ElDeRly-friEndly Alarm handling and MonitorING

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ElDeRly-friEndly Alarm handling and MonitorING
Midterm Workshop Odense (DK), 15th of September
2010
Italian Site Trieste A.S.S. n. 1 and
Tesan-Televita Srl
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Italian Pilot Site in Trieste Region Friuli
Venezia Giulia The Partners
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Geographic location
we are here
Trieste 214.000 Inhabitants 26 elderly -
(21.000gt 80)
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Trieste trial site - Consort flow chart
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Trieste trial site - Demographic Profile
STUDY GROUP STUDY GROUP
MEAN AGE 76
N. FEMALES 18
N. MALES 12
AGE RANGE 66-89
CONTROL GROUP CONTROL GROUP
MEAN AGE 76
N. FEMALES 15
N. MALES 15
AGE RANGE 65-94
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Living Situation
Trieste trial site
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Trieste trial site - Pathological Profile
Diabetes Mellitus Chronic Heart Failure COPD Histoy of Myocardial Infarction History of Stroke
STUDY GROUP 17 16 5 6 5
CONTROL GROUP 16 18 5 7 3
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Trieste trial site - Progress achieved
08/09/2010

• 20 DREAMING users
• 2 Connection programmed
• 2 Users with ADSL problems
• 6 Cases dropped out

Installations started 28/09/2009
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Trieste trial site - Drop Out

• 6 DROP OUT IN TRIAL GROUP
• 1 moved to another city ()
• 1 for personal reasons ()
• 1 refused the devices
• 1 afraid of radiation from wireless equipment
  ()
• 1 permanently transferred to an elderly home
  ()
• 1 dead
• 6 DROP OUT IN CONTROL GROUP
• 3 for personal reasons
• 3 dead
• () Before equipment installation

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01/07/2009 31/04/2010 TM group TM group Control group Control group
Trieste secondary outcomes Total Numbers p.c. mean Total Numbers p.c. mean
home visits by nurses 481 18,5 266 10,64
home visits by GPs 22 0,85 28 1,12
medical clinic visits with GPs 77 2,96 72 2,88
home visits by specialists 43 1,65 32 1,28
medical clinic visits with specialists 119 4,58 140 5,6
home visits by social operators 8 19
emergency calls 9 11
ambulance transports 19 46
accesses to emergency rooms 8 11
hospitalization 22 31
total / average of length of stay in hospital 235 10,7 344 11,1
accesses to elderly home 4 3
total /average of length of stay in elderly home (RSA) 100 25 57 19
falls 17 4
femur fractures 0 0
HbA1c (participants with diabetes only) 9 10
permanent transfer to elderly home? 1 0
death 1   3  
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Equipment Components
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Trieste trial site - Equipments
Devices activated 31/08/2010
Central Unit 20
Environmental Monitor (smoke, water, temp., motion) 20
Mambo 2 - senior mobile replaced
Ello! Set-Top Box Videoconferencing 20
Blood Pressure Monitor 20
Asthma Monitor 2
Weight Monitor - Scale 5
Weight, body-fat, body water Scale 3
ECG 1-Lead ECG 2
ECG 12-Lead ECG 1
Pulse/Oxymeter Monitors 7
Glucometer (replaced) 11
Total Purchased
30
30
30
30
30
7
5
5
5
3
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15
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Trieste Trial Site - Contact Centre

