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Brenda Toonders



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    EP02 - Application / Implementation / Adoption and Use 1 (ID 13)

    • Event: e-Health 2019 Virtual Meeting
    • Type: ePoster Session
    • Track:
    • Presentations: 1
    • Coordinates: 5/27/2019, 03:30 PM - 04:30 PM, Pod 8
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      EP02.03 - Safe Step: Falls Risk Screening Project (ID 97)

      Brenda Toonders, IMPACTT Centre, Champlain LHIN; Ottawa/CA

      • Abstract

      Purpose/Objectives:
      According to the Government of Ontario’s, Injury Prevention Guideline, 2018[1], “The most common injury type associated with falls in older adults is fractures, followed by sprains or strains. These injuries can lead to significant disability including the potential for institutionalization in long-term care settings.” In Champlain, falls are a leading cause of injuries and ER visits and among older adults; with 85% of injury related hospitalizations and $55M of annual healthcare costs. Public Health prioritization of falls prevention is indicative of the fact that injuries do not occur by chance (i.e. they are not accidents), but are predictable and preventable. However, seniors are not routinely assessed for falls risk early enough to motivate preventative measures that could delay frailty. Often identification of an issue occurs when a condition has deteriorated or a fall has already occurred/ imminent. Ontario Centres of Excellence, Health Technology Funding, MOHLTC OCHIS, indicate strong support for technology driven innovations that will help fundamentally reshape prevention, care services and/or their costs. [1] http://health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Injury_Prevention_Guideline_2018_en.pdf


      Methodology/Approach:
      Our objective was to determine value in an innovative broad, early screening and prevention program that increases self-awareness and motivation for falls prevention. The program, Safe Step, used evidence based sensor technology. It engaged 1500+ seniors, in more than 230 events, across 110 locations, with over 60 partners offering social, health and/ or support services. This innovative technology, QTUGTM is an electronic version of a standard mobility assessment used to screen for balance problems. It enabled preventative screening in a more cost-effective[1] way, than any other falls prevention program to-date by using trained technicians (non-professionals i.e. PSWs, therapy assistants). Sensors on shins monitored and analyzed movements during a short (approximately 10 to 15 seconds) TUG test (get up from a chair, walk three metres, turn around, walk back, sit). Combined with basic clinical questions embedded into the application, multiple data points produce personalized frailty and falls risk scores. Medium/high risk participants were provided a physician letter and information on free exercise and falls prevention programs, and told to discuss with physicians. [1] https://www.kinesis.ie/qtug-calculator/


      Finding/Results:
      Quadruple-AIM evaluation work is in-progress. Our data will provide valuable information on the participants’ and technicians’ experiences, the cost of operating a program, the locations/events that are the most opportunistic and the clinical value of the program. Preliminary findings showed 62% were unaware of their falls risk, 40% surprised, and 85% indicated they’ll talk to their physician. Observations indicated that participants were very engaged in this interactive screening and the falls prevention information.


      Conclusion/Implications/Recommendations:
      With 85% of high risk seniors, now indicating that they will talk to their physicians, this program has proven its value as a part of comprehensive, community based, early falls prevention programs. Based on our learnings, we are planning to implement new programs designed to engage seniors after the onset of frailty but prior to a fall. Evaluation results and learnings will design program strategies and appropriate business models across various organizations in the health system.


      140 Character Summary:
      Falls is a leading cause of injuries & health-care costs. Learn how technology has reshaped falls-prevention services, costs and effectiveness.

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    EP04 - Application / Implementation / Adoption and Use 2 (ID 19)

    • Event: e-Health 2019 Virtual Meeting
    • Type: ePoster Session
    • Track:
    • Presentations: 1
    • Coordinates: 5/27/2019, 04:30 PM - 05:30 PM, Pod 8
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      EP04.01 - Innovative eRehab Transforms In-Home Stroke Rehabilitation Services (ID 120)

      Brenda Toonders, IMPACTT Centre, Champlain LHIN; Ottawa/CA

      • Abstract

      Purpose/Objectives:
      Innovative rehab technologies inspires transformations in delivery model and patient experiences for Stroke Rehabilitation Services. Champlain region has 1000+ stroke patients yearly; those living in rural areas have no access to local out-patient stroke rehabilitation services and occupy acute beds to access rehab or go without. Sub-acute capacity planning sees the value of moving patients to in-home care for stroke rehabilitation. Traditional in-home rehabilitation services combine a therapist and rehabilitation assistant for twice weekly, hands-on care with paper instructions for homework. By leveraging technology we can support the delivery of personalized stroke rehabilitation services while giving patients unparalleled access and control over their consumption of those services. By augmenting hands-on therapy via eRehab applications we improve patients’ motivation; resulting in the creation of a new service experience. In-home stroke rehabilitation now offers an instructor-led, patient-centered, self-initiated, service that enables the patients’ Physio/Occupational/Speech Therapy exercises to be consumed whenever they want and enhances twice weekly hands-on therapy visits. Additionally, some technologies may create a seamless treatment pathway bridging the time and service gap between hospital and in-home rehabilitation.


