This document discusses the use of telemonitoring in managing chronic diseases. It provides three key points:
1) Telemonitoring can help reduce delays in treatment for acute medical issues like heart attacks by enabling at-risk patients to quickly contact medical professionals when symptoms start. This can significantly shorten the time between symptom onset and receiving definitive treatment.
2) A study of 290 cardiovascular patients found that telemonitoring reduced the time between symptom onset and seeking help to an average of 105 minutes, compared to 680 minutes without telemonitoring. This likely contributed to lower mortality rates.
3) Telemonitoring may improve medical outcomes and quality of life for chronically ill patients while also reducing healthcare costs by lowering hospitalization rates and lengths
5. Time
Time = Muscle
Delay between onset of symptoms and start of therapy
(door-to-needle-time) too long!
6. reaction time
emergency department transport to hospital
time between onset of bedside treatment definite therapy
symptoms & call for help
225 min STEMI
15 30 15 80
up to 540 min Non-STEMI
0 min 680 min
300.000 patients approx. 50% die
approx. 130.000
with myocardial before reaching
die
infarction/year hospital
approx. 800.000
approx. 60%
patients contact 80% of them with
(450.000
emergency no pathological
patients) are findings
department due
hospitalized
to chest pain
7. Patient
Professional Network
Clinic
Rehabilitation
Telemedical Cardiologist / Family
Service Center (TSC) Physician
Electronic Patient File
8. Evaluation of telemedicine in acute myocardial
Aim
syndrome
Design prospektive, controlled
290 cardiovascular patients
- Male: 194 (67%), age: 68 +/- 6.6 years
Patient - Female: 96 (33%), age: 66 +/- 7.7 years
collective
Inclusion criteria
- coronary heart disease, post MI, post CABG, post PTCA
Observation
6 months / patient
period
9. 12% 3% < 15 Min.
- 60 Min.
> 60 Min.
85%
88% of pts contact the TSC during the first 60 min. after
onset of symptoms
12% prolonged reaction > 1 hour
95% of all pts classified as emergency by TSC
physicians claimed for help during the first 60 min.
10. reaction time
emergency department transport to hospital
time between onset of bedside treatment definite therapy
symptoms & call for help
225 min STEMI
15 30 15 80
up to 540 min Non-STEMI
0 min 680 min
time between onset of symptoms & call for help
44 15 30 15
is dramatically reduced by telemedicine
0 min 105 min
signifi-
cohorts mortality
cance
ACSIS 3899 9,7%
Telemedicine 699 4,4% p < 0,0001
12. Profound reduction in quality of life
Extremely reduced long-term prognosis
Extreme burden on the health budget
estimated 2% to 3% of the total budget = 5 – 10 Billion € / year
Extreme workload for physicians in clinics and surgeries
No. 2 reason for medical consultation
5% of all hospital admissions
No. 1 reason for hospital admissions of patients > 65 years
up to 50% readmission in the first 6 months after dismissal
Frequency (tendency increasing)
2,5% of total population
up to 15% of people > 65 years
Inadequate therapeutical management with insufficient
medical and non-medical therapy
13. Integrated care model
access to electronic patient file with illness and patient related data
VitaView
ECG
Patient patient intake
providing medical
direct communication data for EPF
Blood pressure
Professional network
Weight
„Chronic Illness“
Clinic
Glucose Telemedical Rehabilitation
Service Center (TSC) Cardiologist / Fam. Physician
wireless transmission of
various vital parameters
transmission of data in Transmission of data after
TSC with entry in EPF primary analysis
Electronic Patient File
emergency management /
providing actual clinical findings
VitaCheck
Tele-Care-Monitor
providing health economical
& health political data
Insurance Consultancy
Telemedicine as information & service platform in integrated care models
14. Is medical quality improved by telemedicine?
Reduction Increase
physician contacts quality of life
emergency dispatches risk reduction
hospitalisation rate coping with fears
length of hospital stay therapeutic management
cost / clinic; ICU management in emergency
long-term damage self-responsibility
? mortality – CHF, CHD, stroke life expectancy
?
% %
15. Are telemedical services accepted by the
patients?
100%
90,2
90 88,2
80 77,1
70,7 72
69,9
70
64
60
50
40
30
20
13,3
10
0
Rapid help in Better Higher degree Better coping Increased More self Reduced risk No conflict with
case of therapeutical of personal with fears quality of life responsibility respect to the
emergency management security contact to the
family
physician
16. Is telemonitoring of CHF patients
economically viable?
Reduction in hospital admissions Reduced duration of stay at the
hospital
9 8.17
8
7
6 5.29
5
4 3.09
2.47 2.4
3
2 1.23
1
0
NYHA II NYHA III NYHA IV
Telemedicine Control