Connected health as a tool for patient engagement kvedar 11.7.13
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Connected health as a tool for patient engagement kvedar 11.7.13

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Connected health as a tool for patient engagement - by Joseph Kvedar, MD, Director of the Center for Connected Health.

Connected health as a tool for patient engagement - by Joseph Kvedar, MD, Director of the Center for Connected Health.

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Connected health as a tool for patient engagement kvedar 11.7.13 Connected health as a tool for patient engagement kvedar 11.7.13 Presentation Transcript

  • Connected Health as a Tool for Patient Engagement Joseph C. Kvedar, MD Director Center for Connected Health Partners HealthCare © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Connected Health Goal Integrate care into the day-to-day lives of our patients © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Connected Health Innovation Process CCH Service Product develop. Ideation & Feasibility r r Program develop. Trial/Test Spin-out License © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE. Internal Hand-off
  • About the Center for Connected Health Mission is to facilitate the adoption of Connected Health Technology is an enabler to provide care remotely Benefits include improved engagement, outcomes, and efficiencies © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Connected Health Benefits 1 Just-in-time care 2 Improved self-care © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Connected Health Components Feedback Loop © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Connected Cardiac Care Heart Failure Monitoring 50% Drop in Readmissions © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Proportion of CCCP Enrollees with One or More Hospitalization 100 58.10 Percent 39.80 13.30 One year prior to CCCP enrollment (point estimate and 95% C.I.) One year following CCCP disenrollment (point estimate and 95% C.I.) Data Includes 332 CCCP enrollments among 301 unique patients discharged from the CCCP program prior to July 1, 2009. Results are similar within more recent cohorts of enrollees discharged from the program prior October 1, 2009 and prior to January 1, 2010. © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Diabetes and Blood Pressure Connect Average drop of HbA1c: 1.5 69% achieved a drop in BP © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Greater engagement is associated with greater pre-post HbA1c change Average drop HbA1c by # of uploads 1.8 1.53 Drop in HbA1c 1.6 1.34 1.4 1.2 1 0.8 0.6 0.43 0.4 0.2 0 no uploads 1 - 15 uploads > 15 uploads Practice engagement correlates strongly with better patient outcomes • Patients with greater than 15 uploads had average 1.5 pre-post HbA1c change • P< 0.03 between no uploads and uploads groups J Diabetes Sci Technol 2012;6(6):1328-1336 © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Proportion with 10mmHg or greater drop in SBP Proportion with 5mmHg or greater drop in DBP % of Subjects % of Subjects Decreases in Blood Pressure from Self Monitoring C I P<0.05 C P<0.05 Am Heart J. 2012 Oct;164(4):625-31. © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE. I
  • Future of Connected Health • More varied, miniaturized sensors Given Imaging Exmovere Given Imaging • OMsignal Automated, customized motivational messaging © 2013 MD Revolution Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE. © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Video and Virtual Visits • Increasing interest among clinicians • Consumers familiar with software • Payment reform spurring interest © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • The Future of Video Visits © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Feedback Loops Alone Are Not Motivating – “I didn’t look at it online, I didn’t need to, I thought that’s what my provider was doing” – “If I forget to send it in, after a couple of weeks, she [the nurse] calls me.” – “I stopped using it for my reasons, but no one ever called and asked why I stopped so I never pursued it” © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Sentinel Effect © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Components of Self Care Social Networking Gamification Incentives Coaching Feedback Loop © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Simple Reminders Can Have A Powerful Effect Text-message Reminder Tues. Sunny. High 68, Low 53. Please apply your sunscreen today. Participant reads message and applies sunscreen Remote Monitoring Data Repository (RMDR) Sends SMS when the tube is opened © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Adherence Rate for Sunscreen Use Weekly Adherence Rates (mean +/- SEM) 70.0% 60.0% % Adherence 50.0% 40.0% Reminder group 30.0% No Reminder Group 20.0% 10.0% 0.0% Week 1 Week 2 Week 3 Week 4 Week 5 Study Period Arch Dermatol. 2009;145(11):1230-1236. © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE. Week 6
  • The Power of Activity and Coaching Percent Change in Average Daily Steps Per Quarter Percent Change C, n=30 I, n=27 15.00 10.00 5.00 0.00 -5.00 -10.00 -15.00 -20.00 Q1 Q1-Q2 Q1-Q3 Q1-Q4 Quarter (1 Quarter = 3 weeks) © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Habituation © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Improving physical activity behaviors in T2DM (Text 2 Move) Primary Outcomes: Change in physical activity levels Secondary Outcomes: Change in HbA1c in patients Change in stage of behavior change © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Readiness To Change Connected Health Data Customized Program Design Analytic Engine Practice Location © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Text2Move February January March 10000 8000 6000 4000 2000 Contemplation Preparation © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE. Action 3/29 3/22 3/15 3/8 3/1 2/27 2/25 2/23 2/21 2/19 2/17 2/15 2/13 2/11 2/9 2/7 2/5 2/3 2/1 1/31 1/29 1/27 1/25 1/23 1/21 1/19 1/17 1/15 1/13 1/11 1/9 0
  • Meet Michael Snyder © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Genetic Risk Source: Cell 148, 1293–1307, March 16, 2012 © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Personalized Prevention in Action Glycated HgA1c (%): 6.4 6.7 (329) (369) (Day Number) 4.9 (476) 5.4 5.3 (532) (546) 4.7 (602) Glucose (mg/dL) 160 150 140 130 120 110 100 90 80 -150 0 200 250 300 350 400 450 500 Day Number HRV Infection (Day 0-21) RSV Infection (Day 289-311) Source: Cell 148, 1293–1307, March 16, 2012 © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE. Life Style Change (Day 380-Current) 550 600
  • Motivational State Connected Health Data Customized Program Design Analytic Engine Genetic Profile © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Automating Healthcare Output Input Content: Content: Genes Physiological Functions Health Info & Social Support Coaching Psychological Factors Behavior Games/ Contests Incentives/ Punishments Environmental Factors/ Socioeconomic Status Analytics Tactics: Tactics: Specimen Collection Sensors Text Voice EMRs Text Analysis Rich/ Multi-Media Avatar/ Agent Interactive Software Online & Offline Behavior Tracking © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Implications of Automating Healthcare • Social Contract • Privacy • Accountability • Economics © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Takeaways Feedback Loop • Feedback loops coupled with personalized motivation can lead to sustained behavior change • Virtual care has great future potential • Genetic analysis provides a powerful foundation © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  • Ways to “Connect” The cHealth Blog: chealthblog.connectedhealth.org www.connectedhealth.org Annual Symposium: October 23-24 2014; Boston LinkedIn Group: Connected Health Community Twitter: @connectedhealth @jkvedar Contact Me: jkvedar@partners.org © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.