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H. Harps



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    EP03 - e-Poster Session 3 (ID 54)

    • Event: e-Health 2018 Virtual Meeting
    • Type: e-Poster Session
    • Track: Clinical Delivery
    • Presentations: 1
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      EP03.01 - Home Health Monitoring Patients Use Care 76% Less Than Average (ID 523)

      H. Harps, Telus Health; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: In Canada, chronic diseases like heart and lung disease, cancer and diabetes cause 88% of deaths[1] and consume 67% of direct healthcare costs.[2] Much of these costs spring from emergency visits and hospital readmissions. A Canadian Institute for Health Information study[3] found that 21% of discharged heart failure patients are re-admitted to hospital within 30 days, while 40% are re-admitted within 90 days. The same study discovered that 18% of COPD patients are admitted to hospital once a year; 14% are admitted twice. Clearly there is an opportunity to keep chronic disease patients healthier at lower cost, especially during that critical transition from acute to self-care. Home Health Monitoring (HHM) for chronic diseases such as COPD and Heart Failure are yielding exciting results. HHM solutions in the hands of community paramedics show great promise in helping seniors with chronic conditions in rural and remote communities. HHM programs let patients measure and manage their own health metrics at home while maintaining that critical daily connection with clinicians. In one provincial pilot, heart failure patients with HHM in place used healthcare services 76% less than heart failure patients not using home monitoring. [1] Noncommunicable diseases country profiles: Canada, World Health Organization, 2014. [2] Against the Growing Burden of Disease, Kimberly Elmslie, Centre for Chronic Disease Prevention, PHAC, 2012. [3] All-Cause Readmission to Acute Care and Return to the Emergency Department. Canadian Institute for Health Information, 2012.

      Methodology/Approach: In Home Health Monitoring (HHM) programs, patients are set up with the devices they need to measure their pulse, blood pressure and other health metrics at home. Patients send data to an HHM nurse and answer questions through an online survey about how they feel. If clinicians have any concerns, they call patients, and vice versa. This dynamic lifeline lets patients heal more safely at home, where they’re healthier. It gives clinicians the tools and insights to address issues earlier, before they worsen.

      Finding/Results: Patients in a recent provincial HHM pilot were very positive about the program: 97% would recommend it to others, with many wanting to hold onto the equipment beyond the pilot period. HHM enhances patients’ engagement in their own health. Many felt that both the equipment and clinician contact encouraged them to be more active in self-care, like following their action plan and doing daily recovery exercises. And as studies have shown, engaged patients become healthier patients. Ongoing communication also allowed earlier interventions, resulting in better outcomes at lower cost. The pilot’s 76% reduction in healthcare use bears this out. As compared with average heart failure patients, patients in the program incurred half the MSP billings of patients who were not in the program, 81% less acute inpatient days and 60% less emergency visits. And 86% of clinicians reported satisfaction with their ability to deliver care.

      Conclusion/Implications/Recommendations: HHM is only in its infancy. The benefits of early pilots speak for themselves. Many more pilots are running today, each accompanied with rigorous evaluations. Their lessons are creating the rich store of insight that will help us know the very best way to offer HHM for the greatest benefit to patients in Canada and around the world.

      140 Character Summary: Home health monitoring programs help patients with chronic conditions in urban, rural and remote settings stay healthier at home.

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    OS29 - e-Health Solutions for Patient Self Management (ID 47)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 1
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      OS29.06 - Scaling up Home Telemonitoring: Insights and Lessons from TEC4Home    (ID 532)

      H. Harps, Telus Health; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: TEC4Home Heart Failure (HF) examines using home tele-monitoring to support the safe transition of care from hospital to home. Home monitoring equipment is used to collect biometric measurements (weight, blood pressure, pulse, and oxygen saturation) from patients daily to detect deterioration and implement early interventions, thereby avoiding unnecessary ED readmissions and hospitalizations. This project is led by a Canadian university in partnership with the provincial health ministry, regional health authorities, and a health technology partner. The four year initiative is designed to evaluate the efficacy of home tele-monitoring and to scale up and spread the practice provincially. The Phase 1 feasibility study at 3 sites demonstrated a reduction in re-hospitalizations and improvement in quality of life, resulting in the expansion to the Phase 2 randomized controlled trial with 22 community sites across the province, starting in 2018. This abstract explores insights and lessons learned while scaling up across health authorities in a “real-world” research trial implementation.

      Methodology/Approach: In Phase 1, the feasibility study tested and refined procedures in three domains: model of care (i.e. how monitoring nurses work with patients and health professionals); model of technology (i.e. how the equipment and data will be used); and model of research (i.e. what metrics to use to track outcomes). This approach proved effective. When scaling up from three sites to multiple sites across health authorities in Phase 2, a fourth domain, model of management, was added as another stream. Topics requiring consideration within each domain are listed: Model of Care: How to account for and accommodate variations in standards of care and resourcing between sites, and identify areas of harmonization? How can monitoring nurses develop and share best practices provincially, while also retaining practices relevant to community-specific needs? Model of Technology: How will the monitoring equipment be delivered to patients’ homes in various communities, including ones with limited connectivity and those in remote areas? How will data be captured and shared across jurisdictions using different electronic health systems? Model of Research How to develop capacity for research on sites and across health authorities to set up support for future trials? How to develop a common evaluation framework, identifying key provincial metrics with health authority and site specificity? How to pool data to facilitate analysis and prospective tracking for future quality improvement? Model of Management How to create new job descriptions for monitoring nurses in keeping with health system and professional standards? How to establish policies and practices across health authorities to enable sharing of monitoring nursing capacity and data? How to transition from project to sustainable program with appropriate governance?

      Finding/Results: We will discuss how the above framework guided the project to scale up and roll out the trial.

      Conclusion/Implications/Recommendations: TEC4Home aspires to generate high quality evidence to define future standards of care in home tele-monitoring. This will contribute to the evidence-based policy translation needed to guide the implementation and sustainability of home tele-monitoring in the province. This empirical approach can help harmonize administrative practices and create new channels of collaboration to introduce innovations into routine health practices, establish sustainability, and increase research capacity for an enduring legacy in digital health research. This work is submitted on behalf of the TEC4Home Healthcare Innovation Community.

      140 Character Summary: Scaling up TEC4Home Heart Failure: Insights for collaborative "real-world" large scale trials and implementations.

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