      Methodology/Approach:
      Simple technologies that deliver approved professional exercise applications over gaming-like devices/tvs/tablets can completely modernize and revolutionize service delivery. For example, interactive game-like technology enables patients to be guided and monitored through personalized rehabilitation programs with increasing intensity levels. Patients often describe this rehab as fun and friendly rather than exercise/work. Additionally, by leveraging personal computing devices, on-line speech rehabilitation apps offer significant opportunities to initiate services in those critical first few days post stroke. Therapists remotely monitor and update programs to deliver real-time adaptations to meet patients’ ever changing needs. Quadruple AIM evaluation data defines successes in patient and therapist experiences, outcomes and cost-effectiveness and drives recommendations to sustain and spread this service.


      Finding/Results:
      Technical trials proved feasibility. Current in-home trial evaluation data will help us learn how our innovative approach to combining technology and professional health-care empowers the patient to experience and consume their rehab services when they want and as often as they want and may result in improved clinical outcomes. Participants will gain insight on population profiles appropriate for the technology, treatment needs, benefits, and impact/cost of delivery.


      Conclusion/Implications/Recommendations:
      Continued research and partnerships are essential for health-care organizations to understand how patients respond and adapt to technology-enabled care, while organizations cost-effectively operationalize, coordinate and modernize services in order to meet ever-growing demands. On-going, in-home trials indicate positive feedback; patients report feeling more motivated and indicated games are more valuable than following traditional paper instructions. By leveraging innovative eRehab technology solutions within the home-care delivery model, we are creating a patients-first experience and transforming traditional service models and delivery expectations while expanding availability of in-home post-acute rehabilitation services for stroke patients. Technology and health service partnerships between acute, sub-acute and home-care settings, can help inspire, create and celebrate an integrated stroke rehab program where patient rehab is enabled as early as possible in a seamless manner and grows across their continuum of care.


      140 Character Summary:
      Innovation combining technology & professional health-care empowers patients to experience/consume rehab services differently and improve clinical outcomes.

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    PS01 - AI and Smart Technology in Patient Safety Management (ID 3)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Panel Session
    • Track:
    • Presentations: 1
    • Coordinates: 5/27/2019, 10:30 AM - 11:30 AM, Pod 4
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      PS01.01 - Smart Home Technology Detecting Nighttime Wandering in Persons with Dementia (ID 476)

      Brenda Toonders, IMPACTT Centre, Champlain LHIN; Ottawa/CA

      • Abstract

      Purpose/Objectives:
      The Wander Detection and Diversion (WDD) system is designed to assist caregivers and persons with dementia (PWD) that are at risk of wandering at night. Using smart home technologies such as sensors, smart bulbs, pressure mats and speakers, the system detects when the PWD gets out of bed and automatically provides cue lighting to guide them safely to the washroom and back. It will also guide them back to bed through audio prompts if they near an exit – all without disturbing the caregiver in any way. The caregiver is only woken if the PWD opens an exit door. The system has a flexible design allowing it to be adapted to meet the needs of diverse residences and users such as protection for multiple exit doors or coverage for higher risk areas of the residence such as a kitchen or stairs. The message to the PWD is also customized both in the content and the voice. The goal of the system is to improve the caregiver’s sleep and reduce their stress while supporting the safety of the PWD.


      Methodology/Approach:
      Our team of researchers installs the smart technology devices into participants houses for a 12 week trial period. Before the installation the caregiver is asked a series of questions regarding their stress, depression and anxiety levels, as well as questions regarding how many hours of sleep in a night they are getting and how often their PWD exits the bed during the night. During the 12 weeks the participants are contacted every 2 weeks to ensure satisfaction with the technology. At the end of the 12 weeks the caregiver is asked the same questions as the date of the install, comparing their stress, depression and anxiety levels after having the system in their home for 12 weeks.


      Finding/Results:
      3 male and 1 female participant, age range from 59 years old to 98 years old, had this system installed in their houses for a 12 week trial period. There was an average depression rate of 6.5 and an average anxiety rate of 8 at the beginning of the trial, at the end of the trial the average depression decreased to 4.5 and the average anxiety rate decreased to 6.7. The only issues caregivers have had thus far in the research is that there were a few technical issues and that at the end of the 12 weeks the system had to be uninstalled.


      Conclusion/Implications/Recommendations:
      The study is not completed, however thus far, all participants have been satisfied and said that they felt less stressed, depressed and anxious. All participants were able to get more hours of sleep in a given night, and those who did not had reasons unrelated to the system and their PWD. Next steps include testing other types of sensors and looking for a private sector partner.


      140 Character Summary:
      An off-the-shelf smart home technology solution is installed in participants’ homes for a 12 week trial to detect and redirect nighttime wandering in PWD.