a partnership approach to delivering technology- assisted
TRANSCRIPT
A partnership approach to delivering technology-assisted home-based care to patients with chronic respiratory disease
Vikas Wadhwa, Clinical Director Integrated Services, Eastern Health
Rob Sutherland, Principal and Business Lead,ZEST Health Strategies
• Economic impact of Chronic
Obstructive Pulmonary Disease
in 2008: $98 billion
Chronic Respiratory Diseases Hospital Admission Risk
Programs (HARP)
• Second leading cause of
avoidable hospital
admissions in Australia
• Promote independence
• Reduce risks of
hospitalisation
Background
• Resource intensive
• Regular home visits by
specialist nursing teams
EASTERN HEALTH
+
TELSTRA HEALTH
+
Patient recruitment,
HARP service, Clinical
governance
Software and
Technology
Consortium to develop EMOC
ZEST HEALTH
STRATEGIES
+
SYMBION HOSPITALS
Collaboration, Expertise Service development &
redesign, Research &
Evaluation
Patient 1
Case Study
Patient 2
-Age 37, smoker
-Asthma preventer, occasional ventolin
-2 hospitalisations previous 12 months, ICU
-HARP Respiratory Case Management
-Respiratory Connect home Project
Case Study
Study design and
methodology
1. Reduce frequency of respiratory-related hospital readmissions/ED presentations
2. Improve patient adherence to care plan tasks
3. Reduce average no. of home visits
4. Reduce overall cost of home-based care & support
Study Design
▪ 12 month trial: Aug 2018- Aug 2019
▪ Quasi-experimental
:
Objectives
7
The App
1. Cross Platform (iOS & Android)
2. BYOD or provisioned devices
3. Zero rated data for Telstra
customers
4. TGA approved Bluetooth devices
5. SaaS model
Technology
1. Task reminders
2. Health Questionnaires/Surveys
3. Biometric data – Bluetooth and/or
manual data entry
4. Medication reminders – AMT
integration
5. Triage dashboard
Functionality
Co-design and change management
• Change management and implementation support tailored to the local health service context
Our approach:
✓ Shared governance model
✓ Co-design with the clinical team
✓ Process and patient journey mapping
✓ How-to-guides for patients and HARP staff
✓ Customisation of the technology (alerts for symptoms, Sp02)
• 77% female (n=61)
• Mean Age 65 years
• Age Range 21-96
• 23% male (n=18)
• Mean Age 65 years
• Age Range 20-85
Number of patients
Demographics
Principle referral source
• Acute Hospital (72%)
• Respiratory OPD (13%)
• Other (15%)
Eastern
Health• n=79
10
11
53%
34%
57%66%
34%
Enhanced model of care: Preliminary Outcomes
>1 avoided ED
presentations/ month
Healthcare
Utilisation
15 Avoided ED presentations
87%
Tasks completed as scheduled
Care Plan
Adherence Direct Cost Savings
>$23 000 Average cost of avoided events
Return on Investment
42% Dollars saved in avoided events:
Dollars Invested in technology
Enhanced model of care: Patient experience
Self-management of
respiratory condition Health service-seeking
behaviours
Patient perceptions
of care
“I feel more
comfortable as I know
the [nurses] are
looking at my
readings… that gives
me confidence”
“Sometimes when you’re not
well you doubt yourself. Many
times I’ve been sick and should
have called an ambulance and
haven’t... with the technology if
you get bad someone will ring
and say you need to get an
ambulance. Being told like this
means I’ll do it.”
“You can see the days
you're abnormal and normal...
that's helpful as I could look back
and say, Wednesday, Thursday,
Friday my readings were
abnormal, but this week it’s all
good. What have I done
differently this week to last
week?”
Patient 1
-Action plan, GP visit organised
-Only 1 respiratory presentation to ED 7 months; nil
admissions
-Reduction of carer stress
-Reduced anxiety
-Better recognition of symptoms and proactive in care
Case Study - Outcome
Patient 2
-No further ED presentations or admissions
-Reduced Ventolin
-Return to work fulltime whilst being monitored
-Activated Asthma Action Plan with Telephone Review
initiated through Telehealth Data
-Anxiety relieved
Case Study - Outcome
Learnings and future directions
Change management Software
Optimisation
Bluetooth pairing,
PRN medications,
further device
integration
Smartphone Access
Scaling Up
Hospital In The Home, Diabetes Palliative Care, Cardiology
EMR/PAS Integration
17
Eastern
Health
Acknowledgements
Suzanne Morony Rob Sutherland
Nicola Man
Sue Sinclair
Frank Thien
Mary WestVikas Wadhwa
Dean Martin
Tracey Hart William Grant
Ryder Manson
Vickie Irving
Jim Darcy
Zoltan Kokai
ZEST Telstra
Health
Symbion