• managing clinical folders

• monitoring use of devices

• videoconferencing

• promoting social inclusion

• managing type 1 and 2 alarms/h24

• activating network

• earning the trust of users

• maintaining stable contacts with users

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Contact Centre Alarm type 1 (small changes vs
threshold response defferable)
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Contact Centre Alarm type 2 (severe changes vs
threshold personal/enviromental emergency ) ?
immediate action
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The web Portal
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Trieste trial site Type of alarms
From 28/09/2009 to 08/09/2010 (11 months)
Alarm Type 1 MANAGED BY CC
Hypotension (90/60 mmHg) 188
Hypertension (140/90 mmHg) 1.105
Bradycardia (55 bpm) 561
Tachycardia (110bpm) 96
Hypoglycemia (60 mg) 5
Hyperglycemia (140 mg) 350
Respiratory failure (O2 sat. 95) 87
TOTAL 2.392
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Trieste trial site Type of alarms
From 28/09/2009 to 08/09/2010 (11 months)
Alarm Type 2 MANAGED BY CC WARNED
Smoke detector 37 (cooking) (1 sensor problem) 1 (daugther)
Absence of motion 12 1 (118/no problem)
Severe hypotension (70/50 mmHg) 21 2 (case manager)
Severe hypertension (210/120 mmHg) 17 1 (daugther)
Severe bradycardia (40 bpm) 8 2 (case m.-daugther)
Severe tachycardia (150 bpm) 3 2 (case manager)
Severe hypoglycemia (50 mg) 3 (17 user mistakes) (20 device mistake) 3 (user assistant)
Severe hyperglycemia (300 mg) 15 (3 user mist.) 1 (118/Hosp.)
Mambo 2 alarms 3 (2 user mist.) 1 (118/Hosp.)
TOTAL 119 11
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Trieste trial site - Helpdesk
Objectives

• to provide a single contact point for technical
  queries
• to provide answers for demands or problems of
  users and operators
• to facilitate the restoration of normal
  operational service

Functions

• to receive calls
• to identify problems
• to record and to track complaints
• to call the elderly users and keep them informed

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Trieste trial site - Helpdesk Activities

• From 28/09/2009 to 08/09/2010 (11 months)
• 53 calls to Help Desk
• 35 technical home intervention (66)
• 18 solved by Help Desk phone assistance (34)
• Problems with
• 11 Central Unit (solved with a reboot)
• 11 glucometer (2 sent back)
• 11 video system (2 sent back)
• 8 scale (1 sent back, 2 changed batteries)
• 5 Blood pressure monitor
• 2 smoke sensor
• 1 pulsyoximeter (changed batteries)
• 4 Others (1 mambo, 1 spyrometer, 1 ecg...)
• technicians and operators reported an unexpected
  increase in work
• discrepancy between items of protocol parameters
  and web portal

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Trieste trial site - Status 08/09/2010

• All the case managers get their personal account
  and use the HIS portal (training session ad hoc)
• 3030 baseline questionnaires completed (SF-36
  for QOL and HADS for depression)
• Every participant (trial control group)
  received the personal diary and was instructed
  to fill in them
• Collection of secondary outcomes for the first
  period of the trial (for both group)
  completed
• Monthly meetings in order to coordinate the
  professionals, increase the motivation to
  follow-up the trial protocol and the patients
• Nurses are the key-operators of the projec

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Trieste Trial Site - Problems Solved
Troubles with ADSL connections and contacts with the provider no
Difficulties in handling some vital devices Solvable
Technical problems with Mambo 2 and Glucometers Solvable
The thresholds of type 1 alarms are too sensitive and of limited clinical significance for a real life trial Solvable
Burden of unusual bureaucracy (i.e. project reports, deliverables, financial statements, ecc. - greater than expected) Unsolv.
In some cases the frequent measurements generate anxiety yes
Operators report an increase of work (heavier assistance), and patients feel more the commitment than benefits or safety Solvable
Carried out the Dreaming protocol by ASS 1 yes
Active involvement of professionals Partially
Collaboration by central administration of ASS 1 yes
Functioning of Alarms type 1 and 2 yes
Visibility of the Project within ASS 1 and Regional Government yes
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Trieste trial site Lessons Learned
Implementation and set-up

• Good premises for extending the use of
  telemedicine and videoconference
• Create and share a specific protocol for ECG
  reading
• (in collaboration with local hospital
  cardiology dept.-ICCU)
• Purchased n. 2 webcams for video in 2 Health
  Districts
• Positive Integration between ASS 1 - Public and
  TTL - Private
• Good production of dissemination activities
• To improve
• involvement of GPs
• website use/access ? clinical monitoring MUST be
  helped
• management of the technical equipments and ADSL
  connections

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Trieste trial site

• Thank you for your attention !
• Barbara Dodi
• Tesan-Televita Srl
• Paolo da Col, Sara Koterle
• A.S.S. N. 1 Triestina