DISEASE MANAGEMENT PROJECT UTILIZING TELEMETRIC MONITORING OF BLOOD PRESSURE IN COMMERCIAL PILOTS

1
DISEASE MANAGEMENT PROJECT UTILIZING TELEMETRIC
MONITORING OF BLOOD PRESSURE IN COMMERCIAL
PILOTS

• Thomas Bettes, MD, MPH
• Sukhwant Khanuja, PhD
• Brad Bowman, MD
• Adam Pannell, MBA

2
Morbidity Associated with HTN

• Prevalence 50 million Americans
• Prevalence rate 1 out of 5 (18.4)
• Undiagnosed prevalence gt 15 million (gt 30)
• Undiagnosed prevalence rate 1 out of 18 (5.5 )
• Estimate 55 billion
• (74 direct costs)

National Heart Lung Blood Institute
3
FAA Certification

• Upper limit 155 / 95 without CVE
• Untreated stage 1 (possibly stage 2) HTN within
  FAA medical standards

National Heart Lung Blood Institute
4
Heart Dis. 2001 May-Jun3(3)152-6 Disease
management and pharmacoeconomics as tools for
mass prevention of hypertensive complications

• Disease management programs
• that incorporate pharmacoeconomic analysis and
  computerized methods of targeting
• patients at high risk of hypertensive sequelae
• are useful and cost-effective tools

5
DM Project Highlights

• Identify
• BP measure greater than 120/70 (originally
  140/80) and BMI gt30
• Indicated current heart disease or family history
  in HRA
• Enrollment
• Confidential and secure email, toll free number
  to enroll voluntarily
• Enrolled 23 out of about 200 contacted via e-mail
• Monitoring
• Participants received BP and weight monitors for
  daily transmission
• Pre-set alert parameters (135/90) were set for
  both BP and weight readings
• Intervention
• Participants contacted if readings were outside
  alert parameters
• Participants given access to secure web site to
  view their personal data

6
Carematix Wireless Monitoring Solution
Hosting Center
Hub in the living room
Portal on any PC
Alerts, Charts, Trends
e.g., Weight Scale in the Bathroom
7
Carematix Monitoring Devices
Wireless Hub
Weight Scale
Blood Pressure Monitor
8
Web-Based Monitoring ToolsTables, Charts and
Reports
9
DM Program Metrics

• Participation Metrics
• Clinical outcomes
• Financial outcomes
• Satisfaction Surveys

10
Participation- Compliance

• Enrollment 23
• Compliant in transmitting data 19
• BP transmissions 5.7 times/wk
• Weight recordings 3.3 times/wk

Out of N200 contacted
11
Participation- Certification issues
Indicates a significant number of potentially
disqualifying readings
12
Participation- Dropouts

• 4 Pilots discontinued after enrollment
• (1) Cited confidentiality concerns
• (2) Very compliant for 4.5 months and had good
  control of BP
• (3) Compliant for 2 months and had good control
  of BP
• (4) Discontinued after 1 reading with no known
  reason

13
Clinical Outcomes
Sample size too small to establish a
statistically significant reduction in BP
14
Case Study -Recertification
Average Blood Pressure

• Enrolled 1/18/06 after being grounded.
• Worked closely with Cardiologist to monitor data
• Cardiologist used data to adjust and modify meds

166
130
89
80

• Member scheduled FAA physical and got
  recertified

First 23 readings over 14 days in Jan 06
Latest 40 readings over 30 days in May 06
15
Case Study -Recertification
Trended Data for Pilot over 4 months
16
Financial Outcomes- Medical Claims
Control Group
Intervention Group
N 524 Avg. Age52
N 23 Avg. Age52
6656
6288
5199
4842
-6
7
02/06-08/06
02/05-08/05
02/06-08/06
02/05-08/05
Medical claims decreased instead of increasing
17
Financial Outcomes- Pharmacy
Control Group
Intervention Group
N 524 Avg. Age52
N 23 Avg. Age52
550
528
4
41
137
97
02/06-08/06
02/05-08/05
02/06-08/06
02/05-08/05
Number of script filled went up at a higher
percentage
18
Satisfaction Surveys

• High level of satisfaction and ease of use
  indicated
• Overcame concerns of confidentiality and
  management access to protected health information
  
• Responses indicated high level of awareness,
  control, and responsibility for BP management
• Indicated willingness to endorse to fellow
  employees

19
Participant Satisfaction- Use
Easy to use
Privacy addressed
Data access was useful
Users found the solutions easy to use
20
Participant Satisfaction- Outcome
Helped Manage BP
Confidence for Physical Exam
Made lifestyle changes
Solution helped users manage their health better
21
Participant Satisfaction- Endorsements

• The blood pressure monitor was easy to use and
  the online personal tracking is great. I have
  even lost 12 pounds since I started using the
  tracking program
• The system is a quantum improvement over the
  manual monitoring and log book that I previously
  used. I am more quickly aware of adverse trends
  and can take measures sooner to correct them.
  Thank you American Airlines.
• Actually tracking the trend of my weight and
  blood pressure has been very enlightening and
  beneficial. I know many more pilots who would
  benefit by utilizing this tool
• I would like to take this opportunity to express
  my appreciation of the AA Pilot wellness Program

22
Conclusions

• Issues related to records confidentiality and
  access to data by Management or FAA must be
  overcome in this population
• Increased BP awareness enhanced via telemetric
  monitoring may lead to improved BP control in
  pilot population
• Even in a small sample size a decrease in medical
  claims and improved pharmacy utilization was
  observed
• Additional intervention strategies and longer
  monitoring periods may lead to further
  improvement

23
Contacts

• Thomas Bettes, MD, MPH
• American Airlines
• 817 963 1295
• Thomas.Bettes_at_aa.com
• Sukhwant Khanuja, PhD
• Carematix Inc.
• 312 627 9300
• skhanuja_at_carematix.com