Relazione Bruxelles

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Boario Home Care Project




Dr. Simonetta Scalvini Salvatore Maugeri
Foundation IRCCS (Italy)

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Boario Home Care Project

Boario Home Care project was born five years ago,
in February 1998, in order to realize a telematic
network for the General Practitioners in a
mountain territory (Vallecamonica) and to give
them the possibility, 24 hours a day, of
monitoring the cardiovascular diseases of their
patients using a mobile electrocardiographer.
Thanks to the successful results, the project has
been expanded in northern Italian regions and
then all over the territory.




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Boario Home Care Project

• Today it is a Service Centre for health offering
• Teleconsulting and ECG referrals and
  multispecialty second opinion for General
  Practitioners and Cardiologists
• Home telenursing for chronic cardiac diseases
• Telediagnosis for arrhythmia
• Call Centre for Hospitals

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GPs
Patients
Hospitals


Call Center Teleworking
Nursing triage
Cardiologists
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Boario Home Care Project
Patients

GPs

Cardiologists
Call Center
Nursing triage
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Boario Home Care Project

The General Practitioners received a portable 12
leads electrocardiographer which can be
interfaced with a fixed or a mobile telephone.
The ECG trace, recorded anywhere in the
territory, either in emergency or elective
circumstances, was transferred, in real time, to
the receiving station where the cardiologists
(with teleworking procedure) were available for
the ECG referral and for an interactive
teleconsultation.




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Boario Home Care Project

• The telecardiology connection includes
  different moments. Firstly the GP provides the
  patients anagraphic data and information on the
  patients past medical history, risk factors and
  current complaints. The GP also reports on the
  patients physical signs, observed at site, and
  afterwards sends the ECG trace. The cardiologist
  reports on the ECG trace, discusses the patients
  symptoms, signs and suggests further actions and
  any recommended changes in therapy.

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Boario Home Care Project

• The Center is
• An advanced technological platform (hardware
  software) which can be easily upgraded
• A computerized call center active 24/24 hours all
  year round
• A dedicated human resources team
• An innovative teleworking model
• A network of physicians and patients able to
  offer effective and efficient telemedicine
  services.

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Data-base (April 2003)



58.754 patients



General Practitioners 1224 with their 1.836.000
patients Cardiologists 135



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Action taken on 27934 patients

• No action 18668 patients
• Therapy adjustment 3791 patients
• Problems solution during telephone call 22459
  patients (80.4)
• Referral to the Emergency Department 1695
  patients (6.0)
• Further investigations 3799 patients (13.6)

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Benefits in access to health care
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Benefits in access to health care (1)


Telecardiology community a new approach to take
care of cardiac patients



2254 subjects were entered in the study at the
time of ECG recordings, 42 of patients were
asymptomatic. GPs problems were solved by
Cardiologists in 2004 patients (89) while 92 pts
(16) were sent to the ED and further diagnostic
tests were requested in 158 pts (27).

Cardiologia 1999 Vol 44, n 10 921-24
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Benefits in access to health care (2)

• Services for General Practitioners and their
  patients
• Multispecialty second opinion (diabetology,
  dermatology, pneumology, etc.)
• Biological signals referrals (as ECG, spirometry,
  images, etc..)
• Diagnostic service for arrhythmia
• Home Telenursing for chronic cardiac diseases.

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Benefits in access to health care (3)

• Services for Health Centers/Hospitals
• the outsourcing concerns only the private net,
  the technological platform and the call center
  technical staff while the professional consulting
  by physicians and nurses is executed by the
  hospital personnel.

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• Benefits in the quality of Health Care

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Benefits in the quality of Health Care (1)



Appropriatezza dellinvio in pronto Soccorso
mediante un servizio di telecardiologia sul
territorio.



3456 patients were enrolled ECG and
teleconsultation solved all the problems in 2452
pts (71) 142 (4) were sent to the Emergency
Department further diagnostic tests were
requested in 862 (25) 5 pts were sent to the ED
in the 48 hours after the teleconsultation.
Sensibility 95 Specificity 97.5 Diagnostic
Accuracy94.

