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S109 – day 1 – 1315 – achieving patient orchestrated care
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S109 – day 1 – 1315 – achieving patient orchestrated care

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  • 1. Patient Orchestrated Care Bridget Fletcher, Chief Executive Dr Richard Pope, Hon Consultant Physician
  • 2. overwhelming need for change
  • 3. “Trabant Care”
  • 4. “…I am scared to say something in case there are consequences…” Through their eyes… “…I know you are busy but I am important too…”“…Make me feel I matter…” “…I am not a disease – I am a person…” “…This may be routine for you – but for me it is the first time…” “…I may be old – but I have a brain…” “…Different professionals are telling me different things – who is right?...”
  • 5. “ “Apple Care”
  • 6. Incremental vs Disruptive Innovation “Our NHS does a superb job for millions of people, day in, day out, but it cannot stand still – it needs to adapt to survive” Sir Bruce Keogh
  • 7. Traditionally….
  • 8. Potentially…..
  • 9. How can a person orchestrate their own care?
  • 10. Teleconsultation - Airedale  8 year journey  Initially prison healthcare  Today work with prisons across England  ~ 800 cases/year  Wide range of specialties  Have extended services……
  • 11. Current applications
  • 12. Telehealth Hub  24/7 working  Experienced nurses  2nd tier - physician  Range of technologies  Shared EHR  Resilient infrastructure  Opened September 2011
  • 13. Nursing & Residential Care homes  n=96 live today  deploying to 190  Cumbria to Kent
  • 14. Care home caseload audit (Feb 2014)  Current care homes  Mix of Residential / Nursing  Total 2500 residents  Aged 26-106  Looking only at those homes that refer into Airedale hospital ….
  • 15. Call outcomes
  • 16. Care Homes - summary 0 100 200 300 400 500 600 700 Acute Admissions 1 Year Prior to Deployment of Telemedicine Acute Admissions 1 Year Post Deployment of Telemedicine -35%
  • 17. Care Homes continued 0 200 400 600 800 1000 A&E Attendances 1 Year Prior to Deployment of Telemedicine A&E Attendances 1 Year Post Deployment of Telemedicine 0 2000 4000 6000 8000 10000 Acute Beds Days 1 Year Prior to Deployment of Telemedicine Acute Beds Days 1 Year Post to Deployment of Telemedicine -53% -59%
  • 18. Results: 24 hr teleconsults to 26 COPD patients at home – 1 year pre/post -45% ED attends -60%
  • 19. Feedback… “I would like to express my gratitude and thanks for the level of care you have provided my husband, in particular the consultation at the weekend – the service is marvellous.” “The Doctor was fantastic when one of our dementia patients fell and hurt herself. I would have called an ambulance and she would have endured an A&E visit which would have terrified her. Your consultant saved her from this and reassured me that the cut was superficial and she was fine…” “A very good service. It made me confident within my job so I could do the best I can for our residents. This service taken the pressure off us as we have access quickly to a health professional.” “I have only one word to describe Telehealth – excellent.” “ The Telehealth Hub came into its own last winter when snow and ice brought traffic to a halt. My Husband’s condition deteriorated suddenly and having visual, instant contact with the team was very reassuring. A wonderful service.
  • 20. People want to “live” with their LTCs The NHS needs increased Quality and Improved Efficiency These seemingly conflicting demands can be resolved by A different Patient  Clinician Engagement making it personal, not simply clinical Scale - to thousands of HCPs, millions of Patients People with LTCs - owning their plans and defining their support
  • 21. First tried it ‘on paper’ – cohort of 50 carefully tracked 0 10 20 30 40 50 60 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z AA BB CC DD EE FF GG HH II JJ KK LL MM NN OO PP QQ RR SS TT UU VV WW XX Numberofvisits Patient code Practice visits Pre-care planning Post care planning 0 5 10 15 20 25 30 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z AA BB CC DD EE FF GG HH II JJ KK LL MM NN OO PP QQ RR SS TT UU VV WW XX Numberofattendances Patient code Outpatient attendances Pre-care planning Post care planning 0 0.5 1 1.5 2 2.5 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z AA BB CC DD EE FF GG HH II JJ KK LL MM NN OO PP QQ RR SS TT UU VV WW XX Numberofattendances Patient code A&E attendances Pre-care planning Post care planning 0 0.5 1 1.5 2 2.5 3 3.5 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z AA BB CC DD EE FF GG HH II JJ KK LL MM NN OO PP QQ RR SS TT UU VV WW XX Numberofadmissions Patient code Acute admissions Pre-care planning Post care planning Published in HSJ Dec 2010: “QIPP and Care Plans for long term conditions”
  • 22. © Dynamic Health Systems
  • 23. Example - engaging with own action plan 0.00 1.00 2.00 3.00 4.00 5.00 6.00 Exercise sessions per week Starts using SSC here Patient generated data
  • 24. Feeling better – motivated by results 73.00 74.00 75.00 76.00 77.00 78.00 79.00 80.00 81.00 82.00 12/23/11 0:00 2/11/12 0:00 4/1/12 0:00 5/21/12 0:00 7/10/12 0:00 8/29/12 0:00 10/18/12 0:00 12/7/12 0:00 1/26/13 0:00 3/17/13 0:00 5/6/13 0:00 Weight (kg) Starts using SSC here Patient generated data Clinician generated data
  • 25. Achievement confirmed by clinical results 0 20 40 60 80 100 120 1/22/10 0:00 8/10/10 0:00 2/26/11 0:00 9/14/11 0:00 4/1/12 0:00 10/18/12 0:00 5/6/13 0:00 Haemoglobin A1c level - IFCC standardised Starts using SSC here QoF Clinician generated data
  • 26. In control – aged 80 and happy! In control, 80 & happy
  • 27. Initial Cohort - age profile yrs Patient No.
  • 28. BP before and after 6 months use of supported self care BP before and after 6 months use of supported self care Patient No. mm Hg Ave reduction SBP=19mm DBP=13mm
  • 29. HbA1c change over 6 months following introduction of supported self care Ave = -16 mMol/ Mol
  • 30. Weight change (Kg) over 6 months following the introduction of supported self care Ave loss = 4.5Kg
  • 31. The person orchestrating their own care with clinicians working by exception
  • 32. Technologies converge….
  • 33. signalling choice & needs near the end of life