This document discusses patient self-care through the use of technology. It begins by discussing how technology can facilitate a "shift left" of healthcare delivery from acute to chronic care settings. It then discusses the importance of empathy in designing technologies for patient self-care. Examples are provided of technologies that have been designed and tested to improve patient outcomes for conditions like hemodialysis and congestive heart failure. The document advocates that patients can successfully manage highly complex medical therapies at home with the right technologies and emphasizes exploring what else patients may be able to do to manage their own care.
4. ‘Shift Left’ of Healthcare through Technology1
$1 $10 $100 $1,000 $10,000
0%
100%
COST of CARE/DAY
QUALITY
of LIFE
Healthy,
Independent Living
Chronic
Disease Management
Doctor’s
Office
Community
Clinic
HOME CARE and LTC
Assisted Living
Skilled
Nursing Facility
RESIDENTIAL CARE
Community
Hospital
ICU
Specialty
Clinic
ACUTE CARE
1) from Intel, and Center for Aging Services Technologies (CAST)
14. “We have a serious training problem that needs to be
corrected”
“We need to know how our equipment works: when the
battery is changed, it defaults to its own location.”
“We’ve got to make sure our people understand this”
Senior Air Force Official
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16.
17. AdverseEventsinHealthcare
•IOM 1999: 44, 000 to 98, 000 US deaths annually
due to medical error
•Baker, Norton 2004: 9, 000 to 23, 000 deaths
annually due to preventable adverse events
32. Improved Health Outcomes : Home Hemodialysis
– Normalization of blood pressure without the need for anti-hypertensive medications
– Normalization of abnormal wall thickness of the heart
– Restoration of impaired heart function
– Improvement in peripheral circulation
– Improvement in sleep quality
– Improvement in nutritional determinants
– Elimination of dietary restriction
• Patient autonomy
• Cost effective modality
Chan et al : KI, 2002, Chan et al: NDT, 2003 Chan et al: AJKD, 2003,
Hanly et al: NEJM, 2001
Pierratos et al: JASN, 1998
35. 64
So if patients can do a highly invasive,
potentially fatal therapy at home successfully
with improved health outcomes and lower cost
then ....
WHAT ELSE CAN PATIENTS DO?
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42. Available in ten languages
Néih hóu
Bonjour Guten Tag
Zdravstvuite
Buenos días
Nî hâo
Annyong ashimnikka
Hello
56. “… thought about trends and what to do when the alert popped up”
“… I tested more often at lunch”
“… rewards motivated me to test more”
“… she initiated more conversations about her blood sugars”
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60. Type I
(Lisa Min) Type 2
(Shivani Goyal)
Artificial Pancreas
(Isabelle Dutil)
78. App Definition Statement
Help people control their Asthma through
tracking, reminders, trend analysis,
environmental health factors, and easy
access to their Asthma Action Plan.
102. RCT Study design
• N=100
• duration 6 months
• daily measurements before 10 am - reminder call
• alert algorithm - messages direct to cardiologist
• control group - usual care