Transformation In Chronic Disease Management Through Technology: Improving Productivity And Quality In The Shift From Acute To Home Based Settings
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June 22, 2009 presentation to Cambridge Health Network at King's Fund by Molly Joel Coye, MD, MPH, Founder and CEO Health Technology Center
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Transformation In Chronic Disease Management Through Technology: Improving Productivity And Quality In The Shift From Acute To Home Based Settings
- 1. Cambridge Health Network Molly Joel Coye, MD, MPH Founder and CEO Health Technology Center June 22, 2009 Transformation In Chronic Disease Management Through Technology: Improving Productivity And Quality In The Shift From Acute To Home Based Settings
- 2. A “Blockbuster” Is Discovered… 72% reduction in HF hospitalizations 63% reduction in cardiac-related hospitalizations 0.51 1.82 0.81 2.20 2.18 2.73 RR=0.28 p=0.03 RR=0.37 p=0.029 RR=0.80 p=NS Heart Failure All Cardiac All Reason for Hospitalization Hospitalizations/Patient-Yr Intervention Control
- 3. Frustrated Deployment of a Transformational Technology 72% reduction in HF hospitalizations 63% reduction in cardiac-related hospitalizations SPAN-CHF II: Tufts-New England Medical Center; Lahey Clinic; Beth Israel-Deaconess Medical Center; Rhode Island Hospital. Weintraub et al AHA 2005 0.51 1.82 0.81 2.20 2.18 2.73 RR=0.28 p=0.03 RR=0.37 p=0.029 RR=0.80 p=NS Heart Failure All Cardiac All Reason for Hospitalization Hospitalizations/Patient-Yr Intervention = Remote Patient Management Control
- 9. Health Buddy Project Lessons Ratan (MKR-A) | 5/12/2009 | © 2009 Robert Bosch LLC and affiliates. All rights reserved. RPM Impact On > 30 Conditions In The VA VA Care Coordination/Home Telehealth Studies 2004-007, in Darkins et al. Telemedicine and e-Health, Dec 2008 Credit: HealthHero Bosch Condition # of Patients % Decrease Utilization Diabetes 8,954 20.4 Hypertension 7,447 30.3 CHF 4,089 25.9 COPD 1,963 20.7 PTSD 129 45.1 Depression 337 56.4 Other Mental Health 653 40.9 Single Condition 10,885 24.8 Multiple Conditions 6,140 26.0
- 13. February 2009: The State Of The Union And Budget Proposal “… Hospitals with high rates of readmission will be paid less if patients are re-admitted to the hospital within the same 30-day period… saving roughly $26 billion of wasted money over 10 years .”
- 16. Molly Joel Coye, MD, MPH Founder and CEO 415.537.6960 phone 415.537.6969 fax [email_address] Health Technology Center 524 Second Street, 2 nd floor San Francisco, CA 94107 www.healthtech.org
Editor's Notes
- SPAN-CHF II: Tufts-New England Medical Center, Lahey Clinic, Beth Israel-Deaconess Medical Center; Rhode Island Hospital. Weintraub et al AHA 2005 Dozens of small hospital-sponsored demonstrations around the country have proven that coordinated care can improve quality and drastically cut ED use, hospitalizations, and SNF days. But nowhere has this been taken to scale – that is, used to produce substantial decreases in expenditures for large populations. This is the kind of impact that will be needed to reliably reduce estimates for future hospital capacity requirements.
- SPAN-CHF II: Tufts-New England Medical Center, Lahey Clinic, Beth Israel-Deaconess Medical Center; Rhode Island Hospital. Weintraub et al AHA 2005 Dozens of small hospital-sponsored demonstrations around the country have proven that coordinated care can improve quality and drastically cut ED use, hospitalizations, and SNF days. But nowhere has this been taken to scale – that is, used to produce substantial decreases in expenditures for large populations. This is the kind of impact that will be needed to reliably reduce estimates for future hospital capacity requirements.
- Scale of the impact. Visicu – 20-40% improvement in mortality, 30% drop in LOS and costs CHF Solutions – elimination of ICU charges, decrease ED charges for one of the largest and most expensive patient groups currently utilizing hospital services.
- VHA CCHT (Care Coordination/Home Telehealth) program involves the use of health informatics, disease management and home telehealth technologies to provide routine non-institutional care (NIC) and chronic care management services to veteran patients with diabetes, congestive heart failure, hypertension, posttraumatic stress disorder, chronic obstructive pulmonary disease and depression. The majority (85%) of technology utilized was messaging/monitoring services, 11% video-telemonitors and 3% videophones.
- Smart Pill MedivoxRx. Wizzard Software, MedivoxRx Technologies Announces Plans to Further Enhance Rex-The Talking Bottle and Rex Pharmacy System, Other Recent Events. Press Release August 16, 2006. http://www.wizzardsoftware.com/pr/show_news.php?misc=search&subaction=showfull&id=1155732273&archive=1159802122 Remote Medical Dispensing Schizophrenia Trial - Dr. Dawn Velligan, PHD and Dr. Alec Miller, MD; UTHSCSA (University of Texas Health Center in San Antonio). http://www.informedix.com/professional/results/schizophrenia1.pdf Diabetes Trial - Underserved Diabetes population – St. Vincent Healthcare, Billings, Montana. http://www.informedix.com/professional/results/diabetes.pdf CHF - CHF in VA Population – Wayne State http://www.informedix.com/professional/results/chf_va.pdf
- Barbara Harvath, Steve DeMello and Andrew Broderick are continuing work in this area for us, and they’d welcome questions and comments.