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Richard Mendelsohn- Beyond 2010: SMART Living Panel


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Richard Mendelsohn- Beyond 2010:SMART Living Panel

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Richard Mendelsohn- Beyond 2010: SMART Living Panel

  1. 1. Beyond 2010 – Digitally Enabled Citizen Birmingham OwnHealth Thursday 21 st October <ul><li>Dr Richard Mendelsohn – Clinical Director: Chronic Disease Systems </li></ul>
  2. 2. Drivers <ul><li>Inequalities in Health Outcomes for chronic diseases across NHS BEN population </li></ul><ul><li>Everyone with a LTC needs to have a personalised care plan by 2010 </li></ul><ul><li>Everyone with LTC should have an information prescription by 2008 </li></ul><ul><li>Increased integration of health and social care teams around the needs of the individual </li></ul><ul><li>Single point of access for orchestration and co-ordination of care </li></ul><ul><li>Supporting independence, self-care and self management </li></ul><ul><li>Tele-Empowered patients can make choices and have their self-care supported </li></ul><ul><li>Bends the trend – bridging the affordability gap </li></ul><ul><li>Systematically move care from unstructured and reactive to structured and proactive </li></ul>
  3. 3. <ul><li>Objectives of the service </li></ul><ul><li>To improve the quality and length of life for people with long term conditions by improving their ability and confidence to manage their condition. </li></ul><ul><li>To reduce the unscheduled and unplanned utilisation of health services by people with long term conditions whilst improving the overall quality of care received. </li></ul>
  4. 4. Outcomes <ul><li>The ultimate aim of the programme is to empower members to make positive changes to the way in which they manage their health. This in turn improves clinical metrics and reduces utilisation of healthcare services including acute care. The outcomes that will be expected to be delivered by the service provider are as follows: </li></ul><ul><li>A. A significant reduction in members’ cardiovascular risk factors (body mass index, total cholesterol, systolic and diastolic blood pressure and HbA1c) from their initial measurements, with those members at highest risk demonstrating the greatest changes </li></ul><ul><li>B Members reporting an increased confidence in their ability to self-manage their condition </li></ul><ul><li>C. A measurable trend in which members require fewer GP practice appointments, specialist appointments, hospital admissions and visits to Accident & Emergency departments. </li></ul>
  5. 6. Eight care management priorities Learn about the condition and set treatment goals 2 Make lifestyle changes and reduce risks 6 Take medicines correctly 3 Build on strengths and overcome obstacles 7 Know how and when to get help 1 Act to keep the condition in good control 5 Get recommended tests and services 4 Follow up with specialists and appointments 8
  6. 7. Monitoring Centre can support administration duties, provide basic triage when appropriate, quantify results, coordinate installation and removal and act as a valuable communication hub Clinicians perform daily triage of patient caseload Based in patient homes Telehealth
  7. 8. Current Status <ul><li>9170 members: 2590 monitor level, 6400 support level, and 180 with Assistive Technology </li></ul><ul><li>12,000+ patients in pipeline (i.e. eligible for service) </li></ul><ul><li>30-40 members disenroll each week </li></ul><ul><li>39 GP practices automated data sharing with BOH </li></ul><ul><li>Current Staffing: </li></ul><ul><ul><li>1 Band 8a Programme Manager </li></ul></ul><ul><ul><li>1 Band 7 Service Delivery Manager </li></ul></ul><ul><ul><li>7 Band 6 Clinical Team Leaders ( 6 WTE) </li></ul></ul><ul><ul><li>42 Band 6 Care managers (39 WTE) </li></ul></ul><ul><ul><li>18 Band 5 Associate Care managers (16 WTE) </li></ul></ul><ul><ul><li>6 Band 3 Recruitment Specialists (5.8 WTE) </li></ul></ul><ul><ul><li>8 Band 4 Health Coaches </li></ul></ul><ul><ul><li>1 Band 3 Secretary </li></ul></ul>
  8. 9. <ul><li>Avoidable Hospitalisations </li></ul><ul><li>Avoidable A&E visits </li></ul><ul><li>Total costs </li></ul><ul><li>Condition-specific costs </li></ul><ul><li>Diet </li></ul><ul><li>Exercise </li></ul><ul><li>Medication concordance </li></ul><ul><li>Self-monitoring behaviours </li></ul><ul><li>HbA1c </li></ul><ul><li>LDL cholesterol </li></ul><ul><li>BP </li></ul><ul><li>BMI </li></ul><ul><li>Immunisations </li></ul><ul><li>Eye exam </li></ul><ul><li>Foot exam </li></ul><ul><li>Appropriate medications </li></ul><ul><li>Social support </li></ul><ul><li>Self-efficacy </li></ul>Health behaviour change Recommendations <ul><li>Care Plan Development </li></ul><ul><li>Contacts </li></ul><ul><li>Tasks </li></ul>Psycho- social factors Reduction in Avoidable Utilisation Clinical Improvements Improvements
  9. 10. Total No.: 478 Hospitalisation- Self Declared
  10. 11. AT Admission data Sept 08 –June 09 35 patients 1 2 0 1 62 8 B A B A B A Waiting list Planned Emergency
  11. 12. <ul><ul><li>Years 1 and 2 - detailed internal ongoing outcomes and evaluation programme </li></ul></ul><ul><ul><li>Year 3 - independent assessment by the University of Birmingham to be published 2010 see website </li></ul></ul><ul><ul><li>Year 3 – expecting internal ongoing outcomes and evaluation programme </li></ul></ul><ul><ul><li>Department of Health/Ernst & Young – evaluation </li></ul></ul><ul><ul><li>But i) Regression to mean, and </li></ul></ul><ul><ul><li>ii) A complex intervention </li></ul></ul><ul><ul><li>iii) Population-based </li></ul></ul>Evaluating Birmingham OwnHealth
  12. 13. Birmingham University study <ul><li>676 BOH patients compared with 31,077 controls from GP research database </li></ul><ul><li>Outcome 8-11 months after baseline </li></ul><ul><li>Adjusted for age, sex, baseline values, smoking status, length of follow up, deprivation score </li></ul>An evaluation of Birmingham OwnHealth telephone care management intervention among patients with diabetes or heart disease. A retrospective comparison with the General Practice Research Database. Rachel Jordan, Robert Lancashire, Peymané Adab Unit of Public Health, Epidemiology and Biostatistics, University of Birmingham.
  13. 14. BOH patients with diabetes Mean change compared to controls HbA1c -0.2% [-0.4, -0.1] Systolic BP -3.4mmHg [-5.5, -1.4] Diastolic BP -1.8mmHg [-3.0, -0.6] Total cholesterol -0.1mmol/l [-0.3, -0.1] BMI -0.7kg/m 2 [-1.1, -0.4]
  14. 15. Comparison of satisfaction with care management at year 1 and 2