Remote patient monitoring for chronic disease management a HARP study

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Remote patient monitoring for chronic disease
management a HARP study

• Janette Gogler, Project Manager RPM, ADON Nursing
  Informatics
• Nick Antoniades, Consultant Respiratory Medicine
• Julie Steinkrug, Recruitment and Review Nurse, RPM

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Informatics

• Health Informatics is the appropriate and
  innovative application of the concepts and
  technologies of the information age to improve
  health care and health.
• health informatics -related to the collection,
  analysis and movement of health information and
  data to support health care), and
• Telehealth- related to direct e.g.
  videoconferencing or indirect e.g. website
  delivery of health information or health care to
  a recipient
• www.hisa.org.au

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Telehealth

• The delivery of health care services and the
  exchange of health care information across
  distances using telecommunications and
  information technology
• Emerging as a sustainable and acceptable health
  service delivery technology for clinician and
  clients.
• (National Telehealth Plan for Australia and New
  Zealand May 2001)

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DHS request

• To establish RPM technology for 12 months on a
  pilot basis within HARP (Hospital Admission Risk
  Program) CDP (chronic disease program)
• Evaluate the effectiveness of Remote Patient
  Monitoring (RPM) within context of HARP CDP in
  terms of patient outcomes, cost effectiveness,
  patient involvement in disease management and
  better use of available resources
• Identify the key success factors in utilising RPM
  within CDP
• Identify barriers to utilising RPM within CDP and
  identify strategies to address these barriers
• Provide recommendations to the DHS to inform the
  future use of RPM in HARP disease management
  models of care

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Schematic Diagram of RPM System Showing Data
Pathways
Data Server
Home Clinical Workstation
Med management
Secure Internet Connection
Health education

Health Qs
Health log / diary
Clinical Supervisor Workstation (Austin)
Chronic Disease Management Program
RPM Medical Team (Austin)
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process

• In order to determine if monitoring patients
  physiological symptoms from their home would be
  clinically and economically effective
• Use of remote patients monitoring using the
  latest web technology high quality integration
  of instruments, user services and interfaces
• Clinical measurement modules, education, diary,
  questionnaires.
• Collect data that would provide comparison
  between 2 groups

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Study design

• RCT 160 patients COPD and CHF usual care
• entry criteria moderate to severe illness,
  english speaking, mentally OK, live independently
  , admission to hospital 12/12
• Hypothesis
• RPM measures will show changes that allow early
  identification of disease deterioration
• early intervention by outreach nursing, with
  involvement of GP and hospital based management
  teams where appropriate will reduce the need to
  hospital presentation and /or admission, reduce
  healthcare costs and improve patient quality of
  life.
• Outcome measures of admissions, QOLs,
  exacerbation, predictive capacity for admission
  and exacerbation, patient acceptance and
  adherence

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Data collection

• Measuring patient outcomes using SF36, CRDQ,
  LWHF,CDS, 6-MWD
• Visits to GP diary
• Hospital presentations ACC,ED etc
• Visit types classification
• Cost interventions by us additional running
  costs-set up costs, phone calls-, statistician
• Measuring acute exacerbations

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Complex

• Complex informatics study
• Variables technology, patients illness, home
  environment
• Recruitment issues -
• Technical issues are on going earthing, loose
  plugs, improvisation stories
• Recruited 53 pts
• 12 CHF 6 6
• 41 COPD 20 21usual care

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Study team

• Christine McDonald chief investigator
• David Hare, cardiologist
• Piyush Srivistava, cardiologist
• Robert Pierce, dir. Respiratory medicine
• Nick Antoniades/Marcus McMahon, respiratory
  physicians
• Jane Day, coordinator CDMP
• Respiratory scientists Jeff Pretto, Peter
  Rochford
• Nurses outreach, gym, informatics
• Medcare Systems