tele-health monitoring by maureen ideker
TRANSCRIPT
Tele-Home Monitoring
Blandin Foundation Web- X
December 14, 2017
Maureen Ideker, RN, BSN, MBA
Senior Advisor for Telehealth
Essentia Health, Duluth
Objectives
• Provide basics on Tele-Home monitoring with
examples of use in heart failure & diabetes.
• Describe the equipment needed at home,
broadband & resources needed for services.
• Describe potential savings to counties and
citizens.
Example 1: Elderly Diabetic
Lady
• Maintained at home over 3 years
• Daily video visit for insulin injections
• Saved 36 months at $6,000/Month to the county for
LTC MA - $216,000
Example 2: A common
Disease - Heart Failure?
Prevalence
– Affects 5.8 million in the U.S.
– Over 650,000 new patients annually
– The lifetime risk of developing HF is 20% for Americans ≥40 years of age.
– HF is the most frequent cause of hospitalization in elderly (> 65 y/o)
Prognosis
– 1/2 of people who develop HF die within 5 years
of their diagnosis
– Less than 25% are alive at 10 years
• HF is not always treated correctly
• Patients do not adhere to diet and medication regime
• Projections show the prevalence of HF will increase 46% from 2012 to 2030, resulting in >8 million people ≥18 years of age with HF
Heart Failure
Progression is Inevitable
AHA Heart Disease & Stroke Statistics 2014 Update
What will it Cost?
• Estimated lifetime cost per each individual HF patient
is $110,000/year
• In 2012, total cost for HF was estimated to be $30.7
million
• Projections show that by 2030, the total cost of HF
will increase almost 127% to $69.7 billion from 2012
Summary % Readmissions for
Heart Failure Within 30 Days
• National – 24%
• Essentia Health – Duluth – 9%
• Essentia Health with Tele-Home Monitoring
Scales – 2%
Tele-Home Monitoring Research
• Kaiser-Permanente- conducted the foundational research in mid-1990s(4)
• University of MN replicated it with similar results in 1998
• VA in Florida experienced greater impact in 2004 by adding care coordination
• Ascension Health conducts research under Beacon Grant in 2012 with similar results and adds self management education
U of MN Research:
1998 & 2004
• The impact of using home monitoring devices on
transfers to higher levels of care….1998
• Patients ability to use and acceptance of tele-home
monitoring equipment………2004
MN Telehealth Network Research
1998 – Telehomemonitoring
N = 150
U of MN
Research Patient Groups limited
to CHF, COPD & Diabetes
Daily recording of:
- Weight
- Blood Pressure
- Pulse
- Oxygen Saturation, Spirometry or glucose
readings
- Video visits at least weekly
13
14
Beacon Case Study
• 53 y.o. female with more than 6 chronic
conditions
• 13 hospital admits in 2011, $156,000
• Remote Monitoring and self management
conducted resulting in:
• 1 ED visit and 1 brief hospitalization in 2012:
$2500
Veteran’s Administration Study in
Florida-2004
• Remote home monitoring along with care
coordination, including diabetes, resulted in:
• 50% reduction in hospitalizations
• 11% reduction in ED visits
Essentia Health Using Tele-Home
Monitoring (MN Example – Duluth)
• Over 300 home monitoring devices out for heart failure
hospital discharges, health care home pts, and
homecare/hospice uses.
• Heart Failure program started using devices in 2002.
Named a best practice example by AHRQ.
Readmission rate in this group1-2%. National average
is over 23%. Huge ACO impact.
• Mostly scales deployed,(some Bp units short term
HF Program Model
• Consult 5-7 days after hospital discharge
• Patients managed by APP in ambulatory setting
• Seen by cardiologist initially, annually and as needed
• Registered nurses provide continuous case management:
– Phone triage
– Follow-up on labs/ test results
– Utilize protocols
– Manage telescale data
– ONGOING PATIENT EDUCATION
Monitoring & Exception Review• Patient alerts at Central Station
– Nurse reviews data in both Cardiocom and EPIC
– Makes decision if patient needs to be contacted
• If assessment is needed the nurse considers the following:
– Nursing assessment and education needs
– Review medication list
– Dietary compliance
– Follows diuretic protocol as indicated/or talks with provider
– Initiate office visits or primary care referrals as needed
– Care plan monitoring; hospitalization initiation
– Communication with team members (other specialties)
Advantages to Tele-Home Monitoring
• Facilitates early intervention and prevents ER visits and hospitalizations
• Improved patient adherence with care plan
• Patients get immediate feedback on life style choices
• High patient satisfaction
• Healthier!
• Improved quality of life
• Decreased LTC stays
Financial Considerations
• County costs for MA support – LTC
• Decrease tax-base when leave home
• Decrease local spending
• Increased county costs for MA with disability
References
• Chumber NR, Neurgaard B, Koob R, Qin H, Joo Y. Evaluation of a
care-coordination/home-telehealth program for veterans with
diabetes. Eval health professions 2005;28:464-478.
• Erickson C, Ideker M, Fauchald S. Integrating Telehealth Into the
Graduate Nursing Curriculum. The Journal for Nurse Practitioners
2015; e1-5.
• Finkelstein S, Speedie S, Potthoff, . Home telehealth Improves
Clinical Outcomes at Lower Cost for Home Healthcare.
Telemedicine and e-Health Vol 12, N0 2, 2006: 128-136.
• Finkelstein S, Speedie S, Zhou X, Ratner E, LeMire T, Valley K,
Dahle L. Virtual assisted-Living Umbrella for the Elderly (VALUE):
What the community thinks.
References Continued…
• Johns Hopkins Medicine. A Typical Hospital at Home Program
Follows these Steps. http://www.hospitalathome.org/about-us/how-
it-works.php.
• Johnston B, Wheeler L, Deuser J, Sousa KH. Outcomes of the Kaiser-Permanente Tele-Home health research project. Arch Fam Med 2000;9:40-45.
• Klapper B, Kuhne H. Patient self-management by telehealth using
the Bosch model of care. Journal of Telemedicine and Telecare
2010;16:193-195.
• Snell, A. Reducing Hospital Readmissions Using Remote Patient
Monitoring and Patient Engagement Tools. Beacon Research
Study, Ascension Health Presentation, Indianapolis, 2013.
