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K. Gordon

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    RF07 - Techniques to Accelerate Innovation (ID 28)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Rapid Fire Session
    • Track: Health Business Process
    • Presentations: 1
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      RF07.02 - Designing and Embedding Telemonitoring in an Integrated Care Model (ID 148)

      K. Gordon, University Health Network; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Chronic care continues to be focused on single conditions treated individually, often without consideration of greater complex multi-morbidity needs. In-between appointments, patients are left to provide self-care, as well as manage and monitor their health. An opportunity has arisen to address the challenges that patients with multiple chronic conditions (MCCs) face by combining the two innovations: telemonitoring and an integrated complex medicine clinic (CMC). The objective of this novel team-based clinic is to integrate care and stabilize ailing patients with MCCs by bringing together clinicians to create a comprehensive care plan. William Osler Health System (WOHS) is in the process of creating this integrated CMC model. In terms of the telemonitoring, patients will be able to monitor their chronic conditions at home through a smart-phone based telemonitoring application. By leveraging patientsÂ’ ability to manage and initiate self-care at home, patients are given opportunities to participate in care and could mitigate adverse events. Furthermore, health professionals can track patient status through physiological readings in-between appointment visits. The aim of this study is to conduct a needs assessment to inform the design and implementation of telemonitoring into an integrated care setting for patients with MCCs.

      Methodology/Approach: A qualitative case study was undertaken to determine how to design and integrate telemonitoring into the development of an integrated CMC model at William Osler. Semi-structured interviews were conducted to determine the specific needs and requirements, desired workflow, and anticipated challenges of implementing telemonitoring in this model. Patients and healthcare professionals were recruited using snowball sampling. The investigators used conventional content analysis to interpret interview responses and obtain more detailed understanding of their work, clinical pathways, perspectives and challenges around managing MCCs, as well as their needs and preferences for development of the CMC model and telemonitoring system.

      Finding/Results: Six patients and ten care team members (including administrators, clinicians, and allied health staff) were interviewed to reach saturation at WOHS. Preliminary analysis indicates interviewees are positive about the opportunities for telemonitoring in this new clinic model but have common concerns related to affordability and digital literacy. Patient interviewees are particularly interested in how telemonitoring could improve their health and symptoms under more consistent monitoring by multiple health care professionals in one place, communicating seamlessly. Interestingly, most respondents view this integrated model as a bridge from hospital to family medicine in order to stabilize complex care needs effectively. Finally, interviewees indicated the nurse or the nurse practitioner should be responsible for monitoring alerts generated by the telemonitoring application. A preliminary workflow map for the CMC has been distributed for stakeholder-review. Once the workflow map is approved and operationalized in the model, the telemonitoring system will be embedded within this novel workflow design.

      Conclusion/Implications/Recommendations: Based on this research, a six-month mix methods pilot study will be undertaken to determine the feasibility of implementing the telemonitoring system into the CMC model. The potential impact of this research includes a sustained program combining telemonitoring within the integrated model that improves health outcomes, reduces healthcare utilization costs and is scalable to other healthcare institutions.

      140 Character Summary: Telemonitoring in an integrated care clinic presents an opportunity to design and develop a novel care delivery model for patients with complex chronic conditions.

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