connected health as a tool for patient engagement kvedar 11.7.13
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Connected health as a tool for patient engagement - by Joseph Kvedar, MD, Director of the Center for Connected Health.TRANSCRIPT
Connected Health as a Tool for Patient Engagement
Joseph C. Kvedar, MDDirectorCenter for Connected HealthPartners HealthCare
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Connected Health Goal
Integrate care into the day-to-day lives of our patients
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Connected Health Innovation Process
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Ideation & Feasibility
Product develop.
r
Trial/Test
r
Spin-out
Program develop.
License
CCHService
InternalHand-off
Technology is an enabler to provide care remotely
Benefits include improved engagement, outcomes, and efficiencies
Mission is to facilitate the adoption of Connected Health
About the Center for Connected Health
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Connected Health Benefits
Improved self-care1 Just-in-time
care 2
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Connected Health Components
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FeedbackLoop
Heart Failure Monitoring
Connected Cardiac Care
50% Drop in
Readmissions
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Data Includes 332 CCCP enrollments among 301 unique patients discharged from the CCCP program prior to July 1, 2009. Results are similar within more recent cohorts of enrollees discharged from the program prior October 1, 2009 and prior to January 1, 2010.
Proportion of CCCP Enrollees with One or More Hospitalization
39.80
13.30
58.10
100
One year prior to CCCP enrollment (point estimate and 95% C.I.)
One year following CCCP disenrollment (point estimate and 95% C.I.)
Percent
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Average drop of HbA1c: 1.5
69% achieved a drop in BP
Diabetes and Blood Pressure Connect
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Greater engagement is associated with greater pre-post HbA1c change
Practice engagement correlates strongly with better patient outcomes
• Patients with greater than 15 uploads had average 1.5 pre-post HbA1c change
• P< 0.03 between no uploads and uploads groups
no uploads 1 - 15 uploads > 15 uploads0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
0.43
1.34
1.53
Average drop HbA1c by # of uploads
Dro
p in
Hb
A1
c
J Diabetes Sci Technol 2012;6(6):1328-1336
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Proportion with 10mmHg or greater drop in SBP
CI
P<0.05
Decreases in Blood Pressure from Self Monitoring
Proportion with 5mmHg or greater drop in DBP
P<0.05
CI
% o
f S
ub
ject
s
% o
f S
ub
ject
s
Am Heart J. 2012 Oct;164(4):625-31.
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Future of Connected Health
• More varied, miniaturized sensors
• Automated, customized motivational messaging
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Given Imaging
Given ImagingOMsignal
Exmovere
MD Revolution© 2013 Center for Connected Health – All Rights Reserved
Content Confidential – DO NOT DUPLICATE.
• Increasing interest among clinicians
• Consumers familiar with software
• Payment reform spurring interest
Video and Virtual Visits
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The Future of Video Visits
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– “I didn’t look at it online, I didn’t need to, I thought that’s what my provider was doing”
– “If I forget to send it in, after a couple of weeks, she [the nurse] calls me.”
– “I stopped using it for my reasons, but no one ever called and asked why I stopped so I never pursued it”
Feedback Loops Alone Are Not Motivating
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Sentinel Effect
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Components of Self Care
Social Networking Gamification Incentives Coaching
FeedbackLoop
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Text-messageReminder
Participant reads message and applies sunscreen
Sends SMS when the tube is opened
Tues. Sunny. High 68, Low 53. Please apply your sunscreen today.
Remote MonitoringData Repository (RMDR)
Simple Reminders Can Have A Powerful Effect
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Adherence Rate for Sunscreen Use
Arch Dermatol. 2009;145(11):1230-1236.
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The Power of Activity and Coaching
Q1 Q1-Q2 Q1-Q3 Q1-Q4
-16.00
-14.00
-12.00
-10.00
-8.00
-6.00
-4.00
-2.00
0.00
2.00
4.00
Percent Change in Average Daily Steps Per Quarter
C, n=30
I, n=27
Quarter (1 Quarter = 3 weeks)
Per
cen
t C
han
ge
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Habituation
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Improving physical activity behaviors in T2DM(Text 2 Move)
Primary Outcomes: Change in physical activity levels
Secondary Outcomes: Change in HbA1c in patients Change in stage of behavior change
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Customized Program Design
ReadinessTo Change
Connected Health Data
PracticeLocation
Analytic Engine
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1/9
1/11
1/13
1/15
1/17
1/19
1/21
1/23
1/25
1/27
1/29
1/31
0
2000
4000
6000
8000
10000
January
2/1
2/3
2/5
2/7
2/9
2/11
2/13
2/15
2/17
2/19
2/21
2/23
2/25
2/27
February
3/1
3/3
3/5
3/7
3/9
3/11
3/13
3/15
3/17
3/19
3/21
3/23
3/25
3/27
3/29
3/31
March
Text2Move
Contemplation Preparation Action
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Meet Michael Snyder
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Genetic Risk
Source: Cell 148, 1293–1307, March 16, 2012
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Glycated HgA1c (%):(Day Number)
Glu
cose
(m
g/d
L)
Day Number
-150 200 250 300 350 4000 450 500 550 600
160
150
140
130
120
110
100
90
80
6.4(329)
6.7(369)
RSV Infection(Day 289-311)
Life Style Change(Day 380-Current)
HRV Infection(Day 0-21)
4.9(476)
5.4(532)
5.3(546)
4.7(602)
Personalized Prevention in Action
Source: Cell 148, 1293–1307, March 16, 2012
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Customized Program Design
Motivational State
Connected Health Data
Genetic Profile
Analytic Engine
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Content:
Psychological Factors
Tactics:
Genes Coaching
Games/Contests
Health Info &Social Support
Incentives/Punishments
Text
Rich/Multi-Media
Avatar/Agent
Voice
InteractiveSoftware
Physiological Functions
Behavior
Environmental Factors/Socioeconomic Status
Content:
Tactics:
SpecimenCollection
EMRs
Sensors
TextAnalysis
Online & OfflineBehavior Tracking
Analytics
Input Output
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Automating Healthcare
Implications of Automating Healthcare
• Social Contract
• Privacy
• Accountability
• Economics
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• Feedback loops coupled with personalized motivation can lead to sustained behavior change
• Virtual care has great future potential
• Genetic analysis provides a powerful foundation
Takeaways
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FeedbackLoop
The cHealth Blog: chealthblog.connectedhealth.org
www.connectedhealth.org
Annual Symposium: October 23-24 2014; Boston
LinkedIn Group: Connected Health Community
Twitter: @connectedhealth @jkvedar
Ways to “Connect”
Contact Me: [email protected]
© 2013 Center for Connected Health – All Rights ReservedContent Confidential – DO NOT DUPLICATE.