Italian Heart Journal Suppl 2000 1 (7) 905-909
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Benefits in the quality of Health Care (2)


CHEST PAIN PREHOSPITAL ASSESSMENT WITH A
TELECARDIOLOGY SERVICE



952 patients were enrolled ECG and
teleconsultation solved all the problems in 700
pts (74) 83 (9) were sent to the Emergency
Department further diagnostic tests were
requested in 162 (25) 7pts were sent to the ED
in the 48 hours after the teleconsultation.
Sensibility 97.4 Specificity 89.5
Diagnostic Accuracy86.9.
Journal of Telemedicine and Telecare 2002 8
231-236

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Benefits in the quality of Health Care (3)
Telediagnosis for palpitations 200 pts were
randomly assigned to receive a transtelephonic ER
for 7 days or a 24 h Holter monitoring the
symptomatic patients during Holter were 49 in
comparison with 75 pts symptomatic during ER
monitoring.

49
75
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• Economic benefits

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Economic benefits (1)

Potenziale riduzione dei costi per il Servizio
Sanitario Nazionale mediante un servizio di
telecardiologia dedicato ai medici di medicina
generale.






891 pts were enrolled and followed with a
telecardiology service a 47 reduction of ED
admission and 95 of cardiac consulences were
obtained with the telecardiology service in
comparison with the usual care followed by the
GPs.
Italian Heart Journal 2001 2 (10) 1091-1097

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Economic benefits (2)

Telecardiology a new support for GP in the
management of elderly patients.



311 elderly pts were enrolled and followed with a
telecardiology service a 37 reduction of ED
admission and 94 of cardiac consulences were
obtained with the telecardiology service in
comparison with the usual care followed by the
GPs.

• Age and Ageing 2002 vol.31, N2153

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Economic benefits (3)

Home Telenursing for chronic cardiac diseases



Telemonitoring (scheduled appointment)
(Clinical data, therapy, ECG) Teleassistance
(occasional appointment)
(Symptoms, ECG) Teleconsulting (between GP and
Cardiologist)

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Sperimentazione e valutazione del rapporto costo
beneficio di sistemi di teleassistenza nel
cardiopatico cronico ad alto rischio.

• 250 patients were given a device able to record a
  one lead trace the trace could be transmitted
  to a Call Center where especially trained nurses
  were available for the evaluation of the trace
  and for an interactive teleconsultation about
  patients state of health, symptoms, diuresis and
  therapy.
• This group of patients was compared with a group
  of 150 pts followed in usual care.
• The preliminary results of the project are
  characterized by a significant reduction in
  instabilization (22.9 vs 55.4) and
  hospitalizations (17.6 vs 36.5).

• Ricerca finalizzata 2000 Ministero della Sanità

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Economic benefits Time

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Research projects in progress

• Sperimentazione e valutazione del rapporto
  costo/beneficio di sistemi di teleassistenza nel
  cardiopatico cronico ad alto rischio
• IRCCS, Fondazione S. Maugeri-Pavia/Health
  Ministry 2000
• CRITERIA Confronto fra Reti Tecnologiche per
  gestire al domicilio pazienti post acuti e
  cronici.
• IRCCS, Fondazione S. Maugeri-Pavia/Health
  Ministry 2002
• La riabilitazione nella assistenza sanitaria
  complessiva criteri di qualità accesso e
  passaggio tra percorsi differenziati.
• IRCCS, Fondazione S. Maugeri-Pavia/Health
  Ministry 2002

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No-profit Union for Research, Development, and
Experimentation in Telemedicine.
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Clinical Review Telemedicine

• Home telenursing
• Teleconsulting between GPs and specialists
• Electronic referrals to specialists and hospitals
• Call centers and online health

British Medical Journal, 2001 323 557-60