Facilitating self management of chronic disease through home based tele monitoring for patients with ccf and copd
Facilitating Self-Management ofChronic Disease through HomeBased Tele-Monitoring for Patientswith CCF and COPDSuzie HooperAugust 2011
Acknowledgement• Jo McLaren RN• Emma Boston RN• Belinda Smith RN• Sue Rowe RN• Carmel Bourne RN
Background• Chronic Obstructive Pulmonary Disease (COPD) andCongestive Cardiac Failure (CCF) are two of the mostprevalent 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 inall Western countriesAIHW (2005), Abhayaratna (2006)
Project Background• Funding for the pilot was through the Medibank PrivateSpecial Purpose Fund.• MBP and SJGHC wanted to collaborate to develop ahome-based CDM program utilising emergingtechnology• SJGHC investigated potential home monitoring systems• Selected the Intel Health Guide• Patients with current hospital cover with MedibankPrivate were eligible for participation in the project.
Target groupTarget group for the pilot:• Patients with a diagnosis of CCF or COPD• Recent hospitalisation for their condition and /or a history of multiple admissions for thiscondition• Potential to reduce the likelihood of hospitaladmission• Patients from both metropolitan and regionalareas
St John of God Health Care• Australia’s largest Catholicnot-for-profit private healthcare group.• Established in 1895 in WA bythe Sisters of St John of God.• 15 hospitals in Australia andNZ, metropolitan and rural /regional
St John of God 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
Project Aims• To determine the effectiveness of a home based tele-monitoring system for patients with COPD and CCF• Identification of an ‘at risk’ cohort of Medibank Privatemembers who would benefit from the program,following an admission to hospital for their condition• Reduction in hospital admission rates, bed days andassociated hospitalisation costs
Project Aims• Improved self-management of the disease• Provision of an integrated program of care betweennurses, doctors, hospital and the community• Improved member wellness (measured subjectivelyand objectively)
Program elements• Pre-program assessment and recruitment if suitable• Initial home visit by Health Choices nurse to set upsystem• Daily home-based physiological tele-monitoring for 12weeks
Program elements• Daily monitoring of vital signs andphysical symptoms• Web-based data upload tocentral monitoring data centre.• Interpretation of physiologicparameters by a skilledregistered nurse centrally.• Appropriate intervention as indicated.• Weaning over 4 weeks.• Data collection and analysis.
Monitoring System• Web-based central monitoring system (Intel HealthManagement Suite)• On-line interface that allows nurses to securely monitortheir patient’s condition• SJGHC developed EXCEL patient data base andpatient record
Patient DemographicsSJGHC /MPL Tele-monitoring Pilot ProgramPatient Gender2011024681012141618Male FemaleGenderNumberofpatientsMaleFemale
Patient DemographicsSJGHC /MPL Tele-monitoring Pilot ProgramRegion20110510152025Bendigo Berwick NepeanRegionNumberofpatientsBendigoBerwickNepean
Patient DemographicsSJGHC/MPL Tele-monitoring Pilot ProjectDiagnosis201131%63%6%CCFCOPDCCF/COPD
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
Hospitalisation• Number of Admissions to hospital - 7• Reason for admission1. Worsening disease palliative2. Cardiac complications full time care3. Chest Infection 10 day stay recommenced monitoring(had commenced weaning)4. Blood transfusion (leukaemia) 1 day stay recommenced monitoring5. Back surgery currently in hospital6. Pneumonia 7 day stay recommenced monitoring (hadnot commenced weaning)7. Chest infection 10 day stay – home with PICC line andrecommenced monitoring
Clinician FeedbackSuccesses- Good system that is very easy for the patients to use- Currently assessing patient and carer satisfaction- Comprehensive system of data that provides thewhole picture that usually indicates when interventionis needed (some exceptions)- Minimal requirement for phone follow up related toclinical issues
Clinician FeedbackDifficulties- Connectivity issues in outer-metro and regional areasrelated to wireless internet- Issues with firewall protection within SJGHC (unableto use videoconferencing)- Clinicians need reasonable computer skills- Complexities related to multiple clinicians monitoringpatients – knowledge of patients reduces necessityfor patient contact
Patient Feedback• COPD patient who has had 6 hospital admissions in thelast half of 2010 has now stayed out of hospital for 10months and feels he is in control of his health – remainsout of hospital and wife went on overseas for a holiday.• COPD / CCF patient admitted monthly prior tomonitoring and rehab program – feels more in control ofher health - remains out of hospital 14 weeks.
Patient Feedback• COPD / CCF patient – remained out of hospital –increased confidence – has taken a trip to Sydney tomeet 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 ofincreased confidence in managing their condition.
Issues for consideration• Need for broadband internet to facilitate consistentmonitoring and utilise video capability• Need the formal data analysis to determine quantitativeand qualitative outcomes• Develop proposals to access funding more broadly
Thanks to our collaborators• 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)
References1. Australian Institute of Health and Welfare (2005) Chronic Respiratory Disease inAustralia. Their prevalence, consequences and prevention.2. Abhayaratna, Smith, Becker, Marwick, Jeffery and McGill (2006) Prevalence of heartfailure and systolic ventricular dysfunction. MJA 184(4) 151-1543. Australian Bureau of Statistics (2001) National Health Survey4. Krum H. and Stewart S. (2006) Chronic Heart Failure; time to recognise this major publichealth problem. MJA 184(4) 147-1485. Australian Institute of Health and Welfare (2004) Heart, Stroke and Vascular Disease –Australian Facts 20046. Krum H. , Jelinek M., Stewart S., Sindone A., Atherton J., Hawkes A., (2006) Guidelinesfor the prevention , detection and management of people with chronic heart failure inAustralia 20067. 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 ofCandesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. The Lancet, Vol 362. 759-766