Using Technology to Transform Care for Patients with Parkinson Disease


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Presentation by E. Ray Dorsey, MD, Associate Professor of Neurology, Director, The Johns Hopkins Parkinson’s Disease and Movement Disorders Center

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  • Using Technology to Transform Care for Patients with Parkinson Disease

    1. 1. Using technology to transform care for patients with Parkinson disease MATRC Telehealth Summit March 18, 2013
    2. 2. Disclosures Grant funding Consulting Stock options •Agency for Healthcare Research and Quality •Avid Radiopharmaceuticals •Google •Excellus BlueCross BlueShield •Lundbeck •Macklin Foundation •National Institute for Neurological Disorders and Stroke •Prana Biotechnology •Verizon Foundation •Avid Radiopharmaceuticals •Clintrex •Lundbeck •Medtronic •ConsultingMD •Pursuing a patent related to receiving care via telemedicine Patents 2 2
    3. 3. Outline • The burden of Parkinson disease and other chronic conditions is growing, but access to care is limited • Technology can remove geographic barriers to care 3
    4. 4. Outline • The burden of Parkinson disease and other chronic conditions is growing, but access to care is limited • Technology can remove geographic barriers to care 4
    5. 5. The burden of Parkinson disease and other neurodegenerative conditions is growing Distribution of individuals with Parkinson disease by country from 2005 to 2030* 2005 100% = 4.1 million individuals 2030 100% = 8.7 million individuals Others, 10% Brazil, 4% U.S. 7% Others, 12% Brazil, 4% U.S. 8% China, 57% China, 48% India, 8% India, 8% Europe, 14% Europe, 20% *Among individuals over 50 in the world’s ten most and Western Europe’s five most populous nations Source: Neurology 2007;68:384-6 5
    6. 6. Access to specialty care and clinical trials is geographically restricted in the US Distribution of Parkinson disease specialists in Maryland* In Maryland, 20 of 23 counties do not have access to a Parkinson disease specialist *excludes NIH/NINDS, FDA, neurosurgery, and the Washington D.C. area Sources: Movement Disorders Society directory; 6
    7. 7. Forty percent of Medicare beneficiaries with Parkinson disease have not seen a neurologist Source: Courtesy of AW Willis 2012 7
    8. 8. Access to care is even more restricted around the world • In Bolivia, not one of the individuals identified with Parkinson disease had seen a physician for his or her condition • In China, there are ~50 Parkinson disease specialists for ~2 million people with the condition • In 40% of all countries, anti-Parkinsonian drugs are generally not available • In 83% of low income countries, there are no available treatments for Parkinson disease Worldwide, most people with Parkinson disease have likely not been diagnosed and most likely have not been treated Sources: Movement Disorders Society directory; Neurology 2007;68:384-6; WHO Country Resources for Neurologic Disorders 2004 (WHO, 2004) 8
    9. 9. Patients who see a specialist have significantly better outcomes and survival Six-year survival among patients with Parkinson disease Patients who see a neurologist Patients who see a primary care physician Patients with Parkinson disease who see a neurologist are: • 14% less likely to have a hip fracture • 21% less likely to be placed in a skilled nursing home facility • 22% less likely to die Source: Neurology 2011; 77:851-857
    10. 10. Excellent specialty care is available and can improve outcomes for a variety of conditions Model of improving outcomes Specialists lead to higher quality care •Heart disease  More appropriate medication use •Asthma  Greater adherence to national management guidelines •Diabetes  Better process measures Higher quality care improves outcomes •Heart failure  Increased survival •Asthma  Improved quality of life •Diabetes  Fewer complications Sources: NEJM 1994;331:1136-42; Arch Int Med 1998;158:457-64; Diabetes Care 2004;27:398-406; CMAJ 2005;172:189-94; J Allergy Clin Immunol 2005;116:1307-13; Mov Disord 2007;22:515-22 10
    11. 11. Outline • The burden of Parkinson disease and other chronic conditions is growing, but access to care is limited • Technology can remove geographic barriers to care 11
    12. 12. We are using simple, inexpensive technology to reach patients around the world Telemedicine can be used to reach people anywhere Equipment •Laptop or portable device •Internet connectivity •Web cam, microphone •Encrypted software •In-home care •Remote patient monitoring •Remote study participation Source: Dorsey ER et al. Mov Disord 2010;25:1652-9; Biglan KM, Dorsey ER, et al. Mov Disord 2009;24:1073-1076 12
    13. 13. Telemedicine visits are similar to in-person visits in content 13
    14. 14. We completed a randomized, controlled trial of virtual housecalls for Parkinson disease 11 patients receive 3 20 patients with PD at two centers Outcomes: in-person visits over 6 months Randomized 9 patients receive 3 telemedicine visits over 6 months in home 1. Feasibility 2. Clinical outcomes 3. Economic value Telemedicine In-person Sponsors: Source: “Randomized, controlled trial of “virtual housecalls” for Parkinson disease” (2013) JAMA Neurology. In press. 14
    15. 15. Telemedicine is a feasible means of providing care into people’s homes Proportion of visits completed as scheduled 91% Percent 93% Telemedicine In-person 15
    16. 16. Patients in both arms had similar clinical outcomes Change in Quality of Life Points on PDQ-39 scale N=20 total Change in Motor Function Points on modified UPDRS Part III* scale N=20 total +6.4 Better Better +3.9 +4.0 Telemedicine (n=9) +1.2 +1.2 In-person care (n=11) Telemedicine (n=9) In-person care (n=11) *Excludes assessments for rigidity and postural stability 16
    17. 17. Patients in the telemedicine arm rated their quality of care higher Better Change in Quality of Care Points on Patients Assessment of Chronic Illness Care (PACIC) N=10 total +1.4 +1.5 In-person care (n=6) Telemedicine (n=4) Worse - 3.8 17
    18. 18. Telemedicine flips the paradigm Patient time spent on in-person versus telemedicine visits 18
    19. 19. Using telemedicine, we have extended our reach into homes in 5 states… Our program has saved patients roughly 20,000 miles of travel 19
    20. 20. …and 15 countries Our program has saved patients over 200,000 miles of travel 20
    21. 21. With support from Verizon, we launched a free telemedicine clinic for patients with PD Patients call 855.237.7666 to request an appointment Patients selected each month to participate Supported by: Recommendations sent back to patients and their physician Technology specialist assists in setup If you or someone you know live in MD, DE, CA, FL, or NY, and are interested in receiving a free consultation: Call 855-237-7666 to enroll! Patients receive care from PD specialist 21 Source:
    22. 22. We are just scratching the surface of what is possible Growth horizons Phase 3 3 Phase Expand scope to other Expand scope to other conditions (e.g. conditions (e.g., Huntington Alzheimer’s, disease, ataxia) Huntington disease, etc.) Impact Phase 2 Increase scale and reach of model nationally and globally Phase 1 Provide care to individuals with Parkinson disease directly in their homes (“virtual house calls”) Our vision is to provide patientcentered care to individuals with Parkinson disease anywhere they live Time 22