Patient Groupslimited to CHF, COPD & Diabetes Daily recording of: - Weight - Blood Pressure - Pulse - Oxygen Saturation, Spirometry or glucose readings - Video visits at least weekly 13
- 14.
- 15. Beacon Case Study •53 y.o. female with more than 6 chronic conditions • 13 hospital admits in 2011, $156,000 • Remote Monitoring and self management conducted resulting in: • 1 ED visit and 1 brief hospitalization in 2012: $2500
- 16. Veteran’s Administration Studyin Florida-2004 • Remote home monitoring along with care coordination, including diabetes, resulted in: • 50% reduction in hospitalizations • 11% reduction in ED visits
- 17. Essentia Health UsingTele-Home Monitoring (MN Example – Duluth) • Over 300 home monitoring devices out for heart failure hospital discharges, health care home pts, and homecare/hospice uses. • Heart Failure program started using devices in 2002. Named a best practice example by AHRQ. Readmission rate in this group1-2%. National average is over 23%. Huge ACO impact. • Mostly scales deployed,(some Bp units short term
- 18. HF Program Model •Consult 5-7 days after hospital discharge • Patients managed by APP in ambulatory setting • Seen by cardiologist initially, annually and as needed • Registered nurses provide continuous case management: – Phone triage – Follow-up on labs/ test results – Utilize protocols – Manage telescale data – ONGOING PATIENT EDUCATION
- 19. Monitoring & ExceptionReview • Patient alerts at Central Station – Nurse reviews data in both Cardiocom and EPIC – Makes decision if patient needs to be contacted • If assessment is needed the nurse considers the following: – Nursing assessment and education needs – Review medication list – Dietary compliance – Follows diuretic protocol as indicated/or talks with provider – Initiate office visits or primary care referrals as needed – Care plan monitoring; hospitalization initiation – Communication with team members (other specialties)
- 20. Advantages to Tele-HomeMonitoring • Facilitates early intervention and prevents ER visits and hospitalizations • Improved patient adherence with care plan • Patients get immediate feedback on life style choices • High patient satisfaction • Healthier! • Improved quality of life • Decreased LTC stays
- 21. Financial Considerations • Countycosts for MA support – LTC • Decrease tax-base when leave home • Decrease local spending • Increased county costs for MA with disability
- 22. References • Chumber NR,Neurgaard B, Koob R, Qin H, Joo Y. Evaluation of a care-coordination/home-telehealth program for veterans with diabetes. Eval health professions 2005;28:464-478. • Erickson C, Ideker M, Fauchald S. Integrating Telehealth Into the Graduate Nursing Curriculum. The Journal for Nurse Practitioners 2015; e1-5. • Finkelstein S, Speedie S, Potthoff, . Home telehealth Improves Clinical Outcomes at Lower Cost for Home Healthcare. Telemedicine and e-Health Vol 12, N0 2, 2006: 128-136. • Finkelstein S, Speedie S, Zhou X, Ratner E, LeMire T, Valley K, Dahle L. Virtual assisted-Living Umbrella for the Elderly (VALUE): What the community thinks.
- 23. References Continued… • JohnsHopkins Medicine. A Typical Hospital at Home Program Follows these Steps. http://www.hospitalathome.org/about-us/how- it-works.php. • Johnston B, Wheeler L, Deuser J, Sousa KH. Outcomes of the Kaiser-Permanente Tele-Home health research project. Arch Fam Med 2000;9:40-45. • Klapper B, Kuhne H. Patient self-management by telehealth using the Bosch model of care. Journal of Telemedicine and Telecare 2010;16:193-195. • Snell, A. Reducing Hospital Readmissions Using Remote Patient Monitoring and Patient Engagement Tools. Beacon Research Study, Ascension Health Presentation, Indianapolis, 2013.
- 24. Contact Information • [email protected] •218-371-0596