telehomecare telehomecare project copyright university of minnesota low cost standards-based...

TeleHomeCare ProjectCopyright University of Minnesota

TeleHomeCare

Low Cost Standards-based

TeleHomeCare Demonstration Project Stanley M Finkelstein, PhD

Stuart M Speedie, PhD

George Demiris, PhD

Jan Marie Lundgren, BS

Marshall Hoff, BAUniversity of Minnesota, Minneapolis, MN

Supported by Grant #27-60-98031 from the TIIAP, Dept of Commerce and matching funds from program clinical and industry partners

http://www.telehomecare.umn.edu


TeleHomeCare

Program Partners

• University of Minnesota

• Fairview Home Care, Minneapolis

• HomeHealth Partnership, Crosby & Aitkin, MN

• Lakewood Health System, Staples, MN

• Tri-County Hospital, Wadena, MN

• CareFacts Information Systems, St Paul, MN

• Onvoy, Minneapolis, MN

• QRS, Minneapolis, MN


TeleHomeCare

Minnea polis

CrosbyStaples

Wadena

Partner Sites


TeleHomeCare

Telemedicine

The use of telecommunications and information technology to provide health care services

• within or across institutional boundaries

• between providers

• between patient and provider


TeleHomeCare

Telemedicine from Home

• Places patient directly in care loop

• Patient becomes an active contributor in the care process

• Easy, inexpensive approach to link patient and provider


TeleHomeCare

Home Health Care

• 11 million homebound patients• Cost in 1998 estimated at $42 billion• Medicare/Medicaid/out of pocket• Often elderly and/or poor• Rural and urban • Long term condition, recovery from acute episode,

permanent disability, terminal illness


TeleHomeCare

Objectives

To demonstrate that a telemedicine program combining videoconferencing, Internet access, and physiological home monitoring within a home health care setting can

• improve quality of care

• reduce cost of care

• increase access to care

• improve patient satisfaction with care


TeleHomeCare

Outcome Measures

• Mortality and morbidity

• Time to transfer to higher level of care

• Patient satisfaction

• Utilization of services

• Patient/program costs


TeleHomeCare

Methods - Full Study

Recruitment Plan• Subjects with congestive heart failure, chronic obstructive

pulmonary disease, chronic wound care (40/disease group)

• Control or Study Group 1 or Study Group 2

Control - standard home care (medical problem guidelines)

Study Group 1 - standard care + videoconference + Internet

Study Group 2 - standard care + videoconference + Internet + monitoring


TeleHomeCare

Methods

Equipment -- Home Health Care Agency

Videophone/Camera (ViaTV VC105)

• Monitor

• VCR

• PC with clinical information system (CareFacts CIS)


TeleHomeCare

Nursing Work Station

VCR

CareFacts Workstationwith Internet Access

ViaTV


TeleHomeCare

Methods

Equipment -- Subject’s Home Station

Television

• Telephone

• Videoconferencing/Internet browser (ViaTV VC55)

• Camera (Philips eyeball, 512x492 pixels)

• Monitoring equipment (Study group 2)


TeleHomeCare

Internet Home Equipment


TeleHomeCare

Monitoring Components

QRS SpirometerPulse Oximeter

Also includes a scale and blood pressure cuff


TeleHomeCare

Internet Home Page


TeleHomeCare

Patient Diary Forms


TeleHomeCare

Weekly Report - Numeric Data


TeleHomeCare

Weekly Report - Categorical Data


TeleHomeCare

Feasibility Study Results

• Number of subjects recruited : 24

• Satisfactory participation: 13– CHF: 4 COPD: 9

– Age: 73.8 +/- 12.9 SD yrs

• Unsatisfactory participation: 11 (1 drop-out, 7 refusals after sign-up, 3 homes not acceptable)– CHF: 3 COPD: 7 wounds: 1

– Age: 73.0 +/- 12.6 SD yrs


TeleHomeCare

Feasibility Study Results

• Average length of each case: 35 days

• Average number of virtual visits/subject: 6.7

• Average time of virtual visits: 25 minutes

• Average number of actual visits/subject: 5.9

• Average time of actual visit: 33 minutes

• Content of virtual and actual visits comparable (9 basic themes)


TeleHomeCare

Full Study - Initial Results

• 68 patients agreed to participate

• 53 (19 C, 15 V, 19 M) subjects completed study

• Failure to complete study due to illness/hosp, phone lines, concerns with equipment, move, another study, nurse change

• Average age/range (yrs):

– active: 72.0 (50-89) in C, 79.3 (65-90) in V, 73.1 (50-85) in M

– drop-outs: 78.0 in C, 77.8 (60-96) in V, 77.7 (68-87) in M


TeleHomeCare

Full Study - Initial Results

• # of actual visits: 440 in C, 262 in V, 325 in M

• # of virtual visits: 280 in V, 262 in M

• Technical quality of virtual visits, rated by HC nurses: 94.7% (range 57.1 - 100%)

• Usefulness of virtual visits, rated by HC nurses: 91.8% as good as actual visit

• Subject perception of telehomecare increased significantly after participating in the study

• 32% of C and 12% of V/M were d/c to nursing home or hospital


TeleHomeCare

Conclusions - TeleHomeCare

• Virtual visits can be conducted over POTS• Nurses and patients can successfully interact in a virtual visit• Virtual visits closely parallel actual visits in time and content• Patients can learn to use monitoring devices, daily diaries via

the Internet and web browsing• Physiological monitoring can be a positive addition to the

telemedicine portfolio• Physiological monitoring and daily diaries can “fill the gaps”

between home care visits (actual/virtual)• Transition to home health care protocols is successful


TeleHomeCare

Major Challenges

• Reimbursement• Identifying appropriate subjects• Agency commitment to

– administrative planning and promotion, – training and incentive for nurses, – identify nurse leader (technical aptitude and

motivation)– provide technical support staff

telehomecare telehomecare project copyright university of minnesota low cost standards-based...

Documents

home health care setting

care processeasy

care looppatient

health care serviceswithin

chronic wound care

physiological home monitoring

mnlakewood health system

internet access