Telemedicine as Support for Chronic Disease Management

1
(No Transcript)
2
Telemedicine as Support for Chronic Disease
Management
COPD Julia Davey BSc. (Hons.) RGN
3
(No Transcript)
4
Intermediate Care

• Those services which will help to divert
  admission to an acute care setting through timely
  therapeutic interventions which aim to divert a
  physiological crisis or offer recuperative
  services at or near a persons own home.

5
Role of IT in Intermediate care

• Conventional model is reliant on expensive human
  resource
• Model is not scaleable without huge increase in
  cost
• Enough evidence to suggest that Intermediate care
  is clinically effective and does not lead to
  increase in mortality or re-admission rates if
  best-practice followed
• On cost-savings the evidence is less clear
• IT may be able to help

6
Intermediate care Best Practice

• Standardised medical and social assessments
• Strict adherence to inclusion and exclusion
  criteria
• Capture of baseline observations
• On-going capture of data from patients
• Physiological
• Symptom based
• Life-style
• Protocol-based
• Education of patients and carers

7
Patient-centred Telemedicine

• Multi-disciplinary care record
• Management of Clinical Network staff and roles
• Clinical forms for data capture and exchange
• Access Control, Security
• Protocol driven
• Access to guidelines
• Rich multi-media functionality
• Clinical alerts to build a safety net
• Automating reminders to staff
• Reports, outcome analysis, clinical audit

8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
Todays Model

• Change in emphasis from crisis management to
  preventative partnership
• Patients find it acceptable
• Cuts down home-visits allowing more patients to
  be managed by the same number of healthcare staff
  
• Use of electronic monitoring as an adjunct to
  home visiting
• Embedded rules and alerts in the EPR ensure
  manual intervention happens when required text
  messages to clinical nurse specialists
• Type and extent of data capture at home is not
  restricted

15
Clinical Networking

• Emphasis on connection and partnership rather
  than isolation and self-sufficiency
• Care is delivered seamlessly by a chain of
  interconnected disciplines
• The network enables knowledge (expertise) to be
  distributed
• Patients remain in their community while
  receiving expert care through this network
• Clinical networks emphasise the role of primary
  care in acute health care

16
Principles

• A community wide team
• Prevention
• Focused on maximising QOL
• Especially education and pulmonary rehab
• Getting the diagnosis right at the right time
• Support and Pre-emptive care
• Including LTOT etc
• Hospital at Home
• Rarely in the hospital
• A Dignified death at home

17
COPD Management Board

• Two General Practitioners.
• Two Secondary care physicians
• Two Patient representatives.
• Two nurses (Community and Acute).
• Social Services rep
• Smoking Cessation Lead
• Palliative Care Team Lead
• A senior manager

18
Where Are We Up To?

• Clinical Network in place
• Lead consultant
• Lead nurse Primary and Secondary Care
• Clinical Board
• Social Services representative
• Physiotherapist
• Network working in one locality
• Recruiting staff for the others
• 40 reduction in admission and reduced length of
  stay
• Pulmonary Rehab Started in September 2005
• Clinical Record in place
• First in England
• Including home monitoring

19
Review of Service Since starting the Respiratory
Community Service in 2001, hospital admissions
for those patients seen at home have fallen by
40. Fig2.   Fig.2 Patients on Excelicare System
Summary Results

• Reduction in No. of spells 74
• Under PbR _at_ 2000 per spell 148,000
  
•  
• There has been a 44 reduction in no. of spells
  and a 50 reduction in length of stay (LOS)
  amongst those supported by Excelicare
• 14 patients have died and have not been
  included in the data summary.

20
Benefits to Patients

• Empowers patients to become more actively
  involved in their own treatment
• Provides them with 24-hour access to their
  healthcare provider
• Minimises the inconvenience, cost and time
  incurred in travelling to clinics

21
Benefits to Clinicians

• Allows close, accurate monitoring of patients
  without increasing the load on clinics
• Closer monitoring results in improved compliance
  with treatment
• Enhanced monitoring and compliance improve the
  overall outcome of treatment
• Provides remote access to patient information

22
Conclusion

• Patient-centred telemedicine can improve
  healthcare delivery by supporting intermediate
  care.
• Electronic Patient Record is necessary to
  implement and monitor best-practice.
• Patient-centred telemedicine can lead to cost
  savings while maintaining clinical effectiveness
  of intermediate care.

23
(No Transcript)
24
Contact Details

• Julia Davey
• julia.davey_at_centralsurreyhealth.nhs.uk
• 01372 384336
• 07917 337931